Nutrition in Reproduction Flashcards
What dietary components are recommended to achieve a healthy weight before, during and after pregnancy?
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
What social factors may make it difficult to maintain a healthy pregnancy?
- low socio-economic status
- drugs/alcohol/smoking
- poor mental or physical health
- unsupportive relationship
What myth often results in pregnant mothers eating more during their pregnancy?
- May think they need to eat for TWO (them and the baby) whereas this is not the case
How many extra calories do pregnant women need per day in Trimester 1 compared to Trimester 3?
1 = 70kcals extra per day 3 = up to 500 kcals extra per day
What groups are most at risk of nutritional deficiencies in pregnancy?
- 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
What groups should take a high dose of folic acid preconception and up until 12 weeks of pregnancy?
5mg:
- obese women/diabetics
- history of baby with Neural Tube Defects
- If on anti-epileptics
How can folates (such as folic acid) be taken from a diet?
Folates are mostly found in:
- green leafy vegetables
- fruits (e.g. oranges)
- cereals
What pregnant mothers are most at risk of iron deficiency?
- young age at first pregnancy
- repeated pregnancies
- multiple pregnancies
How can iron deficiency in pregnancy be managed/minimised?
- Optimisation of age of first pregnancy
- Increase inter-pregnancy intervals
- Improve dietary intakes through education (fish, veg)
- Daily or intermittent iron supplements
What maternal and foetal complications can result from a lack of vitamin D in pregnancy?
Maternal Risks:
- Osteomalacia, Pre-eclampsia, Gestational diabetes
Foetal Risks
- SGA, Rickets, Neonatal Hypocalcaemia, Asthma/Resp. Infection
What food-derived infections are pregnant women are at risk of?
Listeria - pâté, soft cheeses, cooked sliced meat, smoked salmon
Salmonella - raw meat and egg, unpasteurised milk
Toxoplasmosis
What is the aim of the Healthy Start scheme in the UK?
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
Exclusive breastfeeding is recommended for how long after birth?
6 months
What are the risks of having a low BMI during pregnancy?
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
Women with a high starting BMI are recommended to put more weight on during pregnancy than those with a low BMI. TRUE/FALSE?
FALSE
- lower BMI should put more weight on than women with high BMI
What maternal risk factors does obesity cause in pregnancy?
- longer time to conception
- miscarriage
- gestational diabetes
- pre-eclampsia
- shoulder dystocia COMMON
- C/Section
- PPH
What foetal risks are increased by obesity in pregnancy?
Fetal anomalies ↑ Miscarriage ↑ Macrosomia ↑ Still Birth ↑ NICU admission ↑ Neonatal Death ↑
Later life T2DM
HOw is obesity in pregnancy managed antenatally?
- 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
HOw is obesity in pregnancy managed during labour?
- 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
What problems may occur in an operative delivery of a baby in an obese patient?
IV access difficult spinal airway problems abdominal entry PPH anticipated
What advice and management should be given to obese women post-partum
- extra monitoring if sleep apnoea
- Thromboprophylaxis (TED stockings often dont fit)
- Fragmin Dose (weight dependent)
- Support breastfeeding
- Wound problems
Many women of childbearing age are undergoing bariatric surgery. What advice must be given about conception following this?
- Delay conception until weight is stable (this can take up to 1-2 years)
- If weight is not stable risk of Preterm delivery increases
What complications can bariatric surgery cause?
- nutritional deficiencies (affect absorption) Usually - Vitamin D, B12, folate
- High risk of GDM (difficult to diagnose as OGTT may be impossible)
What are the basics of managing pregnant patients who have had bariatric surgery?
- vitamins
- supplements
- avoid oral contraception due to lack of absorption
What cultural event may cause nutritional difficulties for the mother and baby?
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
What vitamins often need supplemented if a woman with a vegetarian diet is pregnant?
iron
Vit B12
Vitamin D
What vitamins often require supplementation in a vegan diet if a patient is pregnant?
iron
Vit B12
Calcium
Vitamin D
How much fruit and veg should be eaten in a pregnancy diet?
- 5-a-day
- More veg than fruit (due to sugars)
- Avoid dried fruit/fruit juices (high in sugars)
- Increase veg consumption => reduce carbs
What rules should pregnant women follow with regards to the carbs in their diet?
- portion size of 30-50g/ meal
- Avoid 2 sources of carbs
- Wholemeal options
HOw should pregnant women consume fats and spreads in their balanced diet?
- Unsaturated fats (healthy heart => olive, sunflower, rapeseed oil)
- In small amounts
How much dairy are pregnant women encouraged to have?
- 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
Why is exercise useful in gestational diabetes, and what types of exercise are recommended for pregnant women?
- 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
