Nutrition in Pregnancy Flashcards
inclusion of what in diet pre conception is vital to health in pregnancy
Iron Folic acid Calcium Iodine Vit D Polyunsaturated fatty acids
what vitamins should all women be recommended pre, during and post pregnancy
400 micrograms / day folic acid pre conception and during first trimester (1st 12 weeks)
10 micrograms throughout pregnancy and breast feeding
when should women aim to reach their optimal weight
pre conception
how many extra calories do you need during pregancy
first trim 70
260 2nd
500 3rd
what groups are most at risk (through diet) during pregnancy
exclusion diets: vegan, vegetarian, gluten free
underweight/ overweight
adolescents (improper mobilisation of fat pre natally)
multiple pregnancies (depletion of maternal reserves)
low income families
previous poor pregnancy outcome
smokers
what is folic acid important for
biosynthesis of DNA and RNA, amino acid metabolism
who should get higher folic acid doses
obese women, diabetics, Hx of baby with NTD or FH, on AED should get 5 milligrams
what foods are folates high in
green leafy veg
fruits (oranges)
cereals
offal
why is iron important in pregnancy
involved in enzyme processes
if low increases risk of still birth
role in oxygen transfer
anaemia
who is at risk of iron deficiency
young mothers
repeated pregnancies
multiple pregnancies
how do you manage iron deficiency
optimise age of first pregnancy/ increase baby intervals
improve diet - meat, fish, legumes, green leafy veg
supplementation
what extra requirements during breast feeding
640 extra calories
vit D
calcium
less iron
how much protein during pregnancy
1st trim +1g/day
2nd trirm +8g/day
3rd + 26g/day
what is required for calcium metabolism
vit D
what is the bioavailablity of calcium highest in
milk and its derivatives
mineral water
what is DHA and what is it in
Docosahexaenoic Acid (DHA: is the major polyunsaturated fatty acid contained in the human brain and retinal rods) 2 to 3 servings of fish per week during pregnancy
why is vit D important
regulation of cytokine metabolism and in the modulation of the immune system, thereby contributing to the embryo implantation and regulating the secretion of several hormones
how can you maintain vit D in pregnancy
Vitamin D supplement 10micrograms /day
deficiency worse in A/W, more pigmented skin tones, obesity, alcohol abuse, previous deficiency, bone pain
what are the maternal risks of vit D deficiency
Osteomalacia, Pre-eclampsia, Gestational diabetes, Caesarean section, Bacteria vaginosis
what are the fetal risks of vit D deficiency
SGA, Neonatal Hypocalcaemia ,Asthma/Respiratory Infection, Rickets
what are the key food related infections pregnancy women are at risk of
listeria
toxoplasmosis
salmonella
what food and drinks should you avoid in pregnancy
Soft cheese Undercooked meat, cured meats, game Tuna Raw/partially cooked eggs Pate Liver Vitamin & Fish Oil Supplements alcohol caffeine water if abroad
what is the healthy start scheme
available to pregnant women on benefits/ <18
vit supplements: c, D and folic acid
voucher for food
what are the risks in pregnancy of low BMI
Maternal- nutritional depletion esp if hyperemesis develops
Fetal- Intrauterine growth restriction
Preterm Labour
Low Birthweight
what is the antenatal management for maternal low BMI
Exclude eating disorders- manage appropriately
USS for growth 28, 32, 36 weeks
what do you need to adjust in labour if mother has low BMI
be aware of blood loss - normal volume may be large amount for her
dosage of drugs
what BMI is obese
> /= 30
what BMI is overweight
> /= 25
what BMI is underweight
<18.5
how does weight affect fertility
decreased in both low and high BMIs
what are the maternal risks of obesity
Risk of miscarriage (OR 1.31 95% CI 1.18 – 1.46)
Risk of gestational diabetes (4 – 9-fold)
Risk of pre-eclampsia (3 – 10-fold
Risk of thromboembolic disease ↑
Risk of infection ↑
Risk of labour dystocia ↑
Risk of shoulder dystocia ↑
Risk of C/S/operative delivery increased ↑
Risk of PPH ↑
Risk of infection↑
Risk for depression/MH issues ( social isolation, loss of confidence, unemployment) ↑
Reduced breastfeeding rates↑
what are the fetal risks of obesity
Fetal anomalies ↑ Miscarriage ↑ Macrosomia ↑ Still Birth ↑ NICU admission ↑ Neonatal Death ↑ Less likely to be breastfed ↑Later life risks- Type 2 diabetes, Cardiovascular disease
what is the antenatal management of obesity in pregnancy
High risk pregnancy (Red Pathway)
Counselling about risks and scan difficulties
Optimum Programme
-Nutritional advice and regular exercise
-Weight monitoring
Folic Acid 5mg till 12 weeks
Vitamin D 10mg ( healthy start vitamins – Vit C, Vit D, Folic acid 400ug)
Low Dose Aspirin ( 150 mg daily from 12/40 until delivery)
VTE score- (fragmin from booking/28 weeks – beware BMI>50)
OGTT 24-28 weeks
USS growth from 28 weeks
Anaesthetic review in third trimester ( 34 weeks) if BMI 40 or more
MDT in third trimester if BMI>50 or more
what is the intrapartum management of obesity in pregnancy
Consultant Led Unit esp BMI>35
Fetal monitoring difficult
Determine presentation with USS
IV access
FBC, G&S
Anaesthetic review- early epidural
MDT plan review- incl plan for manual handling
Bariatric beds/ avoid lithotomy on Labour bed- will tip
Ranitidine regulary- water /isotonic fluids (reduces stomach acid, heart burn)
CTG- FSE on fetal scalp
Active third stage- IM syntometrine – deep muscle covered by fat so use other muscle eg deltoid/ IV oxytocin (prevents PPH)
what needs to be done for operative delivery in obese women
Consultant Obstetrician and Anesthetist if BMI 40 or more
More assistants may be required
Extra antibiotics- preop and after
Anticipate problems- IV access, difficult spinal, airway problems, abdominal entry
Extra equipment- table extentions, Alexis O retractor
Anticipate PPH
what might be needed post partum for obesity in pregnancy
extra monitoring if sleep apnoea Thromboprophylaxis TEDs usually don’t fit Fragmin Dose weight dependent Usually for 6 weeks postnatal Support breastfeeding Weight management Wound problems
what needs to be considered in women who have had bariatric surgery
advise delaying pregnancy until weight stable
nutritional complications and deficiencies (bypass and sleeve gastrectomy affect absorption) (vit D, B12, folate, Fe)
deflate gastric bands
hyperemesis think thiamine deficiency
high risk of GDM
what is the management for maternal bariatric surgery
Fetal abnormalities Reported Neural tube defects ( folic acid def) micropthlamia due to Vit A deficiency Hypocalcaemia Cerebral haemorrhage ( Vit K def)
Supplements A-Z supplements- use beta carotene Adcal D3 1Tablet BD Vit D 25mcg Ferrous gluconate 300mg/ IV Fe Thiamine B12 50-100mg Folic acid 5mg Vit B12 1mg IM 3 monthly
Contraception- avoid oral (impaired absorption)
should muslim women avoid fasting in ramadan
yes but support them if they want to
what sources of iron for vegetarians/ vegans
Pulses
dark green vegetables
wholemeal bread
eggs(for vegetarians who include them in their diet)
fortified breakfast cereals (with added iron)
dried fruit, such as apricots
what sources of vit B 12 for vegetarians/ vegans
Milk, cheese, eggs, fortified breakfast cereals Fortified unsweetend soya drinks Fortified plant spreads Yeast extract Supplementation of Vit B12
what sources of vit D for vegetarians/ vegans
Direct sunlight Egg yolk Some breakfast cereals Winter milk Most plant based spreads Some breakfast cereals Supplementation of Vit D (10micrograms for pregnancy per day
what sources of calcium for vegans
dark green leafy vegetables pulses fortified unsweetened soya, rice and oat drinks brown and white bread calcium-set tofu sesame seeds and tahini dried fruit
how is the majority (80%) of GDM managed
diet alone
what are the diagnostic values for GDM
5.1 fasting and 8.5 after OGTT
when should GDM monitor BG
4x per day, before meals and before bed
what should GDM do after a big meal
go for a walk
what advice for fruit and veg in GDM
5-a-day
Fruit have natural sugars in them (aim for 2 per day)
Try to have more veg than fruit
1 portion of fruit= 1 palm
Avoid dried fruit and fruit juices, since high in sugars and in a more rapidly absorbed format
Don’t eat all at one go, sparse them during the day
Increase veg consumption to help reduce amount of CHOs
what advice for complex carbs in GDM
Required at all meal times
Reduced portion size of 30-50g/ meal
Avoid 2 sources of CHO
Wholemeal options provide same amount of CHO and cals but in a different format- sustaining bloods between meals
what advice for fats and spreads in GDM
high in calories unsaturated better (plant based)
what advice for airy and alternatives in pregnancy
Naturally occurring sugars in milk and yogurt
None in cheese or soya/ nut milk
Some pregnant women can use milk for heartburn, which will impact on BGs
Limit to 150mls/ day and switch to low fat greek style yogurt, which has less sugars
foods with how much sugar should you avoid
more than 25.5 g per 100g
what advice for exercise in pregnancy
all women should walk 30 mins per day
low impact exercise
high impact can harden pelvic floor, cause anaerobic metabolism and high temps which are harmful to baby, can rupture membranes
why is exercise good in GDM
- Increases amount of glucose used by muscles for energy= lowers BGs
- Insulin used more efficiently- BGs are maintained/ lower
- Helps prevent weight gain and helps reduce weight
