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HUNT243 > Lecture 6 > Flashcards

Lecture 6 Flashcards

Maternal nutrition during pregnancy: energy requirements

1
Q

Pregnancy is an …. state for which …… changes alter nutrient metabolism

A

Pregnancy is an anabolic state for which hormonal changes alter nutrient metabolism.

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2
Q

Pregnancy is an anabolic state for which hormonal changes alter nutrient metabolism to support

A

1- Fetal growth and development
2-Reproductive tissue accretion
3-Maternal Homeostasis

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3
Q

Most nutrient requirements increase during

A

pregnancy and are typically estimated by adding an increment to the non-pregnant, non-lactating requirement.

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4
Q

Energy needed to balance

A

Basal energy expenditure
Thermic effect of food
Physical activity

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5
Q

Basal energy expenditure

A

Attributed to maintenance increase over the non-pregnant state due to added metabolism of uterus and fetus and increased work of the maternal heart and lungs = 450 to 750 KJ

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6
Q

Thermic effect of food

A

remains unchanged

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7
Q

Physical activity

A

energy cost remains the same

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8
Q

Recommended energy intakes in the different trimesters

A

Increases in total energy expenditure are minor with minimal weight gain expected during the 1st trimester, energy increases recommended only in the 2nd and 3rd trimesters

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9
Q

around about the number energy requirements for each trimester

A

1st trimester- Extra energy not required

2nd trimester - 1,400 kJ/d (or 340 kcal/d)

3rd trimester- 1,900 KJ/d (or 452 kcal/d)

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10
Q

Long-chain polyunsaturated fatty acids

A

Linoleic and a-linolenic acid are essential and used to make LCPUFAs

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11
Q

Chain elongation/saturation enzymes are shared by both

A

n-3 and n-6 fatty acids with competition between substrates for these enzymes

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12
Q

Endogenous synthesis of …. is far more effective than ….

A

AA
DHA

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13
Q

LCPUFAS background

A

LCPUFAs are essential for normal fetal development, particularly neural and visual function

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14
Q

DHA

A

Is a critical component of cell membranes especially in the brain and retina (50% of total rod and outer segments)

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15
Q

AA

A

Is both a membrane component and a precursor to potent signalling molecules, the prostaglandins and leukotrienes (mediate inflammatory responses)

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16
Q

Fetal LCPUFA accumulation:
n-3 fatty acid deposition

A

n-3 fatty acid deposition in the developing fetal brain and retina initially occurs fairly slowly and then rapidly accumulates during the last trimester

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17
Q

Fetal LCPUFA accumulation:
Fetus has active desaturates but limited

A

Fetus has active desaturates but limited ability to make LCPUFAs so it is dependent on placental supply for both LCPUFAs and essential fatty acids (linoleic and a-linolenic acid)

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18
Q

Fetal LCPUFA accumulation:
Cord blood concentrations influenced by ….

A

Maternal diet

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19
Q

Rich supply of n-3 fatty acids during pregnancy are associated with

A

Reduced incidence of low birth weight

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20
Q

????Higher DHA and/or EPA intake=

A

increase GA and heavier infants

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21
Q

???? Significant gene-diet interaction =

A

FADS (homozygous minor allele) had shorter pregnancies and lighter infants such that maternal and fetal fatty acid requirements during pregnancy depend on maternal genetic variation in LCPUFA synthesis

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22
Q

Results from a meta analyses about n-3 fatty acids during pregnancy

A

DHA and EPA supplementation during pregnancy does not significantly improve cognition or development in children

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23
Q

The meta analyses did however find that omega 3 reduces the risk of

A

egg and peanut allergy

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24
Q

Monomethylmercury occurs

A

naturally in the environment and in industrial pollution accumulating in streams and seas

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25
Q

Monomethylmercury taken uo by ………. and higher concentrations in

A

aquatic organism and concentrated in fish and higher concentrations in longer living fish such as shark, ray, swordfish

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26
Q

An estimated ……..% of the mercury finds its way into fish originates with……..

A

An estimated 40% of the mervury that eventually finds its way into fish originates with coal-burning power plants and chlorine production plants

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27
Q

Methylmercury concerns:
Maternal methylmercury exposure is directly

A

related to fish consumption

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28
Q

Methylmercury concern

A

Neurotoxin; Large amounts can damage the developing nervous system of the fetus and delay mental development

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29
Q

what are the guidelines / advice for pregnant women

A

Eat longer-lived and larger fish - Less than three to four times a week

Eat school shark, southern bluefin tuna, marlin and trout- only once a week or fortnight

Bluff and pacific oysters and queen scallops can have high cadmiun - should be eaten no more than once a month

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30
Q

what is the most common micronutrient deficiency in pregnant women

A

Iron

31
Q

The total cost of iron during pregnancy and therefore the requirement may be as much as……. to meet the demands

A

1000mg

32
Q

Requirements for absorbed iron increase slowly during pregnancy

First trimester
Third trimester

A

1.2mg/d first trimester
5.6mg/d Third trimester

33
Q

What is the RDI for pregnant women aged 14-50 per day and what is the upper limit

A

27mg

45mg

34
Q

Low Hb indicative of moderate or severe anemia has been associated with an increased risk of……… for the infant:

A

LBW, SGA, preterm birth, decreased infant iron stores, and consequent impaired cognition and growth of the child

35
Q

Low Hb indicative of moderate or severe anemia has been associated with an increased risk of……… for the mother:

A

For the mother, severe anamia may increase the risks of cardiac failure or death from peripartum hemorrhage

peripartum (occurring during the last month of gestation or first few months after delivery)

36
Q

what percentage of people globally have anaemia

A

40%

37
Q

Iron supplementation recommended by WHO and folic acid - and for who

A

WHO recommends routine iron supplementation of 60mg daily (plus 400 mcg folic acid) for pregnant women living in areas where malnutiriton is prevalent

38
Q

when should pregnant women start taking these supplements

A

Taken as early as possible and throughout pregnancy

39
Q

Women that take supplements during pregnancy are less likely to have

A

LBW babies and mean BW was more controlled

40
Q

Supplements during pregnancy dont have any affect on

A

Preterm birth or neonatal death

41
Q

Screening iron status in NZ

A

Iron status booking <20wks and at 26-28wks gestation

42
Q

At screening if your Hb is <100 at booking

A

urgent indication to start oral iron supplementation and consideration of parenteral (IV) iron

43
Q

Side effects iron medication

A

Nausea, vomiting, constipation, diarrhea, dark colored stools, and/ or abdominal distress

44
Q

how to take iron supplement

A

Start with half the dose and gradually increase to the full dose, taking the supplement divided doses with food

45
Q

Supplemental iron is available in two forms:

A

Ferrous and ferric. Ferrous iron salts are the best absorbed forms

46
Q

Prophylactic iron supplementation in pregnancy

A

refers to the routine provision of iron supplements to all pregnant women, regardless of whether they have been diagnosed with iron deficiency or anemia.

In iron replete women may increase the risk of gestationsla diabetes and increased oxidative stress

47
Q

Interventions aimed at preventing iron deficiency

A
  • Food based strategies
    -Iron supplementation
    -Fortification of staple foods with iron
48
Q

Delayed ‘optimal’ cord clamping

A

changing the timing from immediately after delivery to 1-3 minutes after delivery IMPROVES iron status of infant

49
Q

why does the delay improve iron status

A

Transfer from the placenta of about 80ml of blood at 1 minute after birth, reaching about 100ml at 3 minutes

these additional volumes can supply extra iron amounting to 40-50mg/kg of body weight

50
Q

Iodine

A

Essential for the production of thyroid hormones required for regulating the body’s metabolism and for normal growth and neurocognitive development of the fetus, infant and child.

51
Q

severe iodine deficiencies cause …….

are they common or rare in NZ

A

Severe iodine deficiency cuases intellectual disability

rare - Due to WHO universal salt iodisation

52
Q

Iodine and pregnancy

A

Despite mandatory bread fortification, pregnant women are still susceptible to iodine deficiency due to higher requirement

53
Q

Iodine supplementation

A

150mcg tablet taken once a day when pregnant and breastfeeding

54
Q

Vitamin A

A

Key nutrient in pregnancy as it plays important roles in reactions involved in cell differentiation

55
Q

Is vitamin A deficiency rare or common

A

Deficiency is rare in industrialised countries but a major problem in developing nations and can produce malformations in fetal lungs, urinary tract and heart

56
Q

Excessive intakes of vitamin A

A

Increase risk of fetal abnormalities

Craniofacial, cardiovascular, thymus dysfunction and microcephaly : Small ears or no ears, abnormal or missing ear canal

57
Q

Vitamin D: Increased risk for pregnant people with /who

A
  • Naturally dark skin tone

-Live south of nelson/marlborough during winter or spring

-spend limited time outdoors and/or have minimal sun exposure due to cultural or personal reasons

58
Q

Vitamin D insufficiency linked to: maternal health outcomes

A

-Gestational health outcomes
-Pre-eclampsia

59
Q

Vitamin D insufficiency linked to: Infant health outcomes

A

-Low birth weight
-Dental Decay
-Acute Respiratory infections

60
Q

Listeria Monocytogenes

A

Foodborne bacteria: widely distributed yet does not cause symptoms in healthy individuals but can cause listeriosis in pregnant women and newborn infants

61
Q

how does listeriosis develop

A

As a result of infection with listeria monocytogenes, usually from a food

62
Q

what does Listeriosis cause

A

Causes influennza type symptoms and can result in premature labour and reduced fetal movements.

63
Q

If listeriosis is not treated

A

it can be life threatening to fetus via infection of placenta, membranes and amniotic fluid, causing intrauterine sepsis and fetal death

64
Q

Precuations

A

Listeria can multiply over a wide range of temperatures from 1.5 degrees to 50 degrees

Foods should be heated thoroughly to steaming hot (over 70degrees)

grows happily in refrigerated conditions at 4 degrees

pregnant women should avoid unsafe foods

65
Q

Foods that are unsafe -listeria

A

such as:

uncooked seafood
hummus based dips and spreads
cold pre cooked chicken
raw unpasteurised milk
soft serve ice cream
soft cheese

66
Q

how many infection in pregnant women are reported each year

what was the percent of mother to mother transmission

what percent did this cause fetal complications

A

19-30 infections

96%

83%

67
Q

Toxoplasmosis

A

Parasitic disease cuased by toxoplasma gondii
- can cause eye or brain damage in unborn babies

68
Q

Toxoplasmosis can come from

A

eating unwashed vegetables, undercooked meat or ready to eat meats such as salami or ham

drinking raw unpasteurised milk

cross contamination from cats

69
Q

Alcohol and pregnancy

A

Alcohol readily passes the placenta such that fetal blood alcohol levels will be similar to maternal blood alcohol levels

70
Q

Fetal alcohol syndrome (FAS)

A

Is most recognisable outcome of maternal alcohol drinking, first characterised in 1973

71
Q

Features of FAS

A

Growth deficiency pf prenatal onset

Central nervous system dysfunction

A specific pattern of facial characteristics

72
Q

Fetal alcohol spectrum Disorder

A

1- Full FAS is generally only present with exposure of fetus to regular heavy alcohol intake

2-Alcohol related neurodevelopment disorder (ARND)

3- Alcohol related birth defects (ARBD)

73
Q

Alcohol recommendations: New Zealand

A

-Stop drinking alcohol if coud be or are pregnant

-Packaged alcohol containing more than 1.15% alcohol will be required to have a “pregnancy warning label”

-Fermented food and drinks, such as kombucha, may contain low levels of alcohol from the brewing process and should be avoided

HUNT243 (29 decks)

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