Nutrition in reproduction Flashcards
What is important pre-conception to ensure maternal well-being and favourable outcomes of pregnancy?
Consumption of a varied and balanced diet
What micronutrients are often lacking in industrialised societies diets?
- iron
- folic acid
- calcium
- iodine
- vitamin D
- polyunsaturated fatty acids
What dose of folic acid is needed pre-conception and during first trimester?
400 micrograms
What dose of vitamin D is recommended to mums and when should it be taken?
10 micrograms through pregnancy and through breast feeding
What groups are most at risk of dietary deficiencies?
- 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
Which women require a 5mg dose of folic acid?
Obese women, diabetics, history of baby with NTD or FH, on anti-epileptics
Where are folates found in food?
Green leafy vegetables, fruits (such as oranges), cereals and offal
What are iron rich foods?
Meat, fish, legumes and green leafy vegetables
Who is at risk of iron deficiency in pregnancy?
Young age at first pregnancy
Repeated pregnancies
Multiple pregnancies
How should iron deficiency in pregnancy be managed?
- 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)
What are the essential components of diet in pregnancy?
- calories
- protein
- fats
- calcium
- DHA
What is the calorie recommendation in pregnancy
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
What are the protein recommendations in pregnancy?
increased by 1g/day in the first trimester, 8g/day in second trimester and 26g/day in third trimester
What are the fat recommendations in pregnancy?
Quality is more important than total amount
What is the recommendation for calcium in pregnancy?
Requires Vitamin D
Bioavailablility of calcium highest in milk and derivatives in mineral water
What is the recommendation for docosahexaenoic acid?
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
What is vitamin D required for in pregnancy and breast feeding?
- regulation of cytokine metabolism
- modulation of the immune system
- contributing to the embryo implantation
- regulating the secretion of several hormones
What dose of vitamin D supplement should be taken?
10 ug/day
What are the maternal risks of vitamin D deficiency?
Osteomalacia
Pre-eclampsia
Gestational diabetes
Caesarean section
Bacterial vaginosis
What are the foetal risks of vitamin D deficiency?
- SGA
- neonatal hypocalcaemia
- asthma/respiratory infection
- rickets
What foods should be avoided in pregnancy?
- Soft cheese
- Undercooked meat, cured meats, game
- Tuna
- Raw/partially cooked eggs
- Pate
- Liver
- Vitamin & Fish Oil Supplements
Who is the healthy start programme available to and what does it provide?
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
What does breastfeeding require?
- Require Vitamin D, calcium, but less iron
- Fat stores during pregnancy but if underweight require more calories
What are the risks to mum if she has a BMI ≤18.5kg/m2?
Nutritional depletion especially if hyperemesis gravidarum develops
What are risks to foetus if mum has a BMI of ≤18.5kg/m2?
IUGR
Preterm labour
Low birthweight
What is the antenatal management if mum has a BMI of ≤18.5kg/m2?
- exclude eating disorder
- USS for growth 28, 32, 36 weeks
What is the labour management if mum has a BMI of ≤18.5kg/m2?
Usually normal
Beware of ‘normal blood loss’
Drug adjustments- fragmin 2500iu if booking weight <50kg
What are the maternal risks of obesity?
- miscarriage
- gestational diabetes
- pre-eclampsia
- thromboembolic disease
- infection
- C/S delivery
- PPH
- depression/MH problems
What are the foetal risks of maternal obesity?
- foetal anomalies
- miscarriage
- macrosomia
- still birth
- NICU admission
- death
- less likely to be breastfed
- increased lifelong risk of T2DM and CV disease
What is the red pathway?
High risk pregnancy pathway
Where shhould obese women deliver?
In a consultant led unit
How can presentation be determined in obese women?
with USS
What needs to be done for obese women in delivery?
IV access
FBC, G&S
Early epidural
Bariatric bed
Ranitidine regularly- water/isotonic fluids
CTG - FSE on foetal scalp
How is IM syntometrine delivered in obese women?
Deep muscle covered in fat so use other muscle e.g. deltoid
What do obese women require before operative delivery?
Extra antibiotics- pre and post op
What problems should be anticipated in operative delivery with obese mother?
IV access, difficult spinal, airway problems, abdominal entry, PPH
Describe postpartum managment for obese women?
- extra monitoring if sleep apnoea
- thromboprophylaxis
- TEDs dont fit
- fragmin dose weight dependent
- 6 weeks postnatal
- support breastfeeding
- weight management
- wound problems
Which bariatric surgeries confer a high risk of nutritional deficiencies?
Bypass and sleeve gastrectomy as they affect absorption
What are common nutrional deficiencies aftern bariatric surgery?
Vitamin D, B12, folate, iron
Why is hyperemesis relevant in mothers who have had bariatric surgery?
Thiamine deficiency
How should monitoring of GDM be carried out in women who have had bariatric surgery?
OGTT may be impossible
HBA1C, FBS, BG monitoring
What supplements are essential in women who have had bariatric surgery?
- 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
What monitoring is essential in bariatric patients in pregnancy?
- Ca
- PO4
- Ferritin
- Vitamin A, D, E, K
- Mg
- FBC
- U&E
- LFT
- Zn
- Cu
What foetal abnormalities are seen in mothers who have had bariatric surgery?
- Neural tube defects ( folic acid def)
- micropthlamia due to Vit A deficiency
- Hypocalcaemia
- Cerebral haemorrhage (Vit K def)
What aspects of culture and nutrition should be considered in pregnancy?
- OTC supplements
- OTC herbal remedies
- muslim- fasting
What are the dietary sources of iron?
- 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
What are the dietary sources of B12?
- Milk
- cheese
- eggs
- fortified breakfast cereals
- fortified unsweetened soya drinks
What are the sources of Vitamin D?
- Direct sunlight
- egg yolk
- some breakfast cereals
- winter milk
- most plant based spreads
What are dietary sources of calcium for vegans?
- 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
What are dietary sources of B12 for vegans?
- fortified breakfast cereals
- Fortified unsweetened soya drinks
- Fortified plant spreads
- Yeast extract
- Supplementation of VitB12
What is the recommendation for fruit and veg in GDM?
- 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
What are the recommendations for complex carbohydrates in GDM?
- 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
What is the advice on fats and spreads in GDM?
Unsaturated fats ar better for a healthy heart (olive, sunflower, rapeseed oil)
Small amounts
What is the advice for dairy and alternatives in GDM?
- 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
Why is exercise particularly useful in GDM?
- increases amount of glucose used by muscles for energy= lowers BG
- Insulin used more efficiently- BGs are maintained/lower
- helps prevent weight gain and reduce weight
