Nutrition During Pregnancy 2

Question 1

Weight gain

Answer 1

Recommendations influenced by prepregnancy status of the mother. If in healthy range, weight gain of 10-14kg- reduced LBW baby, lower risk of complications
1/3 - foetus
Body fat changes, placenta, amniotic fluid, increased extracellular fluid, blood supply of Mother
2-3kg fat gain
For an obese woman may deduct this fat need from recommended weight gain

Question 2

Postpartum weight retention

Answer 2

Concern over preg weight gain and long term obesity
6-7kg lost at delivery
At loss difficult in women who gained greater than 20kg or with low activity levels
Normal weight gain - 1kg heavier at 1 year postpartum
Lactating/ breastfeeding women lose slightly more

Question 3

Energy requirements

Answer 3

Additional 1200-1300kJ/d but depends on trimester
Second 1.4MJ
Third 1.9MJ
Assessing caloric intake by weight gain, no noticeable oedema, not eating for two with caloric intake

9 cups of fluid. Recommended water, diluted fruit juice and other unsweetened beverages

Question 4

Carbohydrates, artificial sweeteners and alcohol

Answer 4

Carb intake (50-65%)
Basic foods veg, fruits and whole grains with fibers are best choice
Artificial sweeteners have no evidence of harm
Alcohol ingestion strongly advised to avoid

Question 5

Protein

Answer 5

+14g/d or approx. 60g/d in second and third trimester
Average intake of typical female in Aus is significantly more
May be difficult for vegos and vegans

Question 6

Fat

Answer 6

Approx 33% of calories from fat
Fat consumed in foods is used as an energy source for foetal growth and development
Serves as a source of fat soluble vitamins
Provides essential fatty acids
Maternal intake of omega3 fatty acids and pregnancy outcome
- adequate EPA and DHA during pregnancy and lactation linked to higher intelligence, better vision and more mature CNS
- dietary intake recommendations for EPA and DHA do not exceed 3G/d

Question 7

Folate

Answer 7

Increased requirements 400-600mg
Functions:
Metabolic reactions
Deficiencies lead to abnormal cell division and tissue formation
Folate and congenital abnormalities
Neural tube defects
Malformations of the spinal cord and brain (spina bifida, ancephaly, encephalocele)
Associated with anaemia and reduced foetal growth
Folate requirements increased- extensive organ and tissue growth
Sources: fruit, veg and whole grains

Question 8

Other vitamins and minerals

Answer 8

Vit A- needed for cell differentiation. In Aus concern for toxicity and birth defects -teratogenicity
Vit D- supports foetal growth and immune system. Deficiency associated with GDM
Iodine- maternal thyroid hormone production increases by approx 50% in early pregnancy, thus increasing demand for iodine - required for thyroid function and energy production and for foetal brain development
Fluoride- teeth begin to develop- not recommended to supplement
Sodium- restriction not indicated in normal pregnancy or control of oedema or high blood pressure. Plays a critical role in maintaining body’s water balance

Question 9

Calcium

Answer 9

Increase by 600mg
Foetal skin mineralisation and maintain maternal bones
Calcium and release of lead from bones
- low intake of calcium are related to increased release of lead - harmful to foetus
- needs can be met with three cups of milk or calcium fortified soy milk or other adequate sources of calcium

Question 10

Iron

Answer 10

RDI: from 18 to 27 approx
309mg for foetus and scents, 250mg lost at deliver, 450mg for increased RBC
Iron deficiency anaemia- preterm delivery, late pregnancy - lower score on intelligence, language, gross motor and attention tests. Low haemoglobin with signs of iron deficiency plus paleness, exhaustion and rapid heart rate.
Iron deficiency- condition marked by depleted iron stores sign weakness, fatigue, short attention span, poor appetite, increased susceptibility to infection and irritability

Supplementation
Absorbed better when mixed with other minerals
Amount absorbed depends on the need and amount of iron in supplement
Side effects: nausea, cramps, gas and constipation
May interfere with zinc absorption

Question 11

Caffeine

Answer 11

No apparent long term consequences for children
Does increase iron absorption and high intake increases risk of miscarriage and LBW
Limit 300mg/d (3cups of tea or instant coffee)

Question 12

Healthy diets for pregnancy

Answer 12

Effect of taste and smell changes during pregnancy on intake
May lead to change in taste and smell
pica may result, an eating disorder of non-food substances

Question 13

Assessment of dietary intake

Answer 13

Cultural considerations
Evaluations of:
Dietary intakes
Weight status
Biomarkers of nutrient status 
Vitamin and mineral supplementation 
Herbal remedies 

Multivitamin and mineral prenatal supplements recommended. But nutrients should be met by a well balanced diet. Iron is exception, recommended for inadequate diets, multifetal pregnancy, smokers, drinkers, vegans or diagnosed nutrient deficiencies

Question 14

Herbs to avoid

Answer 14

Aloe Vera 
Anise 
Black cohosh 
Black Haw 
Blue cohosh 
Borage
Buckthorn 
Comfrey 
Cotton root
Dandelion keen
Ephedra 
Ergot feverfew 
Ginseng
Juniper
Licorice 
Raspberry Leaf

Question 15

Exercise and pregnancy outcomes

Answer 15

No evidence that moderate or vigorous exercise undertaken by healthy women is harmful
Recommendation is 3-5 times a week for 30mins at 60-70% VO2 max

Question 16

Food safety concerns

Answer 16

Foodborne:
Listeria monocytogenes
Toxoplasma gondii

Mercury contamination:
High levels in large, long lived predatory fish
Lower content in bottom feeders
Avoid shark, swordfish, king mackerel and title fish

Question 17

Common health problems

Answer 17

*Nausea and vomiting
- hypermesis gravidarum: severe N/V during pregnancy
- management n/v
Separate liquid and food intake, avoid odours and foods that trigger NV
- dietary supplements for treatment
- b6, multivitamins, ginger

*heartburn
- management oh heartburn
Ingest small meals frequently
Do not go to bed with full stomach
Avoid foods that make heartburn worse

*constipation
Consume dietary fiber with water
Laxative pills of recommended

Question 18

Obesity

Answer 18

Associated with higher rates of GDM and hypertensive disorders
^ blood glucose levesls
^ C-reactive proteins
^ blood levels of insulin and insulin resistance
^ blood pressure
High total LDL cholesterol and triglycerides
Low HDL cholesterol

Higher rates of 
Stillbirth 
Large GA newborns 
C-section delivery 
Increased risk of obesity or T2DM in child in later life 

Recommendations:
Meet nutrient needs
Consume a variety of basic foods 
Participate in physical activity 
Maintain appropriate rates of weight gain

Question 19

Preeclampsia- eclampsia

Answer 19

A pregnancy specific syndrome occurring >20 weeks gestation accompanied by proteinuria (urinary excretion of >0.3g protein in 24 hour urine sample, or >30mg/dl protein or >2 on dipstick reading.
Eclampsia- occurrence of seizures not attributed to other causes
Hypertension

Oxidative stress, inflammation and endothelial dysfunction
Blood vessel spasms and construction, increased BP
Adverse maternal immune system responses to placenta
Platelet aggregation and blood coagulation due to defects in prostacyclin relative to thromboxane
Insulin resistance
Elevated TGs, cholesterol and FFAs
Increased albumin (uri protein)
Decreased plasma vol exp
Low urine output
Persistent and severe headaches
Sensitivity of eyes to bright lights
Blurred vision
Abdominal pain
Nausea
Signs and symptoms range from mild to severe

Question 20

Health caonsequences of eclampsia/ pre-eclampsia

Answer 20

Early delivery by C section
Acute renal (kidney) dysfunction
Increased risk of gestational diabetes, hypertension and T2DM later in life
Abruptio placenta (rupture of placenta)
Newborn growth restrictions
Respiratory distress syndrome in new born

Cause is unknown. Already to originate from abnormal implantation and vascularisation of placenta with poor blood flow.

Question 21

Diabetes and consequences

Answer 21

T1D, T2D, GDM
GDM
- up to 8% of pregnant women in Aus will develop. Women who develop appear to be predisposed to insulin resistance in type 2 diabetes
- associated with increased levels of blood glucose, triglycerides, fatty acids and blood pressure
- pregnant women screened between 26-28 weeks

Elevated risk from Morher- risk of adverse outcomes
- spontaneous abortion, stillbirth or neonatal death
- congenital abnormalities
- increased insulin leads to increased glucose uptake and triglyceride formation in foetus
Foetal changes increased likelihood later in life of insulin resistance and or t2D, high Bp, obesity

Question 22

Diabetes risk factors

Answer 22

Inherited predisposition 
Excess body fat 
Low pa levels 
Weight gain bw pregnancies 
Underweight 
Aged over 35
Native American, Hispanic, African American, south or East Asian, Pacific Islander, indigenous Aus 
Family history 
Chronic hypertension 
History of GDM in previous pregnancy 
Low fiber intake, high glycaemic load

Question 23

Diabetes diagnosis

Answer 23

Glucose screening recommended for women at high risk- marked obesity, diabetes in parent or sibling, history of glucose intolerance, previous macrosomic infant, current glucosuria

Glucose screening
First screen: 50g oral glucose challenge test- if elevated, 3 hour 100g oral glucose tolerance test (OGTT) is given
Gestational diabetes diagnosed if two of the following exceeded-
overnight fast 95mg/dl
1 hour after glucose load 180mg/dl
2 hours after glucose load 155mg/dl
3 hours after glucose load 140mg/dl

Low risk women not needing glucose screens
Age lower than 25
Not Hispanic etc
No diabetes in first degree relatives
Normal prepregnancy weight and normal weight gain during pregnancy
No history of glucose intolerance
No prior obstetrical outcomes

Question 24

Diabetes treatment

Answer 24

First approach normalise BGL With diet and exercise
If postprandial glucose remains high 2 weeks after sharing to diet and exercise, insulin injections are aged
Medical nutrition therapy decreases risk of adverse perinatal outcomes
Regular aerobic exercise decreases insulin resistance and blood glucose is gestational diabetes
Exercise should approximate 50-60% of VO2 max 3 times per week

Assess dietary and exercise habits
Develop individualised diet and exercise plan
Monitor weight gain
Interpret BGL and urinary ketone results
Ensure follow up during/ after pregnancy

Urinary ketone testing- monitored with dipsticks
Postpartum follow up- 15% will remain glucose intolerant postpartum. 10-15% will develop type 2 in 2-5 years
Prevention- reduce excessive weight and obesity, increase physical activity, decrease insulin resistance prior to pregnancy

Question 25

Foetal alcohol spectrum

Answer 25

Describes range of effects that foetal alcohol exposure has on mental development and physical growth.
Behavioural problems
Mental retardation
Aggressiveness
Nervousness and short attention span
Stunting growth and birth defects
Foetal exposure to alcohol is a leading preventable cause of birth defects

Alcohol easily crosses placenta to foetus
Remains in foetal circulation because foetus lacks enzymes to break down alcohol
Exposure during critical periods of growth can permanently impair organ and tissue formation, growth, health and mental development
Heavy drinking increases risk of miscarriage, stillbirth and infant death
Approx 49% of foetuses born to women who drink heavily will have foetal alcohol syndrome.
Safe dose not identified, so recommendation is no alcohol

Foetal alcohol syndrome characteristic
Abnormalities of eyes, Nose, heart and CNS
Growthnretardation, small head, mental retardation