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nutrition thru life > micronutrients (pregnancy) > Flashcards

micronutrients (pregnancy) Flashcards

1
Q

____ _____ is used to determine iron EAR.

A

Factorial Modeling

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2
Q

True/False: The Ca deposition (25-30g) for pregnancy will come from maternal stores.

A

False; maternal stores not affected (from dietary Ca)

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3
Q

What are the components of iron factorial modelling (the factors considered) during PREGNANCY? (3)

A

Basal losses
fetal requirements (deposit in fetus and tissue)
Growth (tissue, storage, Hb for blood volume)

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4
Q

Is there a higher Mg requirement between pregnant and non-pregnant women? Why?

A

Yes; pregnant women need 35mg extra per day to account for weight increase
Absorption efficiency from diet not changed

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5
Q

Is there an increased need for P? Why or why not?

A

No; intestinal absorption increases 10%

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6
Q

Do pregnant women have any change in Ca requirements? Why/why not?

A

No

Increased intestinal absorption will account for fetal growth needs

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7
Q

Most of the factors that cause increased intestinal absorption of Ca are likely _____

A

hormones

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8
Q

Is decrease in serum Mg levels of concern during pregnancy? What would be the cause?

A

No; normal

hemodilution

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9
Q

During pregnancy, the blood levels of active vitamin ____ increase, which may be linked to Ca; what is the role?

A

D

unclear role

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10
Q

What indicates that the decrease in Mg levels is normal and not signalling deficiency in diet?

A

Hemodilution - decrease parallels that of blood proteins (diluted to the same extent)

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11
Q

Most of the iron needed in pregnancy is necessary for:

A

blood volume expansion

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12
Q

What component of iron factorial modelling does not need to be considered in pregnant women?

A

Menstrual losses

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13
Q

When does the intestinal absorption of iron increase during pregnancy? Is extra iron still needed in the diet?

A

2nd trimester -> 25% efficiency from food iron

Yes; increased absorption alone is not enough

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14
Q

What assumption is made when prescribing supplementation of iron for pregnancy? Why is this assumption made?

A

pre-pregnancy iron stores were INADEQUATE

average Canadian diet does not have enough iron

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15
Q

What are the risks associated with anemia during pregnancy? (4)

A

Perinatal maternal mortality (risk of death before/after birth)
Perinatal infant mortality
LBW
premature birth

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16
Q

Does moderate anemia still carry a risk?

A

Yes; 2x risk of maternal death
limited BV expansion
prematurity/LBW

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17
Q

At what stage of pregnancy is the demand for iron the highest?

A

3rd

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18
Q

The total amount of extra iron needed during pregnancy is about:

A

1g

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19
Q

Insufficient iron would cause: (4)

A
  • less Hb synthesis
  • less RBC increase
  • less BV expansion
  • heart has to work harder to supply fetus with oxygen
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20
Q

Why are both low and high concentrations of Hb indicators of pregnancy risk?

A

low Hb -> anemia

high Hb -> indicates high blood pressure, less plasma

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21
Q

True/False: If a woman was consuming an adequate amount of iron pre-pregnancy, then she does not need to have supplementation during pregnancy.

A

True; can use maternal stores

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22
Q

What is high Hb concentrations an indicator of? (2)

A

decreased plasma volume -> indicator of HYPERTENSION, PREECLAMPSIA

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23
Q

True/False: Iron deficiency is rare in developed countries due to high consumption of animal protein.

A

False
high incidence in both pregnant and non-preg women
(1/3-1/2 of pregnant women are anemic)

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24
Q

Potassium (does/does not) have any changes in requirement during pregnancy.

A

does not

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25
Q

Is there a difference in RDA for iron in the 3 trimesters? Why?

A

No; all use requirements calculated for 3rd trimester

Need to establish IRON STORES during first trimester

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26
Q

Why is it important to ensure the fetus has adequate iron stores before birth?

A

No iron in milk

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27
Q

True/False: reduced sodium diets can help prevent pregnancy hypertension

A

False; no evidence to suggest this

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28
Q

The pregnancy EAR/RDA for iron is based on: (4)

A

increase iron stores during 1st trimester
adequate amounts during remaining trimesters (especially 3rd)
upper limit of 25% absorption
calculate RDA as 120% of EAR

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29
Q

The requirements for Na are the same as ____.

A

Cl

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30
Q

How much extra Na is needed over the course of the pregnancy?

A

2.1-2.3g

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31
Q

The extra sodium needed during pregnancy is twice the amount of the accumulated iron increase. Yet, why do we recommend iron supplements but not extra sodium?

A

assume that pre-pregnancy iron stores are INADEQUATE - need to build up
Most people consume excess sodium already

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32
Q

What is the small amount of extra sodium needed for? (2)

A

Increase in BV and fluid -> need to maintain osmolality

to make products of conception

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33
Q

There is no change in ___ or ___ for sodium during pregnancy.

A

AI; UL

34
Q

The ___% increase in Thiamine need is due mostly to ________, but also due to _____.

A

30%
growth in maternal/fetal compartments
increased energy utilization

35
Q

Why was it determined that there is an increased need for riboflavin in pregnancy? (2)

A

signs of ARIBOFLAVINOSIS observed more in preg women

decreased urinary excretion of riboflavin (more conserved)

36
Q

An additional ____ mg is needed of riboflavin per day for pregnancy

A

0.3

37
Q

Which B vitamins have a noticeable increase in requirement during pregnancy? (5)

A 
Thiamine
Riboflavin
B6
Folate
B12
38
Q

What is the evidence that B6 supplementation is needed during pregnancy? Why is there still uncertainty concerning this?

A

decrease in pyridoxal phosphate levels in plasma

Could be a normal occurence during pregnancy, unknown if actually due to deficiency

39
Q

True/False: with the recommended supplementation of B6, pyridoxal phosphate levels in pregnant women should be the same as normal nonpregnant women.

A

False; much higher supplementation is needed to maintain nonpregnant levels

40
Q

True/False: requirement of B6 is increased in the third trimester

A

True

41
Q

There is significant fetal uptake of vitamin B___

A

6

42
Q

Can a high vitamin B6 intake in the first half of pregnancy help to prevent deficiencies later on?

A

NO; Not stored in the body

43
Q

What are the considerations for B6 needs of pregnant women? (3)

A

accumulation in fetus/placenta
increased metabolism/weight
75% bioavailability

44
Q

True/False: the increased requirement for B6 is only in the last trimester

A

False: need increase throughout, but needs are increased in second half of pregnancy

45
Q

Is there an increased need for Niacin? How is this reflected by the EAR estimation?

A

No evidence to suggest changes in needs

BUT: added 3mg to EAR to account for increased growth/energy use

46
Q

____________ is used as an indicator of folate adequacy, because it reflects ____ _____.

A

RBC folate maintenence

tissue stores

47
Q

There is a (high/low) transfer rate of folate to the fetus. What type of transfer, and what indicates this?

A

high

ACTIVE TRANSFER: increased concentration of folate in CORD BLOOD vs maternal blood (moved from mother to fetus)

48
Q

True/False: 100micrograms of folate supplement should be adequate for pregnant women

A

False. Combined with low folate diet, is not enough

EAR is 520 micrograms -> RDA is 600

49
Q

If folate is inadequate, this leads to ______, which could potentially cause ______

A 
decrease in concentration in serum and RBC
MEGALOBLASTIC ANEMIA (large abnormal blood cells)
50
Q

The significant folate increase is due to: (2)

A
  • increased chem rxns (single C transfer)

- nucleotide synthesis (FOR CELL DIVISION: blood/tissue/fetus/uterus/placenta)

51
Q

does pre-pregnancy folate require supplementation? Why or why not?

A

yes; 400 micrograms recommended for all women capable of becoming pregnant
reduce risk of NTDs

52
Q

How does urinary excretion of biotin change in pregnancy? What could this indicate?

A

decreases to 50% of before

possibly a sign of increased need? unclear (could be normal physiological change)

53
Q

Deficiencies in vitamin ___ have been noticed in infants of vegetarian mothers.

A

B12

54
Q

Why is dietary B12 especially important during pregnancy?

A

Only NEWLY ABSORBED B12 is readily transported across placenta
maternal stores are not a good source

55
Q

the 600 micrograms of folate needed per day in pregnancy should be a combination from:

A

supplements, fortified food, folate rich foods

56
Q

how does the increased absorption of B12 occur? Is this enough to account for the increased needs in pregnancy?

A

increased number of INTRINSIC FACTOR B12 RECEPTORS (CUBULIN in gut)
No, still need some increase

57
Q

What happens to serum B12 levels in pregnancy?

A

decreases; reaches 50% of original by 3rd trimester

58
Q

Is the biotin recommendation changed for pregnancy?

A

No, same AI

59
Q

What evidence suggests there might be an increased need in biotin during pregnancy?

A

increased ratio of biotin metabolites in blood (3 hydroxyisovaleric acid) vs biotin excretion in urine

60
Q

The factors affecting biotin requirement are: (4)

A
  • eat raw egg whites (avidin binds, decrease bioavailability)
  • impaired absorption (BIOTINIDASE deficiency)
  • anticonvulsants (induce biotin catabolism)
  • *pregnancy (possibly)
61
Q

Can the decrease in serum B12 be attributed to hemodilution?

A

No; hemodilution not yet occur in first trimester, but decrease still observed.
Hemodilution only account for part of it.

62
Q

There is a large amount of choline delivered to the fetus; what consequences can this have?

A

Depletion of maternal stores

63
Q

How can we make choline endogenously?

A

Methylate phosphatidylethanolamine -> phosphatidylcholine

Break down PHOSPHATIDYLCHOLINE with phospholipases

64
Q

Suboptimal levels of ___ or ___ will increase the need for choline.

A

B6

B12

65
Q

Do most Americans consume enough choline? What is an excellent source?

A

No (9/10)

egg yolk

66
Q

____ is important for embryogenesis and perinatal development, and was found to improve spatial memory in rats.

A

Choline

67
Q

What positive effect could extra choline have on the fetus? How?

A

Decrease circulating cortisol (stress hormone) -> decreased risk of health problems later in life (hypertension, diabetes)

increase methylation -> affect DNA expression related to cortisol production

68
Q

Are the requirements for pantothenic acid different when pregnant?

A

No; but rounded up from average intake

69
Q

Is additional vitamin C needed in pregnancy - why or why not?

A

yes

hemodilution (decreased conc in blood) and transfer to fetus

70
Q

What important product is made from choline, and what pathway does it participate in?

A

Betaine

methyl donor for 5-me-TH4-folate in homocysteine-methionine pathway

71
Q

What is the rate of vitamin C transfer from mother to fetus? What is the recommended extra amount needed?

A

no precise data

10mg/day (rounded up from amount to prevent scurvy in infant)

72
Q

What vitamin has a higher CV of 20%, and why?

A

Vitamin A

variability of half life of liver vit A

73
Q

What is the requirement for vit A based on in pregnancy, and what assumption does it make?

A

accumulation in fetal liver

assume liver has 50% of body vit A when liver stores are low (in newborns)

74
Q

What would increase vitamin C needs even further? How would this affect pregnancy?

A

smoking/drugs
aspirin
alcohol
*should not consume during pregnancy, but even if abstain, body has damage from before and still need extra to detox

75
Q

Maternal vit A absorption is about ___-%

A

70%

76
Q

Compare the UL critical effect of vit A in pregnant vs nonpregnant women

A

nonpregnant: LIVER DAMAGE
pregnant: TERATOGENICITY

77
Q

Vitamin A needs increase mostly in the ___ trimester, by ____ extra per day, when most accumulation takes place.

A

third

50 micrograms

78
Q

Vitamin E deficiency is a concern in ____ infants, as it leads to ____ _____. Can supplementation prevent this?

A

premature; hemolytic anemia

NO: no sign of deficiency during preg, no evidence that supplementation will prevent

79
Q

Does the RDA for vitamin E change? Why or why not?

A

No. No signs of deficiency

80
Q

Is vitamin D supplementation required? Why or why not?

A

No. Small amounts transferred to fetus, does not affect maternal status

81
Q

What is the vitamin K recommendation based on?

A

highest median intake

nutrition thru life (15 decks)

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