Nutrition in Reproduction Flashcards
What nutrients are particular important pre-conception?
Iron Folic acid Calcium Iodine Vitamin D Polyunsaturated fatty acids
What is the recommendation for maintaining a healthy weight in before, during and after pregnancy?
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
How much folic acid and vit D is recommended to pregnant women?
400 micrograms folic acid pre-conception and 1st trim
10 micrograms vit D through pregnancy and continuation if breast feeding
What groups are most at risk of malnutrition in pregnancy?
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
What is the role of folic acid?
Metabolic reactions such as biosynthesis of DNA, RNA and amino acid metabolism
NEURAL TUBE DEFECTS
Who should be on the higher dose of 5mg in pre-pregnancy and pregnancy?
Obese women
Diabetics
History of baby with NTD or HF
AEDs
What can folate be found in?
Green leafy veg
Oranges
Fortified in cereals
What impact can iron deficiency have in pregnancy?
Still birth
Essential roles in transfer of oxygen to tissues
Anaemia
Who is at risk for anaemia in pregnancy?
Young age at 1st pregnancy
Repeated pregnancies
Multiple pregnancies
How is iron deficiency managed in pregnancy?
Optimisation of age at 1st pregnancy
Increase inter-pregnancy intervals
Improve dietary intake through education
Daily or intermittent iron supplementation
How many extra calories should be consumed whilst pregnant?
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
How much extra protein should be consumed whilst pregnant?
1 g/day in 1st trim
8/g day in 2nd trim
26 g/day in 3rd trim
Is calcium important in pregnancy?
YES; required vitamin D to be metabolised. Can lead to neonatal hypocalcaemia = seizures
High in milk
What is DHA?
Major polyunsaturated fatty acid contained in human brain and retinal rods
Is fish recommended in pregnancy?
Yes 2 to 3 servings to optimise foetal development
What is vit D involved in?
Regulation of cytokine metabolism and in modulation of immune system, thereby contributing to embryo implantation and regulating secretion of hormones
How much vit D is recommended to not only pregnant women but everyone living in scotland?
10 micrograms/ day
What are the maternal risks of vit D deficiency in pregnancy?
Osteomalacia PET GBD C/S Bacterial vaginosis
What are the foetal risks of vit D deficiency in pregnancy?
SGA
Neonatal hypocalcemia
Asthma/ resp infections
Rickets
Foods to avoid in pregnancy?
Soft cheese Undercooked meat, cured meats, game Tuna Raw/ partially cooked eggs Pate Liver Vitamin and fish oil supplements
Who is the healthy start scheme available to?
Women on benefits or under 18
What is involved in the healthy start scheme?
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
What is recommended in terms of exclusive breastfeeding?
6 months exclusive breastfeeding
What are the demands on the women for exclusive breastfeeding?
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
What are the vitamin requirements in breastfeeding?
Vit D
Calcium
Less iron
What is a low BMI?
<18.5
What are the foetal and maternal risks of pregnancy in underweight women?
M; nutritional depletion esp if HG
F; IUGR, preterm labour, low birthweight
What is the antenatal mx of underweight pregnant women?
Exclude eating disorders
USS for growth; 28, 32 and 36 weeks
What is the labour management of underweight women?
Usually normal
Beware “normal blood loss” for these women will have a much bigger impact
Drug adjustments; LMWH is based on weight
What are the maternal risks of obesity?
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
What are the risks to the foetus from an obese mother?
Foetal anomalies Miscarriage Macrosomia Still birth NICU admission Neonatal death Less likely to be breastfed Increased later life risks of T2DM, CV disease
What is the management antenatally of an obese mother?
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
What is the intrapartum management of obese women?
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)
What is the management of the postpartum period in obese women?
Extra monitoring if sleep apnoea Thromboprophylaxis; TEDs don't fit, fragmin dose is weight dependent Support breastfeeding Wt management Wound problems
What are the different types of bariatric surgery?
Gastric bypass
Sleeve gastrectomy
Gastric banding
Which types of bariatric surgery confer the highest risk to nutritional deficiencies?
Bypass
Sleeve
What are common vitamin deficiencies assoc with bariatric surgery?
Vit D B12 Folate Fe Hyperemesis; think thiamine
What can occur due to vit A deficiency?
Microphthalmia
What can occur due to vit K deficiency?
Cerebral haemorrhage
What supplementation should be given to women post bariatric surgery who want to conceive?
Beta carotene Adcal D3 Vit D Ferrous gluconate Thiamine Folic acid Vit B12
What contraceptive methods should be avoided in women who have had bariatric surgery?
Oral
Should women who are muslim fast in ramadan?
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
Good sources of iron?
Pulses Dark green veg Wholemeal bread Eggs Fortified breakfast cereals Dried fruit, such as apricots
Good sources of vit B12?
Milk Cheese Eggs Fortified breakfast cereals Fortified unsweetened soya drinks Yeast extract
Good sources of vit D?
Direct sunlight Egg yolk Breakfast cereals Winter milk Plant based spreads
What are good sources of calcium?
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
What % of GDM can be managed via diet?
80%
Cut off for GDM in sign guidance?
- 1 fasting
8. 5 2hr post OGTT
What is the advice surrounding fruit and veg in GDM?
5-a-day
More veg than fruit
Max 2 portions of fruit a day
Avoid dried fruit and fruit juices
What is the advice surrounding complex carbs in GDM?
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
What is the advice surrounding fats and spread in GDM?
No carbs, but high in calories
Unsaturated fats are better for a healthy heart (olive, sunflower, rapeseed oil)
What is the advice surrounding dairy in GDM?
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
In terms of labels; what should absolutely be avoided?
If over 22.5g per 100g
Why is exercise very important in GDM management?
Increases amount of glucose used by muscles for energy - lowers bg
Insulin used more efficiently
Helps to prevent wt gain and promotes wt loss
