Nutrition in Reproduction Flashcards
What is essential in ensuring maternal well-being and favourable pregnancy outcomes?
Consumption of a varied and balanced diet in the pre-conception period
What are some micronutrients that are commonly deficient during pregnancy?
Iron, folic acid, calcium, iodine, vitamin D, polyunsaturated fatty acids
What are the recommendations for achieving a healthy weight?
Meals based on starchy foods, fibre rich foods, low fat diet, reduce fried foods and refined sugars, reduce portion size, increase physical activity
What micronutrients are prescribed to all women during pregnancy?
Folic acid = 400mcg preconception and first trimester
Vitamin D = 10mcg through pregnancy and if breastfeeding
What are the groups most at risk of having a nutritional deficiency during pregnancy?
Exclusion diets = vegetarian, vegan, gluten free
Underweight/overweight or smokers
Multiple pregnancies or low family incomes
Previous poor pregnancy outcome or adolescent
What are the normal roles of folates?
Play crucial role in many metabolic reactions such as biosynthesis of DNA and RNA
When would you give 5mg of folic acid, rather than the usual 400mcg?
Obese women, diabetics, history of baby with NTD or FH, taking anti-epileptics
What are some natural sources of folic acid?
Green leafy vegetables, fruit, cereals, offal
What are some natural sources of iron?
Meat, fish, legumes, green leafy vegetables
What is the normal role of iron?
Involved in numerous enzymatic processes and plays essential roles in transfer of oxygen to tissues
What can iron supplements increase the risk of?
Stillbirth
What does iron deficiency cause?
Anaemia = affects 22% of women of childbearing age in Europe
What groups are most at risk of iron deficiency?
Young age at first pregnancy, repeated pregnancies, multiple pregnancies
What are some ways to lower risk of iron deficiency?
Increase interpregnancy intervals and improve dietary intake
How many extra calories should be consumed during pregnancy?
70 kcal/day in first trimester
260 kcal/day in second trimester
500 kcal/day in third trimester
How many extra calories should be consumed while breastfeeding?
500 kcal/day during first 6 months of exclusive breastfeeding
How much should protein intake increase by during pregnancy?
Increase RDA by 1 g/day in first trimester, 8 g/day in second trimester and 26 g/day in third trimester
What is DHA?
Major polyunsaturated fatty acid in human brain and retinal rods
How much DHA is recommended during pregnancy?
2-3 servings of fish per week
Why is vitamin D important during pregnancy?
Involved in regulation of cytokines and immune modulation = contributes to embryo implantation and regulates secretion of several hormones
What are some risk factors for vitamin D deficiency?
Autumn/winter months, pigmented/covered skin, obesity, bone pain, GITY disease, previous deficiency, alcohol abuse
What are the maternal risks associated with vitamin D deficiency?
Osteomalacia, pre-eclampsia, gestational diabetes, C-section, bacterial vaginosis
What are the foetal risks associated with vitamin D deficiency?
SGA, neonatal hypocalcaemia, asthma, respiratory infection, Rickett’s
What are some foods to avoid during pregnancy?
Soft cheese, tuna, undercooked meats, cured meats, raw/partially cooked eggs, pate, liver, vitamin and fish oil supplements
What women have access to the Healthy Start scheme?
Pregnant women on benefits or under age 18
What supplements are given under the Healthy Start scheme?
70mg vitamin C, 10mcg vitamin D and 400mcg of folic acid
How much money in vouchers is given under the Healthy Start scheme?
£3.10 per week for pregnant women
£6.20 per week for babies <1 year
£3.10 per week for children added 1-4 years
What does nutrient need during breastfeeding depend on?
Volume and composition of milk produced
Mother’s nutrient needs and nutritional status
What micronutrients do women need when they are breastfeeding?
Vitamin D and calcium, but need less iron
What effect does being underweight have on fertility?
Reduces fertility = twice as likely to take more than 1 year to conceive if BMI <= 18.5
What are the risk of being underweight during pregnancy?
Maternal nutritional depletion, foetal intrauterine growth restriction, preterm labour, low birth weight
What is the antenatal management for underweight women?
Exclude eating disorder
US for growth at 28, 32 and 36 weeks gestation
What is the labour management for underweight women?
Usually normal but beware of “normal blood loss”
May need dose adjustments = 2500iu fragmin if booking weight <50kg
What are the maternal risks of obesity during pregnancy?
Ovulatory dysfunction, miscarriage, gestational diabetes, pre-eclampsia, thromboembolic disease, infection, labour/shoulder dystocia, C-section, PPH, depression, reduced rate of breastfeeding
What are the foetal risks of obesity during pregnancy?
Foetal anomalies, miscarriage, macrosomia, stillbirth, NICU admission, neonatal death, type 2 diabetes and CV disease in later life
What is the antenatal management for obese women?
Red pathway for high risk pregnancy Regular exercise and weight monitoring VTE score and OGTT at 24-28 weeks USS for growth from 28 weeks Anaesthetic review at 34 weeks if BMI >=40
What is given to obese women antenatally?
5mg folic acid until 12 weeks gestation
10mcg vitamin D
150mg aspirin daily from 12 weeks until delivery
What is the intrapartum management for obese women during pregnancy?
Consultant led unit = especially if BMI >35
IV access and USS to determine presentation
Foetal monitoring difficult = CTG-FSE on foetal scalp
Early epidural, bariatric beds and regular ranitidine
IM syntometrine for active third stage of labour
What is the postpartum management for obese women?
Extra monitoring if sleep apnoea present
Thromboprophylaxis with fragmin for 6 weeks postnatally = dose is weight dependent
What are the features of the operative delivery for an obese woman?
Consultant obstetrician and anaesthetist is BMI >=40
Need extra antibiotics and additional staff
May have airway problems and anticipate PPH
What are women advised to do following bariatric surgery in regards to conception?
Delay conception until weight stable = 1-2 years
What are the types of bariatric surgery?
Gastric bypass, sleeve gastrectomy, gastric banding
What types of bariatric surgery are associated with a high risk of deficiency?
Bypass and sleeve gastrectomy = deficiency of vitamin D, folate, B12 and iron common
What are some foetal anomalies associated with bariatric surgery?
Neural tube defects = folic acid deficiency
Hypocalcaemia
Microphthalmia = vitamin A deficiency
Cerebral haemorrhage = vitamin K deficiency
What type of contraception should be avoided in women who have had bariatric surgery?
Oral contraception
What supplements are given following bariatric surgery?
A-Z supplements = Adcal D3 twice daily, 25mcg vitamin D, 300mg ferrous gluconate, 50-100mg B12, 5mg folic acid
Why should Muslim women avoid fasting during Ramadan?
Higher risk of ketosis
How are most women with gestational diabetes managed?
Most can be managed by diet alone (80%)
What are some sources of iron for women following a vegetarian diet?
Pulses, dark green vegetables, wholemeal bread, eggs, fortified breakfast cereals, dried fruits
What are some sources of vitamin B12 for women following a vegetarian diet?
Milk, cheese, eggs, fortified breakfast cereals and unsweetened soya drinks
What are some sources of vitamin D for women following a vegetarian diet?
Direct sunlight, egg yolk, some breakfast cereals, winter milk, most plant based spreads
What are some sources of iron for women following a vegan diet?
Pulses, dark green vegetables, wholemeal bread, fortified breakfast cereal, dried fruit
What are some sources of calcium for women following a vegan diet?
Dark green leafy vegetables, pulses, fortified unsweetened soya and oat drinks, brown and white bread, calcium set tofu, dried fruit, sesame seeds, tahini
What are some sources of vitamin B12 for women following a vegan diet?
Fortified breakfast cereals and plant based spreads, yeast extract, fortified unsweetened soya drinks, supplements
What are some sources of vitamin D for women following a vegan diet?
Direct sunlight, fortified plant spreads, some breakfast cereals, supplements
What are the recommendations for fruit and vegetable intake during pregnancy?
5-a-day = aim for more veg than fruit as fruit has natural sugars
Avoid dried fruits and fruit juices = high in sugar
1 portion of fruit = 1 palm
What are the recommendations for complex carbohydrate intake during pregnancy?
Required at all meals = portion of 30-50g per meal
Avoid having 2 sources in one meal
Wholemeal better = sustains bloods between meals
What are the recommendations for fats and spreads during pregnancy?
High in calories so take small amounts
Unsaturated fats better for healthy heart
What are the recommendations for dairy and its alternatives?
Cheese and soya/nut milk better = avoid natural sugars present in milk and yogurt
Limit to 150ml/day and switch to low fat greek yogurt
What food group is best to avoid/limit intake from?
Foods high in fat, salt or sugar = avoid anything with 25.5g of sugar or more per 100g
Why is exercise beneficial for gestational diabetes?
Increases amount of glucose used by muscles for energy = lowers blood glucose
Insulin used more efficiently
Helps prevent weight gain and reduces weight
