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Nutrition in Reproduction Flashcards

1
Q

What is essential in ensuring maternal well-being and favourable pregnancy outcomes?

A

Consumption of a varied and balanced diet in the pre-conception period

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2
Q

What are some micronutrients that are commonly deficient during pregnancy?

A

Iron, folic acid, calcium, iodine, vitamin D, polyunsaturated fatty acids

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3
Q

What are the recommendations for achieving a healthy weight?

A

Meals based on starchy foods, fibre rich foods, low fat diet, reduce fried foods and refined sugars, reduce portion size, increase physical activity

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4
Q

What micronutrients are prescribed to all women during pregnancy?

A

Folic acid = 400mcg preconception and first trimester

Vitamin D = 10mcg through pregnancy and if breastfeeding

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5
Q

What are the groups most at risk of having a nutritional deficiency during pregnancy?

A

Exclusion diets = vegetarian, vegan, gluten free
Underweight/overweight or smokers
Multiple pregnancies or low family incomes
Previous poor pregnancy outcome or adolescent

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6
Q

What are the normal roles of folates?

A

Play crucial role in many metabolic reactions such as biosynthesis of DNA and RNA

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7
Q

When would you give 5mg of folic acid, rather than the usual 400mcg?

A

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

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8
Q

What are some natural sources of folic acid?

A

Green leafy vegetables, fruit, cereals, offal

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9
Q

What are some natural sources of iron?

A

Meat, fish, legumes, green leafy vegetables

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10
Q

What is the normal role of iron?

A

Involved in numerous enzymatic processes and plays essential roles in transfer of oxygen to tissues

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11
Q

What can iron supplements increase the risk of?

A

Stillbirth

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12
Q

What does iron deficiency cause?

A

Anaemia = affects 22% of women of childbearing age in Europe

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13
Q

What groups are most at risk of iron deficiency?

A

Young age at first pregnancy, repeated pregnancies, multiple pregnancies

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14
Q

What are some ways to lower risk of iron deficiency?

A

Increase interpregnancy intervals and improve dietary intake

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15
Q

How many extra calories should be consumed during pregnancy?

A

70 kcal/day in first trimester
260 kcal/day in second trimester
500 kcal/day in third trimester

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16
Q

How many extra calories should be consumed while breastfeeding?

A

500 kcal/day during first 6 months of exclusive breastfeeding

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17
Q

How much should protein intake increase by during pregnancy?

A

Increase RDA by 1 g/day in first trimester, 8 g/day in second trimester and 26 g/day in third trimester

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18
Q

What is DHA?

A

Major polyunsaturated fatty acid in human brain and retinal rods

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19
Q

How much DHA is recommended during pregnancy?

A

2-3 servings of fish per week

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20
Q

Why is vitamin D important during pregnancy?

A

Involved in regulation of cytokines and immune modulation = contributes to embryo implantation and regulates secretion of several hormones

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21
Q

What are some risk factors for vitamin D deficiency?

A

Autumn/winter months, pigmented/covered skin, obesity, bone pain, GITY disease, previous deficiency, alcohol abuse

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22
Q

What are the maternal risks associated with vitamin D deficiency?

A

Osteomalacia, pre-eclampsia, gestational diabetes, C-section, bacterial vaginosis

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23
Q

What are the foetal risks associated with vitamin D deficiency?

A

SGA, neonatal hypocalcaemia, asthma, respiratory infection, Rickett’s

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24
Q

What are some foods to avoid during pregnancy?

A

Soft cheese, tuna, undercooked meats, cured meats, raw/partially cooked eggs, pate, liver, vitamin and fish oil supplements

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25
Q

What women have access to the Healthy Start scheme?

A

Pregnant women on benefits or under age 18

26
Q

What supplements are given under the Healthy Start scheme?

A

70mg vitamin C, 10mcg vitamin D and 400mcg of folic acid

27
Q

How much money in vouchers is given under the Healthy Start scheme?

A

£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

28
Q

What does nutrient need during breastfeeding depend on?

A

Volume and composition of milk produced

Mother’s nutrient needs and nutritional status

29
Q

What micronutrients do women need when they are breastfeeding?

A

Vitamin D and calcium, but need less iron

30
Q

What effect does being underweight have on fertility?

A

Reduces fertility = twice as likely to take more than 1 year to conceive if BMI <= 18.5

31
Q

What are the risk of being underweight during pregnancy?

A

Maternal nutritional depletion, foetal intrauterine growth restriction, preterm labour, low birth weight

32
Q

What is the antenatal management for underweight women?

A

Exclude eating disorder

US for growth at 28, 32 and 36 weeks gestation

33
Q

What is the labour management for underweight women?

A

Usually normal but beware of “normal blood loss”

May need dose adjustments = 2500iu fragmin if booking weight <50kg

34
Q

What are the maternal risks of obesity during pregnancy?

A

Ovulatory dysfunction, miscarriage, gestational diabetes, pre-eclampsia, thromboembolic disease, infection, labour/shoulder dystocia, C-section, PPH, depression, reduced rate of breastfeeding

35
Q

What are the foetal risks of obesity during pregnancy?

A

Foetal anomalies, miscarriage, macrosomia, stillbirth, NICU admission, neonatal death, type 2 diabetes and CV disease in later life

36
Q

What is the antenatal management for obese women?

A 
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
37
Q

What is given to obese women antenatally?

A

5mg folic acid until 12 weeks gestation
10mcg vitamin D
150mg aspirin daily from 12 weeks until delivery

38
Q

What is the intrapartum management for obese women during pregnancy?

A

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

39
Q

What is the postpartum management for obese women?

A

Extra monitoring if sleep apnoea present

Thromboprophylaxis with fragmin for 6 weeks postnatally = dose is weight dependent

40
Q

What are the features of the operative delivery for an obese woman?

A

Consultant obstetrician and anaesthetist is BMI >=40
Need extra antibiotics and additional staff
May have airway problems and anticipate PPH

41
Q

What are women advised to do following bariatric surgery in regards to conception?

A

Delay conception until weight stable = 1-2 years

42
Q

What are the types of bariatric surgery?

A

Gastric bypass, sleeve gastrectomy, gastric banding

43
Q

What types of bariatric surgery are associated with a high risk of deficiency?

A

Bypass and sleeve gastrectomy = deficiency of vitamin D, folate, B12 and iron common

44
Q

What are some foetal anomalies associated with bariatric surgery?

A

Neural tube defects = folic acid deficiency
Hypocalcaemia
Microphthalmia = vitamin A deficiency
Cerebral haemorrhage = vitamin K deficiency

45
Q

What type of contraception should be avoided in women who have had bariatric surgery?

A

Oral contraception

46
Q

What supplements are given following bariatric surgery?

A

A-Z supplements = Adcal D3 twice daily, 25mcg vitamin D, 300mg ferrous gluconate, 50-100mg B12, 5mg folic acid

47
Q

Why should Muslim women avoid fasting during Ramadan?

A

Higher risk of ketosis

48
Q

How are most women with gestational diabetes managed?

A

Most can be managed by diet alone (80%)

49
Q

What are some sources of iron for women following a vegetarian diet?

A

Pulses, dark green vegetables, wholemeal bread, eggs, fortified breakfast cereals, dried fruits

50
Q

What are some sources of vitamin B12 for women following a vegetarian diet?

A

Milk, cheese, eggs, fortified breakfast cereals and unsweetened soya drinks

51
Q

What are some sources of vitamin D for women following a vegetarian diet?

A

Direct sunlight, egg yolk, some breakfast cereals, winter milk, most plant based spreads

52
Q

What are some sources of iron for women following a vegan diet?

A

Pulses, dark green vegetables, wholemeal bread, fortified breakfast cereal, dried fruit

53
Q

What are some sources of calcium for women following a vegan diet?

A

Dark green leafy vegetables, pulses, fortified unsweetened soya and oat drinks, brown and white bread, calcium set tofu, dried fruit, sesame seeds, tahini

54
Q

What are some sources of vitamin B12 for women following a vegan diet?

A

Fortified breakfast cereals and plant based spreads, yeast extract, fortified unsweetened soya drinks, supplements

55
Q

What are some sources of vitamin D for women following a vegan diet?

A

Direct sunlight, fortified plant spreads, some breakfast cereals, supplements

56
Q

What are the recommendations for fruit and vegetable intake during pregnancy?

A

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

57
Q

What are the recommendations for complex carbohydrate intake during pregnancy?

A

Required at all meals = portion of 30-50g per meal
Avoid having 2 sources in one meal
Wholemeal better = sustains bloods between meals

58
Q

What are the recommendations for fats and spreads during pregnancy?

A

High in calories so take small amounts

Unsaturated fats better for healthy heart

59
Q

What are the recommendations for dairy and its alternatives?

A

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

60
Q

What food group is best to avoid/limit intake from?

A

Foods high in fat, salt or sugar = avoid anything with 25.5g of sugar or more per 100g

61
Q

Why is exercise beneficial for gestational diabetes?

A

Increases amount of glucose used by muscles for energy = lowers blood glucose
Insulin used more efficiently
Helps prevent weight gain and reduces weight

Reproduction (62 decks)

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