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Repro and Sexual Health > Nutrition in Reproduction > Flashcards

Nutrition in Reproduction Flashcards

1
Q

What nutrients are particular important pre-conception?

A 
Iron 
Folic acid
Calcium
Iodine
Vitamin D 
Polyunsaturated fatty acids
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2
Q

What is the recommendation for maintaining a healthy weight in before, during and after pregnancy?

A

Meals based on starchy food
Fibre rich
5 portions of fruit and gev
Low fat
Reduce fried food; drinks and confectionery high in added sugars
Having breakfast
Reduce portion size of meals and snacks, and how often eating
Increase physical activity
Effective wt loss programmes before pregnancy

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3
Q

How much folic acid and vit D is recommended to pregnant women?

A

400 micrograms folic acid pre-conception and 1st trim

10 micrograms vit D through pregnancy and continuation if breast feeding

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4
Q

What groups are most at risk of malnutrition in pregnancy?

A

Vegan, vegetarian, GF
Underweight/ overweight
Adolescents; improper mobilization of fat storage during prenatal period
Multiple pregnancies; increased risk of depletion of maternal reserves
Low income family
Previous poor pregnancy outcome: preterm delivery, PET, IUGR
Smokers; lower levels of DHA

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5
Q

What is the role of folic acid?

A

Metabolic reactions such as biosynthesis of DNA, RNA and amino acid metabolism
NEURAL TUBE DEFECTS

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6
Q

Who should be on the higher dose of 5mg in pre-pregnancy and pregnancy?

A

Obese women
Diabetics
History of baby with NTD or HF
AEDs

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7
Q

What can folate be found in?

A

Green leafy veg
Oranges
Fortified in cereals

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8
Q

What impact can iron deficiency have in pregnancy?

A

Still birth
Essential roles in transfer of oxygen to tissues
Anaemia

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9
Q

Who is at risk for anaemia in pregnancy?

A

Young age at 1st pregnancy
Repeated pregnancies
Multiple pregnancies

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10
Q

How is iron deficiency managed in pregnancy?

A

Optimisation of age at 1st pregnancy
Increase inter-pregnancy intervals
Improve dietary intake through education
Daily or intermittent iron supplementation

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11
Q

How many extra calories should be consumed whilst pregnant?

A

70 kcal/day extra in 1st trim
260-500 kcal/day in 2nd and 3rd trim
Increase of 500 kcal/day during first 6 months of breastfeeding

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12
Q

How much extra protein should be consumed whilst pregnant?

A

1 g/day in 1st trim
8/g day in 2nd trim
26 g/day in 3rd trim

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13
Q

Is calcium important in pregnancy?

A

YES; required vitamin D to be metabolised. Can lead to neonatal hypocalcaemia = seizures
High in milk

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14
Q

What is DHA?

A

Major polyunsaturated fatty acid contained in human brain and retinal rods

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15
Q

Is fish recommended in pregnancy?

A

Yes 2 to 3 servings to optimise foetal development

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16
Q

What is vit D involved in?

A

Regulation of cytokine metabolism and in modulation of immune system, thereby contributing to embryo implantation and regulating secretion of hormones

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17
Q

How much vit D is recommended to not only pregnant women but everyone living in scotland?

A

10 micrograms/ day

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18
Q

What are the maternal risks of vit D deficiency in pregnancy?

A 
Osteomalacia
PET
GBD
C/S 
Bacterial vaginosis
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19
Q

What are the foetal risks of vit D deficiency in pregnancy?

A

SGA
Neonatal hypocalcemia
Asthma/ resp infections
Rickets

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20
Q

Foods to avoid in pregnancy?

A 
Soft cheese
Undercooked meat, cured meats, game
Tuna
Raw/ partially cooked eggs
Pate
Liver 
Vitamin and fish oil supplements
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21
Q

Who is the healthy start scheme available to?

A

Women on benefits or under 18

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22
Q

What is involved in the healthy start scheme?

A

70 mg vit C
10 micrograms vit D
400 micrograms folic acid
£3.10 per week for pregnant women, £6.20 per week for pregnant women with additional baby under 1, £3.10 per week for pregnant women with children 1-4

23
Q

What is recommended in terms of exclusive breastfeeding?

A

6 months exclusive breastfeeding

24
Q

What are the demands on the women for exclusive breastfeeding?

A

Demands of lactation exceed pre-pregnancy demands by approx 640 kcal/ day during first 6 months postpartum compared with 300 kcal/ day in last 2 trim

25
Q

What are the vitamin requirements in breastfeeding?

A

Vit D
Calcium
Less iron

26
Q

What is a low BMI?

A

<18.5

27
Q

What are the foetal and maternal risks of pregnancy in underweight women?

A

M; nutritional depletion esp if HG

F; IUGR, preterm labour, low birthweight

28
Q

What is the antenatal mx of underweight pregnant women?

A

Exclude eating disorders

USS for growth; 28, 32 and 36 weeks

29
Q

What is the labour management of underweight women?

A

Usually normal
Beware “normal blood loss” for these women will have a much bigger impact
Drug adjustments; LMWH is based on weight

30
Q

What are the maternal risks of obesity?

A 
Fertility issues 
Risks of miscarriage 
Risks of GDM 
Risks of PET 
Risk of VTE 
Infection 
Shoulder dystocia
C/S 
PPh
Depression/ MH issues
Decreased breastfeeding rates
31
Q

What are the risks to the foetus from an obese mother?

A 
Foetal anomalies
Miscarriage
Macrosomia
Still birth 
NICU admission 
Neonatal death 
Less likely to be breastfed
Increased later life risks of T2DM, CV disease
32
Q

What is the management antenatally of an obese mother?

A

High risk pregnancy; red pathway therefore obstetric led care
Higher BMI incurs higher risk
Optimum programme; nutritional advice and regular exercise, weight monitoring
Folic acid 5mg till 12 weeks
Vit D 10 mg
Low Dose Aspirin (150 mg daily from 12/40 until delivery)
VTE score
OGTT 24-28 wks
USS growth from 28 weeks
Anaesthetic review in 3rd trim (34 wks) if BMI > 40
MDT in 3rd trim if BMI >50

33
Q

What is the intrapartum management of obese women?

A

Consultant led until esp. BMI >35
Foetal monitoring difficult; Foetal scalp electrode
Determine presentation with USS
IV access
FBC and G+S
MDT plan review
Bariatric beds / avoid lithotomy position
Ranitidine regularly
Active 3rd stage; IM oxytocin (choose deltoid muscle)

34
Q

What is the management of the postpartum period in obese women?

A 
Extra monitoring if sleep apnoea
Thromboprophylaxis; TEDs don't fit, fragmin dose is weight dependent 
Support breastfeeding
Wt management
Wound problems
35
Q

What are the different types of bariatric surgery?

A

Gastric bypass
Sleeve gastrectomy
Gastric banding

36
Q

Which types of bariatric surgery confer the highest risk to nutritional deficiencies?

A

Bypass

Sleeve

37
Q

What are common vitamin deficiencies assoc with bariatric surgery?

A 
Vit D 
B12 
Folate 
Fe 
Hyperemesis; think thiamine
38
Q

What can occur due to vit A deficiency?

A

Microphthalmia

39
Q

What can occur due to vit K deficiency?

A

Cerebral haemorrhage

40
Q

What supplementation should be given to women post bariatric surgery who want to conceive?

A 
Beta carotene
Adcal D3 
Vit D 
Ferrous gluconate
Thiamine
Folic acid
Vit B12
41
Q

What contraceptive methods should be avoided in women who have had bariatric surgery?

A

Oral

42
Q

Should women who are muslim fast in ramadan?

A

No; recommend against
Islamic law gives permission for pregnant and breastfeeding women to opt out of fasting if she fears that it will harm her health or health of baby

43
Q

Good sources of iron?

A 
Pulses
Dark green veg
Wholemeal bread 
Eggs 
Fortified breakfast cereals
Dried fruit, such as apricots
44
Q

Good sources of vit B12?

A 
Milk
Cheese
Eggs
Fortified breakfast cereals
Fortified unsweetened soya drinks
Yeast extract
45
Q

Good sources of vit D?

A 
Direct sunlight
Egg yolk
Breakfast cereals
Winter milk
Plant based spreads
46
Q

What are good sources of calcium?

A 
Dark green leafy veg
Pulses
Fortified unsweetened soya, rice and oat drinks
Brown and white bread
Calcium set tofu 
Sesame seeds and tahini 
Dried fruit
47
Q

What % of GDM can be managed via diet?

A

80%

48
Q

Cut off for GDM in sign guidance?

A
  1. 1 fasting

8. 5 2hr post OGTT

49
Q

What is the advice surrounding fruit and veg in GDM?

A

5-a-day
More veg than fruit
Max 2 portions of fruit a day
Avoid dried fruit and fruit juices

50
Q

What is the advice surrounding complex carbs in GDM?

A

Required at all meal times
Reduced portion size of 30-50 g/day
Avoid 2 sources of CHO
Wholemeal options provide same amount of CHO and cals by in a different format

51
Q

What is the advice surrounding fats and spread in GDM?

A

No carbs, but high in calories

Unsaturated fats are better for a healthy heart (olive, sunflower, rapeseed oil)

52
Q

What is the advice surrounding dairy in GDM?

A

Naturally occuring sugars in milk and yoghurt
None in cheese or soya/ nut milk
Some pregnant women use milk for heartburn which impacts on BG
Limit to 150mls a day and switch to low fat greek style yoghurt which has less sugars

53
Q

In terms of labels; what should absolutely be avoided?

A

If over 22.5g per 100g

54
Q

Why is exercise very important in GDM management?

A

Increases amount of glucose used by muscles for energy - lowers bg
Insulin used more efficiently
Helps to prevent wt gain and promotes wt loss

Repro and Sexual Health (77 decks)

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