Module 2: Pregnancy I

Question 1

major stages of pregnancy for offspring

Answer 1

Embryo Period: first 8 weeks
Fetal Period: 8-40 weeks
Neonatal Period: 40+ weeks

Question 2

major stages of pregnancy for mother

Answer 2

Pre-conception (LMP)
Pregnancy
- 1st trimester
- 2nd trimester
- 3rd trimester
Postnatal

Question 3

maternal anabolic phase when is it

Answer 3

0-20 weeks

Question 4

maternal anabolic phase

Answer 4

Increased maternal plasma volume
Increased cardiac output
Buildup of fat, nutrient & liver glycogen stores
Increased appetite and food intake
- Sometimes increased ghrelin: we need a physiological way to increase energy
Decreased exercise tolerance
Increased placental weight
10% of fetal growth

Question 5

maternal catabolic phase when is it

Answer 5

20+ weeks

Question 6

maternal catabolic phase what is it

Answer 6

Increased uterine blood flow
Increased fetal weight
Mobilization of fat and nutrient stores
Increased blood glucose, triglycerides, and fatty acids
Accelerated metabolism
90% of fetal growth

Question 7

what are energy needs in pregnant women used for?

Answer 7

Synthesis of fetal, placental, uterine, and breast tissues
Buildup of maternal fat stores
Increased metabolic activity
Fetus accounts for ⅓ of energy needs

Question 8

nutritional considerations for preconception

Answer 8

fish consumption
folate
iron
vitamin A

Question 9

why do we limit fish consumtion

Answer 9

limit methyl-mercury

Question 10

folate in preconception nutrition

Answer 10

Begin folic acid supplementation (400 mcg) at least 1 month before conception to decrease neural tube defects (prenatal vitamins
If history of NTDs need 4000 mcg

Question 11

iron in preconception nutrition

Answer 11

Iron deficiency anemia may increase risk of preterm delivery and anemia in childhood

Question 12

vitamin A in preconception nutrition

Answer 12

Excess is harmful

Question 13

Should caffeine be consumed during pregnancy? When is it most critical?

Answer 13

Limit to 200 mg/day (one 11oz cup)
New recommendations: none during 1st trimester
Reductions in blood flow could hinder placentation and placental transport

Question 14

vegetarian/vegan mother concerns

Answer 14

Nutrients of concern: iron, calcium, vitamin B12
Blood tests every trimester
Replacement as needed

Question 15

dairy free mother concerns

Answer 15

nutrient of concern: calcium

Question 16

gluten free/low carb mother concerns

Answer 16

Nutrient of concern: folate
A lot of folate comes from fortified foods which are often wheat products

Question 17

complex carbohydrates requirements and why

Answer 17

a lack can lead to reflux!
Minimum 175g/day
45-65% of intake
Complex carbs
No alcohol

Question 18

proteins requirements and why

Answer 18

71 g/day
Too little or excessive protein intake can be detrimental
Too much protein can lead to kidney damage because the kidneys are already processing a lot more fluids than usual

Question 19

healthy fats requirements and why

Answer 19

33% of total calories
Fat soluble vitamins
Essential fatty acids

Question 20

water requirements and why

Answer 20

2.5 L per day (~10 cups)
Can be from other liquids, but water is best
Dehydration can contribute to:
Constipation
Hemorrhoids
urinary/bladder infections
Excessive swelling
Extended Braxton-Hicks contractions
Preterm birth

Question 21

benefits of exercise

Answer 21

Daily moderate aerobic and strength exercise recommended, 30-45 minutes a day
Trained athletes may continue more intense exercise
Benefits:
Physical fitness
Weight management
Decreases risk of gestational diabetes in obese women
Psychologic well-being
Better labor and delivery?
Increasing evidence, but there is currently mixed data
Individuals with higher BMI can start with low-intensity, short term exercise during pregnancy

Question 22

What are the general weight gain guidelines/trends for pregnancy? How/where is weight gain distributed during pregnancy? Why is weight gain essential?

Answer 22

Steady weight gain throughout pregnancy
In first half, the weight gain goes towards energy stores, placenta
In second half, we see the maternal weight gain contribute to increase in adipose and weight in the fetus
We do not want to lose weight during pregnancy → lipolysis during pregnancy is dangerous!
Early weight gain goes towards maternal plasma volume (making sure we have enough blood flow for placenta and fetus)

Question 23

multifetal pregnancies and weight gain

Answer 23

Dietary intake in twin pregnancy
Higher caloric need
Benefits from increases in essential fatty acids, iron, and calcium

Question 24

What are the macronutrient and micronutrient requirements? What should be avoided?

Answer 24

Required: folate, iron, vitamin D, calcium, vitamin A, omega-3 fatty acids, water

Avoided: methylmercury, caffeine, alcohol