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Maternal Adaptations During Pregnancy > Micronutrient Requirements in Pregnancy > Flashcards

Micronutrient Requirements in Pregnancy Flashcards

1
Q

what are micronutrients

A
  • vitamins and minerals
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2
Q

micronutrients are needed in body in ___ amounts

A

small

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3
Q

do micronutrients provide any energy

A

no

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4
Q

why is it important to eat a variety of foods for balanced nutrition when it comes to micronutrients

A

because micronutrients are contained in many foods in different amounts

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5
Q

for optimal foetal development when are micronutrients required in pregnancy

A

at different periods of pregnancy

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6
Q

what are possible complications from deficient maternal micronutrient status in pregnancy

A

(maternal)
- anaemia
- hypertension
(neonate)
- impair foetal function, growth, development
- influence offspring metabolism -> lead to increased risk of chronic disease

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7
Q

list some key micronutrients in pregnancy and what they promote

A
  • folate, iron, zinc, calcium, vitamin D
  • promote red blood cell production, enzyme activity, bone development, brain development
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8
Q

what does folate do

A
  • (neonate) prevent neural tube defects
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9
Q

what does calcium do

A
  • (maternal) prevent hypertensive disorders
  • esp recommended in women with low calcium intakes or who at high risk of hypertensive disorders in pregnancy
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10
Q

what does iodine do

A
  • prevent iodine deficiency disorders, recommended only in women at high risk of IDDs
  • improve cognitive function
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11
Q

what does iron do

A
  • reduce maternal anaemia
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12
Q

what micronutrients have insufficient evidence to recommend additional intake during pregnancy to support birth outcomes (although may have higher intake recommended)

how should they exist in pregnant and normal women

A
  • vitamin B, vitamin C, vitamin E, zinc
  • included in a healthy dietary pattern
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13
Q

what is guidelines around vitamin D in pregnancy and why

A
  • no addition is recommended to support pregnancy outcomes
  • but should be given if woman vit D deficient
    => routine screening of pregnant women for vit D deficiency is recommended
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14
Q

what are guidelines around alcohol during pregnancy

A
  • no alcohol is safest
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15
Q

what are guidelines around caffeine in pregnancy

A
  • small evidence to suggest benefit from reducing caffeine intake
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16
Q

what is reducing caffeine intake preventing

A
  • pregnancy loss
  • low birth weight infants
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17
Q

what is increased requirement for iron in pregnant women compared to non-pregnant women

A

9 milligrams per day

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18
Q

what is increased requirement for zinc in pregnant women compared to non-pregnant women

A

2-3 milligrams per day

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19
Q

list the micronutrients with recommended increased requirements in pregnant women

how can these be obtained, esp for those not recommended due to lack of evidence

A
  • iron, zinc, iodine, selenium, vitamin A, vitamin B, vitamin C
  • by eating food from 5 food groups
  • supplement if recommended
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20
Q

which micronutrients do not require a change in daily micronutrient intake in pregnant women (some are key micronutrients in pregnancy)

A
  • calcium, phosphorus, vitamin D, vitamin E
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21
Q

maternal adjustments in calcium absorption during pregnancy occur how (2) ways

A
  • increased parathyroid hormone
  • increased parathyroid hormone receptor protein
    => maintain serum calcium level
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22
Q

what maternal adaptations have occurred that would require maintenance of serum calcium level

A
  • extracellular fluid volume expansion
  • renal function increase
  • placental calcium transfer
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23
Q

what increases during pregnancy to allow intestinal absorption of calcium to double

A
  • maternal blood concentrations in active form of vitamin D (125-dihydroxy vitamin D)
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24
Q

what increases during pregnancy to lead to increased active form of vitamin D

A
  • one alpha hydroxylase (enzyme) in placenta increases
  • which increases conversion inactive form of vitamin D (25-hydroxy) to active form of vitamin D (125-dihydroxy)
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25
Q

in addition to consuming additional food sources, do we need supplements to meet additional requirements

A
  • for most women, not needed despite marketing
  • for malnourished women and women from low income countries - supplementing can improve birth outcomes
26
Q

what micronutrients are the only 2 supplements recommended during pregnancy

A
  • iodine
  • folic acid
27
Q

what is recommended amount of iodine in supplementation

A
  • 220 micrograms iodine per day in total
  • recommended to take 150 microgram iodine supplement daily to reach total intake
28
Q

when does iodine supplementation and recommendation change again

A
  • when breastfeeding
  • to 270 micrograms
29
Q

what is recommended amount of folic acid in supplementation

A
  • 600 micrograms per day in total
  • 200 micrograms higher
30
Q

how manu micrograms in a typical folic acid supplement

A

400 micrograms

31
Q

when is folic acid supplementation recommended

A
  • recommended to supplement in the month preceding conception and in first trimester of pregnancy
32
Q

although no other supplements are recommended, what else may be supplemented and to who

A
  • iron
  • to women at risk - anaemic or very low iron levels
33
Q

what does trace mineral mean

A

only found in very small amounts inbody

34
Q

what is iodine

A

trace mineral
essential mineral

35
Q

where is iodine found in body

A
  • most stored in thyroid
  • some circulating in blood
36
Q

why is iodine stored in thyroid

A
  • thyroid uses iodine to produce thyroid hormones
37
Q

what happens if consume too much iodine

A
  • it is excreted
38
Q

important thing iodine contributes to & a MoA

A
  • normal foetal brain development
  • since foetus entirely dependent in early pregnancy on maternal thyroid hormones for brain development
39
Q

if iodine is inadequate there may be maternal deficiency that results n low supply of iodine for unborn baby, which can lead to…

A
  • problems in brain and nervous system development in unborn children and infants
  • reduced IQ in foetus
40
Q

what can severe iodine deficiency result in

A
  • endemic goiter
  • hypothyroidism
  • cretinism
  • decreased fertility
  • miscarriage
  • increased infant mortality
  • hypothyroxinaemia
  • trophoblastic or embyronic foetal disorders
  • foetal mental retardation
41
Q

when does foetal thyroid gland develop which is capable of

A
  • 10-12 wks gestation
  • capable of iodine organification & thyroid hormone production around 16-20wks gestation
42
Q

what are the likely effects from mild to moderate iodine deficiency

A
  • subtle cognitive and neurological impairments
43
Q

is adequate iodine difficult to get from food alone

A

yes

44
Q

what has been implemented to increase iodine intake in population in Australia

A
  • mandatory iodine fortified bread (all breads that used salt are required to contain iodised salt; organic bread not contain)
45
Q

since fortification, has iodine intakes improved

A

yes

46
Q

what other sources of food contain iodine (without fortification)

A
  • dairy
  • seafood (and eggs)
47
Q

what is folate

A
  • type of B vitamin
48
Q

functions of folate

A
  • make DNA
  • form red blood cells
  • grow and repair cells and tissues
49
Q

what does folate contribute to in preganncy

A
  • growth and formation of neural tube in early pregnancy
50
Q

women in what areas are at increased risk of folate insufficiency

A
  • areas where malaria prevalent
  • areas where sickle cell disease prevalent
51
Q

when is folic acid supplementation recommended

A
  • during preconception and early pregnancy = critical
52
Q

folic acid vs folate

A
  • folic acid: man-made synthetic form of folate
  • used in supplements and fortified foods
53
Q

what can folic acid supplementation during preconception and early pregnancy prevent

A
  • 40-80% of neural tube defects
54
Q

when do neural tube defects occur in pregnancy

A

during 3rd and 4th week of pregnancy

55
Q

what do neural tube defects involve

A
  • failure of neural tube to close properly
56
Q

what deficiency can folic acid supplementation sometimes mask & what can this lead to

A
  • vitamin B12 deficiency
    -> can contribute to unwanted side effects such as multiple pregnancies (higher risk of perinatal complications)
57
Q

what is perinatal

A

a number of weeks immediately before and after birth

58
Q

how is the neural tube formed

A
  • a layer of cells that goes on to form brain and spinal cord
59
Q

how do we get folate through fortification

A
  • fortified bread (excluding organic bread) - folic acid required in flour
60
Q

other sources of dietary folate (non-fortified)

A
  • green leafy vegetables
  • legumes
  • eggs

Maternal Adaptations During Pregnancy (4 decks)

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