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HUNT 243 > Lecture 6 - Maternal Nutrition During Pregnancy > Flashcards

Lecture 6 - Maternal Nutrition During Pregnancy Flashcards

1
Q

pregnancy is considered a what state

A

anabolic state

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2
Q

during pregnancy, hormonal changes alter nutrient metabolism to support :

A
  • fetal growth and development
  • reproductive tissue accretion
  • maternal homeostasis
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3
Q

what happens to basal energy expenditure (BEE) during pregnancy

A

increase over the non pregnant state due to added metabolism of uterus and fetus increased work of the maternal heart and lungs

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4
Q

what happens to the thermic effect of food during pregnancy

A

remains unchanged

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5
Q

what happens to the energy cost of physical activity during pregnancy

A

energy cost remains the same

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6
Q

what is equivalent to total energy expenditure

A
  • basal energy expenditure
  • thermic effect of food
  • physical activity
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7
Q

what is the recommended energy intake during the first trimester of pregnancy

A

extra energy not required

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8
Q

what is the recommended energy intake during the second trimester of pregnancy

A

1,400kJ/day added to estimated energy requirement of non pregnant women

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9
Q

what is the recommended energy intake during the third trimester of pregnancy

A

1,900kJ/day added to estimated energy requirement of non pregnant women

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10
Q

what are linoleic (18:2n-6, LA) and a-linolenic acid (18:3n-3, LNA) and what are they used to make

A

essential fatty acids omega 3 and omega 6, used to make LCPUFA’s

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11
Q

what is desaturation of LCPUFAs

A

inserting of double bonds into the fatty acid chain

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12
Q

what are LCPUFAs

A

long chain polyunsaturated fatty acids

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13
Q

what is elongation of LCPUFAs

A

adding two carbon atoms onto the carboxyl end of the fatty acid chain

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14
Q

what is desaturation of LCPUFAs catalysed by

A

desaturase enzyme

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15
Q

what is elongation of LCPUFAs facilitated by

A

elongase enzyme

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16
Q

what are LCPUFAs essential for

A

for normal fetal development, particularly neural and visual function

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17
Q

endogenous synthesis of AA is far more effective than …

A

DHA

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18
Q

what is DHA (LCPUFAs)

A

a critical component of cell membranes, especially in the brain and retina

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19
Q

what is AA (LCPUFAs)

A

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

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20
Q

how does n-3 fatty acid deposition in the developing fetal brain and retina occur

A

initially occurs fairly slowly and then rapidly accumulates during the last trimester

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21
Q

why is the fetus dependent on placental supply for both LCPUFAs and essential fatty acids

A

the fetus has active desaturases but limited ability to make LCPUFAs

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22
Q

what influences the cord blood concentrations of LCPUFAs

A

maternal diet

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23
Q

in NZ most of us get enough of what essential fatty acid but we get less of what one

A

most of us get enough of linoleic acid (omega 6) but we get less of a-linoleic acid (omega 3)

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24
Q

a rich supply of n-3 fatty acids during pregnancy is associated with what

A

reduced incidence of low birth weight

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25
Q

higher DHA and / or EPA intake during pregnancy increases

A

increases gestational age and heavier infants (better healthy weight)

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26
Q

why do maternal and fetal fatty acid requirements during pregnancy depend on maternal genetic variation in LCPUFA synthesis

A

because it was found FADS (homozygous minor allele) had shorter pregnancies and lighter infants

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27
Q

a meta-analysis found that omega-3 intake during pregnancy reduced risk of

A

peanut and egg allergy

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28
Q

what is monomethylmercury

A

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

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29
Q

monomethylmercury is taken up by what

A

taken up by aquatic organisms and concentrated in fish

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30
Q

what fish have higher concentrations of monomethylmercury

A

higher concentrations in longer living fish such as shark, ray, swordfish etc

31
Q

tuna for canning is often lower in monomethylmercury why ?

A

the fish are often smaller

32
Q

an estimated 40% of the mercury that eventually finds its way into fish originates with …..

A

coal burning power plants and chlorine production plants

33
Q

maternal methylmercury exposure is directly related to :

A

related to fish consumption

34
Q

what is the concern of methylmercury

A

neurotoxin, large amounts can damage the developing nervous system of the fetus and delay mental development

35
Q

what is the recommendation for eating longer living fish during pregnancy

A

less than three to four times per week

36
Q

what is the recommendation for eating fish such as shark, southern bluefin tuna and trout while pregnanct

A

only once a week or once a fortnight

37
Q

what is the most common micronutrient deficiency during pregnancy

A

iron

38
Q

why does iron intake need to increase during pregnancy

A
  • expansion of our maternal red blood cells (because we are developing a temporary organ)
  • fetal erythropoiesis
  • allow for enough blood loess that will likely occur at delivery
39
Q

what is the RDI of iron for pregnant women aged 14-50 years, and how much is this an increase compared to non pregnant women

A

27mg/day, 9mg increase

40
Q

what is the upper limit of iron intake

A

45mg/day

41
Q

low Hb indicative of moderate or severe anaemia has been associated with an increase risk of what for the infant

A
  • low birth weight
  • small gestational age
  • preterm birth
  • decreased infant iron stores
  • consequent impaired cognition and growth of the child
42
Q

low Hb indicative of moderate or severe anaemia has been associated with an increase risk of what for the mother

A
  • severe anaemia may increase the risk of cardiac failure or death from peripartum hemorrhage
43
Q

an estimated what % of pregnant women have anaemia globally

A

40%

44
Q

what is peripartum

A

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

45
Q

what is the WHO recommendation of iron supplementation in areas of the world where this is an issue in pregnancy (this doesn’t apply to NZ)

A

routine iron supplements of 60mg daily for pregnant women living in areas where malnutrition is prevalent

46
Q

how does iron status screening work for pregnant women in NZ

A

iron status at booking (<20 weeks) and 26-28 weeks gestation

47
Q

how to reduce the side effects of iron medication

A
  • start with half the dose then gradually increase
  • taking the supplement in divided doses with food
48
Q

what is delayed ‘optimal’ cord clamping mean and what does it improve

A

means changing the time of cord clamping from immediately after delivery to 1-3 minutes after delivery, this improves iron status of the infant

49
Q

how much blood will be transferred from the placenta to the infant at 1 minute after birth, and at 3 minutes

A

about 80ml, reaching 100ml at 3 minutes

50
Q

iodine is essential for the production of what

A

production of thyroid hormones, required for regulating the babies metabolism, for normal growth and neurocognitive development of the fetus, infant and child

51
Q

severe iodine deficiency causes

A

intellectual disabilties

52
Q

what is the RDA for iodine in non pregnant women vs pregnant

A

150mcg/d

220mcg/d

53
Q

recommended intakes of vitamin A increase by what in pregnancy

A

~10%

54
Q

intakes of vitamin A above 10,000 IU per day increase risk of

A

fetal abnormalities

55
Q

what is retinoic acid syndrome

A

collection of birth defects including crainofacial, cardiovascular, thymus dysfunction and microcephaly

56
Q

vitamin D deficiency linked to maternal health outcomes such as

A
  • gestational diabetes
  • pre eclampsia
57
Q

vitamin D deficiency linked to infant health outcomes such as

A
  • low birth weight
  • dental decay
  • acute respiratory infections
58
Q

what is listeria and what does it cause in healthy people and pregnant people

A

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

59
Q

what does listeriosis develop as a result of

A

infection with listeria monocytogenes, usually from a food

60
Q

what symptoms does listeriosis cause

A

causes influenza type symptoms and can result in premature labour and reduced fetal movements

61
Q

listeria can multiply over a wide range of temperatures from …

A

-1.5 to 50 degrees

62
Q

what temperature should you heat foods to, to minimise the risk of listeria

A

70 degrees

63
Q

foods that are considered unsafe in terms of listeria

A
  • uncooked, smoked or ready to eat fish or seafood
  • pate, hummus
  • cold - pre cooked chicken
  • ham and other chilled pre cooked meats
  • pre prepared or stored salads
  • raw unpasteurised milk
  • soft serve ice creams
  • soft cheeses
64
Q

what is toxoplasmosis

A

a parasitic disease cause by toxoplasma gondii, can cause eye or brain damage in unborn babies

65
Q

toxoplasmosis infection can come from :

A
  • eating unwashed vegetables, undercooked meat or ready to eat meat
  • drinking raw unpasteurised milk
  • cross contamination of coming in contact with cats or their faeces
66
Q

what symptoms do pregnant women usually show when they have toxoplasmosis

A

a pregnant women is often asymptomatic

67
Q

alcohol readily passes the what and what does this mean

A

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

68
Q

what are the key features of fetal alcohol syndrome (FAS)

A
  • growth deficiency of prenatal onset
  • central nervous system dysfunction
  • a specific pattern of facial characteristics
69
Q

what are the central nervous system dysfunction related to alcohol examples include

A

microcephaly

delayed development

hyperactivity

attention deficits

learning disabilities

intellectual deficits

70
Q

fetal alcohol spectrum disorder includes

A
  • full FAS
  • alcohol related neurodevelopment disorder
  • alcohol related birth defects
71
Q

full FAS is generally only present when ….

A

with exposure of fetus to regular heavy alcohol intake, or to very high alcohol concentrations at critical periods

72
Q

what does alcohol related neurodevelopment disorder include

A

difficulties with mathematical skills,

difficulties with memory or attention

poor school performance

and poor impulse control and / or judgement

73
Q

alcohol related birth defects includes

A

problems with the heart, kidneys, bones and / or hearing

74
Q

packaged alcohol containing more then 1.15% alcohol requires …

A

to have a “pregnancy warning label”

HUNT 243 (17 decks)

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