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FN 2241 > Lecture 3 - Part III > Flashcards

Lecture 3 - Part III Flashcards

1
Q

When is nausea and vomitting common?

A

weeks 5-10

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2
Q

What is the most likely cause of nausea and vomitting?

A

High levels of hormones in the blood

-sometimes the Fe in supplements can contribute

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3
Q

How do you treat nausea?

A

Select foods that are well tolerated

-preferably high in carbs

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4
Q

What is hyperemesis gravidarum and what can it lead to?

A

Severe nausea vomiting and dehydration thought pregnancy

  • wt loss
  • malnutrition
  • electrolyte imbalance
  • lack of wt gain
  • small infant
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5
Q

What do you treat hyperemesis gravidarum with?

A

Diclectin

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6
Q

What is the cause of constipation and hemorrhoids?

A

Relaxed gastrointestinal muscle tone

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7
Q

How do you prevent constipation and hemorrhoids?

A

Adequate fibre: 28g/day
Adequate water: 3L/deay
Active living

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8
Q

how do you treat constipation and hemorrhoids?

A

Increase fluids and food high in insoluble fibres
Prune juice
Check iron supplement
Do not take laxatives

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9
Q

What is the cause of heartburn/gastroesophageal reflux?

A

Relacation of gastrointestinal tract muscles

  • due to progesterone
  • relaxing of lower esophageal sphincter
  • reflux of stomach content in esophagus
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10
Q

What is the treatment for heartburn/gastroesophageal reflux?

A 
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
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11
Q

What is pica and why dopes it occur?

A

Craving substances with little to no nutritional value
-usually non food cravings

Due to Fe deficiency

Is an eating disorder

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12
Q

What dopes exercise influence while pregnant?

A 
Energy needs
Nutrient utilization
Wt gain
Fetal growth
-smoother labour if fit before pregnancy
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13
Q

What does regularly exercising benefit for mom and baby?

A

Well being
-physically and mentally healthier
Shorter labor
Increase placenta function and fetal growth

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14
Q

What is PARmed-X?

A

For pregnancy, a physical activity readiness medical examination
-health screening prior to participating in prenatal exercise

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15
Q

What are the fitness recommendations during pregnancy?

A

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

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16
Q

What are the possible adverse effects on exercise during pregnancy?

A

Vigorous exercise decreases glucose and O2 to placenta
Dehydration, overheating
No contact sports, danger of flashing or scuba diving

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17
Q

When doing a nutrition assessment of pregnant women, what are we looking for?

A

Patient history: medical history etc

ABCD findings

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18
Q

For pregnant women nutrition assessment what are we looking for under patient history?

A

Health, diet, SES drug history

Review of high risk pregnancy factors

History of previous/present illness

  • obstetrical history
  • chronic diseases
  • pregnancy related disorders
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19
Q

What is anthropometric data?

A

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

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20
Q

What is biochemical data?

A

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
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21
Q

How do we assess Fe status?

A

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)

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22
Q

How do we assess Protein status?

A 
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

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23
Q

What is clinical data?

A

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

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24
Q

What is dietary assessment?

A

To determine adequacy of intake

  • energy and nutrient intake
  • variety
Usual Eastin habit
Eastin disorder
Supplement
Food availability
Caffeine, alcohol, drugs
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25
Q

What are the goals of nutrition intervention during pregnancy?

A

Meet and increase energy&nutrient needs for pregnancy
Promote optimal wt gain
Give therapeutic dietary support when needed
Prepare for lactation and motherhood

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26
Q

How do we get our food safety tips while pregnant?

A

Health canada
Food and nutrition
Safe food handling for pregnant women

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27
Q

Why is food safety big for pregnant women?

A

Increase susceptibility to infections during pregnancy

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28
Q

What are the important steps for prevention of illness due to food?

A

Cooked thoroughly
Reheat well
Choose wisely when eating out
Caution at social gathering where food sits out

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29
Q

What are the illnesses that can arise from food?

A 
Listeria
-spontaneous abortion, Brian infection, stillbirth
Echoli
Slamonella 
Campylobacter
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30
Q

What is toxoplasmosis ?

A

Mental retardation, blindness, seizures and death

-due to raw/undercooked meat, raw produce and cat litter

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31
Q

What is a high risk pregnancy?

A

Pregnancy characterized by factors that increase probability that the birth will be surrounded by problems

32
Q

What are the characteristics of a high risk pregnancy?

A 
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
33
Q

If you have a baby before 30 what chances are halved of developing what syndrome?

A

Downs

34
Q

What is placenta prevue?

A

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

35
Q

What are the consequences if you have nutrient deficiencies or in excess?

A 
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.)
36
Q

What happens when there is malnutrition and its relation to fetal development?

A

When one is lacking, usually others are too
Immediate of later effect
Damage can be irreversible

37
Q

What are the classic nutrient deficiencies?

A

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

38
Q

What are the common nutrients to see a toxicity from and the what are the results of having too much?

A

Vitamin A: Microcephaly, hydrocephalus, spontaneous abortion
Vitamin D: Hypercalcemia
Iodine: Congenital Goiter
Folate: Masks B12 deficiency

39
Q

How does being pregnant when an adolescent affect our body?

A

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

40
Q

If you have a baby over the age of 35 what do we see in terms of health of the infant?

A

Increase birth defects preterm births
Growth retardation
Deaths

41
Q

Why is smoking so bad during pregnancy?

A 
Placental probelsm
Vaginal bleeding
Decrease in fetal blood supply and development
Harmful compounds 
O2 deprivation
Birth complication
SIDS
LBW and SGA
42
Q

What is FAS?

A

Fetal alcohol syndrom

  • Alcohol related birth defects
  • physicla and mental retardation
  • Facial malformation
  • impaired CNS
  • Spontaneous abortion
  • PREVENTABLE
43
Q

What is FAE?

A

Fetal alcohol effects

  • alcohol related neurodevelopment disorder
  • learning disability
  • behavioural abnormalities
  • motor impairments
  • overall more cognitive effects, could look normal on the outside
44
Q

What meds should we avoid while pregnant?

A 
Aspirina nd ibuprofen 
-blood thinner
Accutane (vit A)
-spontaneous abortion
-major birth defects
Mental illness drugs
45
Q

What are the effects of drug use?

A 
Cross placenta
Impair fetal development 
PTB,LBW
Sudden infant death
Abnormal newborn cries and behaviours
Impaired child development 
Withdrawal syndrome
46
Q

What environmental contaminants are harmful?

A

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

47
Q

How does caffeine affect pregnancy?

A

Impaired ability to fetus to metabolize
Moderate to heavy use decrease infant Bw
-300mg/day from all sources

48
Q

What sugar substitutes should we avoid?

A

Saccharin
Cyclamates

If PKU avoid aspartame

49
Q

Are herbal teas and preparations safe during pregnancy?

A

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

50
Q

What is oxidative stress and inflammation?

A

• The effect of free radicals on the body

We don’t always see the inflammation

51
Q

What are the conditions that increase oxidative stress and inflammation?

A

Hypertension

GDM

52
Q

What factors increase and decrease oxidative stress and inflammation?

A

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
53
Q

What are the consequences or oxidative stress and inflammation?

A

Damage/oxidative stress int he endothelium of blood vessels can lead to blood flow restriction and increased risk of blood clots and plaque

54
Q

What is the leading cause of maternal mortality?

A

Hypertension

-BP 140/90 or greater

55
Q

What is chronic hypertension?

A

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

56
Q

How is likely to have chronic hypertension?

A

Obese

Greater than 35 years

57
Q

What is gestational hypertension?

A

elevated BP mid to late pregnancy without protein in urine

-resolves within 12 weeks post partum

58
Q

What is preeclampsia/eclampsia?

A 
Increased BP
Protein in Urine
Blurred vision
Abdominal pain
Low platelet count
abnormal liver enzymes 
Seizures
59
Q

What are the nutritional considerations in relation to hypertension during pregnancy?

A 
Overal balance diet
Wt gain recommendations dont change
Caution around Na
Multivitamin
Meeting all nutrient recommendations 
Moderate exercise
Healthy body wt
60
Q

What is GDM?

A

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

61
Q

What are the possible outcomes for GDM?

A

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

62
Q

How do you manage GDM?

A

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

63
Q

what is the RDs role in diagnosis, follow up during pregnancy and post partum?

A

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
64
Q

If you have GDM what should you diet look like?

A

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)
65
Q

What are the dietary goals if you have GDM?

A 
Min 174g carbs
Low GI foods
High fibre
Limit simple sugar
Avoid TF STA, aim for healthy fats
66
Q

What happens when you have DM2 during pregnancy?

A

Need multidisciplinary team
Have normal BG range
Continu monitoring post partum for changes in insulin

67
Q

What happens when you have DM1 during rpegnancy

A 
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
68
Q

Why are the rates of multiple increasing?

A

IVF
More women having babies later 35+
More overweight/obese

69
Q

What is the difference between fraternal and identical?

A

Fraternmal: 2 eggs, double hormone release

Identical: 1 egg that splits

Can share amniotic sac/placenta or each have their own

70
Q

Is the growth rate of multiples the same as singleton?

A

Yes up until 28wks then growth slows

71
Q

Do you need extra energy when having multiples?

A

~150 extra cals/day,
Increased needs for water and nutrients
-EFA for eyes
-Ca and Fe

72
Q

What is the weight gain recommendations for twins ?

A

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

73
Q

What is the background with eating disorders and pregnancy?

A

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

74
Q

What are the consequences of pregorexia?

A 
Misscarriage
Hypertention
Preterm labour
Anemia
UTI
difficult deliveries
Wt gain generally below recommendations and infant often SGA
75
Q

What is the treatment if you have an eating disorder and you become pregnant?

A

Multidisciplinary team within ED treatment centre
Behaviour based therapy
Ketone dip stick used to give a visual for inadequate nourishment for the developing fetus

FN 2241 (12 decks)

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