Lecture 6b: Maternal Nutrition Flashcards
What is iodine essential for?
The production of thyroid hormones
What are thyroid hormones required for?
- Regulating body’s metabolism
- Normal growth
- Neurocognitive development of fetus/infant
What does severe iodine deficiency cause?
Intellectual disability
What does NZ iodine fortification look like?
Mandatory iodine in bread flour
What does WHO recommend for prevention of iodine deficiency?
Universal salt iodisation
What is the RDI for non-pregnant VS pregnant women?
100 vs 160
When should a women take iodine?
As soon as a women becomes aware she is pregnant - throughout entire pregnancy and breastfeeding
What is Vitamin A important for?
Cell differentiation - recommended intakes increase by 10% in pregnancy
How common is Vitamin A deficiency?
Rare in industrialised countries - major problem in developing nations
What can Vitamin A deficiency cause?
Malformations in:
- Fetal lungs
- Urinary tract
- Heart
What is the UL for Vitamin A intake?
> 3000 RE per day (10,000 IU)
No more than 100g of ?? should be eaten once a week during pregnancy
Liver
What can excessive intake of Vitamin A cause?
Fetal abnormalities
What forms can vitamin A be taken in excessive intakes?
Retinol or Retinoic Acid (not beta-caotene)
Why is excessive vitamin A easily done?
A number of supplements taken by pregnant women contain Vitamin A, so can be taking too much very easily
What is retinoic acid syndrome?
Collection of birth defects including:
- Craniofacial
- Cardiovascular
- Thymus dysfunction
- Microcephaly
What is a common defect from retinoic acid syndrome?
Small ears or no ears, abnormal or missing ear canals
When is Vitamin D deficiency at increased risk for pregnant women?
- Dark skin tone
- Live south of Nelson during winter or spring
- Limited time outdoors
- Minimal sun exposure
What are sources of Vitamin D?
Sunlight, only a few foods
What is maternal vitamin D insufficiency linked to?
- Gestational diabetes
- Pre-eclampsia
What is infantile vitamin D insufficiency linked to?
- LBW
- Dental decay
- Acute respiratory infections
What are food safety considerations during pregnancy?
- Listeriosis
- Toxoplasmosis
What is listeriosis?
Develops as a result of infection with listeria monocytogenes - usually from a food
What does listeriosis cause?
Influenze type symptoms and can result in premature labour and reduced fetal movements
What happens if listerosis is not treated?
Life-threatening to fetus via infection of:
- Placenta
- Membranes
- Amniotic fluid
Causes:
- Sepsis and death
What are precautions for listeria?
- Foods heated thoroughly to steaming hot (>70)
- Avoid unsafe foods
What are unsafe foods for listeria?
- Uncooked, smoked or ready to eat seafood
- Pate, hummus, spreads
- Pre-cooked meat products
- Pre-prepared/stored salads
- Unpasteurised milk
- Soft-serve ice cream
- Soft, semi-soft cheese
How many listeria infections are reported per year?
19-30
How many cases of listeria had the infection spread to fetus?
96% of cases
How many causes of listeria saw major foetal or neonatal complications?
In 83% of infants of infected mothers
What is toxoplasmosis?
A parasitic disease caused by toxoplasma gondii
What can toxoplasmosis cause?
Eye or brain damage in unborn babies
What can a toxoplasmosis infection come from?
- Unwashed vegetables
- Undercooked meat
- Ready to eat meats
- Unpasteurised milk
- Cross-contamination of cat faeces
How does alcohol pass through the fetus?
Alcohol readily passes the placenta such as fetal blood alcohol levels will be similar to maternal blood alcohol levels
What is the most recognisable outcome of maternal alcohol drinking?
Fetal Alcohol Syndrome (FAS)
What are features of FAS?
- Growth deficiency/Development delays
- CNS dysfunction
- Facial characteristics
What are examples of CNS dysfunction?
- Microcephaly
- Delayed development hyperactivity
- Attention deficits
- Learning disabilities
- Intellectual deficits
What are the facial characteristics of FAS?
- Short palpebral fissures
- Thin upper lip
- Underdeveloped jaw
- Smooth and/or long philtrum
What is does the Fetal Alcohol Spectrum Disorder (FASD) include?
- Full FAS
- Alcohol related neurodevelopment disorder (ARND)
- Alcohol related birth defects (ARBD)
When is the full spectrum of FAS seen?
Only seen with heavy drinking during pregnancy regularly OR high concentrations at critical development periods
What are the alcohol recommendations during pregnancy in NZ?
- Stop drinking if you could be or are pregnant
- Fermented drinks that may contain low levels should be avoided
What packaged alcohol contains a pregnancy warning label?
Containing more than 1.15%
What is the gold standard of evidence assessment?
Meta-analyses
What is the order of quality of evidence?
- Critical Appraisal
- Experimental studies
- Observational studies
What are examples of critical appraisal?
- Meta analyses
- Systematic reviews
- Critically appraised literature
What are examples of experimental studies?
- RCT
- Non-randomised CT
What are examples of observation studies?
- Cohort studies
- Case studies
- Individual case reports
