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HUNT243 > Lecture 6a: Maternal Nutrition > Flashcards

Lecture 6a: Maternal Nutrition Flashcards

1
Q

What state is pregnancy?

A

an anabolic state - building

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2
Q

What alters nutrient metabolism in pregnant mothers?

A

Hormonal changes

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3
Q

What is a higher energy requirement in pregnant mothers needed to support?

A
  1. Fetal growth and development
  2. Reproductive tissue accretion
  3. Maternal homeostasis
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4
Q

What happens to basal energy expenditure during pregnancy?

A

Increases due to added metabolism of uterus and fetus and increased work of the maternal heart and lungs

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5
Q

What happens to thermic effect of food during pregnancy?

A

Remains unchanged

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6
Q

What happens to the cost of physical activity during pregnancy?

A

Energy cost remains the same

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7
Q

What is recommended energy intake during first trimester?

A

Extra energy not required

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8
Q

What is the recommended energy intake during second trimester?

A

1,400kJ/d (340kcal/day) added to EER of non-pregnant women

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9
Q

What is the recommended energy intake during third trimester?

A

1,900kJ/d (452kcal/d) added to EER of non-pregnant women

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10
Q

What are LCPUFA’s?

A

Long-chain polyunsaturated fatty acids

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11
Q

What are essential and used to make LCPUFA’s?

A

Linoleic (6) and a-linolenic acid (3)

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12
Q

What happens when we eat omega-6 and omega-3 fatty acids?

A

They go through cycles of desaturation and elongation

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13
Q

What is desaturation?

A

adding on double bonds

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14
Q

What is elongation?

A

adding 2 C atoms to carboxyl end of the chain

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15
Q

What do Omega-6 fatty acids (linoleic acid) end up as?

A

Arachidonic acid (AA) - one cycle

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16
Q

What do Omega-3 fatty acids (a-linolenic acid) end up as?

A

EPA and DHA

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17
Q

Why is more AA generated compared to EPA and DHA?

A

Omega 3 is more of a process, therefore less EPA and DHA are generated compared to AA

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18
Q

Why is there competition between substrates for n-3 and n-6 fatty acids?

A

Because chain elongation/saturation enzymes are shared between them

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19
Q

What is DHA a critical component of?

A

Cell membranes, especially in the brain and retina

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20
Q

What is AA a critical component of?

A

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

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21
Q

What is fetal LCPUFA accumulation?

A

Fetus has active desaturases but limited ability to make LCPUFA’s so it is dependent on placental supply for both LCPUFAs and essential fatty acids - therefore accumulates over pregnancy

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22
Q

What is the cord blood concentration of LCPUFA’s influenced by?

A

Maternal diet

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23
Q

What happens to n-3 fatty acid deposition in brain and retina look like over pregnancy?

A

Occurs fairly slowly and then rapidly accumulates during the last trimester

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24
Q

What are sources of linoleic acid (n-6)?

A

Soybean, safflower, sunflower and corn oils; green leafy vegetables; nuts and seeds

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25
Q

What are sources of a-linolenic acid (n-3)?

A

Soybean, canola, flaxseed and walnut oils; nuts and seeds

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26
Q

What are sources of AA?

A

Egg yolk and meats (organ meats)

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27
Q

What are sources of EPA?

A

Fish oils, oily fish

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28
Q

What are sources of DHA?

A

Fish oils, oily fish

29
Q

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

A

reduced incidence of low birth weight

30
Q

What are LCPUFA’s (DHA and EPA) thought but not proved to do during pregnancy?

A

Improve cognition or development in children

31
Q

What is monomethylmercury?

A

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

32
Q

What is monomethylmercury taken up by?

A

Aquatic organisms and concentrated in fish

33
Q

Where are higher concentrations of monomethylmercury found?

A

Longer living fish such as shark, ray, swordfish, gemfish, orange roughy

34
Q

What percent of mercury from power plants ends up in fish?

A

40%

35
Q

What is the concern over methylmercury?

A

It is a neurotoxin; large amounts can damage the developing nervous system of the fetus and delay mental development

36
Q

What is the recommendation for fish and seafood in pregnant women?

A

Reduce mercury intake; eat long-living fish less than 3-4 times a week - fish from geothermal areas only once a week or fortnight

37
Q

What is the most common micronutrient deficiency during pregnancy?

A

Iron

38
Q

Requirements for absorbed iron increase slowly from ?? in the first trimester to ?? in the 3rd trimester

A

1.2mg/d to 5.6mg/d

39
Q

Why do iron requirements increase during pregnancy?

A
  • Pregnant women have more blood
  • Growing fetus
  • Blood loss during delivery
40
Q

What is the RDI for pregnant women aged 14-50 years?

A

27mg/d (increased by 9mg)

41
Q

What is the UL for iron in pregnant women?

A

45mg/d

42
Q

What is peripartum?

A

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

43
Q

Anemia has been associated with in increased risk of what for newborns?

A
  • LBW
  • SGA
  • Preterm birth
  • Decreased iron stores
  • Impaired cognition
  • Impaired growth
44
Q

Anemia has been associated with in increased risk of what for mothers?

A
  • Cardiac failure
  • Death from peripartum hemorrhage
45
Q

What percent of pregnant women have anaemia globally?

A

40%

46
Q

Where is anemia in pregnant women the highest and lowest?

A
  • Highest in SE Asia (58%)
  • Lowest in Americas (25.5%)
47
Q

What is the WHO global nutrition target for 2025 in women?

A

a 50% reduction in anemia among women

48
Q

What are the iron supplementations for pregnant women from WHO?

A

60mg daily for pregnant women living in areas where malnutrition is prevalent

49
Q

When does WHO recommend iron supplementation?

A

Taken as early as possible and throughout pregnancy

50
Q

What are women taking iron supplements less likely to have?

A

LBW babies and mean BW was higher than controls

51
Q

What does iron supplementation NOT have an effect on?

A

Preterm birth or neonatal death

52
Q

What is the screening procedure for iron status in NZ?

A

Iron status is taken at 20 weeks and at 26-28wks gestation

53
Q

What procedures are taken to establish iron status?

A

Complete blood count (CBC), serum ferritin, hemoglobin (Hb)

54
Q

What does HB <100 at booking indicate?

A

Urgent indication to start oral supplementation and consideration of parental (IV) iron

55
Q

Why should serum ferritin be taken?

A

To establish the diagnosis of iron deficiency (especially before parenteral iron)

56
Q

What Hb indicates severe anemia?

A

<89g/L

57
Q

What happens at the first visit <20 weeks for iron status?

A
  • Request complete blood count and ferritin
  • Encourage iron rich diet
  • Provide blood form for repeat blood tests at 26-28wks
58
Q

What happens at the second visit at 26-28wks for iron status?

A
  • Request complete blood count and ferritin
  • Continue iron rich diet
59
Q

What are the side effects of iron medications?

A
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhoea
  • Dark coloured stools
  • Abdominal distress
60
Q

How should iron medications be taken?

A
  • Start with half the dose and gradually increase to the full dose
  • Divided doses with food
  • Coated or delayed-release may have fewer side effects; but less absorption
61
Q

What are the two forms of supplemental iron?

A

Ferrous and ferric

62
Q

What form of supplemental iron is the best abosorbed?

A

Ferrous iron salts

63
Q

What is elemental iron?

A

The amount of iron available for absorption

64
Q

What is prophylatic iron supplementation?

A

routine administration of iron supplements to pregnant women to prevent iron deficiency and iron-deficiency anemia

65
Q

What are the risks of prophylatic iron supplementation?

A
  • Increased risk of gestational diabetes
  • Increased oxidative stress
66
Q

What are interventions aimed at preventing iron deficiency?

A
  • Food-based
  • Supplementation
  • Fortification
67
Q

What is delayed ‘optimal’ cord clamping?

A

Changing from immediately after to 1-3 minutes after delivery to clamp cord

68
Q

What happens during delayed cord clamping?

A

Transfer from the placenta about 80ml at 1 min to about 100ml at 3 minutes of blood

69
Q

What are the benefits of delayed cord clamping?

A

Addititonal volumes can supply extra iron of 40-50mg/kg of body weight

HUNT243 (11 decks)

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