Diabetes/Nutrition/Obesity Flashcards

Question

Identify components of weight gain during pregnancy

Answer 1

Average pregnancy weight gain distribution * 6 - 8 lbs: Baby * 1.5 lbs: Placenta * 2 lbs each: Amniotic fluid, uterus growth, breast growth * 8 lbs: added body fluid * 7 lbs: added muscle and fat stores

Answer 2

* **_Lactose intolerant_** – may be deficient in calcium * Recommended: * 1300 mg/day \< 19 age * 1000 mg/day if \> 19 years old * Use special products like lactaid * Intolerance may improve during the latter part of the pregnancy * Tums are good source of Ca++ * **_Gluten intolerant_** – may not get enough B vitamins if not eating fortified foods * Gluten-free products aren’t always fortified, though this might be getting better

Answer 3

* Compulsive, purposeful intake of nonnutritive substances that the consumer does not define as food for \> 1 month * Examples: ice (pagophagia— 70% of pica), dirt/clay (geophagia— 18% of pica), corn starch (amylophagia), soap (4% of pica), charcoal, ash, paper, chalk, cloth, baby powder, coffee grounds, eggshells, and nail polish * Etiology poorly understood. * Possible nutrient deficiencies: zinc, iron, and Ca * Associated with iron deficiency anemia (unclear if resulting or predisposing factor) * Cultural beliefs * Psych/behavioral response to stress, a habit or disorder, or a manifestation of an oral fixation * Appears to be more common in: African Americans, people living in rural areas, and family hx of pica * Complications vary based on the type of pica:. * Heavy metal poisonings (especially lead) * Alimentary canal damage * Excessive pregnancy weight gain (especially starch ingestion) * Nutrient deficiencies, constipation, electrolyte imbalances, gastrointestinal disturbances, parasitic in fections, dental complications, gestational hyperglycemia, and metabolic disturbances. * Often unreported due to embarassment

Answer 4

* Flavor preferences start in utero based on what the parent consumes * Exposure to a variety of healthy food flavors starting in utero and early infancy → children’s flavor preferences → potential to improve lifelong health * Adding the concept of preand postnatal flavor learning to nutrition education → empower pregnant/breastfeeding parents to influence their child’s future nutritional health by eating a large variety of healthy food.

Answer 5

* Source of vitamins and concentrated calories * No exact RDI, but 20 – 35% of daily intake. * Limit saturated and trans fats * Fatty acids: Omega-3’s * ALA – in plants, must eat because our body doesn’t make it * EPA, DHA found in seafood, we can make it but better to ingest * **_DHA_** = 30% fetal brain weight and is important for neuro, recommeng 300 mg/day * Eat seafood 2x/week (limit to 12 oz total)

Answer 6

* Source of glucose * Simple carbs - fruit, milk/milk products, processed + refined foods are broken down quickly * Complex/starches - some cereals, whole grains, some vegetables like corn, broccoli, legumes - take longer to break down. * RDI 175 g/day (most women already get this)

Answer 7

* Forms structural basis of new cells and tissues. * Sources: meat/poultry, dairy/eggs, legumes/soy, nuts/seeds. * RDI 71g for pregnancy + lactation. * Most women already get 74 g unless no meat diet or food insecure. * High protein bad (may elevate fetal ammonia)

Answer 8

* Need for increase starts 2nd tri – peaks end of 3rd tri for increased parent/fetus RBCs. * RDI 25 mg day (amount in most PNVs). * Heme iron more easily absorbed (meat/poultry/fish) than non heme iron (eggs/plants/legumes). * Heme absorption efficient and not influenced by what its eaten with. * Need supplimentation if: * Hct \< 33% in 1st + 3rd trimesters * \< 32% in 2nd trimester

Answer 9

* Water soluable form of Vitamin B9. * Found in green leafy vegetables, bananas, fortified cereals (since 1998), lentils. * Reduces NTD, oral cleft, and cardiovascular problems when taken in early pregnancy. * Need 400 mcg before and during pregnancy.

Answer 10

* Needed for fetal skeleton development. * Active transport across placenta so fetal levels higher than parent. * RDI: \< 19 years old need 1300 mg/day, 19 – 50 years old and breastfeeding need 1000 mg/day. * Groups at risk for lower Ca intake: adolescent, lactose intolerant, vegetarian, low income. * Food sources: * Milk/cheese/yogurt (higher fat = lower Ca), * Broccoli, chinese cabbage, kale * Ca-fortified orange juice and cereals.

Answer 11

* Fat soluable, acquired through diet or expsosure to sunlight. * Steroid hormone precursor. * Helps body use Ca and fetal bone growth * RDI 600 IU/day * Food sources: milk, fish liver oils, fortified dairy and cereals, egg yolks

Answer 12

* Assess psychological risk factors, depression, and potential eating disorders. Refer for counseling if necessary. * Advise a pregnancy wt gain consistent * Assess comorbidities of obesity and patterns of previous weight gain and loss. * Perform a nutritional assessment * Have patient identify one to two nonnutritious foods that could be dropped or changed immediately for more nutritious foods. * Refer for nutrition counseling if available * Screen for diabetes at first visit * Offer early screening for neural tube defects (NTDs) - including early serum screening and ultrasound at 11– 13 weeks to assess nuchal translucency. * Obesity often limits ultrasound visualization and women may need to be rescheduled 1– 2 weeks later, past the ideal nuchal translucency evaluation time. * Schedule frequent visits every 2 weeks for regular weight gain assessment and nutrition counseling.

Answer 13

* Classified as: anorexia nervosa, bulimia, or eating disorders not otherwise specified (EDNOS), such as binge eating * _Anorexia nervosa_ - group of symptoms including unwillingness to maintain weight at a minimal normal weight for age/ht, intense fear of gaining wt, body image disturbances, and amenorrhea x at least 3 consecutive months * _Bulimia nervosa_ - symptoms such as inaccurate perception of body image, a sense of lack of control during recurrent binge eating occurring at least 2x/week for at least 3 months, use of compensatory behaviors to prevent weight gain (vomiting/laxatives/excessive exercise) at least 2x/week for at least 3 months * _EDNOS_ is a diagnosis of exclusion; it involves those who exhibit some symptoms but do not fit the criteria of anorexia or bulimia. * Greater likelihood of: miscarriage, cesarean, stillbirth, LBW, low Apgar, microcephaly, breech, and cleft lip and palate * Successful strategies to assist women with eating disorders include: * Care from the same provider throughout pregnancy. * Increased prenatal visit schedule with small goal setting and nutrition counseling * Referral to a nutritionist and a mental health-care provider.

Answer 14

* Unpasteurized dairy products and juices * Smoked and lunch meats (if eaten, reheat until hot) * \> 200 mg caffeine * Always avoid high mercury: tilefish, mackerel, shark, sword fish, marlin, orange roughie, albacore white tuna (should eat the darker variety) * Raw fish * Unwashed fruits/veggies (wash for at least 30 seconds) * \> 12 oz/week of fish * Saccarine (artificial sweetner)

Answer 15

* Grains: 6 oz daily (ie 1 slice bread, 1 cup cooked rice) * Veggies: 2 – 3 cups and vary the colors * Fruits: 2 cups, whole fruit better than juice * Dairy: 3 – 4 cups, choose low fat if overweight * Protein: 5 – 6 oz, eat seafood 2x/week * Oils: 6 tsp

Answer 16

Nutrients of concern in vegetarian diets: * Iron * Protein * B vitamins * Vitamin D and calcium * Omega-3 fatty acids

Answer 17

* Obese = BMI 30 - 34.9 * Morbidly obese = \> 35 * BMI \> 40 at especially high risk during pregnancy

Answer 18

* Persistent and severe N/V, dehydration, fluid and electrolyte imbalance, and weight loss (can lose 5% or more of body weight). * Most common cause of hospitalization in 1st half of pregnancy, second only to preterm labor for pregnancy hospitalizations overall * Maternal complications: * Vomiting-induced esophageal rupture → GI bleeding Wernicke’s encephalopathy (after several weeks of vomiting) - thiamine deficiency and is a potentially fatal medical emergency. Reversible but can cause persistent neurological deficits. Most common sign is apathy. * Persistent vomiting → hyponatremia. Early signs: anorexia, HA, N/V, and lethargy can be missed since the clinical presentation is similar to HG itself. * Fetal complications: * FGR * Preterm birth, SGA * Recurrence in subsequent pregnancies is approximately 15% * Management: antiemetics and intravenous (IV) rehydration * Restore volume, electrolyes, thiamine (if vomiting \> 3 weeks) * Often managed outpatient, even on IV therapy. * Inpatient admission: severe dehydration, ketonuria, weight loss \> 5%, and the inability to keep down any food or fluids * May be appropriately managed by CNM/NP with MD consult/comanagement as required by the pt condition. Inpatient may require referral for management if the provider does not have inpatient privileges.

Diabetes/Nutrition/Obesity Flashcards

(45 cards)