Chapter 4: Nutrition During Pregnancy I Flashcards
Liveborn Infant
A liveborn infant is the outcome of delivery when a completely expelled or extracted fetus breathes, or shows any sign of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the cord has been cut or the placenta is still attached.
Placenta
A disk-shaped organ of nutrient and gas interchange between mother and fetus. At term, the placenta weighs about 15 percent of the weight of the fetus.
Edema
Swelling (usually of the legs and feet, but can also extend throughout the body) due to an accumulation of extracellular fluid.
Steroid Hormones
Hormones such as progesterone, estrogen, and testosterone produced primarily from cholesterol.
Glucogenic Amino Acids
Amino acids such as alanine and glutamate that can be converted to glucose.
Ketones
Metabolic by-products of the breakdown of fatty acids in energy formation, b-hydroxybutyric acid, acetoacetic acid, and acetone are the major ketones, or “ketone bodies”.
Amniotic Fluid
The fluid contained in the amniotic sac that surrounds the fetus in the uterus.
Growth
Increase in an organism’s size through cell multiplication (hyperplasia) and enlargement of cell size (hypertrophy).
Development
Progression of the physical and mental capabilities of an organism through growth and differentiation of organs and tissues, and integration of functions.
Differentiation
Cellular acquisition of one or more characteristics or functions different from that of the original cells.
Critical Periods
Pre-programmed time periods during embryonic and fetal development when specific cells, organs, and tissues are formed and integrated, or functional levels established. Also called sensitive periods.
Small for Gestational Age (SGA)
Newborn weight is <10th percentile for gestational age. Also, called small for date (SFD).
Disproportionately Small for Gestational Age (dSGA)
Newborn weight is <10th percentile for weight for gestational age; length and head circumference are normal. Also called asymmetrical SGA.
Proportionately Small for Gestational Age (pSGA)
Newborn weight, length, and head circumference are <10th percentile for gestational age. Also called symmetrical SGA.
Appropriate for Gestational Age (AGA)
Weight, length, and head circumference are between the 10th and 90th percentiles for gestational age.
Large for Gestational Age (LGA)
Weight for gestational age exceed the 90th percentile for gestational age. Also defined as birthweight greater than 4500g (10lb) and referred to as excessively sized for gestational age, or macrosomic.
Shoulder Dystocia
Blockage or difficulty of delivery due to obstruction of the birth canal by the infant’s shoulders.
Cerebral Palsy
A group of disorders characterized by impaired muscle activity and coordination present at birth or developed during early childhood.
Developmental Programming of Later Disease Risk
A process by which adverse nutritional and other exposures during critical periods of growth and development modify gene function. Such changes may predispose individuals to develop cardiovascular diseases, type 2 diabetes, hypertension, obesity, and other disorders later in life. Also called fetal origins hypothesis, developmental programming, developmental origins of adult health and disease, and the “Barker hypothesis”.
Developmental Plasticity
The concept that development can be modified by particular environmental conditions experienced by a fetus or infant.
Epigenetic
Alterations in gene activity that do not change the structure of DNA. Gene activity can be shut off or turned on, or slowed or sped-up by epigenetic mechanisms. Epigenetic mechanisms are affected by environmental factors.
Gravida
Number of pregnancies a woman has experienced.
Parity
The number of previous deliveries experienced by a woman. Women who have delivered infants are considered to be “parous”.
Nulliparous
No previous deliveries
Primiparous
One previous delivery
Multiparous
Two or more previous deliveries
Eicosanoids
Molecules synthesized from essential fatty acids. They exert complex control over many bodily systems, mainly in inflammation and immunity, and act as messengers in the central nervous system.
Gene Variants
An alteration in the normal coding sequence of a gene. The different forms of the same genes are considered “alleles”.
Iron Deficiency
A condition marked by depleted iron stores. It is characterized by weakness, fatigue, short attention span, poor appetite, increased susceptibility to infection, and irritability.
Iron-Deficiency Anemia
A condition often marked by low hemoglobin often marked by low hemoglobin level, it is characterized by the signs of iron deficiency plus paleness, exhaustion, and a rapid heart rate.
Hypothyroidism
A condition characterized by growth impairment, intellectual disabilities, and deafness when caused by inadequate maternal intake of iodine during pregnancy. Used to be called cretinism.
Bioactive
Constituents in foods or dietary supplements other than those needed to meet basic human nutritional needs that are responsible for changes in health status.
Pica
An eating disorder characterized by the compulsion to eat substances that are not food.
Geophagia
Compulsive consumption of clay or dirt.
Pagophagia
Compulsive consumption of ice or freezer frost.
Amylophagia
Compulsive consumption of laundry starch or cornstarch.
Listeria
A foodborne bacterial infection that can lead to preterm delivery and stillbirth in pregnant women. Listeria infection is commonly associated with the ingestion of soft cheeses, unpasteurized milk, ready-to-eat deli meats, and hot dogs.
Toxoplasmosis
A parasitic infection that can impair fetal brain development. The source of the infection that can impair fetal brain development. The source of the infection is often hands contaminated with soil or the contents of a cat litter box; or raw or partially cooked pork; lamb, or venison.
Infant Mortality Rate
Significant because increased IMR decreases a nation’s average life expectancy.
Maternal Anabolic Changes
Occur during 1st 20 weeks of pregnancy. “Building maternal reserves”. Only 10% of fetal weight gain happens.
Maternal Catabolic Changes
Occur during 2nd 20 weeks of pregnancy. Mom transfers stored components to baby. 90% of fetal weight gain occurs.
Body Water Changes
Total body water increases by 7-10 liters which is primarily intracellular. This will also cause some hemodilution which decreases some biochemical values.
Maternal CHO/Fasting Metabolism
Insulin resistance
Glucose to glycogen conversion inhibited
Increased reliance on fat for energy
Increased tendency toward ketosis
Fetal CHO/Fasting Metabolism
Glucose is the preferred fuel
Constant supply is vital
Protein Metabolism
Pregnancy is anabolic
Nitrogen needs increase
Nitrogen excretion is reduced
Also known as positive nitrogen balance
Lipid Metabolism
Serum lipids are significantly higher in pregnancy to support hormone production. Also needed for nerve and cell wall formation.
Calcium Metabolism
Increased rate of bone turnover and reformation.
Sodium Metabolism
Increased need to support the increase in body water.
N&V
Nausea occurs in 80%
Emesis occurs in 50%
Both are considered a positive indicator of fetal health.
N&V Management
Separate liquids and solids
Avoid strong odors
Intake as able
Eat before getting out of bed
Causes of Heartburn
Increased GI pressure from the baby. Progesterone causes muscle relaxation which also affects the esophageal sphincter.
Heartburn Management
Small frequent meals.
Avoid being supine after meals.
Avoid GI stimulants and individually offending foods.
Primary Functions of the Placenta
Hormone/enzyme production
Nutrient/gas exchange
Removal of fetal waste
Some use in blocking harmful substances
Fetal Phase
9 weeks to birth. Characterized by hypertrophy, cell size increases due to accumulation of protein and lipids. Malnutrition during this phase can cause problems, but they are potentially reversed or diminished with improved nutrition.
Infant Risks of Preterm Deliveries
Death Neuro problems/low IQ Congenital malformations Cerebral palsy *Cause is unknown
Suspected Correlations of Preterm Delivery
Infections
Low pre-pregnancy weight
Inadequate pregnancy weight gain
History of preterm birth
Preterm Delivery Interventions
Nutrition counseling
Home visits
Adequate prenatal care
Weight Gain During Pregnancy
Recommendation for normal weight female is 25-35#. Rate of gain: 4-5# in first trimester and balance gradually gained in 2nd and 3rd trimesters.
CHO
Should be 50-60% (absolute minimum of 175 g/day. Focus on complex CHO, whole grains, and fruits and vegetables. Adequate CHO intake and avoiding fasting will protect against excessive ketosis. Prolonged ketosis associated with poor growth and IQ of baby.
Protein
RDA is 17 g qd. This is 25g more per day. Not usually a problem.
Vegetarian Issues
Protein intake for vegans must be higher due to low digestibility of protein up to 30%. Other nutrients which may be deficient: vit D, vit B12, Ca, Z, and kcals.
Linoleic Acid
Is an omega-6 EFA and can be converted to ARA.
Alpha-Linolenic Acid
Is an omega-3 EFA. Can be converted to DHA and EPA. Linolenic Acid and DHA vital to fetal vision. May also optimized neural development.
Folate
Needed for new cell development and cells that divide rapidly. Adequate intake prior to pregnancy and in the first 21-27 days of pregnancy reduces the risks of NTDs. RDA for pregnancy is 600 mcg qd (400 from fortified foods/supplements, 200 from food). Women with prior history of ND in pregnancy, or with family history of NTD may be encouraged to take a pharmaceutical dose of folic acid (up to 4000 mcg or mg qd) prior to pregnancy to reduce the risk of NTD.
Calcium
Altered metabolism promotes increased absorption/decreased excretion of Ca in pregnancy. Dietary deficiency can still lead to bone loss. Low intake associated with HTN in fetus and mom.
Iron
Should be an increase in red cell mass during pregnancy. Increase in plasma volume is even greater, so iron status standards are different for pregnancy. 30 mg qd after 1st trimester is standard.
Sodium
Restriction is not indicated in pregnancy. Only exception is a sodium restriction that was improving pre-pregnancy HTN. DOES NOT ASSIST with pre-pregnancy related edema or HTN.
Saccharin (Sweet’N’Low)
Can cross from the mother to the fetus and due to poor clearance may remain in the tissues of the fetus. “Women should consider careful use of saccharin during pregnancy”.
Aspartame and Acesulfame K
Appears to be safe when consumed within FDA recommendations.
Cheese and Deli Meat
Some cheeses and deli meats contain listeria, a bacterium which can cause food-borne illness. Eating contaminated foods can cause flu-like symptoms in the mother and can cause infections in the fetus that can lead to miscarriage and stillbirth.
Toxoplasmosis
May become infected by consuming undercooked meat or eggs, by gardening or by cleaning out the cat’s litter box. Babied affected by the infection can suffer from blindness and brain damage.
