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FN 3344 > Lecture 6 - Pregnancy & Lactation > Flashcards

Lecture 6 - Pregnancy & Lactation Flashcards

1
Q

Why is it important to assess nutrition during pregnancy?

A

To look for:

  • Physiological changes
  • Changes in dietary preferences
  • Condition Brough on by pregnancy that affect nutrition (nausea, vomiting)
  • Nutrition habits affect pregnancy health outcomes
  • Self report measures
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2
Q

What is the best way to assess nutrition during pregnancy?

A

There is no consensus in the literature on a best way

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3
Q

Why is self-reporting measures questionable?

A

Hard to generally make a statement cause there is so much variety

A lot of nutrition assess mantis all self reported so accuracy of this is always in question

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4
Q

When getting a medical history, what kind of information is in that?

A

Obstetrical history
Chronic disease
Pregnancy related disorders
Family history

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5
Q

What is the information to obtain under the obstetrical history?

A 
Current and previous pregnancies
Parity-number of times female has been pregnant
Multiple pregnancies
Compilations during pregnancy
Macro/microsomic birth
Stillbirth
Preterm infant/intrauterine growth
Bed rest/ at risk pregnancy
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6
Q

What are 4 pregnancy related disorders?

A

Hyperemesis- extreme nausea and vomitting

Anemia- low iron

Gestational Diabetes-first onset is during pregnancy

Reflux/Heartburn

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7
Q

In patten history what do we need to know about psycho-social health?

A 
Age (teen vs mature)
Economic situation
Culture
Support Systems
Communication barrier
History of abuse/mental illness
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8
Q

In patten history what do we need to know about food, diet and lifestyle?

A 
Usual eaten habit
Nutrient Supplement
Food Availability
Physical Activity
Herbal Remedies (no safe herbs)
Substance Use
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9
Q

What anthropometric data should we obtain?

A 
Height Weight
Pre-preg BMI
Assess/Monitor pattern of weight gain
Weight History
Weight gain goals
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10
Q

What is the average weight gain for pregnant women who are underweight, normal, overweight and obese?

A

Under: 28-40
Normal: 25-35
Over: 15-25
Obese: 11-20

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11
Q

During pregnancy, where does all of the weight go too?

A 
Breasts - 2
Mom Fluid volume - 4
Placenta - 1.5
Blood to placenta - 4
Infant - 7.5
Increase uterus size and muscles - 2
Necessary fat stores - 7
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12
Q

What happens to anything gained afar the recommended weight?

A

Will be stored in excess fat and will be harder to lose

-especially if there are multiple pregnancies back to back

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13
Q

If you have a high BMI what are some maternal complication that can occur?

A 
Reduced fertility
Impaired glucose tolerance 
Gestational Diabetes
Thromboembolism
Hypertensive disorder of pregnancy
Increased risk miscarriage
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14
Q

If you have a high BMI what are some fetal complication that can occur?

A

Fetal congenital abnormalities
Fetal growth restriction
Stillbirth
Increased risk of morbidity in later life

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15
Q

What are the normal hemoglobin levels in the different trimesters?

A

Non preg: 120g/L
1stT: 110 g/L
2ndT: 105g/L
3rdT: 110 g/L

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16
Q

What other chemical data to we obtain from labs for pregnant women?

A 
Hematocrit
Ferritin
-65-120mcg/L
Transferrin
-help to mobilize the Fe during pregnancy
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17
Q

When do we screen for Gestational diabetes?

A

24-28 weeks

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18
Q

What are the factors that make us screen earlier for gestational diabetes?

A 
Previous GDM
BMI >30kg/m^2
Prediabetes
Polycystic ovarian syndrome
High risk populaiton
Older than 35
History of macrocosmic infant
Corticosteroid use
Acanthosis nigricans. (skin darkening)
Sedentary lifestyle 
Current fetal macrosomia or polyhydraminos (excessive accumulation of amniotic fluid)
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19
Q

what is the relation with obesity, physical inactivate and GDM?

A

Of you are obese, less likely to be iniactive and not lead a healthy liifestyle. Probably consuming more glucose than normal. This can lead to an increased risk for GDM. Which can be transferred to baby cause its used to an environment with high glucose so when its born its body Kida freaks out and leads to complications with its pancreas or diabetes itself

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20
Q

What is the method to test for GDM?

A

50g glucose test, with PG 1 hour later

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21
Q

How do you classify someone with GDM?

A

<7.8mmol/L Normal
7.8-11.0 mmol/L Moderate
>11.1mmol/L Have GDM

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22
Q

Why do we diagnose GDM?

A

If it goes undiagnosed it can cause:

  • Macrosomia
  • Shoulder dystocia and nerve injury
  • Neonatal hypoglycaemia
  • Preterm delivery
  • Hyperbilirubinemia
  • increase risk of baby with obesity or diabetes
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23
Q

What is insulin resistance?

A

Normal amount of insulin is inadequate to produce a normal insulin response form muscle/fat/liiver; a reduction in insulin sensitivity

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24
Q

What is isulin sensitivity?

A

The ability of the body to respond to insulin

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25
Q

Can you get insulin resistance during pregnancy?

A

Pregnancy has a normal insulin resistance response

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26
Q

When examining clinical data, what do we look for for fluid status?

A

Presence of edema or dehydration

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27
Q

In terms of muscle mass and fat deposition in clinical data, what evaluations are subjective?

A

Main muscle groups

Presence of fat deposition

28
Q

Why do we as pregnant women if they have GI discomfort / complaints?

A

Because the foetus is pushing up all GI organs and can affect how much she can eat / nutrients absorbed

29
Q

During a dietary addedment what information should we obtain from women?

A 
Energy
Protein &amp; Macros
Micronutrients:
-Fe
-Ca
-Folate
-Vit D
-Vit B12
-Choline
Fluids (type &amp; quantity)
30
Q

What are the extra energy needs for the different trimesters?

A

1st: None
2nd: Additional 340 daily calories
3rd: Additional 450 daily calories

31
Q

What are the protein requirements for pregnant women ?

A

DRI recommends:

1.1g/kg or additional 25g/day

32
Q

Why is float important?

A

Preventing neural tube defects

  • Early weeks of pregnancy are critical for formation and closure of neural tubes that will later develop to form the brain and spinal cord
  • By thee time a women suspects she is pregnant (around 6th week), thee embryos neural tube has normally closed
33
Q

if you are lacking nutrients, (, what others deficiencies are associated with?

A 
Congenital heart deefect
Oralfacial clefts
Limb and urinary anomalies
Low birthweight
Preterm birth
34
Q

What the the recommended intakes of folate for pregnant women?

A

Take multivitamin with 400micrograms of folic acid 3 months priori and during pregnancy
-including b12

35
Q

What happens to Fe during pregnancy?

A

Body avidly conserves it

36
Q

How much does Fe absorption increase when your period stops?

A

Fe increases threefold

37
Q

If Fe conservation increases, why is there still a low supply in mom?

A

Fe stores dwindle because the developing fetus draws heavily on its mothers iron strop up to a supply sufficient to carry it through the 1st 3-6 months of life

38
Q

How much Fe is an infant worn with?

A

270mg/Fe

-Fe stores double in last few weeks of gestation (4mg/d/term)

39
Q

How much more Fe do you lose during natural vs cesarean section?

A

Cesarean section because there is more maternal blood loss

-further draining the mothers Fe supply

40
Q

How much total Fe. does baby pull and how much total Fe does mom need throughout pregnancy?

A

300mg total of what foetus is going to take

700-800mg mom needs in total

41
Q

What daily amount of Fee should women take?

A

16-20mg throughout entire pregnancy

30mg/day in 2nd and 3rd trimester

42
Q

When does Ca double in pregnant women?

A

early pregnancy and Ca is stored in mothered bones

43
Q

What happens when the baby needs to build bones?

A

Ca in mom becomes mobilized and Ca shifts across the placenta
-final weeks more than 300miligrams/day is transferred

44
Q

What is Cholines role in pregnant women?

A

Acts as a neurotransmitter

Optimized memory and hippocampal function in the developing brain

Important for lactation as well
-mom continues to transfer choline during lactaition

45
Q

why is DHA important in pregnancy?

A

Retinal development in fetus and gray matter in Brian tissues

  • 5oz cooked fish or
  • less than 3g EPA+DHA/day supplementation
46
Q

Why is vitamin D important in pregnancy?

A

Bone mineralization and uptake of Ca

  • 600IU/d during pregnancy and breastfeeding
  • usually from prenatal vitamin
47
Q

What items should pregnant women avoid?

A 
Alcohol
Drugs
Herbal Products
Sweeteners
Unpasturized things
Deli Meat
Raw Sprouts
Undercooked meat
Raw eggs
48
Q

During the dietary assessment, what info should we gees from seating pattern?

A

Usual daily intake
Intolerances, likes/dislikes, restriction, aversions, cravings
Unhealthy/poor seating habits
Disordered eating

49
Q

What is hyperemesis gravid arum?

A

Severe nausea and vomitting

50
Q

What is GERD?

A

Gastroesophageal. Reflux Disease

51
Q

What are the exercise recommendation for pregnant women?

A
  1. All women without problems should be physically active throughout pregnancy.
    - previously inactive
    - GDM
    - Overweight/obese
  2. Pregnant women should accumulate 150mmins of moderate intensity physical activity each week
  3. Physical activity should be accumulate over a minimum of 3 days/week
52
Q

What are the 5 As for healthy pregnancy weight gain?

A

Ask for permission to discuss weight

Assess potential root causes of weight gain
-lots of reasons why people eat the way they do

Advise on pregnancy weight gain risk management options

Agree on realistic SMART plan to achieve health behaviour outcomes

Assist women in identifying barriers and facilitators, educate, refer and arranger follow up

53
Q

When were you as an embryo were formed?

A

Egg that formed you was created when your grandmother was pregnant with your mom
-effects can last 3-6months

54
Q

What is DOHaD?

A

Developmental origins of health and disease

  • Genetic Predisposition
  • Epigenetics modifications
  • Gestational Experience (smoking weight gain GDM diet drugs stress)
55
Q

How long it recommends to do exclusive breastfeeding?

A

first t6 months of life and sustains for up to 2 year or longer

-by Health Canada, Canadian paediatric society, DC and breasfeeding committee for Canada

56
Q

What is breastmilk made of

A

Specific Nutrients. (lactoferrin)

Anti-infective immunoglobulins
White blood Cells
Compounds that stimulate maturation of small intestine
Compounds that. aid in digestion and absorption of nutrients

57
Q

What are the benefits of breastmilk?

A

Enhanced cognitive devleopment

Protect against GI infections, acute otitis media [ear inflections], respiratory tract infection, sudden infant death syndrome

Obesity later in life

58
Q

What is the current initiation of breastfeeding in canada?

A

Rose to 89% in 2011/12

59
Q

How many moms who initiate breastfeeding stop?

A

25% stop before their infant is 1 month old

-due to struggling, lack of support and not latched propeerly

60
Q

What % of Canadian moms exclusively breastfed their infants?

A

26%

61
Q

Will mom ever run out of milk?

A

Mom will always have enough, all about supply and demand

-but baby needs to be latched properly to get eenough

62
Q

Which mothers are most at risk of not following recommendations for breastfeeding?

A

Less educated

Not married

Lower Socio-economic status

63
Q

What is the most common reason for stopping breastfeeding?

A

Mother believe there is not enough breastmilk

-rare

64
Q

How do you reassure parents that baby is getting enough?

A

Growth (via charts)
Frequency of wet/soiled diapers
-6 wet diapers/day
Signs of good hydration

65
Q

What are the Baby friendly Initiative steps?

A
  1. Written infant. feeding policy communicated to all staff
  2. Ensure all staff have knowledge and skills to implement policy
  3. Inform pregnant. women and families importance of BF
  4. Uninterrupted Skin to Skin right after birth
  5. Assist moms to BF and maintain lactation despite challenges
  6. Support moms to exclusivly BF
  7. Facilitate rooming in (mom and baby stay together)
  8. Encourage BF on request (not every 2hr)
  9. Support moms to career and feed without use of artificial teats/pacifiers
  10. Provide transitions from hospital to community health services
66
Q

What are the nutritional requirements during lactation?

A

0-6 post partem= +330cals/day
7-12 post partem= +400cal/day

Fluid: 3.8L/day
PRO: 10-35% energy
Omega 3: 1.3 g/d

+MVM containing 400 micrograms of folic acid

  • Fe 10 mg
  • B12: 2.8mcg/day
  • Choline: 550mg/day
67
Q

How much Vitamin D should lactating mom give infants?

A

400 IU

FN 3344 (13 decks)

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