Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Life Cycles > Maternal Nutrition > Flashcards

Maternal Nutrition Flashcards

1
Q

Human Fetal Growth

A
  1. Ovum released from ovary
  2. Fertilization by sperm in fallopian tube
  3. Fertilized egg divides rapidly to form solid mass of cells which buries itself in endometrial lining of the uterus
  • 1st Half - 10% growth
  • 2nd Half - 90% growth
  • Cell division complete **by 34-36 weeks **
  • Last 4-6 weeks, growth continues by increase in cell size
  • Normal full term gestation - **40 weeks **
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stage 1

A

Blastogenesis Stage

  • Fertilized egg divides into cell that fold in on one another
  • Inner mass of cells gives rise to embryo
  • Outer layer becomes the placenta
  • Ends 2 weeks after fertilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stage 2

A

Embryonic Stage

  • Cells **differentiate into 3 layers **
  • All major features of fetus achieved
  • Embryonic growth = hyperplasia

By 60 days…

  • Ectoderm: outermost layer
    • Brain, hair, nervous system, skin
  • Mesoderm: intermediate layer
    • Voluntary muscles, bones, excretory system, cardiovascular system
  • Endoderm: innermost layer
    • Digestive, glandular organs, respiratory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stage 3

A

Fetal Stage

  • Period of most rapid growth
  • Weight increases 6 g to 3.5kg
  • Fetal growth = hyperplasia and hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Growth-Retarded Infants

A

Early Gestation Deficiency

  • Can Cause
    • Fetal malformations
    • Teratogenic effects
    • Death of embryo
  • Quantitative requirements very small
  • Severe deficiency necessary to cause malformation

Deficiency after 3 months

  • No teratogenic effects
  • Fetal growth impaired

In Last Trimester

  • Highest nutrient requirements
  • Even mild deficiency could have serious effects on growth
  • Cell number and size reduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Small for Gestational Age (SGA)

A

<10 percentile

Type 1

  • Disproportional
  • Growth retardation affecting wt
  • HC and length appropriate
  • Poorly developed muscles
  • Limited subcutaneous fat
  • Results from inadequate nutrition during final stage

Type 2

  • Proportional
  • All <10%
  • Diet deficient throughout gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Appropriate for Gestational Age (AGA)

A

10-90th percentile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Large for Gestational Age (LGA)

A

>90th percentile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nutritional Influences on Growth

A
  • Most information from animal studies - some human studies on restricted food intake overall, and some for individual nutrients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Caution with Animal Data

A
  • Malnutrition consequences are greater in animals
  • Relative Growth rates are faster
  • Timing of max growth differs
  • Number and size of animal fetuses are larger
  • Magnitude of deprivation studied is rarely encountered in normal human circumstances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Maternal Malnutrition

A

Can interfere with conception

Threatens pregnancy

Impairs cell metabolism

Most damaging when cells are undergoing rapid division

Timing and severity of deficiency are key factors

Different causes of growth failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Growth Failure

A

Can’t survive intrauterine insults without adverse effects

Fate of baby depends in part on nutrition after birth too

Effect on brain cells is biggest concern

Brain size may be permanently reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

LBW

A

LBW: <2.5kg at birth

VLBW: <1.5 kg at birth

7-8% of annual incidence of LBW due to intrauterine growth failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pregnancy Assessment Tools

A

Weigth gain graphs **based on pregravid weight **

The higher your pregravid weight, the less you should gain during pregnancy

Routine GTT for Gestational DM

  • BMI <18.5: 28-40 lbs
  • BMI 18.5-25: 25-35 lbs
  • BMI >25: 15-25 lbs
  • BMI > 30: 11-20 lbs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Blood Vol/Composition Changes

A

Total body water increases 7-10 L

Plasma vol increase (~50%) associated with good pregnancy outcome

RBC production increase, but not at the same rate as plasma volume, so *Hct actually decreases relative to plasma vol *

  • Hct normally 33-43%
  • Pregnancy HCT > 33%

Hgb levels decrease relative to plasma vol

  • Normal: >12 g/dL
  • 1st and 3rd trimester: >11 g/dL
  • 2nd trimester: >10/5 g/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Serum Nutrient Levels

A

Non Pregnant Pregnant

TP: 6.5 - 8.5 mg/dL ** 6.0 - 8.0** mg/dL

Albumin: 3.5 - 5 g/dL ** 3 - 4.5** g/dL

Glucose: <110 mg/dL ** <120** mg/dL

Chol: 120-190 mg/dL ** 200-325** mg/dL

Vit C: 0.2 - 2.0 mg/dL ** 0.2 - 1.5** mg/dL

Folate: 5 - 21 ng/mL ** 3.15** ng/mL

Fe: >50 mcg/dL ** >40** mcg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cardiac Changes

A

Cardiac Hypertrophy

  • Increased cardiac output, HR and SV
  • Decreased BP during first half due to peripheral vasodilation from hormonal changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Respiratory Changes

A
  • Displaced diaphragm
  • Deeper Breathing
  • increased tidal volume
  • More efficient exchange of lung gases
  • Increased oxygen-carrying capacity of blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Renal Changes

A
  • Increased blood flow through kidneys
  • Increased GFR, related to decreased oncotic pressure with decreased serum albumin
  • Plasma components greater than renal capacity to reabsorb
  • Kidneys must manage increased metabolic demands, as well as excretion of fetal waste products
  • Caused by:
    • Hormones
    • Posture
    • Nutritional intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

GI Changes

A
  • Increase appetite and thirst
  • High progesterone -> lower GI motility and decreased intestinal secretion -> **increased nutrient absorption **
  • Heart burn and reflux
  • Nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Morning sickness

A

Occurs any time of day

Last longer than most expect

Average duration is 17 weeks

10-20% have NVP **until delivery **

Causes - Theories

  • Phys response to hormone changes
  • Dehydration
  • Low levels of minerals lost through vomiting
  • Psychological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Morning Sickness Treatment

A

Management of Symptoms

  • Avoid offensive odors - “Radar Nose)
  • Limited medications due to potential teratogenic effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Morning Sickness Dietary Recommendations

A
  • Avoid dehydration
  • Eat whatever foods seem most appealing
  • Eat small amounts frequently
  • Eat in a relaxing, pleasant environment
  • Avoid large meals
  • Sometimes greasy, fried and spicy foods can be problematic
  • Individualize diet plan based on individual intolerances, triggers
  • Avoid overly warm temperatures
  • Alternative therapies
    • B6
    • Acupuncture
    • Ginger
    • lemonade, fresh lemons
    • Motion sickness bands
    • hypnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hyperemesis Gravidarum

A

Severe, prolonged persistant vomiting

1-2%

Hospitalization usually required for hydration and electrolyte replacement

Sometimes IV nutrition required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Eating Behaviors

A

Changes based on

  • Medical advice
  • Superstitious food beliefs from family and friends
  • Folk Lore
  • Some want smaller babies for easier delivery so they eat less

Cravings

  • Sweets, fruit, salty foods, dairy

Increased intake of: **calcium and calories **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Food Aversions

A

Meat and animal proteins

Alcohol

Coffee / Caffeinated drinks

Built in protective mechanism?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pica

A

Compulsion for persistent ingestion of unsuitable substances that have little or no nutritional value

Cause not understood, but not a new practice

Not limited to any one geographic area, race, culture or social status

More common in African Americans

Not limited to pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Types of Pica

A

Geophagia: dirt or clay

Amylophagia: laundry starch

Pagophagia: ice, freezer frost

Other

  • Paper
  • Burnt matches
  • Coffee grounds
  • Cigarette ashes
  • Antacids, MOM
  • Moth balls
  • Toilet air fresheners
  • Flip flops
  • Cardboard
  • Rubber
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pica Theories

A
  • Relieves nausea and vomiting
  • Calms hunger pains
  • Triggered by a deficiency of an essential nutrient
  • Tradition carried on from prior generations
  • Perception that it has benefiial effects
    • Prevents birth marks, makes skin lighter
    • Relieves nerves of mother
    • Helps baby “slide out”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pica Negative Effects

A
  • Nutrient deficiencies
  • Malnutrition - nonfood substances replace foods
  • Malabsorption
  • Intestinal obstruction
  • Obesity
  • Lead poisoning
  • Irritable uterus - related to fecal impaction
  • Anemia
  • Infection
  • Can lead to death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hormonal Changes

A

More than 30 different hormones secreted throughout gestation

Two main: progesterone and estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Progesterone

A
  • Smooth muscle relaxation
  • Uterine expansion
  • Decrease gastric motility -> increase nutrient absorption
  • Induces maternal fat deposition
  • Facilitates gas exchange
  • Increase renal sodium excretion
  • Interferes with folic acid metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Estrogen

A
  • Decrease serum proteims
  • Promotes growth of uterus
  • Enhances flexibility of uterus at birth
  • Hydroscopic effect
  • Interferes with folic acid metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Metabolic Changes

A

Increased BMR in 2nd half of pregnancy

  • usually rises by 4th month
  • Increases 15-25% by term

Maternal fat use increases to conserve glucose for fetus -> maternal glucose levels fall as fetal demands increase

Maternal lipolysis increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Placenta

A

Joins mother and offspring

Nourishment and endocrine secretions for development and growth of embryo and fetus

Active role in reproduction

Major pregnancy hormones produced

Facilitates exchange of nutrients, oxygen and waste - efficiency of transfer determines fetal health

Contains fetal and maternal components

Fetal and maternal blood are separated by placental membrane and never mix

Transfer of nutrients **impeded by insufficient vascularization **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Nutrient Transfer

A

Simple/passive diffusion

  • Nutrients move from high -> low concentrations in fetal blood
  • Water, O2, CO2, fatty acids, steroids, electrolytes, Vit E and K

Facilitated Diffusion

  • Rate of transfer faster than passive diffusion
  • Monosaccharides, Vit A, D and Fe

Active Transport

  • Requires both carrier proteins and energy (ATP)
  • Amino acids, water soluble vitamins, Ca, Fe, PO4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Respiratory and Excretory Exchange

A

Fetus cannot tolerate variation in rate of oxygen supply, so mother compensates by adjusting cardiac output

Urea, creatinine, and uric acid move through placenta by diffusion and active transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Maternal Malnutrition

A
  • Reduced blood vol expansion
  • Inadequate increase in Cardiac Output
  • Decreased placental blood flow
  • Decreased placental weight, size
  • Reduced nutrient transfer
  • Results in fetal growth retardation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Historical Practices

A

Casual observation between diet and outcome

Imitative magic

  • “You are what you eat”
  • “if you eat sour foods you’ll have a sour baby”

Obstetrical problems influenced dietary recommendations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Rickets

A
  • Impaired mineralization of bones due to Vit D, Ca and Phos deficiencies
  • Carried serious risk
  • Death of mom and child was common
  • Contracted pelvis
  • Restricted diet was recommended so the baby would be smaller and easier to deliver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Historical Development ‘60’s - 70’s

A

1960’s: renewed interest in infant mortality -> reevaluation of influence of diet

1969 - White House Conference on Food, Nutrition and Health

  • Prompted by widespread hunger and malnutrition in US
  • Pregnancy and infants studied

1970: Benchmark National Research Council report

  • “Maternal Nutrition & Course of Pregnancy”
  • identified that there were limited studies available
  • Recommended long term longitudinal studies

1973: NRC guidelines for supplementary food during pregnancy and for public health workers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

WIC 1970’s

A

Special supplemental food program for at risk women, infants and children

Foods include:

  • Infant cereal with Fe
  • Certain cereals
  • eggs
  • Peanut butter
  • 100% fruit juice
  • Cheese
  • Infant formula with Fe
  • Milk
  • Dried beans/peas
  • Tuna
  • Vegetable juice
  • Farmer’s Market vouchers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

WIC 2009

A

Food packages “time for a change”

  • Aligned with 2005 DGA
  • Infant guidelines aligned with AAP
  • promote and support long-term breastfeeding
  • Accomodates cultural food preferences
  • Wider variety of food
  • Soy-based beverages, tofu, fruits, vegetables, baby foods, whole wheat bread, other whole grains
44
Q

WIC Eligibility

A
  1. Women
    - Pregnant and post partum
    - Up to 6 months coverage for mom if bottle feeding
    - Up to 12 months coverage for mom if breast feeding
  • Infants of eligible women
  • Children under the age of 5
  1. Low Income
    - 1 person: <$21,257 annually
    - If pregnant, each unborn infant counts as an extra person in the household size, so income **eligibility gets easier **
  2. At nutrition risk according to health professional
    - medically-based risk
    - Dietary risk
  3. Must be **resident of the state **
45
Q

WIC Overview

A
  • Administered by state health departments
  • Must offer nutrition education and health services directly or provide referral for services
  • Strong congressional support
  • Reaches 93% of eligible
  • Most thoroughly evaluated publically funded program
46
Q

WIC Positive Impact

A

WIC eligible who receive services vs. WIC eligible who do not receive services

  • Increased
    • Birth weight
    • Prenatal and med care
    • Head circumference
  • Decreased
    • LBW or VLBW
    • Premature Births
    • Fe deficiency anemia - during pregnancy, post-partum and in low income children
  • Improved Maternal Intake of…
    • Protein and kcals
    • Fe
    • Ca, P, Mg
    • Vit C, B6, B12
    • Thiamin, Riboflavin, niacin
  • Cost Effective
  • Nutrition education component has the **most positive effect **
47
Q

WIC- Associated Services

A
  • Immunization
  • Drug screening
  • Medicaid eligibility determination
    *
48
Q

Historical Development 1980’s-90’s

A

1981: ACOG-ADA Guidelines

  • Guidelines for Assessment of Maternal Nutrition
  • National consensus on the relavant risk factors before and after pregnancy

1981: NRC Perinatal Guide issued

  • Nutrition Services for Perinatal Care
  • Addressed infant feeding issue
  • Raised **concerns about substance abuse **

1990: National Academy of Sciences

  • Nutrition during Pregnancy: Weight Gain and Nutrient Supplements
  • Most recent landmark document available
  • Frequently cited in pregnancy literature
49
Q

Malnutrition Natural Experiments

A

Evaluation of birth statistics before, during and after famine/war

  • WWII - Russia, Holland, Japan and GB
  • Siefe of Sarajevo (1990’s)
    • Famine → Increased…
      • infertility rates
      • Infant mortality
      • LBW rates
    • Famine during early pregnancy → Increased teratogenicity, still births
    • Famine during l_ate pregnancy _→ LBW
  • After war, *trends reverse within 1 year *
50
Q

Malnutrition Organ Studies

A

Organs and still born infant size from low income women < those of *higher income women *

Placenta is always available for study

Decreased placental size and cell number in:

  • IUGR (Intrauterine Growth Retardation) babies
  • Needy/Poor populations
  • Maternal anorexia nervosa
51
Q

Nutritional Correlates of BW

A
  • Plasma vol expansion
    • Greater vol expansion → greater BW
  • Maternal body size (ht & pregravid wt)
  • Bigger mom = bigger baby
  • Maternal pregnancy wt gain
  • Underwt mom → higher incidence of LBW and prematurity
  • Obese women → higher risk for HTN, gestational DM, UTI
52
Q

Maternal Weight Gain

A
  • Best wt. gain amount still debated
  • Recommended: 25-35 lbs
    • 1/3 wt. gain d/t Fetus
    • 2/3 wt. gain d/t Maternal tissue
  • ~40% US women gain recommended amount
  • Underweight: retain some of weight gained for own needs
  • Overweight: can use some of own stores to support fetal growth
53
Q

Excessive Maternal Weight Gain

A

Bad for mother and fetus

  • Increase risk for HTN and C-section
  • Increase risk for long-term weight control problems later in life

Young mothers and first time mothers usually gain more than older or multigravidae women

Rate of wt gain is as important as total wt gain

Sudden wt gain **= fluid retention **

54
Q

Low Weight Gain

A
  • Restriction of body fat development can be detrimental
  • Can increase risk for heart dx, DM, HTN later in child’s life
  • Risk of chonic disease may begin in-utero
55
Q

Calorie Requirements

A
  • Increases d/t…
    • 1/3 - increased heart work
    • 1/3 - increased work of respiration, accretion of breast tissue, uterus and placenta
    • 1/3 - fetus
  • DRI does not apply to all women - wide range of differences in BMR
  • **Always use pregravid wt**
    • Add extra kcals after multiplying basal * AF

1st Trimester

  • equation = same as pregravid
  • 30 kcal/kg

2nd trimester

  • Pregravid Equation **+ 340 kcal/day **
  • 36 kcal/kg

3rd Trimester

  • Pregravid equation + 452 kcal
  • 36 kcal/kg
56
Q

Protein Requirements

A

DRI 2002

  • Additional 25g protein/day
    or
  • 1.1g protein/kg (pregravid wt)
57
Q

Fluid Requirements

A
  • 1 mL / 1 kcal - this is more personalized
    or
  • 9 cups/day
58
Q

Vitamins

A

Prenatal Vitamin for Low income women

  • Decreased preterm delivery, LBW and congenital defects

Huge variation in PNV content

59
Q

Folate

A
  • Received most attention
  • Required for cell division
  • Requirements increase due to extensive organ and tissue growth
  • Deficiency causes megaloblastic anemia and production of abnormal RBC
  • Importnat role in preventing neural tube defects

Folate Supplementation

  • All women of childbearing age
    • DRI: 0.4 mg/day (400 mcg)
    • UL: 0.8 mg/day (14-18 yo)
      • *1.0 mg/day (>18)**
  • Pregnancy
    • DRI: 0.6 mg/day
    • UL: same
60
Q

Neural Tube Defects

A
  • Malformations of spinal cord and brain
  • Neural tube closes by 28 days of gestation
  • Genetic and environmental causes as well
  • Most common congenital defect in US

70% of cases can be prevented with folate

  • Impaired metabolism of folate may be involved
  • Connection with B12
  • Excess folate can mask B12 deficiency
  • Recommended folate intake can be obtained through diet alone
  • Most eat diet with inadequate folate
  • 1998 → FDA mandate for folic acid fortification of enriched flour, bread, corn meal, rice, noodles, macaroni and other grains
61
Q

Encephalocele

A

Protrusion of brain through skull

62
Q

Ancephaly

A

Absense of the brain or spinal cord

Baby dies before or shortly after birth

63
Q

Spina Bifida

A

Spinal cord fails to close, leaving a gap

Spinal fluid collects in gap

Children grow into adulthood

Paralysis of lower limbs

Varying degrees of **bowel/bladder incontinence **

64
Q

B12

A

Important for cell division

Deficiency is rare

Can contribute to megaloblastic anemia

High risk in vegetarian women

Recommended supplementation: 2 mcg/day

65
Q

B6

A

Importnat for AA metabolism and protein synthesis

May help with NVP

Controversial

Dose tested 30 mg/day

66
Q

Vit C

A

Recommended intake easily met

Associated with premature rupture of membranes

Large intakes may → **fetal dependency **

67
Q

Thiamin, Riboflavin, Niacin

A

Requirements relate to caloric intake since they play a role in metabolic pathways

The more you eat, the more vitamins you need

Animal studies not applicable

68
Q

Vit D

A

Maternal deficiency may → neonatal hypocalcemia and poor bone formation

Excess amounts are harmful

69
Q

Vit A

A

**The most concern for toxicity during pregnancy**

Maternal reserves adequate for preg

Megadoses = teratogenic

Vit A analogs (acne and wrinkles) are very teratogenic

  • Accutane, Retin A

Highest Risk: 2 weeks prior to conception and throughout first 2 months of gestation

  • Dermatologists won’t recommend acne meds unless woman is on relaiable BC

“Retinoic Acid syndrome”

  • Small/missing ears or ear canals
  • Flat nasal bridge
  • Brain malformations
  • Heart defects
70
Q

Iron

A

Fetus is a parasite regarding Fe

Additional 1000mg required during pregnancy

  • 300 mg - fetus and placenta
  • 250 mg - lost at delivery
  • 450 mg - increase RBC mass

Supplementation

  • 30 mg/day during 2nd and 3rd trimester
  • Divide doses between meals
  • Vit C containing juice to enhance absorption

For Fe deficiency anemia…

  • 60-180 mg/day until Hgb >11

Major fetal accumulation during 3rd trimester

Premature infants have high risk of deficiency

Maternal deficiency may affect birth

Absorption increases during pregnancy

71
Q

Calcium

A

Fetus acquires most in last trimester

Premature infants have low Ca reserve

Requirements *don’t change *

**>18 years: 1000 mg/day **

<18 years: 1300 mg/day

Ca absorption increases during pregnancy

Higher level of Ca supplementation may prevent pregnancy-induced HTN

72
Q

Magnesium

A

Mostly found in bones

Role in nerve and muscle function

Supplementation may relieve leg cramps, decrease preeclampsia and IUGR

Slightly higher recommendations during preg

<18 years: 400 mg/day

19-30 years: 350 mg/day

31-50 years: 360 mg/day

73
Q

Zinc

A

Important role in reproduction

Deficiency may correlate with poor preg outcomes

Status can be **decreased by Fe supplementation **

74
Q

Iodine

A

Synthesis of thyroid hormones

American Thyroid Association: Rec 150 mcg in PNV

Deficiency causes neonatal cretinism

  • Mental retardation, deafness, dwarfism, goiter, hypothyroidism
  • China, Africa, Eastern Europe
  • Atypical in US due to iodine fortification
  • Most common preventable cause of mental retardation
  • Subclinical iodine deficiency may cause **developmental delay **
75
Q

Fluoride

A

Permanent Tooth formation begins during pregnancy

Prenatal fluoride supplementation is controversial

Only trace amounts pass through placenta

**Supplementation not shown to alter rate of dental carries **

76
Q

Sodium

A

Maintain body’s water balance

Metabolism is altered due to changes in hormonal levels

Increased requirements due to increase volume, increase body water and tissue synthesis

Dietary _Na restriction not recommended _

  • Has not improved preeclampsia, edema, BP
  • may have detrimental effect if dietary quality otherwise affected
77
Q

Alcohol

A

Fetal Alcohol Syndrome (FAS)

  • Abnormalities, teratogenicity
  • Recognized in 1973
  • New Term: Fetal Alcohol Spectrum

2005 CDC Requirements for Diagnosis - Must have all

  • Prenatal and postnatal growth failure
  • Thin upper lip
  • Indistinct Philtrum (vertical groove in upper lip)
  • Small eyelid opening
  • Neurological disorder

Non Diagnostic Characteristics

  • Small teeth
  • Cleft lip/palate
  • Micrognathia: underbite and receeding chin
  • Small jaw: interferes with feeding
  • Microcephaly: (HC <10%tile)
  • Epicanthal fold: fold of skin over inner corner of eye
  • Flat nasal bridge
78
Q

Fetal Alcohol Effects

A

Moderate ETOH consumption/occasional binge drinking

Physical characteristics more subtle

**No facial characteristics **→ **More difficult to diagnose

More difficult to secure needed services

Cognitive and behavioral problems can be just as severe as FAS

**Not just a mild form of FAS**

79
Q

Negative effects of Alcohol

A

Direct toxic effect on fetus

  • ETOH crosses placenta
  • Higher rate of spontaneous abortion, PROM

Maternal Malnutrition frequently associated with alcoholism

Altered nutrient metabolism

  • Thiamin, folic acid, Vit A, B6, Magnesium, Zinc, phosphorus, calcium

Change in normal hormonal effect

Diminished oxygen delivery to fetus

Higher rate of LBW baby

Impaired cell migration

**Deleterious effects on sperm **

80
Q

Cigarette Smoking

A

Higher risk of perinatal morbidity and mortality

Sometimes lower food/calorie intake and utilization by mom

Fetal growth retardation

CO and nicotine decrease placental perfusion and O2 transport to fetus

Increased incidence of LBW - especially in older, smoking women

81
Q

Caffeine

A

Animal studies: teratogenic effects, congenital malformations at high intake

Human: no relationship to birth defects, moderate consumption advised

FDA and ACOG recommend <300 mg/day

Generally **up to 4 cups coffee/day is safe **

82
Q

Saccharin

A

Sweet ‘n Low

Not teratogenic

Weakly carcinogenic in rats

Crosses placenta

Low/moderate consumption advised

83
Q

Aspartame

A

Equal, Nutrasweet, Nutra-taste

Compound: L-aspartyl-L-phenylalanine methyl ester

Metabolized into aspartic acid, phenylalanine and methanol

Phenylalanine → tyrosine (rapid break down)

High circulating levels of phenylalanine is known to **damage fetal brain **

84
Q

Phenylketonuria (PKU)

A

Condition lacking phenylalanine hydroxylase

Can’t convert phenylalanine to tyrosine

Women without PKU have extremely low circulating amounts of phenylalanine

Huge consumption necessary to raise serum levels - 12 oz soda every 8 minutes for 24 hours

Aspartame - no risk for non-PKU mothers

  • FDA and American Academy of Pediatrics Committee on Nutrition consider it a safe substance for pregnant women and developing infant
  • Moderation recommended due ot limited data
  • Consumption of diet soda should not replace intake of other nutritious beverages
85
Q

Heavy Metals

A

Embryotoxic

Permanent brain damage from prenatal and neonatal exposure

Cadmium, nickel, selenium shown to cause malformations in animal studies

Lead associated with spontaneous abortion and menstrual disorders

Mercury poisoning in humans

86
Q

Mercury in Fish

A

Hg:

  • Paper and cement manufacturing
  • Coal burning and incineration

Drifts into waterways → converted into toxic form: methylmercury

Fish absorb methylmercury

Large predator fish have more

High levels of Hg can accumulate in brain → neurological problems

Greatest risk:

  • unborn
  • breast fed babies
  • very young children
87
Q

Safe Fish

A

Flounder

Cod

Haddock

Whitefish

Pollack

Salmon

Sole

Canned light or chunk light tuna

Farm-raised freshwater fish

88
Q

Recommended Fish Consumption

A

2010 DGA

Consume 8-12 oz of variety of seafood/wk

Albacore limited to 6oz/week

No tilefish, shark, swordfish, king mackeral

US FDA safety limit = 2x Canada’s limit

89
Q

Pesticides

A

Public health professionals concerned

EPA - many registered pesticides are toxic, mutagenic and/or carcinogenic

EPA limits some chemical residues in food

Chemicals are difficult to eliminate from food chain once deposited

Effect of low level exposure not known

No real pesticide-free control population to study

90
Q

PCB’s

A

Polychlorinated biphenyls

Birth Defects

  • SGA
  • dark skin
  • Eye abnormalities

Breast and cow milk most significant route of exposure

91
Q

Food Safety

A

Progesterone decreases body’s ability to resist infection, so pregnant women are more prone to food poisoning

92
Q

Listeria

A

Bacteria found in soil, ground water, on plants, uncooked meats, soft cheese, deli cold cuts, raw milk

Listeriosis: bacterial infection caused by eating food contaminated with liisteria

At risk

  • pregnant
  • very young and very old
  • immunocompromised

Babies can be born with it if mother at contaminated food

Killed by pasteurization, heat

Symptoms:

  • fever, chills, GI, headache, stiff neck, confusion, seizures

Onset: 2-30 days after ingestion

93
Q

Avoiding Listeria

A

Avoid uncooked, soft cheeses

Keep cold foods cold and warm foods warm

Thoroughly cook and reheat everything

Wash hands and food

No advantage to washing poultry and fish

94
Q

Constipation

A

Decreased GI from progesterone

Increased abdominal pressure from enlarging uterus

inadqueate fluid

Iron supplementation

95
Q

Hemorrhoids

A

Enlarged veins in mucous membrane

Causes

  • Decreased GI muscle tone
  • weight of fetus
  • Constipation
  • Straining to have a bowel movement

Treatment

  • Prevent and treat constipation
  • Avoid excessive weight gain
96
Q

Heart Burn

A

Enlarging uterus crowds digestive organs and causes reflux, esophageal burning

Relaxation of Lower Esophageal Sphincter (LES) - 30-50%

Recommendations:

  • avoid large meals
  • Eat slowly in relaxed environment
  • Avoid caffeine, greasy, spicy foods
  • Tums or antacids
97
Q

Gallstones

A

Decreased emptying of GB

Increased cholesterol

98
Q

Chronic HTN

A

1-5% pregnancies

Dx before pregnancy or during 1st half

Underlying - does not resolve after birth

99
Q

Gestational HTN

A

Dx after 20 weeks

No proteinuria

Resolves within 3 months

100
Q

Preeclampsia

A

“Toxemia”

Usually occurs in 3rd trimester

Signs and Symptoms

  • HTN
  • Proteinuria
  • Edema
  • Decreased plasma vol expansion and urine output
  • headaches
  • vision changes

Severe: coma, convulsions

Treatment is delivery

Prevention:

  • Adequate dietary protein
  • Adequate Vit E and C, Na, Ca and Mg
101
Q

HTN Risk Factors

A

African american, american indian

First pregnancy

DM, insulin resistence

Multiple gestation

Low socioeconomic status

Prior pregnancy HTN

Obesity

Lack of prenatal care

Dietary deficiencies

Age <20 or >35

Large fetus

Preexisting HTN, renal or vascular dx

Family hx of HTN or vascular dx

102
Q

Gestational DM

A

7.5% of all pregnant women

Screening: 24-28 weeks

High risk: screen at initial prenatal visit

Screening - 1 hour GLT

  • +/- fasting levels checked (>95)
  • 50g glucose drink → 1 hour check (>135)

Diagnosis

  • 3 hour OGTT
  • Fasting level checked >95
  • 100g glucose drink →
    • 1 hr check >180
    • 2 hr check >155
    • 3 hr check >140
  • If two values are high, diagnose
103
Q

Gestational DM Treatment

A

Oral meds not used during pregnancy because meds cross placenta, so babies pancreas starts making more insulin → hypoglycemia

Risk Factors

  • Obesity
  • Hx and FHx of GDM and DM
  • Hx and FHx of large BW delivery
  • Excess wt gain
  • Wt gain between pregnancies
  • History of stillbirths, miscarriages, congenital abnormalities
  • Mother SGA at her own birth → more likely to develop gestational DM when she has a child
  • Low fiber diet
  • Age > 35

Outcome Goals

  • Well controlled BG
  • Hgb A1c <7% (long term check)

Post-partum

  • many women return to normal glucose tolerance
  • 10-15% develope DM within 2-5 years
104
Q

Adolescent Pregnancy

A

Nutrient needs affected by…

  • Gynecologic age - how soon she becomes pregnant after onset of menses
  • Preconception nutritional status
  • Nutrient stores of mother
  • Maternal growth requirements if mother is still growing
  • Smaller babies because mother’s body still needs calories for growth

Risks

  • LBW or SGA
  • Premature delivery
  • Perinatal and infant deaths
  • Physical deformities
  • C-section
  • Cephalopelvic disproportion
  • Fe deficiency
  • Preeclampsia
  • Morbidity and mortality

Risk Factors for Poor Outcome

  • <15 years old
  • Conception <2 years after onset of menses
  • Low pregravid weight
  • Poor wt gain
  • lack of access to HC
  • Infection, STD’s
  • Preexisting anemia
  • Substance abuse
  • Rapid repeat pregs
105
Q

Multifetal Pregnancy

A

Twins

  • 1980: 1 in 56
  • 2006: 1 in 32
  • >45 years: 1 in 5 births

Triplets

  • 1980: 1 in 3000 births
  • 2006: 1 in 650 births

Optimal Wt Gain

  • Singleton: 25-35 lbs
  • Twins: 35-45 lbs
  • Triplets: ~50 lbs

Calories

  • Twins: +150 kcals/day
  • Triplets: intake level to promote 1.5 lbs/week throughout pregnancy

Protein

    • 10g protein/fetus
  • Singleton: 25g for the first
  • Triplets: add 10g/fetus

Life Cycles (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions