Nutrition Case 1: Prenatal Vitamins

Question 1

what vitamins (if any) are required before pregnancy and why?

Answer 1

1. folic acid (prevent neural tube defects)
2. calcium and vitamin D (can get delpleted in pregnancy)
3. Iron (can get depleted in pregnancy)
4. iodine (helps make thyroid hormones important to promoting pregnancy)
5. B12 helps nervous system relating to reproduction and conception

Question 2

should a woman supplement with folic acid when trying to get pregnant?

Answer 2

yes. Not very much found in food, water soluble so low toxicity and the benefits (preventing neural tube) are significant

Question 3

if a woman is considered low risk for a neural tube pregnancy (no family history or past miscarriage etc) then how much folic acid should she take and for how long?

Answer 3

0.4mg/day for 2-3 months b4 becoming pregnant and then continue until breastfeeding stops

Question 4

is a woman is considered moderate risk (family relative with neural tube pregnancy), how much folic acid should she take and for how long?

Answer 4

1mg/day for at least 3 months b4 conception and until the 12th week of pregnancy, then can decrease to 0.4mg until done breastfeeding

Question 5

if a woman is considered higher risk (has had neural tube pregancy before) what dose of folic acid should she take and for how long?

Answer 5

4mg for at least 3 months before conception and 12 weeks into pregnancy, then can decrease to 0.4-1mg until end of pregnancy

Question 6

if you are going to recommend a folic acid regimen to a woman, what information do you need?

Answer 6

risk factors (family history and personal history surrounding pregnancy with neural tube defects), medical conditions and medications that may warrant higher or lower dosing, amount of folate/folic acid in diet

Question 7

under what conditions would a patient be given a different dose of folic acid?

Answer 7

1. kidney / liver problems

2. can interact with certain drugs (such as methotrexate) and may require higher or lower dosing

Question 8

are there any adverse/toxic effects of folic acid supplementation? what are the concerns if any?

Answer 8

can potentially mask the signs of a B12 deficiency, large unmetabolized doses could potentially increase cancer risk, depression, or cognitive impairment

Question 9

should folic acid be taken on a full or empty stomach to help absorption?

Answer 9

empty

Question 10

what is folate

Answer 10

a water-soluble B vitamin

Question 11

what is folic acid?

Answer 11

synthetic form of folate

Question 12

what is the active form of folate? what is its function?

Answer 12

tetrahydrofolic acid; acts as cofactor in carbon reduction reactions to turn nucleotides into aa

Question 13

what amino acids are made by tetrahydrofolic acid?

Answer 13

methionine, cysteine, serine, glycine, histidine

Question 14

is folic acid and folate equivalent Mcg per mcg?

Answer 14

no

Question 15

for every mcg of folic acid with meals, ____mcg of def are provided

Answer 15

1.7

Question 16

for every mcg of folic acid on an empty stomach, ___mcg of DEF are provided

Answer 16

2

Question 17

folate as many ____ moieties while folic acid exists soley as ___

Answer 17

polyglutamate; monoglutamate

Question 18

monoglutamate forms are carried into the cell where they are changed into ____ , the majorcirculating form of folate in the body

Answer 18

5-methyltetrahydrofolate

Question 19

folic acid in supplement forms is assumed to have ___% bioavailability

Answer 19

100

Question 20

give three examples of foods rich in folate/ folic acid

Answer 20

beans/legume, dark green veggies, fortified foods (enriched flower, cornmeal, enriched pasta)

Question 21

what is the daily requirement of DFE for women?

Answer 21

600ug

Question 22

what are 2 drug classes that can impede the absorption of folate?

Answer 22

1. anticonvusants

2. bile acid sequestrants

Question 23

give 3 examples of anticonvulsants that reduce folate absorption

Answer 23

primidone, phentoin, phenobarbital

Question 24

give 2 examples of bile acid sequestrants that lower folate absorption

Answer 24

cholestyramine and colestipol

Question 25

give 4 examples of drugs that inhibit folate metabolism

Answer 25

1. high dose NSAIDs
2. dihydrofolate reductase inhibitors (methotrexate)
3. thymidylate synthetase inhibitors (5-fluorouracil)
4. silver sulfadiazine (topical antibiotic)

Question 26

give 3 examples of drugs with anti-folate activity

Answer 26

1. triamterene (anti-hypertensive)
2. trimethoprim (antibiotic)
3. sulfasalazine (treatment for IBD)

Question 27

NTD occur with the failed ___ of the neural tube or incomplete ___ during fetal development

Answer 27

closing; neurulation

Question 28

NTD can cause what diseases/disorders?

Answer 28

spina bifida, anencephaly and encephalocele

Question 29

neural tube normation occurs during what stage of pregnancy?

Answer 29

week 3-4

Question 30

the neural plate appears a thickening of the ___

Answer 30

embryonic ectoderm

Question 31

maternal or family history of cardiac, limb, cleft palate, urininary tract, congenital hydrocephaly puts the mother in what risk category?

Answer 31

moderate

Question 32

maternal diabetes, kidney dialysis, use of folate-inhibitors and GI malabsorption diseases like Chron’s disease, celiac, gastric bypass put the pregnancy in what risk category for NTD?

Answer 32

moderate