Lecture 3 - Part II Flashcards
Why is being underweight a bad thing if you are trying to conceive?
Increase risk of preterm birth and perinatal mortality
-BMI less than 18.5kg/m^
If you are underweight, what is the recommendation if you are trying to conceive?
Should gain extra weight during pregnancy (28-40lbs) in order to retain some weight gained for own stores
Why is being overweight a bad thing if you are trying to conceive?
- Increase risk of GDM and postpartum infections
- More likely to have complications at labor and delivery
- infant more lily to be born post term, high BW or macrocosmic
If you are overweight, what is the recommendation if you are trying to conceive?
Should avoid excessive Wt gain during pregnancy (15-25lbs) because they already have the extra fat stored you would normally need if they were at a normal wt
How much weight should each person gain depending on their weight pre-pregnancy?
Under: 28-40lbs
Normal: 25-35lbs
Over: 15-25lbs
Obese: 11-20lbs
When pregnant, how much weight gained goes towards what baby needs?
Breasts: 1-2lbs Baby: 6-8lbs Placenta: `1-2lbs Uterus: 1-2lbs Amniotic fluid: 2-3lbs
When pregnant, how much weight gained goes towards what mom needs?
Your blood: 3-4lbs
Your protein and fat storage: 8-10lbs
Body fluids: 3-4lbs
When do body fat stores increase the most?
Between 10 and 20 weeks then decrease towards the end
What % of the placenta males up the baby weight?
15-20%
How does mom get rid of the extra fluid in her body?
Mom pees a lot of it out in the first 48hrs
What happens when mom breastfeeds?
uterus contracts a little so it can get back down to the size it was, can be painful cramp feeling
How much weight should you gain in the 1st T?
2-8lbs
For the 2nd and 3rdT, how much weight should you gain?
~1lb/wk (norm) >1lb/wk (under) ~0.7lb/wk (over) ~0.5lb/wk (obese) ~1.5lb/wk (twins)
What rate of weight gain is more stable during pregnancy, maternal or fetal?
Maternal is more steady
Fetal has more variation in exponential growth periods
What are the risks of inadequate wt gain?
Increase maternal factors such as:
- low SES
- single moms
- minority groups
- cigarette smokers
- history of eating disorders
What happens when you have a large weight gain over a short period of time?
Water retention leads to signs of preeclampsia which is very risky for mom and baby
What is preeclampsia characterized by?
Hypertension
Water retention
Proteinuria (abnormal quantities of protein in the urine)
what is the recommended amount of weight to be lost after having a baby?
Initially you lose weight from baby and water but after should do 1-4 pounds per month until pre-pregnancy weight it achieved.
What happens if weight is lost too quickly after birth?
Can sacrifice milk production and effect quality and energy status
Should nourish adequately and exercise cautiously
What happens if you gain more weight than needed while pregnant in terms of weight loss?
The more the weight will be retained and it may take longer to lose
What is the placenta?
Organ that develops inside thee uterus in pregnancy, in which maternal and fetal blood circulate in close proximity so that materials can be exchanged between them
What are the main functions of the placenta?
Hormone and enzyme production
Site of breathing and exchange
Protection from harmful elements
What is able to cross into the placenta if mom ingests it/
Alcohol
Excess Vitamins
Drugs
Viruses
When does the placenta develop?
Precedes fetal development
How much does the placenta weigh in relation to the baby?
Its larger than the fetus for most of the pregnancy
Weight about 15% of the weight of the fetus at birth
How does the moms blood enter the placenta?
Enters through uterine arteries
- bathes placental villi
- Leaves via uterine veins with waste products
How does the baby blood interact with the placenta?
Circulatesfrom umbilical artery
- into placental villi
- out through umbilical vein
What is the hCG and what does it do?
Human chorionic gonadotropin
- produced bu chorionic villi in placenta
- incfreases progesterone and estrogen secretion
- increases rapidly in early pregnancy
When we are taking a pregnancy test what is the test looking for?
hCG in urine/plasma
-higher the level the further along you are
What is hCS and what does it do?
Human chorionic Somatotropin
- produced by placenta during second half of pregnancy
- increase maternal insulin resistance
- increase protein synthesis
- increase fat breakdown
What does the increase in estrogen lead to when the placenta tells it to increase it levels?
Increase in:
- lipid formation and storage
- Protein synthesis
- uterine blood flow
- development of uterus and Brest ducts
Promotes flexibility in ligaments
What does the increase in progesterone lead to when the placenta tells it to increase it levels?
- Maintains implanted embryo
- Stimulates endometrial growth
- Relaxes smooth muscles
- Increase breast development
What is the amniotic sac?
Fluid filled ballon structure that houses the developing fetus
-fetus can drink some water and nutrients from the amniotic fluid in the second half of pregnancy
What is the umbilical cord?
Ropelike structure containing blood vessels that extend from fetus umbilicus to placenta
Who gets priority for nutrients, baby or mom?
It varies based on:
- Short term malnutrition
- Longterm malnutrition
- Vitamins/minerals
- Maternal weight and age
What can maternal malnutrition lead to?
Limits placental development
Decrease blood flow and nutrient availability across placenta
Impairs fetal development
Exerts effect during critical periods of development
when does maternal nutrient metabolism in pregnancy start and why?
Immediately
To accommodate needs of fetus
What is affected during maternal nutrient metabolism in pregnancy?
Macros
Minerals
Fasting
When do we need carbs throughout pregnancy and why?
All throughout, but mrore in 3rdT
To make glucose available to fetus because its the preferred energy source
What happens with carbs in the first 20wks vs the last 20wks?
First
-E&P cause an increase in insulin production which leads to an increase in conversion of glucose to glycogen and fat
Second
- moms pituitary secretes hCS which decreases the conversion of glucose to fat and glycogen
- Slight insulin resistance in mom leads to decrease use of glucose
- increased liver production of glucose for fetal development
When do we need protein throughout pregnancy and why?
All throughout, protein storage needs to be continually met
Nitrogen and protein are needed for synthesis of new maternal and fetal tissue
What happens to protein in the body when you’re pregnant?
- Body excretes less nitrogen and conserves amino acids
- Mom needs to increase intake of protein
- About 2 pounds of protein accumulate during pregnancy
When do we need fat throughout pregnancy and why?
Throughout
Major reason: need essential fatty acid (DHA)
- Accumulation on fat stores in baby in 3rdT,
- mom fat stores for post birth
What happens with fat in the first 20wks vs the last 20wks?
First:
-Increase accumulation of fat stores
Second:
-Increase use of fat for energy
What happens when blood lipids levels increase?
- Used by placenta for steroid hormones synthesis
- Used by fetus for nerve and cell membrane formation
What might high levels of triglycerides indicate during pregnancy?
High levels of TG during pregnancy may indicate insulin resistance pre-pregnancy and therefore increase risk of GDM and hypertension development during pregnancy
When do we need water and minerals throughout pregnancy and why?
Throughout
To ensure baby gets what baby needs and also what mom needs
What happens when we consume these minerals?
Ca: increase bone turnover and reformation
Na: kidneys support extra retention
When do we see fasting metabolism throughout pregnancy and why?
When: fasting for longer than 12 hours
- poorly controlled diabetes
- focus on weight loss instead of the caloric needs of pregnancy
Why: to spare glycogen stores/glucose sfor fetus
• Body will give baby what it needs to the sacrifice of mom but only to a certain extent
What happens when the metabolism is fasting?
Glucogenic amino acid use
Fat oxidation
Production of ketones
When the fetus is relying on ketones what are the results?
Reduced growth
Impaired intellectual development
since energy needs increase during pregnancy, what % of the energy goes towards the fetus?
Fetus accounts for ~33% of the increased energy needs
What is the recommended energy intake for all the trimesters?
1: 0
2: 340
3: 452
What are the energy needs during pregnancy if you are not active?
Considerably lower
-common to have low levels of energy expenditure from physical activity in the first T
What type of physical activity is recommended and not recommended?
Recommended: Swimming, walking, prenatal yoga, strengthen pelvic floor
Not recommended: anything that makes mom too hot
What is the recommended protein intake during pregnancy?
71g/day
or 0.8g/kgBw/day + 25g
Protein supplements offer no benefit
What are the carb requirements for pregnancy?
45-65% of total caloric intake during pregnancy should be form carbs
175g/day - but most women need more than this
How much fat should pregnant women consume?
33% fat
-fat consumed in food is used for energy
Need adequate good fats like non and polyunsaturated, should minimize saturated and trans
Why is DHA important?
For growth and development of the fetal brain and nervous system
Adequate DHA and EPA and lactation liked to increased intelligence, better vision and More mature CNS
What is the recommendation for EPA and DHA?
No more than 3g/day
-can thin blood and not clot properly and lead to increase in haemorrhage at birth
Min 300mg/day
What is the serving of fish and what fish should we chose?
150g of cooked fish each week
CHose with low contaminants:
- salmon
- trout
- Herring
- Canned light tuna
- Pollock
What are the recommendations for pregnant women for folate B12 Fe and Zn
Folate: 600mcg/day -assumes 400 from a supplement B12: 2.6mcg/day Fe: 27mg/day Zn: 11mg
Why is folate needed?
Normal development of spine, Brian and skull of the fetus during the first 4 weeks of pregnancy
- day 21-27 is the most important
- problem is most women don’t know that they are pregnant during this stage
What could a deficiency in folate lead to I pregnancy?
Abnormal cell dividsion and tissue formation
Mehtionine shortage
-due to inadequate conversion of homocysteine to methionine as folate is needed for this process
Why is B12 important for pregnancy?
Women with B12 deficiency early in pregnancy are more likely to have a child with a neural tube defect
It is critical to effective functioning of the nervous system and production of red blood cells
Why is Fe important during pregnancy?
More Fe is needed to make hemoglobin
- for the growth of the baby and placenta in 2nd and 3rdT
- if a women is pregnant with insufficient store her requirement is even more
How long do baby Fe store last when born?
4-6 months
What is the deficiency that can occur from low Fe?
Fe-deficiency anemia
-results in LBW, PTB and infant mortality
What can help with Fe absorption in baby?
Allowing the cord to be attached for 10-15 min or at least until the placenta stops pulsing
Why is Zn important during pregnancy?
Very important for rapid cell growth
-associated with LBW and miscarriage
What are sources folate?
Dark leafy greens Dried beans Broccoli Asparagus Oranges/Pineapple juice Fortified lour and grains
What are sources of B12?
Animal products Milk products Ready to eat cereals Nutritional Yeast Fortified Soy
What are sources of Fe?
Meat Legume Tofu Spinach Prunes/apricots/figs Fortified Cereals
What are sources of Zn?
Meat Grains/bread Milk products Black beans Ready to eat cereals Nuts
What are the recommendation for Ca and Vitamin D during pregnancy?
Ca: RDA 1000MG/DAY
VIT D: RDA 15MINCROGRAMS/DAY OR 600IU
What can insufficient Ca intake lead to?
Baby will draw its stores from moms bones and can impair maternal health over time
Why is vitamin D need during pregnancy?
Helps maintain proper levels of Ca which are related to the growth of the baby bones and teeth
Growth retardation, skeletal deformities, preeclampsia, are all associated with Vitamins D deficiency
what are the water needs during pregnancy?
AI= 3L/d
What is the purpose of water during pregnancy?
- drinking extra helps with swollen ankles and feet
- Carries nutrients through women blood to baby
- inadequate consumption can cause contractions that can trigger PTB
- Need a lot for breastfeeding cause you are losing water from your body by having a baby so need to keep that level up
What is the fibre recommendation during pregnancy?
AI= 28g/day
-prevent and reduce indigestion, constipation and heartburn
What should be in a prenatal supplement?
Fe: 30g
Folic Acid: 600microgram
Ca
If you are a vegetarian during pregnancy what should you be cautious of?
Protein sources: soy, yogurt, tofo quinoa
-complementary proteins
