Lecture 6 - Pregnancy & Lactation Flashcards
Why is it important to assess nutrition during pregnancy?
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
What is the best way to assess nutrition during pregnancy?
There is no consensus in the literature on a best way
Why is self-reporting measures questionable?
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
When getting a medical history, what kind of information is in that?
Obstetrical history
Chronic disease
Pregnancy related disorders
Family history
What is the information to obtain under the obstetrical history?
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
What are 4 pregnancy related disorders?
Hyperemesis- extreme nausea and vomitting
Anemia- low iron
Gestational Diabetes-first onset is during pregnancy
Reflux/Heartburn
In patten history what do we need to know about psycho-social health?
Age (teen vs mature) Economic situation Culture Support Systems Communication barrier History of abuse/mental illness
In patten history what do we need to know about food, diet and lifestyle?
Usual eaten habit Nutrient Supplement Food Availability Physical Activity Herbal Remedies (no safe herbs) Substance Use
What anthropometric data should we obtain?
Height Weight Pre-preg BMI Assess/Monitor pattern of weight gain Weight History Weight gain goals
What is the average weight gain for pregnant women who are underweight, normal, overweight and obese?
Under: 28-40
Normal: 25-35
Over: 15-25
Obese: 11-20
During pregnancy, where does all of the weight go too?
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
What happens to anything gained afar the recommended weight?
Will be stored in excess fat and will be harder to lose
-especially if there are multiple pregnancies back to back
If you have a high BMI what are some maternal complication that can occur?
Reduced fertility Impaired glucose tolerance Gestational Diabetes Thromboembolism Hypertensive disorder of pregnancy Increased risk miscarriage
If you have a high BMI what are some fetal complication that can occur?
Fetal congenital abnormalities
Fetal growth restriction
Stillbirth
Increased risk of morbidity in later life
What are the normal hemoglobin levels in the different trimesters?
Non preg: 120g/L
1stT: 110 g/L
2ndT: 105g/L
3rdT: 110 g/L
What other chemical data to we obtain from labs for pregnant women?
Hematocrit Ferritin -65-120mcg/L Transferrin -help to mobilize the Fe during pregnancy
When do we screen for Gestational diabetes?
24-28 weeks
What are the factors that make us screen earlier for gestational diabetes?
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)
what is the relation with obesity, physical inactivate and GDM?
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
What is the method to test for GDM?
50g glucose test, with PG 1 hour later
How do you classify someone with GDM?
<7.8mmol/L Normal
7.8-11.0 mmol/L Moderate
>11.1mmol/L Have GDM
Why do we diagnose GDM?
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
What is insulin resistance?
Normal amount of insulin is inadequate to produce a normal insulin response form muscle/fat/liiver; a reduction in insulin sensitivity
What is isulin sensitivity?
The ability of the body to respond to insulin
Can you get insulin resistance during pregnancy?
Pregnancy has a normal insulin resistance response
When examining clinical data, what do we look for for fluid status?
Presence of edema or dehydration
In terms of muscle mass and fat deposition in clinical data, what evaluations are subjective?
Main muscle groups
Presence of fat deposition
Why do we as pregnant women if they have GI discomfort / complaints?
Because the foetus is pushing up all GI organs and can affect how much she can eat / nutrients absorbed
During a dietary addedment what information should we obtain from women?
Energy Protein & Macros Micronutrients: -Fe -Ca -Folate -Vit D -Vit B12 -Choline Fluids (type & quantity)
What are the extra energy needs for the different trimesters?
1st: None
2nd: Additional 340 daily calories
3rd: Additional 450 daily calories
What are the protein requirements for pregnant women ?
DRI recommends:
1.1g/kg or additional 25g/day
Why is float important?
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
if you are lacking nutrients, (, what others deficiencies are associated with?
Congenital heart deefect Oralfacial clefts Limb and urinary anomalies Low birthweight Preterm birth
What the the recommended intakes of folate for pregnant women?
Take multivitamin with 400micrograms of folic acid 3 months priori and during pregnancy
-including b12
What happens to Fe during pregnancy?
Body avidly conserves it
How much does Fe absorption increase when your period stops?
Fe increases threefold
If Fe conservation increases, why is there still a low supply in mom?
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
How much Fe is an infant worn with?
270mg/Fe
-Fe stores double in last few weeks of gestation (4mg/d/term)
How much more Fe do you lose during natural vs cesarean section?
Cesarean section because there is more maternal blood loss
-further draining the mothers Fe supply
How much total Fe. does baby pull and how much total Fe does mom need throughout pregnancy?
300mg total of what foetus is going to take
700-800mg mom needs in total
What daily amount of Fee should women take?
16-20mg throughout entire pregnancy
30mg/day in 2nd and 3rd trimester
When does Ca double in pregnant women?
early pregnancy and Ca is stored in mothered bones
What happens when the baby needs to build bones?
Ca in mom becomes mobilized and Ca shifts across the placenta
-final weeks more than 300miligrams/day is transferred
What is Cholines role in pregnant women?
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
why is DHA important in pregnancy?
Retinal development in fetus and gray matter in Brian tissues
- 5oz cooked fish or
- less than 3g EPA+DHA/day supplementation
Why is vitamin D important in pregnancy?
Bone mineralization and uptake of Ca
- 600IU/d during pregnancy and breastfeeding
- usually from prenatal vitamin
What items should pregnant women avoid?
Alcohol Drugs Herbal Products Sweeteners Unpasturized things Deli Meat Raw Sprouts Undercooked meat Raw eggs
During the dietary assessment, what info should we gees from seating pattern?
Usual daily intake
Intolerances, likes/dislikes, restriction, aversions, cravings
Unhealthy/poor seating habits
Disordered eating
What is hyperemesis gravid arum?
Severe nausea and vomitting
What is GERD?
Gastroesophageal. Reflux Disease
What are the exercise recommendation for pregnant women?
- All women without problems should be physically active throughout pregnancy.
- previously inactive
- GDM
- Overweight/obese - Pregnant women should accumulate 150mmins of moderate intensity physical activity each week
- Physical activity should be accumulate over a minimum of 3 days/week
What are the 5 As for healthy pregnancy weight gain?
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
When were you as an embryo were formed?
Egg that formed you was created when your grandmother was pregnant with your mom
-effects can last 3-6months
What is DOHaD?
Developmental origins of health and disease
- Genetic Predisposition
- Epigenetics modifications
- Gestational Experience (smoking weight gain GDM diet drugs stress)
How long it recommends to do exclusive breastfeeding?
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
What is breastmilk made of
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
What are the benefits of breastmilk?
Enhanced cognitive devleopment
Protect against GI infections, acute otitis media [ear inflections], respiratory tract infection, sudden infant death syndrome
Obesity later in life
What is the current initiation of breastfeeding in canada?
Rose to 89% in 2011/12
How many moms who initiate breastfeeding stop?
25% stop before their infant is 1 month old
-due to struggling, lack of support and not latched propeerly
What % of Canadian moms exclusively breastfed their infants?
26%
Will mom ever run out of milk?
Mom will always have enough, all about supply and demand
-but baby needs to be latched properly to get eenough
Which mothers are most at risk of not following recommendations for breastfeeding?
Less educated
Not married
Lower Socio-economic status
What is the most common reason for stopping breastfeeding?
Mother believe there is not enough breastmilk
-rare
How do you reassure parents that baby is getting enough?
Growth (via charts)
Frequency of wet/soiled diapers
-6 wet diapers/day
Signs of good hydration
What are the Baby friendly Initiative steps?
- Written infant. feeding policy communicated to all staff
- Ensure all staff have knowledge and skills to implement policy
- Inform pregnant. women and families importance of BF
- Uninterrupted Skin to Skin right after birth
- Assist moms to BF and maintain lactation despite challenges
- Support moms to exclusivly BF
- Facilitate rooming in (mom and baby stay together)
- Encourage BF on request (not every 2hr)
- Support moms to career and feed without use of artificial teats/pacifiers
- Provide transitions from hospital to community health services
What are the nutritional requirements during lactation?
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
How much Vitamin D should lactating mom give infants?
400 IU
