Health Promotion Flashcards

Question

what is the impact of alcohol on digestion?

Answer 1

- folic acid deficiency - malnutrition - dehydration

Answer 2

- increased risk of liver disease, pancreatitis and cancer

Answer 3

- menstrual disorder - sexually transmitted infections - infertility

Answer 4

- increase risk of breast cancer - decreased milk production

Answer 5

* Fetal alcohol syndrome (FAS) * Alcohol-related neurodevelopmental disorder (ARND) * Alcohol-related birth defects (ARBD) * fetal alcohol effects (FAE) Partial FAS (PFAS)

Answer 6

During the 1st trimester the connections between maternal and fetal blood is quite small and the placenta is still developing. Therefore there is a small chance of alcohol passing to baby. However, later on in pregnancy, the connection between maternal and fetal blood is bigger and the placenta is developed. And the alcohol is more likely to pass to baby. The impact of the alcohol on the baby and development will depend on what stage she is drinking alcohol

Answer 7

Birth defects - Heart - Cleft lip and palate - Genital malformations - Kidney and urinary malformations - Facial distortions - Microcephaly - Small jaw

Answer 8

Growth - low birth weight Developmental Problems - Speech impairments - Short attention span and memory problems - Irritability in infancy - Hyperactivity in childhood and ADHD - Learning disabilities and difficulties - Delay in normal development - Risk of depression and psychosis as adults

Answer 9

Week 4 - neural tube closure

Answer 10

Week 6 - heart is beating

Answer 11

Week 9 - kidneys are functional, face starts developing

Answer 12

Week 10 - lip and palate formed

Answer 13

Week 12 - genitals are formed, face is formed.

Answer 14

Week 13 - 28 - Growth, organs are already developed.

Answer 15

Week 24 - neurons maturation begins

Answer 16

growth and brain development

Answer 17

Brain activity increases and some cognitive functions start to happen (dreaming), Neurons starting migrating to develop the folded appearance of the brain.

Answer 18

Overall, 15% of the women worldwide are obese. When looking at overweight, up to 40% of women in the world have BMI over 25.

Answer 19

Obesity is a condition in which there is an excessive body fat accumulation, with multiple pathological consequences for the health of the person. It is usually measured and described by the body mass index (BMI).

Answer 20

However, it is important to notice that high BMI is not the only measurement of obesity and it needs to be interpreted with caution as it is not a direct measure of adiposity. In highly muscular adults, it may be less accurate.

Answer 21

- VTE (especially if BMI>40) - Cardiac problems - Hypertension - Anaesthetic complications - Low oxygenation - Risk of gastric aspiration - Difficult intravenous access - Wound infection - Longer hospital stays - Vit D deficiency - Mental health issues - Infertility

Answer 22

- Gestational diabetes (BMI>30) - Pre-eclampsia (BMI>35) - Induction - C-section/instrumental birth - Labour dystocia PPH

Answer 23

- Miscarriage - Premature birth - Stillbirth - IUGR - Abnormal FHR patterns in birth - Less likely to breastfeed - Macrosomia - Congenital anomalies (NTD and cardiac) Admission to NNU

Answer 24

- Anaesthetic complications are a very important risk to keep in mind: women with obesity have a decreased lung capacity, with leads to chronic low 02 levels. This chronic lack of oxygen can also compromise fetal oxygenation, making them more likely to experience growth restrictions and abnormal fetal heart rate during labour. Also, the increased stomach capacity and acidity of gastric contents puts them at higher risk of aspiration if they need general anaesthetic during labour. Difficult intravenous access can also difficult management of bleeding or shock in pregnancy.

Answer 25

women with a high BMI have a higher risk of gestational diabetes. This is why GTT are offered to all women with a BMI over 30. They also have a higher risk of pre-eclampsia, and as we will see later, this may mean that women with BMI over 35 may be offered prophylactic aspirin during pregnancy. Women with high BMI are also more likely to be offered induction, either because the increased risk of complications or because they are more likely to go post-dates.

Answer 26

less likely to breastfeed, and the reasons for this can be complex and involve both physical and sociocultural factors. From a physical point of view, they may have a lower milk production, which can be related with undiagnosed thyroid problems or the same insulin-resistance metabolic problems that increase their risk of diabetes. This same insulin-resistance metabolic changes can increase the risk of fetal macrosomia, that then increases the risk of shoulder dystocia and neonatal hypoglycaemia.

Answer 27

neonatal outcomes we know that women of high BMI have a higher risk of miscarriage. This is probably related with the metabolic and hormonal changes related with obesity, that also increase the risk of fertility problems. Probably this is also related with the higher risk of premature birth. Stillbirths have been explained by the higher risk of abnormal cardiovascular problems in these women, but it may also be related with the chronic low oxygenation levels we discussed in the previous slide. This also increase the risk of IUGR or abnormal FHR patters during birth.

Answer 28

The folic acid deficiency in women with high BMI increased their risk of neural tube defects. Other congenital abnormalities are also more common, like cardiac ones, but we do not know if this is related with obesity related changes.

Answer 29

- Limitations to appropriate size of cuff - May need different location Finally, women with high BMI have a higher risk of pre-eclampsia, but our skill to effectively screen for this condition depends on the use of appropriate equipment. Large blood pressure cuffs should have a width of 40% of the circumference of the arm. And for some women with very large BMI, the large size of standard cuffs may not be enough. Sometimes, instead of placing the cuff in the upper arm, alternative locations, such the forearm may need to be used.

Answer 30

- Inaccurate SFH measurements (BMI>35) - Limitations of scan accuracy When we try to monitor fetal growth: for women with BMI over 35, symphysis-fundal height (SFH) is unreliable to monitor fetal growth, so they will be offered serial growth scans. However, these scans are more likely to be underestimating or overestimating fetal measurements than in women with normal BMI. And considering that scan results are sometimes determinant to decide early induction, it is easy to understand why larger women have a higher risk of induction. In women with very large BMI, abdominal palpation to assess fetal presentation can be very complicated or sometimes impossible, making these women more likely to require additional ultrasound exposure during pregnancy.

Answer 31

- Assess other risk factors (especially if fertility treatment) - Diet advice - Weight loss advice 5 mg folic acid 3 months before conception (to address their increased risk of neural tube defects)

Answer 32

Ideally, these women should have preconceptional consultations, most likely with their GP, who will risk assess for other risk factors and comorbidities and should work with them in building a diet and weight loss plan before they plan their pregnancy. Many women with high BMI will require fertility treatment, and sometimes, this risk assessment means that they may not be eligible for treatment until they have improved their health and weight.

Answer 33

- 5mg folic acid up to 12 weeks - 10mcg vit D supplement - Review by obstetrician but can remain under midwifery care - Exercise in pregnancy advice - Offer dietitian referral - GDM screening - VTE risk assessment Mental health risk assessment

Answer 34

- Consultant-led care - Serial growth scans - If other PET risk factors, 150mg aspirin daily from 12 weeks Consider serial reweighing in 3rd trimester

Answer 35

- Birth in obstetric unit - At 36 weeks or earlier - Anaesthetist review - Tissue viability assessment - Manual handling assessment

Answer 36

All women should continue with 5 mg folic acid up to 12 weeks of pregnancy, and use 10 mcg Vit D supplements for the rest of the pregnancy and the lactation period.

Answer 37

All women should be advised about safe exercise in pregnancy and ideally offer dietitian referral. There is a lack of consensus on optimal weight gain during pregnancy, and this is why the focus should be on healthy diet more than prescribed weight gain targets. Actually, it is not uncommon for women with a high BMI to lose weight during pregnancy once. However, women with BMI of 35 and over, especially those above 40, may be offered serial weight in the third trimester. The purpose of this is not really to improve outcomes in the mother, but to be able to have more accurate manual moving and handling assessments, that could impact the discussion around their birth options, p.e. about the use of a birthing pool.

Answer 38

- Ranitidine 8 hourly - Active third stage - CTG only if fetal concerns - Encourage mobility - Prevent pressure sores If c-section prophylactic antibiotics at time of surgery

Answer 39

- Breastfeeding support - Continue on 10mcg vit D supplement while feeding - Plan to restart exercise - Mental health risk assessment VTE risk assessment and prophylaxis if other risk factors

Answer 40

- IV access early in labour, considering sitting a second cannula - Inform anaesthetist on admission Birth pool usually contraindicated

Answer 41

Prescribe VTE prophylaxis for 10 days

Answer 42

During labour, women with high BMI should be offered antiacid medication, like ranitidine every 8 hours, to reduce the risk of aspiration if GA needed.

Answer 43

Due to the higher risk of PPH, all women should be offered active third stage. However, for women with BMI above 40, the RCOG recommends having IV access sited early in labour, considering even if second cannula may be desirable, as IV access in these women tends to be very difficult enough.

Answer 44

CTG should only be used if there are fetal concerns. Considering that IA may be difficult to achieve in women of very high BMI, they are more likely to be offered internal fetal monitoring during labour, but there is not really evidence to support this practice, which have other risks associated.

Answer 45

Mobility is essential for these women, especially considering the increased risk of pressure sores if lying on bed for prolonged period of times. However, as we discussed before, due to concerns of moving and handling, birthing pool is usually contraindicated for women with very high BMI.

Answer 46

Due to the higher risk of wound infection, if a csection is needed, prophylactic antibiotics at time of surgery are recommended.

Answer 47

In terms of mode of birth, obesity itself is not a contraindication for spontaneous normal birth. Actually, considering the risks of surgery for these women, csection should be avoided when safe to do. Although some research has suggested that induction of labour at term in obese women may reduce the chance of csection, the evidence of these papers is very flawed and with several bias and methodological limitations.

Answer 48

The senior anaesthetist should be informed on admission of any women with a BMI higher than 40. Epidural may be more difficult to achieve and longer epidural needles may need to be used.

Answer 49

Postnatally, women with obesity required additional breastfeeding support: sometimes it may be in terms of position and attachment, but others it may be related with low milk supply. They should also continue with their vit D supplements while feeding. Bf problems can also contribute to poor mental health, and as these women have a higher rate of mental health problems, careful monitoring and assessment needs to continue after birth.

Answer 50

Women with BMI over 40 also need VTE prophylaxis prescribed, as a score of 2 is already considered at risk postnatally. Women with lower BMI need to be reassess: any other risk factor will put them at high risk.

Answer 51

(213 kg – foot section 181 kg)

Answer 52

around 130 kg, depending on size).

Answer 53

around 180kg

Answer 54

- 1 in 2 women have a high BMI

Answer 55

less than 1 in 4

Answer 56

- Female –risk of infertility increases if underweight - overweight increase in complications such as gestational diabetes - Males- can affect steroid hormone production

Answer 57

- Fruit and vegetables - Potatoes, bread, rice, pasta and other starchy carbohydrates - Beans, pulses, fish, eggs, meat and other proteins - Dairy and alternatives - Oil and spreads

Answer 58

2000kcal woman 2500kcal men

Answer 59

Drink 6-8 cups/glasses of fluid a day Water, lower fat, milk, sugar free drinks including tea and coffee all count. Limit fruit juice and/or smoothies to a total of 150ml a day.

Answer 60

- Alcohol - Weight - Smoking - Other micronutrients Folic acid

Answer 61

- Folic acid, together with vitamin B12, is necessary to form red blood cells. A deficiency can reduce the ability of red blood cells to carry oxygen, this is called ‘macrocytic’ (large cell) anaemia. Together, both vitamins also help nerves to function properly.

Answer 62

- The foetus rapidly develops spine and nerve cells in the first few weeks of pregnancy. Inadequate blood levels of folate at this crucial time increase the risk of the baby’s spine developing a ‘neural tube defect’, resulting in spinal malformation called spina bifida.

Answer 63

- Anyone considering pregnancy, and up to 12 weeks of pregnancy is advised to: - Take a folic acid supplement, or pregnancy-specific vitamin supplement providing 400μg every day - Eat a diet rich in folates and folic acid from foods naturally containing the vitamin and from fortified foods - During the whole of pregnancy and lactation, it is advisable to eat a diet rich in folate as requirements for the vitamin are higher.

Answer 64

You will need more folic acid (five milligrams (mg) a day) if your risk of having a baby with NTD is higher than normal. If you are at an increased risk, your doctor will need to prescribe the higher dose. You may be advised to take an increased dose if: you have had a previous pregnancy affected by NTD, you or your partner have NTD, you are taking certain medications for epilepsy, you have coeliac disease or diabetes, your BMI is 30 or more, you have sickle-cell anaemia or thalassaemia. Speak to your doctor if you think you may need a higher dose.

Answer 65

- Spinach, kale, Brussels sprouts, cabbage, broccoli - Beans and legumes (e.g. peas, blackeye beans) - Yeast and beef extracts - Oranges and orange juice - Wheat bran and other whole grain foods - Poultry, pork, shellfish and liver Fortified foods (e.g. some brands of breakfast cereals – check the label)

Answer 66

- listeria - salmonella - contaminants e.g. mercury - vitamin A - caffeine

Answer 67

Raw shellfish Raw and undercooked meats Unpasteurised milk Raw or undercooked eggs without the Lion Code Always wash hands after handling raw meats, store raw foods separately from cooked foods to prevent cross-contamination. Processed ice-cream made with pasteurised milk and eggs (i.e. from the supermarket) should be safe. UK eggs with the Lion Code can be served raw or lightly cooked.

Answer 68

Soft ripened cheeses including Brie, Camembert and some goat’s cheeses Blue veined cheeses e.g. Danish Blue All unpasteurised dairy products All types of pâte Soft serve ice cream from vans or kiosks Ensure takeaway and cooked-chill ready meals are heated thoroughly and piping hot. Due to a listeria outbreak linked to smoked fish you should only eat smoked fish products that have been thoroughly cooked. Make sure they are steaming hot all the way through.

Answer 69

Shark Marlin Swordfish Limit tuna to four medium cans per week or two steaks. Eat oily fish, e.g. salmon, mackerel, sardines, no more than twice per week.

Answer 70

Multivitamin supplements containing excess retinol form of vitamin A Fish liver oils containing more than 700mcg/day Liver and liver products e.g. pate, faggots

Answer 71

Foods labelled high caffeine content Have no more than 200mg caffeine daily. No more than two mugs of instant coffee (one mug of filter coffee) or three cups of tea a day. Or choose decaffeinated. Other foods containing caffeine include cola, high energy drinks and chocolate.

Answer 72

No. The amount you need to eat will depend on your Body Mass Index (BMI) at the start of your pregnancy (use this BMI calculator to find out your BMI). If you are of healthy BMI, an average adult needs around 1900kcal per day prior to pregnancy, your energy needs will increase by 200 kcal only in the third trimester.

Answer 73

By concentrating on a healthy varied diet and staying active your body should naturally gain sufficient weight for your baby to be born at optimum birth weight. This is important for them to continue to grow and develop well.

Answer 74

Yes. There are two vitamin supplements needed during pregnancy: folic acid and vitamin D. Those who follow a vegetarian/plant-based diet may need to take additional supplementation of iodine, omega-3 fatty acids and vitamin B 12

Answer 75

Vitamin D: Vitamin D helps to absorb calcium and is important for bone health; too little could cause rickets in your baby. Take a supplement of ten micrograms (mcg) of vitamin D every day throughout your pregnancy and when breastfeeding. Higher doses (25mcg) of vitamin D are likely needed for groups at increased risk (with increased skin pigmentation, reduced exposure to sunlight, or those who are socially excluded or living with obesity), but further evidence is needed to support this.

Answer 76

If you are planning pregnancy, are pregnant or lactating have a higher requirement of iodine which can effectively be met with food sources such as fish, milk and dairy products. If you are vegan or have a compromised nutritional intake, it is recommended to take a supplement of 150 mcg daily. Those with pre-existing thyroid conditions need to discuss iodine requirements with their GP or maternal dietitian.

Answer 77

- Adequate consumption of omega-3 fatty acids is vitally important during pregnancy as they are critical building blocks of fetal brain and retina. - Omega-3 fatty acids may also play a role in determining the length of gestation and in preventing perinatal depression. - The most biologically active omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - 200 mg 1- 2 servings oily fish per week or a supplement

Answer 78

If you are taking a prenatal multivitamin, ensure that you only take the recommended dose as high levels of certain vitamins and minerals can be toxic to you and your baby. Do not take vitamin supplements that have vitamin A (retinol) in when you are pregnant as high levels can cause harm to your baby.

Answer 79

Routine iron supplementation for all women in pregnancy is not recommended in the UK . An individual approach is preferable, based on results of blood count screening tests as well as identification of women at increased risk

Answer 80

12.5-18kg 0.5kg/week (1.0 lbs/week)

Answer 81

11.5-16kg 0.4kg/week (1.0lbs/week)

Answer 82

7-11.5kg 0.3kg/week (0.6kg/week)

Answer 83

5-9kg 0.2kg/week (0.5kg/week)

Answer 84

- Changes in hormones, ligamentous laxity (hypermobile joints that are very flexible and have a wider range of motion than most people.) - Changes in muscle power, abdominal being stretched - More pressure of pelvic floor and centre gravity change due to weight gain. - Can change the movement round the pelvis resulting pelvic girdle pain. Higher risk of pelvic girdle pain if had previous lower back pain.

Answer 85

- Advice - activity modification (one legged activities are the issue) - Manual therapy - Advise/supply supports - tubigrip Individualised exercise programmes

Answer 86

- Assess - assessing contraction of pelvic muscle when the woman coughs. - Exercises - Advice

Answer 87

- General Exercise - 150 mins moderate intensity exercise per week. Pelvic Floor Exercise - Strengthening Relaxation

Answer 88

- Perineal massage Epino and aniball - inflate in within the vagina to stretch it and then practice expelling the ballon from 37 weeks of pregnancy.

Answer 89

vaginal delivery as soon as they feel comfortable to, C-section or catheterised as soon as catheter is out.

Answer 90

Exercise in the first six weeks - gentle exercise, any heaviness or discomfort, stop.

Answer 91

- Heaviness - Discomfort - Leaking (urine, gas, poo) - Painful sex - ?? 6 week check GP/Physio

Answer 92

- Progressive gentle exercise - Abdominal exercise - Pelvic floor exercise - Scar massage - When to ask for help…

Answer 93

About well-being and not merely the absence of disease involves respect, safety and freedom from discrimination and violence depends on the fulfilment of certain human rights. relevant throughout the individual’s lifespan, not only to those in the reproductive years, but also to both the young and the elderly. expressed through diverse sexualities and forms of sexual expression. critically influenced by gender norms, roles, expectations and power dynamics.

Answer 94

- Teenage pregnancy - Termination of pregnancy - High risk groups - Sexually transmitted infections - Long acting reversible contraception Sexual wellbeing

Answer 95

- 1 in 2 women experience sexual difficulties, 1 in 10 is distressed or worried about sex life

Answer 96

HPV was the most common STI, followed by chlamydia, HIV and gonorrhoea

Answer 97

Only 50% of pregnancies (either given birth, miscarried or had and abortion) were planned. Most unplanned pregnancies were in women aged 20- 34.

Answer 98

Progressive decrease in frequency of intercourse Preference for positions with more control over the degree of vaginal penetration Lessening of clitoral sensitivity, responsiveness, ability to orgasm

Answer 99

Reduced frequency of any sexual behaviour compared to pre-pregnancy Resumption of sexual intercourse between 5 to 8 weeks postpartum More dyspareunia, less desire and arousal, shorter and “softer” orgasms

Answer 100

- Bacteria, fungi, viruses, protists and archaea that live on and in us. - The community of these microbes is referred to as the Human Microbiome-100 trillion microbes call our body home - We are 90% microbial, 10% mammalian

Answer 101

- 1000 species in our gut - 400 species in the vagina - 700 species on our skin - A person's microbiome is unique

Answer 102

Microbes are critical for human health - they play an essential role in health and wellbeing. - They aid DIGESTION - They help METABOLISM - The interact with the NERVOUS SYSTEM and produce neuro chemicals - They interact with our HORMONES - They have ANTI INFECTIVE properties THEY ARE INTEGRAL TO OUR IMMUNE SYSTEM

Answer 103

Microbes can affect the neurotransmitters sending signals to the brain, and produce chemical and hormones can impact on depression, behaviour and inflammatory diseases such as Alzheimer's disease

Answer 104

The microbiome is passed from mother to baby and therefore we inherit the microbes from our mothers, grandmothers, great grandmothers and so on....

Answer 105

- During birth as the baby descends through the vagina - Whilst in skin to skin During breastfeeding, as the microbes are transferred through breastmilk

Answer 106

1. The mode of birth- Mode of birth can have long term consequences on the health of the microbiome. Babies born by C-Section have a different microbiome from babies born vaginally- much less diversity of microbes 2. Babies born to mothers who had antibiotics during labour also have changes in their gut microbiome. 3. Skin to skin contact- babies placed in skin to skin straight after birth and frequently during the new-born period Breastfeeding- breastmilk has high levels of healthy bacteria and HMOs (go into baby's gut and feed the microbes that are in the baby's gut enabling the microbes to flourish and grow.

Answer 107

- Childhood allergies - Asthma - Obesity - Type 2 diabetes - Bowel disease such as IBS and Chrons disease - Liver diseases - Several types of cancer - Mental health illness

Answer 108

- Increase fibre intake- aim for 40g a day - Eat many different types of fruit and veg- seasonally - Eat and cook veg with high levels of prebiotics such as onion, garlic, leeks, artichokes - Eat food high in polyphenols such as nuts, seeds, berries, olive oil, brassica and green tea- antioxidants fuel for microbes Avoid snacking- having intervals between meals gives microbes a rest

Answer 109

- Fermented foods can act as probiotics adding healthy microbes into the body- sources such as keffir, kimchi, sauerrkraut are recommended for a healthy microbiome - Avoid high sugar, artificial sweeteners and processed food as these reduce gut diversity - Living with pets (especially dogs) increases microbial diversity and a health microbiome - Avoid antibiotics whenever possible and also medicines whenever possible- antibiotics kill off good bacteria as well as harmful ones. Even common medicines like paracetamol can have an effect - Daily use of disinfectants such as surface cleaners has a detrimental effect on the diversity of microbes Unhealthy lifestyle such as smoking, substance use, lifestyle also impacts

Answer 110

- Ensure that we are aware of how the heath of pregnant women and their infants is influenced by the health of the microbiome- keep up to date with research - Ensure that women are aware of how to optimise their microbiome and that of their baby- have informed conversations about the microbiome when talking about birth choice, skin to skin, breastfeeding Support healthy nutrition, exercise, support with substance cessation programmes through pregnancy and into the postnatal period

Answer 111

1. DNA methylation-acts on Cytosine one of the nucleobases that form DNA and RNAswitching on and off genes 2. Histone modification Micro RNA

Answer 112

- Mode of birth - The levels of stress we are exposed to - The pollutants and toxins around us - The nutrition that we consume out down epigenetic tags that can influence our health and the health of our offspring. For up to 5 generations! Relevance nutrition in pregnancy and nutrition in infancy. Breastmilk is highly correlated with positive epigenetic changes - Early years of life have the most epigenetic influence

Answer 113

- Gastroenteritis (infection) - Respiratory infections - Allergies - Obesity - Type 1 and 2 diabetes - Ear infections - Urinary tract infection - NEC ( necrotizing enterocolitis) (infection of the lining of the gut) - Dental caries - SIDS Impaired cognitive and emotional function

Answer 114

- Vitamins and minerals - Fats - Carbohydrates - Protein - Water - Growth factors - Lymphocytes - Stem cells - Immunoglobulins - Leukocytes - Lactoferrin - Oligosaccharides - Milk lipids - Enzymes - IL-7 Cytokines

Answer 115

- Longer term breastfeeding is associated with a 26% reduction in the risk of overweight or obesity. - This is data collected from 113 trials from across the world.- this type of research is called a Meta Analysis and is based on the highest quality of evidence - The longer the baby breastfeeds for the greater the reduction in risk of obesity - Direct feeding at the breast is associated with maximum benefit, though feeding breastmilk via bottle still offers some protection

Answer 116

- When a baby breastfeeds- microbes such as Bifidobacterium passed through breastmilk help to optimise metabolism, influencing adiposity and potentially regulating satiation - Human Milk Oligosaccharides (HMOs) are abundant in breastmilk. These complex sugars are metabolised by the microbiota, supporting bacterial proliferation and function, thus further enhancing the health of the microbiome - Epigenetic changes as a result of breastfeeding changes the gene expression affecting the hormone Leptin that controls our feeling of satiation (being full) - Breastmilk also contains hormones and fatty acids that are thought to impact on metabolism and susceptibility to weight gain through life.

Answer 117

- Parent led feeding rather than responsive feeding- unable to self - regulate and receiving higher volumes and excessive calories - Higher protein and sugar content - Lacks the biodynamic properties Lack of regulation in the marketing of formula means that parents are exposed to aggressive marketing of follow on milks and high sugar baby foods,

Answer 118

- Support maternal and infant mental health and bonding and attachment through pregnancy, birth and into the postnatal period- we will talk more about this in upcoming session - Support an empowering birth experience reducing the risk of birth trauma - Ensure that women know about the importance of mode of birth and breastfeeding from a microbiome and epigenetic point of view - Support healthy nutrition, exercise, support with substance cessation programmes through pregnancy and into the postnatal period Support women who want to, to breastfeed

Answer 119

Islamic law gives permission for pregnant and breastfeeding women to opt out of fasting if she fears that it will harm her health or the health of her baby. Missed days of fasting can be made up later, or if this is not possible, a ‘fidyah’ can be paid by providing food for someone in poverty for every missed day of fasting. Fasting should be discussed with your midwife or GP so that you can have a health check, find any potential complications you may be at risk of when fasting and get their advice on whether fasting is likely to harm you or your baby’s health.

Answer 120

There is some evidence to suggest that pregnant women who fast during Ramadan may have smaller placentas and/or babies with slightly lower birth weights, compared to women who do not fast. Fasting may also increase the risk of becoming dehydrated, especially if Ramadan falls during the summer, and this may affect the way your kidneys function and the amount of fluid surrounding your baby. However, other studies have not found any differences between babies who are born to mothers who have fasted and those who have not fasted during Ramadan. The impact of fasting during pregnancy may depend on the overall health of the mother, the stage of pregnancy and the time of year Ramadan occurs.

Answer 121

If you are fasting, dehydration is something to watch out for, especially if Ramadan falls during long hot summer days. Feeling thirsty or having dark-coloured urine can be early signs of dehydration. Other symptoms may include dizziness, headaches, tiredness, dry mouth and passing small amounts of urine infrequently (less than three or four times a day). If you feel dizzy, faint, weak, confused or tired during fasting, even after resting, then you should break your fast with a sweet drink, to replace lost sugar and fluids, and a salty snack, to replace lost salt, or an oral rehydration solution, and contact your doctor Make sure you are still taking your supplements (such as folic acid and vitamin D)

Answer 122

* Protein * Omega-3 fats * Iron * Calcium * Vitamin B12 * Riboflavin (vitamin B2) * Selenium Iodine

Answer 123

Protein is made up of amino acids, which are the building blocks of your body's cells – and of your baby's. Essential amino acids are those that the body cannot make itself and so are needed from the diet.

Answer 124

soya is a particularly good source of protein for vegetarians and vegans * eggs * dairy products, such as milk, yogurt and cheese * some dairy alternatives, such as soya-based drinks and yogurts (choose versions fortified with calcium and other nutrients) * beans and other pulses, such as chickpeas, kidney beans, soya beans and lentils * some nuts and nut butters, such as peanuts, almonds and cashews (where possible, choose the no added salt or sugar varieties) * tofu * mycoprotein-based products * Some grains (such as quinoa) can also contribute to your protein intake.

Answer 125

Algae-based omega-3 supplements are available that provide a vegan-friendly source but check that any supplements you are taking do not contain vitamin A and are suitable for pregnancy. There are also a limited range of foods and drinks fortified with long-chain DHA.

Answer 126

Long-chain omega-3 fats, in particular DHA (docosahexaenoic acid), are important for the normal development of your baby’s brain and eyes. Oily fish, such as salmon, mackerel and trout are rich sources of DHA. If you do not eat fish, you can get short-chain omega-3 fats, such as α-linolenic acid (ALA), from other foods (see list below). The omega-3 fats these foods contain are not the long-chain versions found in oily fish. The body can convert a small proportion of these short-chain fats into long-chain omega-3s, but this process is not thought to be very efficient.

Answer 127

* some seeds (such as flax and chia seeds) * walnuts and walnut oil * vegetable oils (such as flaxseed, rapeseed and soyabean oil) soya beans

Answer 128

Iron is important for the normal growth and development of your baby. A lack of iron can make you feel tired too. Anaemia due to iron deficiency can often occur during pregnancy, and your doctor or midwife can diagnose this through a simple blood test.

Answer 129

* pulses (such as beans, peas and lentils) * green leafy vegetables (such as watercress) * wholemeal, seeded and wheatgerm bread * quinoa * iron-fortified breakfast cereals (check the label) * dried apricots and figs * sesame and pumpkin seeds

Answer 130

Calcium is important for the growth of your baby’s bones, as well as helping to maintain your own bone health. Calcium is also important when breastfeeding, and requirements for calcium increase during this time. Dairy foods, such as milk and yogurt, are a good source of calcium. Try to select lower fat and lower sugar versions where possible, as these are likely to contain at least the same amount of calcium but without the extra calories. Cheese is also a great source of calcium, but many can be high in fat and salt, so eat in moderation and choose reduced-fat

Answer 131

* bread (breads made using flour which does not contain the wholegrain, such as white and some brown breads in the UK, have to be fortified with calcium by law) * some green leafy vegetables, such as kale, rocket and watercress * calcium-fortified breakfast cereals * calcium-fortified dairy alternatives (such as soya, oat, rice or almond-based dairy alternative drinks and yogurts) calcium-set tofu

Answer 132

Vitamin B12 is important for the normal growth and development of your baby and helps the body to release the energy from the food you eat. Typically, vitamin B12 is only found naturally in foods from animal sources (meat, dairy products and eggs). So vegetarians who consume dairy products and eggs can get enough vitamin B12 from their diet; however vegans may not get enough of this vitamin, due to the lack of reliable sources. Studies have shown low intake and blood concentrations of vitamin B12 in vegans and vegetarians.

Answer 133

If you are vegetarian and eat eggs and dairy foods regularly, you should be getting enough vitamin B12. However, the only reliable source of B12 for a vegan are fortified foods. Products other than eggs and dairy foods which contain vitamin B12 include: * vitamin B12-fortified yeast extract (savoury spread) * vitamin B12-fortified dairy-free alternatives (such as soya, oat and almond dairy-free alternative drinks or vegan spreads) * vitamin B12-fortified breakfast cereals

Answer 134

Like vitamin B12, riboflavin (also known as vitamin B2) is important for the normal growth and development of your baby and helps the body release energy from the food you eat. Riboflavin is also found in animal products (meat, dairy products and eggs), but unlike vitamin B12 it is also found in some plant-based foods. If you are vegetarian and eat eggs and dairy foods regularly (milk is a good source of riboflavin), you should be getting enough.

Answer 135

If you are vegan, products other than eggs and dairy foods which contain riboflavin include: * mushrooms * some nuts and seeds (such as almonds) * yeast extract (savoury spread) (especially fortified varieties) * riboflavin-fortified dairy alternatives (such as soya, oat and almond-based drinks) * riboflavin-fortified breakfast cereals

Answer 136

Selenium is needed for the normal function of the immune system, and to help protect your body’s cells from damage due to oxidative stress

Answer 137

Meat and fish are good sources of selenium, and eggs are also a good source.

Answer 138

Although the actual levels of selenium vary depending on the soil in which plant foods are grown, these include: * some nuts and seeds, especially Brazil nuts, but also cashew nuts and sunflower seeds * some breakfast cereals, such as puffed wheat cereal, shredded wheat and cornflakes * some breads, such as seeded and wheatgerm bread

Answer 139

Iodine is particularly important for your baby's brain development and your requirements increase during pregnancy

Answer 140

Vegetarians, and particularly vegans, are at risk of iodine deficiency as they do not eat foods that are a source of iodine (such as fish and dairy products).

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sources of iodine include fish, eggs, milk and milk products,

Answer 142

* Although seaweed is a concentrated source of iodine, it can provide excessive amounts, particularly brown seaweed (like kelp), and therefore eating it more than once a week is not recommended, especially during pregnancy or breastfeeding. Iodine supplements are available.

Answer 143

folic acid and vitamin d

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* Folic acid: It is recommended that you take a daily folic acid supplement containing 400µg (micrograms) from before you become pregnant until up to 12 weeks of pregnancy. If you did not start taking folic acid before you conceived, you should start as soon as you find out that you are pregnant.

Answer 145

Vitamin D: Pregnant and breastfeeding women should take a daily supplement containing 10μg (micrograms) of vitamin D during the autumn and winter months to help protect their bone and muscle health, as this advice applies to all adults in the UK

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If you decide to take a multivitamin and mineral supplement, select one which is specifically for pregnancy or which does not contain vitamin A, as high levels of vitamin A during pregnancy can harm your baby.

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Healthy Start vitamins for pregnant women (containing folic acid and vitamins C and D) are also available.