Lecture 3 - Part III Flashcards
When is nausea and vomitting common?
weeks 5-10
What is the most likely cause of nausea and vomitting?
High levels of hormones in the blood
-sometimes the Fe in supplements can contribute
How do you treat nausea?
Select foods that are well tolerated
-preferably high in carbs
What is hyperemesis gravidarum and what can it lead to?
Severe nausea vomiting and dehydration thought pregnancy
- wt loss
- malnutrition
- electrolyte imbalance
- lack of wt gain
- small infant
What do you treat hyperemesis gravidarum with?
Diclectin
What is the cause of constipation and hemorrhoids?
Relaxed gastrointestinal muscle tone
How do you prevent constipation and hemorrhoids?
Adequate fibre: 28g/day
Adequate water: 3L/deay
Active living
how do you treat constipation and hemorrhoids?
Increase fluids and food high in insoluble fibres
Prune juice
Check iron supplement
Do not take laxatives
What is the cause of heartburn/gastroesophageal reflux?
Relacation of gastrointestinal tract muscles
- due to progesterone
- relaxing of lower esophageal sphincter
- reflux of stomach content in esophagus
What is the treatment for heartburn/gastroesophageal reflux?
Small frequent meals Eat slow Avoid large meals before bed and avoid laying flat after eating Wear loose clothes Sleep with head elevated Avoid bending after eating Avoid coffee and carbonated drinks
What is pica and why dopes it occur?
Craving substances with little to no nutritional value
-usually non food cravings
Due to Fe deficiency
Is an eating disorder
What dopes exercise influence while pregnant?
Energy needs Nutrient utilization Wt gain Fetal growth -smoother labour if fit before pregnancy
What does regularly exercising benefit for mom and baby?
Well being
-physically and mentally healthier
Shorter labor
Increase placenta function and fetal growth
What is PARmed-X?
For pregnancy, a physical activity readiness medical examination
-health screening prior to participating in prenatal exercise
What are the fitness recommendations during pregnancy?
Do not overexert
Avoid prolonged strenuous exertion
Drink liquids before during and after exercise
Avoid exercising in warm environments
Avoid straining while holding your breath
What are the possible adverse effects on exercise during pregnancy?
Vigorous exercise decreases glucose and O2 to placenta
Dehydration, overheating
No contact sports, danger of flashing or scuba diving
When doing a nutrition assessment of pregnant women, what are we looking for?
Patient history: medical history etc
ABCD findings
For pregnant women nutrition assessment what are we looking for under patient history?
Health, diet, SES drug history
Review of high risk pregnancy factors
History of previous/present illness
- obstetrical history
- chronic diseases
- pregnancy related disorders
What is anthropometric data?
BMI before pregnacy
-used to recommend wt gain
Wt gain during pregnancy
Compare wt gain to length of gestation
Increase gestation time and increase Birth wt
What is biochemical data?
Changes associated with pregnancy complicate lab test analysis
- hemodiliution: Relative decrease in RBC concentrations due to increase plasma volume
- Focuses on: Fe and protein status as well as blood glucose levels
How do we assess Fe status?
Serum Hemoglobin and hematocrit
-hemodilution but further decease signals Fe deficiency anemia
Serum Ferritin
-decrease indicates 1st stages of Fe deficiency (decrease in Fe stores)
How do we assess Protein status?
Some blood protein concentration -decrease due to hempodilution -serum albumin Some blood protein concentration -increases due to estrogen levels
Assessment of A1c (glycosylated Hb) and blood glucose concentrations
-DM screening at 24-28wks
What is clinical data?
Common signs of malnutrition
Problems due to pregnancy
- edema due to increase estrogen and water retention
- decrease in serum albumin concentration
Preeclampsia
-abnormal edema high BP and proteinuria
What is dietary assessment?
To determine adequacy of intake
- energy and nutrient intake
- variety
Usual Eastin habit Eastin disorder Supplement Food availability Caffeine, alcohol, drugs
What are the goals of nutrition intervention during pregnancy?
Meet and increase energy&nutrient needs for pregnancy
Promote optimal wt gain
Give therapeutic dietary support when needed
Prepare for lactation and motherhood
How do we get our food safety tips while pregnant?
Health canada
Food and nutrition
Safe food handling for pregnant women
Why is food safety big for pregnant women?
Increase susceptibility to infections during pregnancy
What are the important steps for prevention of illness due to food?
Cooked thoroughly
Reheat well
Choose wisely when eating out
Caution at social gathering where food sits out
What are the illnesses that can arise from food?
Listeria -spontaneous abortion, Brian infection, stillbirth Echoli Slamonella Campylobacter
What is toxoplasmosis ?
Mental retardation, blindness, seizures and death
-due to raw/undercooked meat, raw produce and cat litter
What is a high risk pregnancy?
Pregnancy characterized by factors that increase probability that the birth will be surrounded by problems
What are the characteristics of a high risk pregnancy?
PTB <37wks Difficult birth Birth defect Early infant death Genetics POverty Low or high BMI Too much or little wt gain Special diets Age (teen or over 35) Nutrient deficiencies Eating disorder Multiples Hypertension Short intervals between pregnancy History of disease problems
If you have a baby before 30 what chances are halved of developing what syndrome?
Downs
What is placenta prevue?
Placenta slides down over the cervix and it can come away and the baby has to be born
-more common in grannies that happens within a shorter period of time
What are the consequences if you have nutrient deficiencies or in excess?
Fetal drouth retardation Congenital malformation/birth defects Spontaneous abortion/stillbirth PTB LBW -neeed to be aware of all the places you can get a vitamin (food skin care etc.)
What happens when there is malnutrition and its relation to fetal development?
When one is lacking, usually others are too
Immediate of later effect
Damage can be irreversible
What are the classic nutrient deficiencies?
Iodine: Cretinism
-Right after birth to baby, without leads to low IQ and short lifespan
Vitamin D: Congenital rockers
-bowed legs and protruding chest
Vitamin A: Congenital malformation
Thiamin: Infantile beri beri, brain lesion
Folate: Neural tube defect, PTB, LBW
What are the common nutrients to see a toxicity from and the what are the results of having too much?
Vitamin A: Microcephaly, hydrocephalus, spontaneous abortion
Vitamin D: Hypercalcemia
Iodine: Congenital Goiter
Folate: Masks B12 deficiency
How does being pregnant when an adolescent affect our body?
Truing to nourish a fetus adds to teen nutrition burden
Adolescent growth can be incomplete
Increase rates of stillbirth, preterm and LBW
Increase of physical problems and infant mortality
If you have a baby over the age of 35 what do we see in terms of health of the infant?
Increase birth defects preterm births
Growth retardation
Deaths
Why is smoking so bad during pregnancy?
Placental probelsm Vaginal bleeding Decrease in fetal blood supply and development Harmful compounds O2 deprivation Birth complication SIDS LBW and SGA
What is FAS?
Fetal alcohol syndrom
- Alcohol related birth defects
- physicla and mental retardation
- Facial malformation
- impaired CNS
- Spontaneous abortion
- PREVENTABLE
What is FAE?
Fetal alcohol effects
- alcohol related neurodevelopment disorder
- learning disability
- behavioural abnormalities
- motor impairments
- overall more cognitive effects, could look normal on the outside
What meds should we avoid while pregnant?
Aspirina nd ibuprofen -blood thinner Accutane (vit A) -spontaneous abortion -major birth defects Mental illness drugs
What are the effects of drug use?
Cross placenta Impair fetal development PTB,LBW Sudden infant death Abnormal newborn cries and behaviours Impaired child development Withdrawal syndrome
What environmental contaminants are harmful?
Lead and mercury
- cross placenta
- impair children cognitive development
- mercury in fish
- lead in water
Cant control these so thing about how we can least expose ourself
How does caffeine affect pregnancy?
Impaired ability to fetus to metabolize
Moderate to heavy use decrease infant Bw
-300mg/day from all sources
What sugar substitutes should we avoid?
Saccharin
Cyclamates
If PKU avoid aspartame
Are herbal teas and preparations safe during pregnancy?
Several herbal teas that should be avoided and depending on the time as well
-red raspberry causes uterine contractions
Essential oils avoided as well
-lavender effect boy hormones
Overall not enough data about safety and no regulations
What is oxidative stress and inflammation?
• The effect of free radicals on the body
We don’t always see the inflammation
What are the conditions that increase oxidative stress and inflammation?
Hypertension
GDM
What factors increase and decrease oxidative stress and inflammation?
Increase:
- processed/high fat meats, trans fat, soft drink/high sugar beverages
- physical inactivity
- Visceral fat
- smoking
Decrease:
- Fruits/veg/whole grain/adequate
- vitamin D
- physical activity
What are the consequences or oxidative stress and inflammation?
Damage/oxidative stress int he endothelium of blood vessels can lead to blood flow restriction and increased risk of blood clots and plaque
What is the leading cause of maternal mortality?
Hypertension
-BP 140/90 or greater
What is chronic hypertension?
Present prior to pregnancy or develops before 20wks of pregnancy or develops anytime during pregnancy and does not resolve after
-if already have it, probably know how to manage it
How is likely to have chronic hypertension?
Obese
Greater than 35 years
What is gestational hypertension?
elevated BP mid to late pregnancy without protein in urine
-resolves within 12 weeks post partum
What is preeclampsia/eclampsia?
Increased BP Protein in Urine Blurred vision Abdominal pain Low platelet count abnormal liver enzymes Seizures
What are the nutritional considerations in relation to hypertension during pregnancy?
Overal balance diet Wt gain recommendations dont change Caution around Na Multivitamin Meeting all nutrient recommendations Moderate exercise Healthy body wt
What is GDM?
Gestational diabetes Millitus
- Women enter pregnancy with insulin resistance or a genetic predisposition for this
- tested at 26wks
Insulin production may be impaired due to physiological changes
What are the possible outcomes for GDM?
Fetus increases insulin production to accommodate for increase glucose delivery which in turn increases their glucose uptake and conversion of glucose to fat
Resolves once placenta is delivered
How do you manage GDM?
Multidisciplinary team (OBGYN, RD with CDE, Nurse, endocrinologist)
Diet and exercise preferred and usually effective
Have enough Carbs to prevent ketones
Metformin and insulin offered at time shown lifestyle modification are ineffective after several weeks of effort
what is the RDs role in diagnosis, follow up during pregnancy and post partum?
Diagnosis
- Assess dietary and exercise habits
- Develop individualized plan
During
- monitor wt gain and intake, make adjustments as needed
- intrepret BG and urinary ketone results
- offere encouragement and support
Post
- Less concern for those who managed with diet and exercise
- increased risk for GDM in next pregnancy
If you have GDM what should you diet look like?
Balanced throughout the day
- 10-20% breakfast
- 20-30% lunch
- 30-40% dinner
- 30% snacks (1/2 cup vanilla ice cream Chapmans best for balancing blood sugar throughout the night)
What are the dietary goals if you have GDM?
Min 174g carbs Low GI foods High fibre Limit simple sugar Avoid TF STA, aim for healthy fats
What happens when you have DM2 during pregnancy?
Need multidisciplinary team
Have normal BG range
Continu monitoring post partum for changes in insulin
What happens when you have DM1 during rpegnancy
More dangerous for both BG management in first half to avoid increased risk of accumulation of extra fat and muscle tissue Careful management of diet Monitor ketone levels High fibre
Why are the rates of multiple increasing?
IVF
More women having babies later 35+
More overweight/obese
What is the difference between fraternal and identical?
Fraternmal: 2 eggs, double hormone release
Identical: 1 egg that splits
Can share amniotic sac/placenta or each have their own
Is the growth rate of multiples the same as singleton?
Yes up until 28wks then growth slows
Do you need extra energy when having multiples?
~150 extra cals/day,
Increased needs for water and nutrients
-EFA for eyes
-Ca and Fe
What is the weight gain recommendations for twins ?
normal BMI: 37-54
Over: 31-50
Obese: 25-42
Under: no recommendation but same or more than normal wt
-wt gain in 1st half of pregnancy increase likelihood of increase BW
What is the background with eating disorders and pregnancy?
Usually some with eating disorder are sub fertile so not a common concern
More common to see bulimia in pregnancy
Symptoms seem to decrease in 2nd and 3rdT but return post pregnancy
What are the consequences of pregorexia?
Misscarriage Hypertention Preterm labour Anemia UTI difficult deliveries Wt gain generally below recommendations and infant often SGA
What is the treatment if you have an eating disorder and you become pregnant?
Multidisciplinary team within ED treatment centre
Behaviour based therapy
Ketone dip stick used to give a visual for inadequate nourishment for the developing fetus
