Nutrition in Pregnancy and Lactation

Question 1

describe how gestational diabetes can affect the fetus

Answer 1

• screening for gestational diabetes = 24-28 weeks of gestation
• can lead to fetal macrosomia

Question 2

describe importance of DHA in pregnancy and lactation

Answer 2

omega-3 fatty acid

• pregnancy:
  
  • promotes fetal brain and eye development
• foods = fish, eggs, flaxseed, walnuts

Question 3

describe the importance of iron in preg. and lactation

Answer 3

• expansion of maternal tissues, including RBC mass
• build iron stores in fetal liver
• maintain additional iron content of placenta
• fetal development and hemoglobin formation in fetus

Question 4

describe folate in preg. and lact.

Answer 4

• required for purine and thymidine synthesis for nucleic acids
• increased maternal erythropoiesis increases folate needs during 2nd and 3rd trimester
• suplementation is critical before and during the first 4 weeks of pregnancy to prevent neural tube defects (NTD)

Question 5

describe important of calcim in preg. and lact.

Answer 5

• mother does not need to consume more since there is increased absorption of Ca from the food
• growth and development of bones and teeth
• decrease risk of pregnancy related HPT and pre-eclampsia

Question 6

describe importance of vit. A in preg. and lact.

Answer 6

• function:
  
  • regulation of gene expression
  • cell prolif. and differentiation
  • vision
  • immunity
• increased vit. A supplements (>10,000 IU) are considered teratogenic

Question 7

describe importance of zinc in preg. and lact

Answer 7

• important for synthesis of DNA and RNA
• poor nutritional zinc status:
  
  • low birth weight
  • premature delivery
  • congenital anomalies

Question 8

describe importance of iodine deficiency in preg. and lact.

Answer 8

• maternal iodine deficiency can lead to congenital hypothyroidism
  
  • may lead to cretinism and result in irreversible development delay and development of brain
• babies have microglossia (large protruding tongue)

Question 9

describe colostrum

Answer 9

• produced by mother’s breasts from birth to 4 days after
• WHO recommends exclusive breastfeeding up to 6 months

Question 10

describe the mechanism of milk production

Answer 10

• when the placenta is delivered, progesterone levels drop and trigger milk production
• prolactin stimulates milk production
• oxyocin stimulates milk excretion

Question 11

describe the phases of breast milk

Answer 11

• colostrum (early milk)
  
  • produced in late preg. to 4 days after birth
  • rich in antibodies (IgA)
• transitional milk
  
  • from 4-10 days after delivery
  • lower in protein compared to colostrum
• mature milk
  
  • approx >10 day til termination of breastfeeding

Question 12

describe the micronutrients in breastmilk

Answer 12

• adequacy of vitamins A and B6
• vit. D insufficient in breast milk
  
  • advise taking babies into sunlight
• breast milk is poor source of iron and zinc
  
  • cannot be improved with maternal supplementation
    
    • prenatal stores sufficient for most babies until 6 months

Question 13

describe infant benefits of breastfeeding

Answer 13

• reduces risk of infxns
• promotes development of the immature gut
• reduces risk of infant allergy

Question 14

describe breastfeeding and HIV

Answer 14

• if there are no antiretroviral drugs and formula is available, avoid breastfeeding completely
• if antiretroviral drugs are not available and formula feeding not possible, breastfeed for first few months of life (3-4 x lower risk of transmission than longer duration)