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REPRODUCTION & GYNAECOLOGY > Nutrition in Reproduction > Flashcards

Nutrition in Reproduction Flashcards

1
Q

What dietary components are recommended to achieve a healthy weight before, during and after pregnancy?

A

meals based on:

  • starchy foods
  • fibre-rich foods
  • 5 fruit and vegetables each day
  • low-fat diet (Reduce fried food; added sugars)
  • Reduced portion size
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2
Q

What social factors may make it difficult to maintain a healthy pregnancy?

A
  • low socio-economic status
  • drugs/alcohol/smoking
  • poor mental or physical health
  • unsupportive relationship
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3
Q

What myth often results in pregnant mothers eating more during their pregnancy?

A
  • May think they need to eat for TWO (them and the baby) whereas this is not the case
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4
Q

How many extra calories do pregnant women need per day in Trimester 1 compared to Trimester 3?

A 
1 = 70kcals extra per day
3 = up to 500 kcals extra per day
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5
Q

What groups are most at risk of nutritional deficiencies in pregnancy?

A
  • Exclusion diets : Vegetarian, Vegan, GF
  • Underweight /Overweight before pregnancy
  • Adolescents: Improper mobilisation of fat storage
  • Multiple preg. - depletion of maternal reserves
  • Previous poor pregnancy outcome
  • Smokers
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6
Q

What groups should take a high dose of folic acid preconception and up until 12 weeks of pregnancy?

A

5mg:

  • obese women/diabetics
  • history of baby with Neural Tube Defects
  • If on anti-epileptics
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7
Q

How can folates (such as folic acid) be taken from a diet?

A

Folates are mostly found in:

  • green leafy vegetables
  • fruits (e.g. oranges)
  • cereals
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8
Q

What pregnant mothers are most at risk of iron deficiency?

A
  • young age at first pregnancy
  • repeated pregnancies
  • multiple pregnancies
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9
Q

How can iron deficiency in pregnancy be managed/minimised?

A
  • Optimisation of age of first pregnancy
  • Increase inter-pregnancy intervals
  • Improve dietary intakes through education (fish, veg)
  • Daily or intermittent iron supplements
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10
Q

What maternal and foetal complications can result from a lack of vitamin D in pregnancy?

A

Maternal Risks:
- Osteomalacia, Pre-eclampsia, Gestational diabetes

Foetal Risks
- SGA, Rickets, Neonatal Hypocalcaemia, Asthma/Resp. Infection

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11
Q

What food-derived infections are pregnant women are at risk of?

A

Listeria - pâté, soft cheeses, cooked sliced meat, smoked salmon

Salmonella - raw meat and egg, unpasteurised milk

Toxoplasmosis

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12
Q

What is the aim of the Healthy Start scheme in the UK?

A

Available to pregnant women:
On benefits
< 18 yrs

Vitamin supplements

  • 70mg vitamin C
  • 10µg vitamin D
  • 400µg folic acid

+ Vouchers to buy discounted fruit/veg

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13
Q

Exclusive breastfeeding is recommended for how long after birth?

A

6 months

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14
Q

What are the risks of having a low BMI during pregnancy?

A

Maternal

  • nutritional depletion esp if hyperemesis develops
  • Beware “normal blood loss” may be lots for small person
  • Drug adjustments for low weight (e.g. fragmin)

Foetal

  • Intrauterine growth restriction
  • Preterm Labour
  • Low Birthweight
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15
Q

Women with a high starting BMI are recommended to put more weight on during pregnancy than those with a low BMI. TRUE/FALSE?

A

FALSE

- lower BMI should put more weight on than women with high BMI

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16
Q

What maternal risk factors does obesity cause in pregnancy?

A
  • longer time to conception
  • miscarriage
  • gestational diabetes
  • pre-eclampsia
  • shoulder dystocia COMMON
  • C/Section
  • PPH
17
Q

What foetal risks are increased by obesity in pregnancy?

A 
Fetal anomalies ↑
Miscarriage ↑
Macrosomia ↑
Still Birth ↑
NICU admission ↑
Neonatal Death ↑

Later life T2DM

18
Q

HOw is obesity in pregnancy managed antenatally?

A
  • High risk pregnancy (Red Pathway => consultant led)
  • Counselling about risks and scan difficulties
  • Optimum Programme
    => Nutritional advice and regular exercise
  • Weight monitoring
  • Folic Acid 5mg till 12 weeks
  • Low Dose Aspirin and fragmin from booking (VTE)
  • OGTT 24-28 weeks
  • USS growth from 28 weeks
  • Anaesthetic review
19
Q

HOw is obesity in pregnancy managed during labour?

A
  • MDT plan - incl. manual handling
  • Bariatric beds/ avoid lithotomy position (bed tips back)
  • Ranitidine regulary (decrease stomach acid)
  • In 3rd stage - IM syntometrine (must use muscle not covered by fat) eg deltoid
  • OR use IV oxytocin
20
Q

What problems may occur in an operative delivery of a baby in an obese patient?

A 
IV access
difficult spinal
airway problems
abdominal entry
PPH anticipated
21
Q

What advice and management should be given to obese women post-partum

A
  • extra monitoring if sleep apnoea
  • Thromboprophylaxis (TED stockings often dont fit)
  • Fragmin Dose (weight dependent)
  • Support breastfeeding
  • Wound problems
22
Q

Many women of childbearing age are undergoing bariatric surgery. What advice must be given about conception following this?

A
  • Delay conception until weight is stable (this can take up to 1-2 years)
  • If weight is not stable risk of Preterm delivery increases
23
Q

What complications can bariatric surgery cause?

A
  • nutritional deficiencies (affect absorption) Usually - Vitamin D, B12, folate
  • High risk of GDM (difficult to diagnose as OGTT may be impossible)
24
Q

What are the basics of managing pregnant patients who have had bariatric surgery?

A
  • vitamins
  • supplements
  • avoid oral contraception due to lack of absorption
25
Q

What cultural event may cause nutritional difficulties for the mother and baby?

A

Muslim- Ramadan

  • pregnant women should avoid fasting
  • Islamic law gives permission to opt out
  • If mother chooses still to fast she must be supported in this
26
Q

What vitamins often need supplemented if a woman with a vegetarian diet is pregnant?

A

iron
Vit B12
Vitamin D

27
Q

What vitamins often require supplementation in a vegan diet if a patient is pregnant?

A

iron
Vit B12
Calcium
Vitamin D

28
Q

How much fruit and veg should be eaten in a pregnancy diet?

A
  • 5-a-day
  • More veg than fruit (due to sugars)
  • Avoid dried fruit/fruit juices (high in sugars)
  • Increase veg consumption => reduce carbs
29
Q

What rules should pregnant women follow with regards to the carbs in their diet?

A
  • portion size of 30-50g/ meal
  • Avoid 2 sources of carbs
  • Wholemeal options
30
Q

HOw should pregnant women consume fats and spreads in their balanced diet?

A
  • Unsaturated fats (healthy heart => olive, sunflower, rapeseed oil)
  • In small amounts
31
Q

How much dairy are pregnant women encouraged to have?

A
  • Use milk alternatives if JUST having milk (normal milk has natural sugars)
  • limit normal milk to 150ml/day
  • switch to low fat greek style yogurt, which has less sugars
32
Q

Why is exercise useful in gestational diabetes, and what types of exercise are recommended for pregnant women?

A
  • Increases amount of glucose used by muscles for energy = lowers Blood glucose
  • Insulin used efficiently
  • Prevents weight gain and reduces weight
  • Walking (30 mins/day) or swimming are recommended forms of exercise in pregnancy

REPRODUCTION & GYNAECOLOGY (58 decks)

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