Periconceptual Nutrition

Question 1

Most common foetal abnormality

Answer 1

NTDs

Question 2

When does NTD occur

Answer 2

When embryonic neural tube fails to close in the fourth week of development

Question 3

Spina bifida (3)

Answer 3

Most common NTD
Spinal cord not fully encased in bone
Damage to cord and spinal nerves

Question 4

Anencephaly (3)

Answer 4

NTD
Fatal condition
Foetus develops with no cerebral hemispheres

Question 5

Folate supplementation advice (5)

Answer 5

400ug per day
4mg per day for women with previous history of NTD
Supplementation should begin 3 months before planned conception
And during first 12 weeks of pregnancy
Folate only supplements

Question 6

What can reduce the risk of NTDs?

Answer 6

Folate

Question 7

Folate protective mechanism (5)

Answer 7

Essential for biosynthesis of purine nucleotides
Prerequisite for cell division
New embryo are competing demands for cell division for RBC formation and CNS development
If folate is limiting both process are impaired

Question 8

What are the unforeseen benefits of folate fortification?(2)

Answer 8

CVD

Cancer

Question 9

Potential hazards of folate fortification (2)

Answer 9

May limit effectiveness of chemotherapy

May delay the diagnosis of B12 deficiency

Question 10

Folate and anaemia detection (3)

Answer 10

Early detection of pernicious anaemia critical for effective treatment
Good folate status masks signs of B12 deficiency
There anaemia diagnosis may be delayed

Question 11

Which vitamin is a teratogen?

Answer 11

Vitamin A (retinol)

Question 12

Why have infant deaths reduced (4)

Answer 12

Improved medical care
Improved living conditions
Improved diet
Improved standards of education

Question 13

Phenylketonuria

Answer 13

Arises due to lack of phenylalanine hydroxylase-autosomal

Question 14

Risks of PKU early in pregnancy (3)

Answer 14

High phe concentration leads to:
Poor growth
Heart defects
Poor brain growth

Question 15

Dietary adjustment for pku (2)

Answer 15

Low phe diet

Monitor concentration of phe and tyrosine on a weekly basis

Question 16

Weight management advice (2)

Answer 16

Obese women encouraged to lose weight before pregnancy

5-10% weight loss will promote fertility and pregnancy outcomes

Question 17

Vitamin A (5)

Answer 17

Retinol is a teratogen 
Can result in:
Congenital abnormalities of eye 
Defects of CNS development 
Skeletal abnormalities 
CV abnormalities

Question 18

Why is folate needed from supplements (4)

Answer 18

Require over 400 micro grams above normal intakes
Impossible to achieve through normal diet
Folate is an unstable vitamin
So liable when cooked or stored for long time

Question 19

Issues with folate advice (3)

Answer 19

40% of pregnancies are unplanned
Women may buy supplements but not take them
Cost of supplements may be a barrier