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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
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
26
How do we get our food safety tips while pregnant?
Health canada Food and nutrition Safe food handling for pregnant women
27
Why is food safety big for pregnant women?
Increase susceptibility to infections during pregnancy
28
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
29
What are the illnesses that can arise from food?
``` Listeria -spontaneous abortion, Brian infection, stillbirth Echoli Slamonella Campylobacter ```
30
What is toxoplasmosis ?
Mental retardation, blindness, seizures and death | -due to raw/undercooked meat, raw produce and cat litter
31
What is a high risk pregnancy?
Pregnancy characterized by factors that increase probability that the birth will be surrounded by problems
32
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 ```
33
If you have a baby before 30 what chances are halved of developing what syndrome?
Downs
34
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
35
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.) ```
36
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
37
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
38
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
39
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
40
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
41
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 ```
42
What is FAS?
Fetal alcohol syndrom - Alcohol related birth defects - physicla and mental retardation - Facial malformation - impaired CNS - Spontaneous abortion - PREVENTABLE
43
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
44
What meds should we avoid while pregnant?
``` Aspirina nd ibuprofen -blood thinner Accutane (vit A) -spontaneous abortion -major birth defects Mental illness drugs ```
45
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 ```
46
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
47
How does caffeine affect pregnancy?
Impaired ability to fetus to metabolize Moderate to heavy use decrease infant Bw -300mg/day from all sources
48
What sugar substitutes should we avoid?
Saccharin Cyclamates If PKU avoid aspartame
49
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
50
What is oxidative stress and inflammation?
• The effect of free radicals on the body | We don’t always see the inflammation
51
What are the conditions that increase oxidative stress and inflammation?
Hypertension | GDM
52
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
53
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
54
What is the leading cause of maternal mortality?
Hypertension | -BP 140/90 or greater
55
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
56
How is likely to have chronic hypertension?
Obese | Greater than 35 years
57
What is gestational hypertension?
elevated BP mid to late pregnancy without protein in urine | -resolves within 12 weeks post partum
58
What is preeclampsia/eclampsia?
``` Increased BP Protein in Urine Blurred vision Abdominal pain Low platelet count abnormal liver enzymes Seizures ```
59
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 ```
60
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
61
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
62
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
63
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
64
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)
65
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 ```
66
What happens when you have DM2 during pregnancy?
Need multidisciplinary team Have normal BG range Continu monitoring post partum for changes in insulin
67
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 ```
68
Why are the rates of multiple increasing?
IVF More women having babies later 35+ More overweight/obese
69
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
70
Is the growth rate of multiples the same as singleton?
Yes up until 28wks then growth slows
71
Do you need extra energy when having multiples?
~150 extra cals/day, Increased needs for water and nutrients -EFA for eyes -Ca and Fe
72
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
73
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
74
What are the consequences of pregorexia?
``` Misscarriage Hypertention Preterm labour Anemia UTI difficult deliveries Wt gain generally below recommendations and infant often SGA ```
75
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

FN 2241 (12 decks)

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