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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
Is there a difference in RDA for iron in the 3 trimesters? Why?
No; all use requirements calculated for 3rd trimester | Need to establish IRON STORES during first trimester
26
Why is it important to ensure the fetus has adequate iron stores before birth?
No iron in milk
27
True/False: reduced sodium diets can help prevent pregnancy hypertension
False; no evidence to suggest this
28
The pregnancy EAR/RDA for iron is based on: (4)
increase iron stores during 1st trimester adequate amounts during remaining trimesters (especially 3rd) upper limit of 25% absorption calculate RDA as 120% of EAR
29
The requirements for Na are the same as ____.
Cl
30
How much extra Na is needed over the course of the pregnancy?
2.1-2.3g
31
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?
assume that pre-pregnancy iron stores are INADEQUATE - need to build up Most people consume excess sodium already
32
What is the small amount of extra sodium needed for? (2)
Increase in BV and fluid -> need to maintain osmolality | to make products of conception
33
There is no change in ___ or ___ for sodium during pregnancy.
AI; UL
34
The ___% increase in Thiamine need is due mostly to ________, but also due to _____.
30% growth in maternal/fetal compartments increased energy utilization
35
Why was it determined that there is an increased need for riboflavin in pregnancy? (2)
signs of ARIBOFLAVINOSIS observed more in preg women | decreased urinary excretion of riboflavin (more conserved)
36
An additional ____ mg is needed of riboflavin per day for pregnancy
0.3
37
Which B vitamins have a noticeable increase in requirement during pregnancy? (5)
``` Thiamine Riboflavin B6 Folate B12 ```
38
What is the evidence that B6 supplementation is needed during pregnancy? Why is there still uncertainty concerning this?
decrease in pyridoxal phosphate levels in plasma Could be a normal occurence during pregnancy, unknown if actually due to deficiency
39
True/False: with the recommended supplementation of B6, pyridoxal phosphate levels in pregnant women should be the same as normal nonpregnant women.
False; much higher supplementation is needed to maintain nonpregnant levels
40
True/False: requirement of B6 is increased in the third trimester
True
41
There is significant fetal uptake of vitamin B___
6
42
Can a high vitamin B6 intake in the first half of pregnancy help to prevent deficiencies later on?
NO; Not stored in the body
43
What are the considerations for B6 needs of pregnant women? (3)
accumulation in fetus/placenta increased metabolism/weight 75% bioavailability
44
True/False: the increased requirement for B6 is only in the last trimester
False: need increase throughout, but needs are increased in second half of pregnancy
45
Is there an increased need for Niacin? How is this reflected by the EAR estimation?
No evidence to suggest changes in needs | BUT: added 3mg to EAR to account for increased growth/energy use
46
____________ is used as an indicator of folate adequacy, because it reflects ____ _____.
RBC folate maintenence | tissue stores
47
There is a (high/low) transfer rate of folate to the fetus. What type of transfer, and what indicates this?
high | ACTIVE TRANSFER: increased concentration of folate in CORD BLOOD vs maternal blood (moved from mother to fetus)
48
True/False: 100micrograms of folate supplement should be adequate for pregnant women
False. Combined with low folate diet, is not enough | EAR is 520 micrograms -> RDA is 600
49
If folate is inadequate, this leads to ______, which could potentially cause ______
``` decrease in concentration in serum and RBC MEGALOBLASTIC ANEMIA (large abnormal blood cells) ```
50
The significant folate increase is due to: (2)
- increased chem rxns (single C transfer) | - nucleotide synthesis (FOR CELL DIVISION: blood/tissue/fetus/uterus/placenta)
51
does pre-pregnancy folate require supplementation? Why or why not?
yes; 400 micrograms recommended for all women capable of becoming pregnant reduce risk of NTDs
52
How does urinary excretion of biotin change in pregnancy? What could this indicate?
decreases to 50% of before | possibly a sign of increased need? unclear (could be normal physiological change)
53
Deficiencies in vitamin ___ have been noticed in infants of vegetarian mothers.
B12
54
Why is dietary B12 especially important during pregnancy?
Only NEWLY ABSORBED B12 is readily transported across placenta maternal stores are not a good source
55
the 600 micrograms of folate needed per day in pregnancy should be a combination from:
supplements, fortified food, folate rich foods
56
how does the increased absorption of B12 occur? Is this enough to account for the increased needs in pregnancy?
increased number of INTRINSIC FACTOR B12 RECEPTORS (CUBULIN in gut) No, still need some increase
57
What happens to serum B12 levels in pregnancy?
decreases; reaches 50% of original by 3rd trimester
58
Is the biotin recommendation changed for pregnancy?
No, same AI
59
What evidence suggests there might be an increased need in biotin during pregnancy?
increased ratio of biotin metabolites in blood (3 hydroxyisovaleric acid) vs biotin excretion in urine
60
The factors affecting biotin requirement are: (4)
- eat raw egg whites (avidin binds, decrease bioavailability) - impaired absorption (BIOTINIDASE deficiency) - anticonvulsants (induce biotin catabolism) - *pregnancy (possibly)
61
Can the decrease in serum B12 be attributed to hemodilution?
No; hemodilution not yet occur in first trimester, but decrease still observed. Hemodilution only account for part of it.
62
There is a large amount of choline delivered to the fetus; what consequences can this have?
Depletion of maternal stores
63
How can we make choline endogenously?
Methylate phosphatidylethanolamine -> phosphatidylcholine | Break down PHOSPHATIDYLCHOLINE with phospholipases
64
Suboptimal levels of ___ or ___ will increase the need for choline.
B6 | B12
65
Do most Americans consume enough choline? What is an excellent source?
No (9/10) | egg yolk
66
____ is important for embryogenesis and perinatal development, and was found to improve spatial memory in rats.
Choline
67
What positive effect could extra choline have on the fetus? How?
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
Are the requirements for pantothenic acid different when pregnant?
No; but rounded up from average intake
69
Is additional vitamin C needed in pregnancy - why or why not?
yes | hemodilution (decreased conc in blood) and transfer to fetus
70
What important product is made from choline, and what pathway does it participate in?
Betaine | methyl donor for 5-me-TH4-folate in homocysteine-methionine pathway
71
What is the rate of vitamin C transfer from mother to fetus? What is the recommended extra amount needed?
no precise data | 10mg/day (rounded up from amount to prevent scurvy in infant)
72
What vitamin has a higher CV of 20%, and why?
Vitamin A | variability of half life of liver vit A
73
What is the requirement for vit A based on in pregnancy, and what assumption does it make?
accumulation in fetal liver | assume liver has 50% of body vit A when liver stores are low (in newborns)
74
What would increase vitamin C needs even further? How would this affect pregnancy?
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
Maternal vit A absorption is about ___-%
70%
76
Compare the UL critical effect of vit A in pregnant vs nonpregnant women
nonpregnant: LIVER DAMAGE pregnant: TERATOGENICITY
77
Vitamin A needs increase mostly in the ___ trimester, by ____ extra per day, when most accumulation takes place.
third | 50 micrograms
78
Vitamin E deficiency is a concern in ____ infants, as it leads to ____ _____. Can supplementation prevent this?
premature; hemolytic anemia | NO: no sign of deficiency during preg, no evidence that supplementation will prevent
79
Does the RDA for vitamin E change? Why or why not?
No. No signs of deficiency
80
Is vitamin D supplementation required? Why or why not?
No. Small amounts transferred to fetus, does not affect maternal status
81
What is the vitamin K recommendation based on?
highest median intake

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