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Reproductive & Sexual Health > Nutrition in reproduction > Flashcards

Nutrition in reproduction Flashcards

1
Q

What is important pre-conception to ensure maternal well-being and favourable outcomes of pregnancy?

A

Consumption of a varied and balanced diet

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2
Q

What micronutrients are often lacking in industrialised societies diets?

A
  • iron
  • folic acid
  • calcium
  • iodine
  • vitamin D
  • polyunsaturated fatty acids
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3
Q

What dose of folic acid is needed pre-conception and during first trimester?

A

400 micrograms

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4
Q

What dose of vitamin D is recommended to mums and when should it be taken?

A

10 micrograms through pregnancy and through breast feeding

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5
Q

What groups are most at risk of dietary deficiencies?

A
  • exclusion diets: vegan, vege, gluten free
  • underweight/overweight
  • adolescents: improper mobilisagiton of fat stores during the prenatal period
  • multiple pregnancy: depletion of maternal reserves
  • low income family: low income of fruit & veg
  • Previous poor pregnancy outcome: reduce risk of preterm delivery, pre-eclampsia, IUGR
  • smokers: low DHA
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6
Q

Which women require a 5mg dose of folic acid?

A

Obese women, diabetics, history of baby with NTD or FH, on anti-epileptics

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7
Q

Where are folates found in food?

A

Green leafy vegetables, fruits (such as oranges), cereals and offal

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8
Q

What are iron rich foods?

A

Meat, fish, legumes and green leafy vegetables

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9
Q

Who is at risk of iron deficiency in pregnancy?

A

Young age at first pregnancy

Repeated pregnancies

Multiple pregnancies

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10
Q

How should iron deficiency in pregnancy be managed?

A
  • Optimisation of age of first pregnancy
  • Increase inter-pregnancy intervals
  • Improve dietary intakes through education
  • Daily or intermittent iron supplementation (women of child-bearing age and during pregnancy)
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11
Q

What are the essential components of diet in pregnancy?

A
  • calories
  • protein
  • fats
  • calcium
  • DHA
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12
Q

What is the calorie recommendation in pregnancy

A

70kcal/day in first trimester to 260 and 500kcal/day in the second and third

500 kcal/day in first 6 months of exclusive breastfeeding

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13
Q

What are the protein recommendations in pregnancy?

A

increased by 1g/day in the first trimester, 8g/day in second trimester and 26g/day in third trimester

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14
Q

What are the fat recommendations in pregnancy?

A

Quality is more important than total amount

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15
Q

What is the recommendation for calcium in pregnancy?

A

Requires Vitamin D

Bioavailablility of calcium highest in milk and derivatives in mineral water

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16
Q

What is the recommendation for docosahexaenoic acid?

A

Major polyunsaturated fatty acid contained in the human brain and retinal rods

2 to 3 servings of fish per week during pregnancy recommended for optimal fetal development

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17
Q

What is vitamin D required for in pregnancy and breast feeding?

A
  • regulation of cytokine metabolism
  • modulation of the immune system
  • contributing to the embryo implantation
  • regulating the secretion of several hormones
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18
Q

What dose of vitamin D supplement should be taken?

A

10 ug/day

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19
Q

What are the maternal risks of vitamin D deficiency?

A

Osteomalacia

Pre-eclampsia

Gestational diabetes

Caesarean section

Bacterial vaginosis

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20
Q

What are the foetal risks of vitamin D deficiency?

A
  • SGA
  • neonatal hypocalcaemia
  • asthma/respiratory infection
  • rickets
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21
Q

What foods should be avoided in pregnancy?

A
  • Soft cheese
  • Undercooked meat, cured meats, game
  • Tuna
  • Raw/partially cooked eggs
  • Pate
  • Liver
  • Vitamin & Fish Oil Supplements
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22
Q

Who is the healthy start programme available to and what does it provide?

A

Pregnant women;

  • on benefits
  • under age 18

Provides Vitamin supplements;

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

AND;

  • £3.10 per week to pregnant women
  • £6.20 per week to women with babies <1 year
  • £3.10 per week for children 1-4 years
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23
Q

What does breastfeeding require?

A
  • Require Vitamin D, calcium, but less iron
  • Fat stores during pregnancy but if underweight require more calories
24
Q

What are the risks to mum if she has a BMI ≤18.5kg/m2?

A

Nutritional depletion especially if hyperemesis gravidarum develops

25
Q

What are risks to foetus if mum has a BMI of ≤18.5kg/m2?

A

IUGR

Preterm labour

Low birthweight

26
Q

What is the antenatal management if mum has a BMI of ≤18.5kg/m2?

A
  • exclude eating disorder
  • USS for growth 28, 32, 36 weeks
27
Q

What is the labour management if mum has a BMI of ≤18.5kg/m2?

A

Usually normal

Beware of ‘normal blood loss’

Drug adjustments- fragmin 2500iu if booking weight <50kg

28
Q

What are the maternal risks of obesity?

A
  • miscarriage
  • gestational diabetes
  • pre-eclampsia
  • thromboembolic disease
  • infection
  • C/S delivery
  • PPH
  • depression/MH problems
29
Q

What are the foetal risks of maternal obesity?

A
  • foetal anomalies
  • miscarriage
  • macrosomia
  • still birth
  • NICU admission
  • death
  • less likely to be breastfed
  • increased lifelong risk of T2DM and CV disease
30
Q

What is the red pathway?

A

High risk pregnancy pathway

31
Q

Where shhould obese women deliver?

A

In a consultant led unit

32
Q

How can presentation be determined in obese women?

A

with USS

33
Q

What needs to be done for obese women in delivery?

A

IV access

FBC, G&S

Early epidural

Bariatric bed

Ranitidine regularly- water/isotonic fluids

CTG - FSE on foetal scalp

34
Q

How is IM syntometrine delivered in obese women?

A

Deep muscle covered in fat so use other muscle e.g. deltoid

35
Q

What do obese women require before operative delivery?

A

Extra antibiotics- pre and post op

36
Q

What problems should be anticipated in operative delivery with obese mother?

A

IV access, difficult spinal, airway problems, abdominal entry, PPH

37
Q

Describe postpartum managment for obese women?

A
  • extra monitoring if sleep apnoea
  • thromboprophylaxis
    • TEDs dont fit
    • fragmin dose weight dependent
    • 6 weeks postnatal
  • support breastfeeding
  • weight management
  • wound problems
38
Q

Which bariatric surgeries confer a high risk of nutritional deficiencies?

A

Bypass and sleeve gastrectomy as they affect absorption

39
Q

What are common nutrional deficiencies aftern bariatric surgery?

A

Vitamin D, B12, folate, iron

40
Q

Why is hyperemesis relevant in mothers who have had bariatric surgery?

A

Thiamine deficiency

41
Q

How should monitoring of GDM be carried out in women who have had bariatric surgery?

A

OGTT may be impossible

HBA1C, FBS, BG monitoring

42
Q

What supplements are essential in women who have had bariatric surgery?

A
  • A-Zsupplents- use beta carotene
  • Adcal D3 1 Tablet BD
  • Vit D 25mcg
  • Ferrous gluconate 300mg/ IV Fe
  • Thiamine B12 50-100mg
  • Folic acid 5mg
  • Vit B12 1mg IM 3 monthly
43
Q

What monitoring is essential in bariatric patients in pregnancy?

A
  • Ca
  • PO4
  • Ferritin
  • Vitamin A, D, E, K
  • Mg
  • FBC
  • U&E
  • LFT
  • Zn
  • Cu
44
Q

What foetal abnormalities are seen in mothers who have had bariatric surgery?

A
  • Neural tube defects ( folic acid def)
  • micropthlamia due to Vit A deficiency
  • Hypocalcaemia
  • Cerebral haemorrhage (Vit K def)
45
Q

What aspects of culture and nutrition should be considered in pregnancy?

A
  • OTC supplements
  • OTC herbal remedies
  • muslim- fasting
46
Q

What are the dietary sources of iron?

A
  • Pulses
  • dark green vegetables
  • wholemeal bread
  • eggs (for vegetarians who include them in their diet)
  • fortified breakfast cereals (with added iron)
  • dried fruit, such as apricots
47
Q

What are the dietary sources of B12?

A
  • Milk
  • cheese
  • eggs
  • fortified breakfast cereals
  • fortified unsweetened soya drinks
48
Q

What are the sources of Vitamin D?

A
  • Direct sunlight
  • egg yolk
  • some breakfast cereals
  • winter milk
  • most plant based spreads
49
Q

What are dietary sources of calcium for vegans?

A
  • dark green leafy vegetables
  • pulses
  • fortified unsweetened soya, rice and oat drinks
  • brown and white bread
  • calcium-set tofu
  • sesame seeds and tahini
  • dried fruit
50
Q

What are dietary sources of B12 for vegans?

A
  • fortified breakfast cereals
  • Fortified unsweetened soya drinks
  • Fortified plant spreads
  • Yeast extract
  • Supplementation of VitB12
51
Q

What is the recommendation for fruit and veg in GDM?

A
  • 5 a day
  • Try to have more veg than fruit
  • 1 portion of fruit= 1 palm
  • Avoid dried fruit and fruit juices, since high in sugars and in a more rapidly absorbed format
  • Don’t eat all at one go, spread them during the day
  • Increase veg consumption to help reduce amount of CHOs
52
Q

What are the recommendations for complex carbohydrates in GDM?

A
  • Required at all meal times
  • Reduced portion size of 30-50g/ meal
  • Avoid 2 sources of CHO
  • Wholemeal options provide same amount of CHO and cals but in a different format- sustaining bloods between meals
  • Different tolerance to carbs
53
Q

What is the advice on fats and spreads in GDM?

A

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

Small amounts

54
Q

What is the advice for dairy and alternatives in GDM?

A
  • Naturally occurring sugars in milk and yogurt
  • None in cheese or soya/ nut milk
  • Some pregnant women can use milk for heartburn, which will impact on BGs
  • Limit to 150mls/ day and switch to low fat greek style yogurt, which has less sugars
55
Q

Why is exercise particularly useful in GDM?

A
  1. increases amount of glucose used by muscles for energy= lowers BG
  2. Insulin used more efficiently- BGs are maintained/lower
  3. helps prevent weight gain and reduce weight

Reproductive & Sexual Health (54 decks)

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