Nutrition Flashcards
what dietary components are recommended to achieve a healthy weight before, during and after pregnancy?
meals based on:
- starchy foods
- fibre rich foods
- 5 fruit and veg per day
- low fat diet
- reduced portion size
what social factors may make it difficult to maintain a healthy pregnancy?
low socio-economic status
drugs / alcohol / smoking
poor mental or physical health
unsupportive relationship
what myth often occurs in pregnant mothers eating more during their pregnancy?
may think they need to eat for two - this is not true
how many extra calories do pregnant women need per day in trimester 1 compared to trimester 3?
1 = 70kcals per day
3 = up to 500kcals per day
what groups are most at risk of nutritional deficiencies in pregnancy?
exclusion diets - vegetarian, vegan, GF
underweight / overweight before pregnancy
adolescents - improper mobilisation of fat storage
multiple pregnancy - depletion of maternal reserves
previous poor pregnancy outcome
smokers
which groups should take a high dose of folic acid preconception and up until 12 weeks?
5mg
- obese women / diabetics
- history of baby with neural tube defects
- if on anti-epileptics
how can folates be taken from a diet?
green leafy vegetables
fruits (eg oranges)
cereals
what pregnant mothers are most at risk of iron deficiency?
young age at first pregnancy
repeated pregnancies
multiple pregnancies
how can iron deficiency in pregnancy be managed / minimised?
optimisation of age of first pregnancy
increase inter-pregnancy intervals
improve dietary intakes through education (fish, veg)
daily or intermittent iron supplements
what maternal and foetal complications can result from lack of vitamin D in pregnancy?
maternal risks
- osteomalacia, pre-eclampsia, GDM
foetal risks
- SGA, rickets, neonatal hypoglycaemia, asthma / resp infection
what food-derived infections are pregnant women at risk of?
listeria - pate, soft cheeses, cooked sliced meat, smoked salmon
salmonella - raw meat and egg, unpasteurised milk
toxoplasmosis
what is the aim of the healthy start scheme in the UK?
available to pregnant women who are on benefits and those <18
vitamin supplements:
- 70mg vitamin C
- 10ug vitamin D
- 400ug folic acid
+ vouchers to buy discounted fruit / veg
exclusive breastfeeding is recommended for how long after birth?
6 months
what are the risks of having a low BMI during pregnancy?
maternal
- nutritional depletion esp if hyperemesis develops
- beware “normal blood loss” may be lots for small person
- drug adjustments for low weight (eg fragmin)
foetal
- IUGR
- preterm labour
- low birthweight
women with a high starting BMI are recommended to put more weight on during pregnancy than those with low BMI - true or false?
false
- lower BMI should put more weight on than women with high BMI
what maternal risk factors does obesity cause in pregnancy?
longer time to conception miscarriage gestational diabetes pre-eclampsia shoulder dystocia c-section PPH
what foetal risk factors are increased by obesity in pregnancy?
fetal anomalies ↑ miscarriage ↑ macrosomia ↑ still Birth ↑ NICU admission ↑ neonatal Death ↑
later life T2DM
how is obesity in pregnancy managed antenatally?
high risk pregnancy (red pathway - consultant led)
- counselling about risks and scan difficulties
- optimum programme
nutritional advice and regular exercise
- weight monitoring
- folic acid 5mg till 12 weeks
- low dose aspirin and fragmin from booking (VTE)
- OGTT 24-28 weeks
- USS growth from 28 weeks
- anaesthetic review
how is obesity in pregnancy managed during labour?
MDT plan - inc manual handling
bariatric beds / avoid lithotomy position (bed tips back)
ranitidine regularly (decrease stomach acid)
in 3rd stage - IM syntometrine (must use muscle not covered by fat eg deltoid)
or use IV oxytocin
what problems may occur in an operative delivery of a baby in an obese patient?
IV access difficult spinal airway problems abdominal entry PPH anticipated
what advice and management should be given to obese women post-partum?
extra monitoring if sleep apnoea thromboprophylaxis (TED stockings often dont fit) fragmin dose (weight dependent) support breastfeeding wound problems
many women of childbearing age are undergoing bariatric surgery - what advice must be given about conception following this?
delay conception until weight is stable (can take 1-2 years)
if weight is not stable then risk of preterm delivery increases
what complications can bariatric surgery cause?
nutritional deficiencies (affect absorption - usually vitamin D, B12 and folate)
high risk of GDM (difficult to diagnose as OGTT may be impossible)
what are the basics of managing pregnant patients who have had bariatric surgery?
vitamins
supplements
avoid oral contraception due to lack of absorption
what cultural event may cause nutritional difficulties for mother and baby?
muslim - ramadan
- pregnant women should avoid fasting
- however, if chooses to then must be supported in this
what vitamins often needed supplemented if a woman with a vegetarian diet is pregnant?
iron
vit B12
vitamin D
what vitamins often require supplementation in a vegan diet if a patient is pregnant?
iron
vit B12
calcium
vitamin D
how much fruit and veg should be eaten in a pregnancy diet?
5 a day
more veg than fruit (due to sugars)
avoid dried fruit / fruit juices
increase veg consumption and reduce carbs
what rules should pregnant women follow with regards to the carbs in their diet?
portion size of 30-50g/meal
avoid 2 sources of carbs
wholemeal options
how should pregnant women consume fats and spreads in their diet?
unsaturated fats (healthy heart = olive, sunflower, rapeseed oil) in small amounts
how much dairy are pregnant women encouraged to have?
use milk alternative if just having milk (normal milk has natural sugars)
limit normal milk to 150ml/day
switch to low fat greek style yoghurt, which has less sugars
why is exercise useful in GDM and what types of exercise are recommended for pregnant women?
increases amounts of glucose used by muscles for energy = lowers blood glucose
insulin used efficiently
prevents weight gain and reduces weight
walking (30mins/day) or swimming are recommended forms of exercise in pregnancy
