Household and Food security in Pregnancy

Question 1

What is Food security?

Answer 1

Food security exists when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life

Question 2

What is Food Insecurity?

Answer 2

1. Limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways

Question 3

Types of Food security

Answer 3

Quantitative (having enough food)
Qualitative (good quality food like variety and nutritious value)
Social (how culturally acceptable is the food they are getting and how they are getting it (food banks currently are not)
Psychological ( how anxiety, thinking about where food is coming from)

Question 4

sequence of severity

Answer 4

1. Begins with worrying about not having enough money to buy food to compromising on quality (the same inexpensive foods) and then compromising on quantity
2. Food shortage, unsuitability of food, monotony, lack of freshness a preoccupation with having access to enough food, a feeling of lack of control over the situation and a need to hide that lack of control

Question 5

Food Insecure and household income

Answer 5

1. 61% of people are making wadges
2. 16% social assistance
3. 12% seniors’ income

Question 6

Food Insecurity and health

Answer 6

1. Associated with poorer reported health
2. Overweight and obesity
3. Associated with poorer mental health
4. Negative academic and psychosocial outcomes in children
5. Poor nutritional intakes in a variety of populations
6. Linked to biochemical or clinical measures of nutritional status

Question 7

Perinatal Health important

Answer 7

1. Perinatal mortality (maternal/infant) is an important indicator of the health of communities and countries
2. Impacted on by may variables
   a. Social economic, environmental, health system
3. An investment in the future
   a. Healthy women cause
   b. Healthy pregnancies cause
   c. Healthy infants cause
   d. Healthy families cause
   e. Healthy communities

Question 8

When does obstetrical care start?

Answer 8

1. When a person finds out they are pregnant
2. But it should before conception

Question 9

Preconception

Answer 9

1. 3 months
2. But also, as son as someone wants to become pregnant
3. Preconception counselling for the couple if there is concern
4. Women of childbearing age
   a. 15-40
   b. 50-75% of pregnancies unplanned
   c. Therefore, many sexually active women are preconceptual at any given time

Question 10

Preconception care

Answer 10

1. Opportunity to positively impact on health of women and men and decrease risk factors impacting on the pregnancy and fetus
2. All members of the conceptual process are important (mother and father)

Question 11

Weight gain by trimester

Answer 11

1. How should this weight gain be divided for a normal BMI of 18.5-24.9
   a. 1st trimester 6 pounds because there are lots of reserves already present for the baby to grow that get depleted later
   b. 2nd trimester-12 pounds
   c. 3rd trimester 12 bounds
   d. Total 25-35 pounds

Question 11

What is preconceptual care?

Answer 11

1. Optimizing weight and nutrition, exercise
2. Modifiable risk factors like smoking, alcohol and drugs
3. Folic acid and multivitamin with iron to prevent neural tube deficits, 0.4mg. regular multivitamins usually have the required dosages
   a. Iron because most clients have lower hemoglobin. Supplement 16-20mg but constipation become a risk
4. Oral health
   a. Increased risk of developing gingivitis because of increased blood flow. Babies are at higher risk for preterm birth with dental disease
5. Immunizations because some can’t happen while pregnant
6. Screening for communicable diseases/STI
7. Genetic counselling
8. Spacing of childbearing and family planning
9. Screening for social risk factors, reducing stress and optimizing mental health

Question 12

Health teaching in pregnancy

Answer 12

1. Prenatal nutrition
2. Folic acid
3. Alcohol
4. Physical activity
   a. Keep doing what your doing
   b. If less thank 150 minutes of low impact work do that
5. Travel
   a. Be near a hospital
6. Smoking
   a. Reduce and ideally stop
   b. Use motivational interviewing to get results
7. Oral health
8. Emotional health
   a. Can impact health outcomes of the fetus
9. Birth preparation

Question 13

Common discomforts of pregnancy

Answer 13

1. Urination
   a. UTI can cause preterm birth
2. Back and hip pain
3. Nausea and vomiting but not hyperemesis gravitation
4. Papules and plaques (a rash)
5. Calf pain from pressure on vessels due to weight gain
6. Some peripheral edema

Question 14

Signs of concern

Answer 14

1. Hyperemesis gravidae
   a. Non stop vomiting
2. Bleeding
3. tiny spotting with implantation or mucus plug development is normal
4. Decreased fetal movement
5. Extreme edema
6. Signs of hypertension such as a severe headache
7. Sudden gush of fluid
8. Severe cramps
9. Dizziness
10. UTI

Question 15

For fetus

Answer 15

1. Fetal movement
2. Fetal heart rate
3. Ultrasound

Question 16

Non routine tests for high risk

Answer 16

1. Biophysical profile
   a. Fetuses move their diaphragm but the lungs are fluid filled so we want to see them moving
   b. Like an internal Apgar
   c. Measure fluid pockets around the fetus (shows there is lots of fluid for they baby, that they can gulp and pee), tone (neurologically well developed) flexion (the baby is moving) heart rate
2. Amniocentesis
3. Chorionic villus testing
4. Doppler

Question 17

Ultrasound

Answer 17

1. When
   a. Recommended for all women to be offered a dating ultra sound between 8-12 weeks and an anatomy ultrasound between 18-22 weeks of pregnancy
2. Why
   a. To confirm pregnancy and EDC (estimated date of confinement)
   b. Number of fetuses
   c. Size for gestational age
   d. How the baby’s integral organs are growing
   e. Placental position and size
   f. Woman’s uterus, fallopian tubes, ovaries
   g. Check for signs of possible genetic problems

Question 18

Why 8-12 weeks

Answer 18

1. Because genetics, placenta, socioeconomic factors have had less of an effect on the child

Question 19

Placenta placement

Answer 19

1. We want fundal
2. Placenta previa
   a. When the placenta is over the cervix. When dilation occurs during labor the placenta is no longer connected to tissue and the baby isn’t getting nutrients
   b. Needs c section

Question 20

Technology

Answer 20

1. Not always needed
2. Reduction in fetal movement = potential for distress/fetus in distress

Question 21

Group B streptococcus (GBS)

Answer 21

1. Screening done in 3rd trimester
2. Are common bacteria which are often found in the vagina, rectum or urinary bladder of 15-40% of women
3. Screening by vaginal/rectal culture 35-37 weeks
4. Treated with antibiotics in labor
   a. If earlier it could come back
5. 2 approaches
   a. Screen and treat all women who are GBA+
   b. Treat based on risk factors

Question 22

Additional non routine tests and screening

Answer 22

1. Ultrasound beyond the recommended
   a. Previous history of early fetal losses
   b. Bleeding or other complications
   c. Measure fetal growth and identify intrauterine growth restriction (IUGR)
   d. Measure amniotic fluid
   e. Confirm position of fetus
2. Doppler flow studies
   a. Measure the velocity of blood flow via ultrasound
3. Marker screening tests/prenatal serum screening/NIPT/cfDNA
4. Nuchal translucency
5. Amniocentesis
6. Chorionic villus
   a. Embryonic tissue from placenta
   b. Results sooner than U/S
7. Non stress test
   a. Electronic fetal monitoring, not in labor
8. Biophysical profile (BPP_
   a. NST + U/S like fetal movement, tone, breathing and amniotic fluid
9. Measurement of amniotic fluid
   a. Increases in volume as the pregnancy progresses
   i. 1 L at birth
   ii. Two sources-fluid from the maternal blood across amnion and fetal urine
   b. Adequate volume is needed for proper growth and development
   i. Protection of fetus
   ii. Infection control
   iii. Temperature control
   iv. Lung and GI development (swallow and breathing, practice using these muscles)
   v. Muscle and bone development (as floats arounds allows development)
   vi. Umbilical cord support by preventing compression
   c. Oligohydramnios vs polyhydramnios/hydramnios

Question 23

Marker screening test

Answer 23

1. AKA prenatal serum screening
2. Blood test offered to women to determine the risk of aneuploidy carry an infant with down syndrome (trisomy 21) Edwards syndrome (trisomy 18) or open neural tube defect (trisomy 13)

Question 24

First trimester serum screen

Answer 24

1. 11-14 weeks
2. PAPP-A and BhCG
3. Determines risk of chromosomal disorders and anomalies

Question 25

Second trimester serum screen

Answer 25

1. 15-20 weeks
2. Quad screen (AFP, E3, inhibin A and bhCG)

Question 26

Counselling should include consider of further testing

Answer 26

1. Amniocentesis, detailed ultrasound to exclude anomalies, and nuchal translucency

Question 27

Nuchal scan for translucency

Answer 27

1. A collection of fluid under the skin at the back of a fetus’ neck
2. Ultrasound examination offered between 11-14 weeks gestation
3. From the measured thickness of the nuchal translucency combined with maternal age the risk of chromosomal abnormality can be calculated

Question 28

Non invasive prenatal testing or cell free DNA testing (cfDNA)

Answer 28

1. A collection of fluid under the skin at the back of a fetus’ neck
2. Ultrasound examination offered between 11-14 weeks gestation
3. From the measured thickness of the nuchal translucency combined with maternal age the risk of chromosomal abnormality can be calculated
   Non invasive prenatal testing or cell free DNA testing (cfDNA)
4. NIPT works by taking a blood sample from a pregnant client and analyzing for abnormalities of specific chromosomes (13, 18, 21, X and Y) associated with conditions like down syndrome a turner syndrome
5. NIPT carries no risk of miscarriage because there is no need to pierce the amniotic sac.
   a. Can be performed 9-10 weeks into pregnancy vs 16 weeks amniocentesis
6. Not yet publicly funded through all Canadian provinces
7. An option available to clients at higher risk

Question 29

Amniocentesis

Answer 29

1. In the 2nd trimester for genetics
   a. 15-16 weeks and takes 2-3 weeks for results
   b. Decisions about pregnancy 18 weeks and termination more difficult after 20 weeks
2. 3rd trimester for fetal maturity
   a. L/S ratio (lecithin/sphingomyelin) should be 2:1 over 35 weeks
   b. 2 components of surfactant which line alveoli of lungs and reduces surface tension when the infant exhales
   c. Phosphatidylglycerol (PG) appears around 35 weeks

Question 30

Prenatal classes

Answer 30

1. Varying lengths and times
2. Different groups
   a. Single parent, high risk, adolescent, culture and languages, methods (Lamaze, Bradley)
3. Tour of hospital
4. Preparation for birth
   a. Education
   b. Breathing, relaxation and pain control
   c. Operative deliveries
   d. Postpartum adjustment
   e. Infant care
5. Breastfeeding classes

Question 31

Prenatal care

Answer 31

1. Values pregnancy as a state of health
2. Diversity of needs recognized, a variety of personal and cultural meanings are brought by families to pregnancy and birth
3. Accessing care in pregnancy can provide opportunities for health teaching and positive contributions to overall health status of the woman and her family