Module 4 - Pregnancy & Lactation Flashcards
Historically, the EER was measured by what method?
factorial method
What is the current method for measuring the EER?
doubly labeled water (DLW)
What is the “gold standard” method for measuring total energy expenditure in humans?
Doubly Labeled Water
What does Doubly Labeled Water measure?
Total energy expenditure.
What type of energy costs can Doubly Labeled Water help assess in pregnant women?
Energy costs for fetal growth and expanding maternal tissues
What are the three parts of total energy expenditure?
- basal needs
- thermic effect food (energy expended when digesting and absorbing food)
- different physical activity levels
Needs vary by
trimester
- first trimester: little change over NPNL state
- second and third trimesters: needs increase
What is the most accurate method for approximating total energy expenditure?
a. 24-hour dietary recal
b. factorial method
c. food frequency questionnaire
d. doubly labeled water method
d. doubly labeled water method
EER during pregnancy during 1st trimester (0-13 weeks)
- 1st trimester energy deposition is negligible
- use EER equation for non pregnant, non lactating women. Includes: age in years, height in cm, weight in kg
EER during pregnancy 2nd (14-27 weeks) and 3rd (28 weeks +) trimester
EER equation uses age in years, height in cm, weight in kg, gestation in weeks
IOM recommendations
- encourage women to reach normal body weight before pregnancy
- promote prenatal weight gain within recommended ranges
- encourage women to return to normal weight by 1 year after delivery
Why is there different milk output in the first half (0-6 mo) and second half (7-12 mo) of lactation?
baby gets bigger = needs more milk
What is the energy cost of milk production and energy mobilization during 0-6 months of lactation?
energy cost of milk production: 540 kcal/day
energy mobilization: 140 kcal/day
What is the energy cost of milk production during 7-12 months of lactation?
380 kcal/day
Nutrients of concern in pregnancy/lactating women
- folate/folic acid
- iron
- iodine
- choline
- zinc
- calcium
- vitamin D
- potassium
- dietary fiber
How does the Recommended Dietary Allowance (RDA) for folate during pregnancy and lactation compare to other life stages?
It is higher during pregnancy and lactation
Why is it important for women to have adequate folic acid intake at least 1 month before conception and during the first 2-3 months of pregnancy?
To prevent neural tube defects in the developing baby
How do iron needs during pregnancy compare to pre-pregnancy?
Iron needs increase during pregnancy compared to pre-pregnancy
When do iron needs fall during pregnancy and postpartum?
Iron needs fall before menstruation returns
What is the prevalence of iron deficiency among pregnant women and during the third trimester?
About 1/10 pregnant women are iron deficient, and 1/4 women in the third trimester are iron deficient
Why is adequate iron essential during pregnancy?
To produce hemoglobin and synthesize iron-dependent enzymes
Why is adequate iodine intake during pregnancy and lactation important?
It supports the neurocognitive development of the fetus
Which dietary sources are common for iodine intake?
Dairy products, eggs, seafood, and iodized table salt.
Do most prenatal supplements contain iodine?
No, most prenatal supplements do not contain iodine
How do choline needs during pregnancy and lactation compare to those of non-pregnancy women?
needs increase
Why is choline important during pregnancy and lactation?
It helps replenish maternal stores and supports the growth and development of the child’s brain and spinal cord
How does the Recommended Dietary Allowance (RDA) for zinc during pregnancy and lactation compare to other life stages?
The RDA for zinc is higher during pregnancy and lactation than in other life stages
Do most prenatal supplements contain choline?
no
Why is zinc important during pregnancy and lactation?
Zinc supports fetal and infant growth
What percentage of pregnant people in the United States have low total zinc intake from foods and supplements?
11% of pregnant people in the U.S. have low total zinc intake
Can caffeine pass from a mother to her infant through breastmilk?
Yes, caffeine can pass from mother to infant in small amounts through breastmilk
Are alcoholic beverages recommended during pregnancy?
no
Exercise
- can benefit both mother and baby
- increases or maintains cardiorespiratory fitness & reduces risk of excessive weight gain & gestational diabetes
What is the recommended exclusive food source for infants for the first 6 months of life?
Human milk. If not available, use iron-fortified infant formula
How long should infants be fed human milk along with complementary foods?
For 2 years or beyond
What vitamin should infants be given as a supplement starting soon after birth?
Vitamin D, with a recommended dose of 400 IU/day
What precaution should be taken when providing supplemental vitamin D to infants?
Avoid double dosing, especially if using iron-fortified formula that already contains vitamin D. Double-check the formula content
Rationale for 6 months exclusive breastfeeding
- prevents 823,000 annual deaths in children <5 years old
- protects against respiratory tract, acute ear, GI infection, diarrhea, atopic disease (ex: asthma), sudden infant death syndrome (SIDS), type 1 diabetes, necrotizing enterocolitis, childhood overweight and obesity
- promotes bonding between baby and parent
- may enhance infant motor development and cognition
- may enhance IQ
- prevents 20,000 annuals deaths due to breast cancer
- protects against type 2 diabetes
- prolongs duration of lactational amenorrhea
Complexity & benefits of human milk
- > 1000 nutrients & bioactive components
- some components have a single function, many synergize due to milk’s matrix
- nourish (supporting physical growth, development, and metabolism)
- communicate (relaying complex info
- protect (shielding the infant from infection and educating when immune system is naive)
Why should infants be introduced to nutrient-dense, developmentally appropriate food?
to complement human milk or infant formula feeding
Is it okay to introduce infants to nutrient-dense developmentally appropriate food before 4 months or after 6 months?
not recommended
Benefits of complementary foods
- adequate nutrition
- exposure to flavors, textures, and different types of foods
Importance of iron-rich foods
- iron supports neurologic development and immune function
- babies born with body stores of iron adequate for first 6 months
- human milk low in iron (77% of infants fed human milk have inadequate iron intake)
Importance of zinc-rich foods
- zinc supports growth and immune function
- zinc content in human milk declines after 6 months (54% of infants fed human milk have inadequate zinc intake)
Foods that babies should avoid
- sugar
- sodium
- honey
- unpasteurized foods & beverages
Signs of developmental readiness for beginning to eat solid foods
- being able to control head and neck
- sitting up alone or with support
3 bringing object to the mouth - trying to grasp small objects, such as toys or food
- swallowing food rather than pushing it back out
