Nutrition in Pregnancy Flashcards
how does being underweight affect fertility?
reduced fertility
twice as likely to take more than a year to fall pregnant
caused by hormone imbalances that affect ovulation
how does obesity affect fertility?
reduced fertility
less chance of getting pregnant overall
more likely to take over a year
perturbations to the hypothalamic-pituitary-ovarian axis causes menstrual cycle disturbance
3X more likely to suffer oligo/anovulation
impairs endometrial development and implantation
PCOS
risks to mother in obesity?
reduced fertility
risk of miscarriage
gestational diabetes
pre-eclampsia
risks to the foetus in obesity?
stillbirth
metabolic abnormalities - macrosomnia
fetal defects and congenital anomalies
risks to child after birth in obesity?
high birth weights and long term obesity
diabetes
cardio-metabolic abnormalities
what is the “thrifty pheontype”?
programming of the foetus that may result from adaptations invoked by fetal malnutrition
fetal malnutrition > down regulation of developmental processes during gestation (ie metabolic adaptation) > insulin resistance and impaired glucose tolerance making individual able to retain as much energy as possible > prepares the fetus to live in energy sparse environment in life > if infant then encounters an energy abundant environment, those adaptations increase risk of type 2 diabetes
dietry advice to achieve and maintain a health weight before, during and after pregnancy?
meals based on starchy foods
fibre-rich
5 fruit and veg
low fat
reduce fried foods and sugary foods/drinks
eat breakfast
reduce portion size and frequency of meals and snacks
what supplements are given to all pregnant women?
400mcg folic acid for 3 months pre-conception and first trimester
10mcg Vit D through pregnancy and continuation of breastfeeding
nutritional needs in pregnancy?
only really change in last 3 months
only slightly increase (not eating for 2)
5mg folic acid is recommended for which women?
obese
diabetic
history of baby with neural tube defects or family history
on antiepileptics
risks of low Vit D in pregnancy?
maternal - osteomalacia - pre-eclampsia - gestational diabetes - C section - bacterial vaginosis fetal - small for dates - hypocalcaemia - asthma/resp infection - rickets
who is at risk of iron deficiency?
young age at first pregnancy
repeated pregnancy
multiple pregnancy
how is iron deficiency managed in pregnancy?
optimise age of first pregnancy
increase inter-pregnancy interval
improve dietary intake
daily or intermittent iron supplementation
when is Vit A given? what is the risk?
only in cystic fibrosis
teratogenic in high doses
what is the healthy start scheme?
scheme available to all pregnant women on benefits or under 18
includes vitamin supplements (vit C, D and folic acid) and vouchers for milk etc
what foods should be avoided in pregnancy?
soft cheese undercooked meat cured meats game tuna raw/partially cooked eggs pate liver vitamin and fish oil supplements
nutritional demands if exclusively breastfeeding?
demands of lactation exceed pre-pregnancy demands by around 640kcal/day during first 6 months post partum
- only 300kcal extra in last 2 trimesters of pregnancy
require vit D and calcium but less iron
more calories if underweight but generally have fat stores from pregnancy
recommended weight gain in pregnancy?
if underweight = 12.5 - 18kg
BMI 18.5 - 24.9 = 11.5 - 16kg
BMI 25 - 29.9 = 7 - 11.5kg
BMI 30+ = 5-9kg
maternal risks of obesity?
diabetes
hypertension
thrombosis
infection
fetal risks of obesity?
macrosomnia
NICU admission
still birth
neonatal death
how is the majority of gestational diabetes managed?
diet alone (80%)
fruit and veg recommendations?
5 a day
more veg than fruit
1 portion = 1 palm
space out through day
complex carbohydrates recommendations?
required at all meal times
reduced portion size of 30-50g/meal
avoid 2 sources
better to have in a wholemeal format
dairy recommendations?
limit to 150mls per day and switch to low fat greek style yogurt (less sugar)
