Ch 20: Pregnancy and Lactation

Question 1

What is the micronutrient of concern re: toxicity in pregnancy?

Answer 1

Vitamin A

Question 2

What causes presence of urinary ketones in pregnancy?

Answer 2

Inadequate hydration, hyperglycemia, or inadequate energy intake

Question 3

Which labs should be checked in pregnancy to assess iron status?

Answer 3

TIBC, serum iron, hemoglobin, and hematocrit

Question 4

For patients with DM1 or GDM, what are recommended blood sugar targets?

Answer 4

Fasting: 95 mg/dL or lower
1-hour post prandial target is 140 mg/dL or lower
2-hour post prandial target is 120 mg/dL or less

Question 5

What is the AI for fluid intake during pregnancy?

Answer 5

3 L/day, with approximately 2.3 liters from beverages and the rest coming from water contained in food

Question 6

What is the RDA for CHO in pregnancy?

Answer 6

175 g/d

Question 7

Which type of IV lipid emulsion should be considered for pregnant patient requiring PN?

Answer 7

IF patient does not have a history of fish allergy, clinicians may want to consider using a ILE product with fish oil to ensure adequate provision of DHA

Question 8

During the 2nd trimester which hormones may lead to increased insulin resistance and decreased insulin sensitivity?

Answer 8

Progesterone, estrogen, human placental lactogen, growth hormone, and cortisone levels–this made lead to GDM

Question 9

What should be supplemented for the breastfed infant?

Answer 9

Vitamin D and iron (right away if preterm, at 4-6 months of age if term)

Question 10

What are the energy and protein requirements for a lactating women?

Answer 10

• Energy for first 6 months postpartum: Prepregnancy EER + 330 kcal
• Energy for second 6 months postpartum: Prepregnancy EER + 400 kcal
• Protein needs: 1.3 g/kg/day or 25 g/d to maintenance protein requirements

Question 11

What should be checked if a RYGB patient becomes pregnant unexpectedly?

Answer 11

vitamin B12, folate, vitamin D, and an iron panel should be checked as soon as feasible and deficiencies promptly corrected; pregnant women with history of malabsorptive disorders are also at risk for micronutrient deficiencies and require close examination and monitoring

Question 12

How are energy requirements in pregnancy usually calculated?

Answer 12

Using pregravid weight or ideal body weight

Question 13

The National Research Counsel recommends that transferrin saturation in pregnancy be maintained above what?

Answer 13

20%; a transferrin saturation of 16% or serum iron level of less then 60-70 mcg/dL may indicate iron deficiency of pregnancy

Question 14

In the pregnant trauma patient, how should protien needs be estimated?

Answer 14

Protein can be estimated by using same methods for nonpregnant patients, beginning with 1.5-2.0 g/kg pregravid weight

Question 15

How much DHA is recommended in the diet of pregnant and lactating women?

Answer 15

At least 200 mg DHA in the diet (supplements have not shown to be beneficial)

Question 16

In the pregnant trauma patient, how should energy needs to estimated?

Answer 16

If IC is unavailable, traditional equations that estimate needs of critically ill patients can be used with 200-300 kcal/d added for pregnancy

Question 17

A serum ferritin concentration of what is concerned iron deficiency?

Answer 17

12 mcg/L; however, concentrations less than 35 mcg/L may indicate deficiency

Question 18

Which deficiencies are common in pregnancy?

Answer 18

Iron, folate, vitamin b12, calcium, and zinc

Question 19

Per the IOM, what are estimated energy excess needs during 1st, 2nd, and 3rd trimester of pregnancy?

Answer 19

0 kcals is needed for 1st trimester, 340 for 2nd trimester, and 452 for third trimester per IOM

Question 20

True or false: Glucosuria is related to maternal hyperglycemia

Answer 20

False; Glucosuria is not necessarily r/t maternal hyperglycemia

Question 21

What causes Wernickes Encephalopathy in pregnancy and what is the classic triad of symptoms?

Answer 21

triad of Wernicke’s encephalopathy caused by thiamin deficiency is confusion, ophthalmoplegia, and ataxia. This condition is usually precipitated by provision of glucose without prior or concurrent thiamin supplementation (hyperemesis gravadium)

Question 22

What are the protein requirements in healthy pregnancy?

Answer 22

1.2 g/kg/day in early pregnancy, and 1.52 g/kg/d in late pregnancy (pg 403)