Maternal Adaption of the Digestive System

Question 1

What effect can oestrogen have on a pregnant woman’s gums?

Answer 1

Can cause them to become oedematous (excess fluid retention) and so prone to bleeding

Question 2

What is PTYALISM?

Answer 2

An increase in salivation. Saliva may not actually increase however women may swallow less often due to nausea

Question 3

What is PICA?

Answer 3

Abnormal cravings for non-food items

Question 4

What are the causes of nausea?

Answer 4

Reduction in gastric secretions and slower gastric emptying

Question 5

How does progesterone cause REGURGITATION and ACID REFLUX

Answer 5

It causes relaxation of the lower oesophageal sphincter

Question 6

Why is there an increase int he absorption of nutrients in the small intestine?

Answer 6

Progesterone makes the peristaltic motion less efficient and so the food spends more time in the small intestine

Question 7

What causes constipation?

Answer 7

Reduced motility within the large intestine caused by progesterone which allows more water to be reabsorbed

Question 8

What causes a sensation of thirst?

Answer 8

Adaptions in the cardiovascular system require an increase in fluid intake

Question 9

Why are pregnant women less able to tolerate large meals in the third trimester?

Answer 9

The pressure of the enlarged uterus reduces the stomach capacity

Question 10

What are HAEMORRHOIDS?

Answer 10

A swollen vein or group of veins in the region of the anus

Question 11

What causes haemorrhoids?

Answer 11

The effects of the pressure exerted by the enlarged uterus gradually reducing the efficiency of venous return. This is further compounded by the effect of progesterone reducing smooth muscle tone.

Question 12

What treatments and advice would you offer for constipation?

Answer 12

Increase daily intake of fibre - at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.

Avoid dehydration by drinking plenty of water.

Get more exercise by going for a daily walk or run.

Identify a routine of a place and a time of day when you are comfortably able to spend time in the toilet. Respond to your bowel’s natural pattern: when you feel the urge, do not delay.

Laxatives may also be offered if the above doesn’t work

Question 13

What treatments and advice would you offer for haemorrhoids?

Answer 13

Eat plenty of food that is high in fibre, like wholemeal bread, fruit and vegetables, and drink plenty of water – this will prevent constipation, which can make piles worse

Avoid standing for long periods

Take regular exercise to improve circulation
Might be helpful to use a cloth wrung out in iced water to ease the pain – hold it gently against the piles

Avoid straining to pass a stool as this may make piles worse

Question 14

When hyperemesis is diagnosed what would you expect to discover when carrying out a urinalysis and why are these abnormalities present?

Answer 14

Excessive ketones in the urine (ketonuria) indicate that the body is not using carbohydrates from food as fuel and is inadequately trying to break down fat as fuel. Ketonuria is a sign that the body is beginning to operate in starvation mode.

Question 15

What is the average weight gain in pregnancy?

Answer 15

11-13kg

Question 16

What are the increased risks of obesity in pregnancy?

Answer 16

Miscarriage
Fetal congenital malformations
Thromboembolism
Gestational diabetes
Pre-eclampsia
Wound infections
Stillbirth and neonatal death 
There is a higher caesarean section rate and lower breastfeeding rate for women with an elevated BMI

Question 17

How many servings of bread, rice, pasta and cereal should be consumed during pregnancy?

Answer 17

6-11 per day

Question 18

How many servings of vegetables and fruit should be consumed during pregnancy?

Answer 18

3-5 per day for vegetables

3-4 per day for fruit

Question 19

How many servings of dairy and protein should be consumed during pregnancy?

Answer 19

4 servings of dairy

3-4 servings of protein

Question 20

How often should oils, fats and sugars be consumed during pregnancy?

Answer 20

As occasionally as possible

Question 21

What is the standard daily dose of folic acid?

Answer 21

400 μg (micrograms)

Question 22

Why is folic acid prescribed during pregnancy?

Answer 22

To lower the risk of Neural Tube Defects

Question 23

Which foods should be avoided in pregnancy?

Answer 23

Soft mould-ripened cheeses like brie, all blue veined cheese, camembert and unpasteurised milk; this is to reduce the exposure to listeria which can cause miscarriage, stillbirth and neonatal complications.

Meat or vegetable pate.

Undercooked or poorly heated ready meals.

Organ meat particularly liver as Vitamin A in large quantities in the first trimester may be detrimental.

Shark, marlin and swordfish. Sardines, herring, mackerel and salmon must be eaten in moderation due to mercury levels.

Caffeine must be limited to 300mg per day as high levels have been associated with low birth weight and miscarriage.

Alcohol should be avoided.

All eggs must be cooked thoroughly to avoid salmonella.

Question 24

What are the parameters of normal glucose level?

Answer 24

3.5 & 5.5 mmols

Question 25

Which hormones cause systemic insulin resistance?

Answer 25

Human placental lactogen (HPL) and progesterone

Question 26

Why is a systemic insulin resistance beneficial in pregnancy?

Answer 26

It allows a more readily and sustained supply of glucose to be easily available to the fetus