Nutrition in Pregnancy

Question 1

how does being underweight affect fertility?

Answer 1

reduced fertility
twice as likely to take more than a year to fall pregnant
caused by hormone imbalances that affect ovulation

Question 2

how does obesity affect fertility?

Answer 2

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

Question 3

risks to mother in obesity?

Answer 3

reduced fertility
risk of miscarriage
gestational diabetes
pre-eclampsia

Question 4

risks to the foetus in obesity?

Answer 4

stillbirth
metabolic abnormalities - macrosomnia
fetal defects and congenital anomalies

Question 5

risks to child after birth in obesity?

Answer 5

high birth weights and long term obesity
diabetes
cardio-metabolic abnormalities

Question 6

what is the “thrifty pheontype”?

Answer 6

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

Question 7

dietry advice to achieve and maintain a health weight before, during and after pregnancy?

Answer 7

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

Question 8

what supplements are given to all pregnant women?

Answer 8

400mcg folic acid for 3 months pre-conception and first trimester
10mcg Vit D through pregnancy and continuation of breastfeeding

Question 9

nutritional needs in pregnancy?

Answer 9

only really change in last 3 months

only slightly increase (not eating for 2)

Question 10

5mg folic acid is recommended for which women?

Answer 10

obese
diabetic
history of baby with neural tube defects or family history
on antiepileptics

Question 11

risks of low Vit D in pregnancy?

Answer 11

maternal
- osteomalacia
- pre-eclampsia
- gestational diabetes
- C section
- bacterial vaginosis
fetal
- small for dates
- hypocalcaemia
- asthma/resp infection
- rickets

Question 12

who is at risk of iron deficiency?

Answer 12

young age at first pregnancy
repeated pregnancy
multiple pregnancy

Question 13

how is iron deficiency managed in pregnancy?

Answer 13

optimise age of first pregnancy
increase inter-pregnancy interval
improve dietary intake
daily or intermittent iron supplementation

Question 14

when is Vit A given? what is the risk?

Answer 14

only in cystic fibrosis

teratogenic in high doses

Question 15

what is the healthy start scheme?

Answer 15

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

Question 16

what foods should be avoided in pregnancy?

Answer 16

soft cheese
undercooked meat
cured meats
game
tuna
raw/partially cooked eggs
pate
liver
vitamin and fish oil supplements

Question 17

nutritional demands if exclusively breastfeeding?

Answer 17

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

Question 18

recommended weight gain in pregnancy?

Answer 18

if underweight = 12.5 - 18kg
BMI 18.5 - 24.9 = 11.5 - 16kg
BMI 25 - 29.9 = 7 - 11.5kg
BMI 30+ = 5-9kg

Question 19

maternal risks of obesity?

Answer 19

diabetes
hypertension
thrombosis
infection

Question 20

fetal risks of obesity?

Answer 20

macrosomnia
NICU admission
still birth
neonatal death

Question 21

how is the majority of gestational diabetes managed?

Answer 21

diet alone (80%)

Question 22

fruit and veg recommendations?

Answer 22

5 a day
more veg than fruit
1 portion = 1 palm
space out through day

Question 23

complex carbohydrates recommendations?

Answer 23

required at all meal times
reduced portion size of 30-50g/meal
avoid 2 sources
better to have in a wholemeal format

Question 24

dairy recommendations?

Answer 24

limit to 150mls per day and switch to low fat greek style yogurt (less sugar)