Practice Midterm Qs Flashcards
Which of the following statements is correct?
Proper nutrition can reduce the risk of maternal mortality
Infants born with low birth weights are less likely to have health challenges in the first year
Lower average maternal age is contributing to an increase in maternal mortality in Canada
Infant mortality rates are much lower than maternal mortality rates in Canada
Proper nutrition can reduce the risk of maternal mortality
Abby was born at 38 weeks and weighed 2400 g. Abby would be considered:
Term and low birth weight
Preterm and low birth weight
Preterm and normal birthweight
Term and normal birth weight
Term and low birth weight
Which of the following does NOT describe the germinal stage of development?
At the end of this stage the trophoblast implants into the uterus and becomes the placenta
During this stage the ectoderm, mesoderm and endoderm form
It is the stage from conception to ~2 weeks
It begins in the uterine tubes and ends at the uterus
During this stage the ectoderm, mesoderm and endoderm form
Immunoglobulins (antibodies) likely cross the placenta by:
Mixing of maternal/fetal blood
Immunoglobulins do not cross the placenta
Endo/exocytosis
Passive diffusion
Endo/exocytosis
Which of the following statements about the placenta is incorrect?
It functions in waste removal from the fetus
It is fully functional at ~2 weeks gestation
It is a key endocrine organ of pregnancy
It has a high metabolic rate
It transports nutrients and gasses to the fetus
It is fully functional at ~2 weeks gestation
Jayleen’s pre-pregnancy weight was 54 kg and her height is 1.68 m.
At 20 weeks, how much weight would you hope Jayleen has gained?
Between 8.5-10 kg
Between 10.5-12 kg
Between 4.5-6 kg
Between 3.7-5.2 kg
Between 3.7-5.2 kg
According to the Indicator Amino Acid Oxidation Method:
The RDA for pregnancy is likely higher than currently estimated
The RDA for pregnancy is likely lower than currently estimated
The AMDR for pregnancy is likely higher than currently estimated
The AMDR for pregnancy is likely lower than currently estimated
The RDA for pregnancy is likely higher than currently estimated
Sarah has been making every effort to consume a very healthy diet in accordance with all the recommendations in Canada’s Food Guide.
Which of the following is the correct advice for Sarah following Canadian guidelines?
Despite her healthy diet, Sarah should still take a supplement with 400 mcg folic acid throughout her pregnancy
Despite her healthy diet, Sarah should still take a supplement with 400 mcg folic acid before and for the first three months of her pregnancy
Because of her healthy diet, she is likely able to meet the RDA for folate for pregnancy from her foods and beverages alone
Despite her healthy diet, Sarah should still take a supplement with at least 1 mg of folic acid throughout her pregnancy
Despite her healthy diet, Sarah should still take a supplement with 400 mcg folic acid throughout her pregnancy
Current evidence supports the use of omega-3 fatty acid supplements for:
Reduced risk of pre-term birth
Reduced likelihood of postpartum depression
Reduced incidence of allergies in offspring
All of these
Improved brain development/cognition in offspring
Reduced risk of pre-term birth
For food safety, all of the following should be avoided in pregnancy EXCEPT:
Raw sprouts
Canned pate
Soft cheese
Undercooked meat, fish, or eggs
Unpasteurized dairy or juice
Canned pate
Deficiency of this micronutrient is associated with an increased risk of preterm birth and pregnancy loss.
Supplements are also recommended for prevention of nausea in pregnancy.
Iron
Omega-3 DHA
Vitamin B12
Vitamin B6
Folic acid
Vitamin B6
Which of the following is TRUE of iron needs for pregnancy?
Those following a vegan diet are recommended to take supplements containing 1.8x the iron of non-pregnant people
The RDA is 1.8x higher for those following plant-based diets
Low iron intake is the leading cause of cognitive delays in newborns
Iron deficiency anemia is the first sign of inadequate iron intake
The RDA is 1.8x higher for those following plant-based diets
Which of the following is TRUE of folate for pregnancy?
Individuals at higher risk for neural tube defects generally do NOT need more folic acid
Only about half of pregnant people in Canada take a supplement containing folic acid
High folic acid intakes (from supplements) is associated with higher risk of autism in the offspring
Everyone capable of becoming pregnant should be taking a folic acid supplement daily
Everyone capable of becoming pregnant should be taking a folic acid supplement daily
Factors that promote breastfeeding success include all of the following EXCEPT:
Early initiation and frequent breastfeeding
Responsive feeding
Skin-to-skin contact with infant
Anticipatory guidance provided in pregnancy
Supporting milk production and collection of colostrum before birth
Supporting milk production and collection of colostrum before birth
The International Code on the Marketing of Breastmilk Substitutes states all of the following EXCEPT:
Breastmilk substitutes (ie infant formula) should not be advertised
Free samples of infant formula should not be provided to parents
Health care facilities should not promote the use of infant formula
Physicians should not promote the use of unpasteurized donor milk
Physicians should not promote the use of unpasteurized donor milk
With respect to the vitamin and mineral composition of human breast milk, which of the following is NOT true?
Vitamin B12 content of breast milk is not affected by maternal diet
Vitamin D content is low, so exclusively breastfed infants should have a daily vitamin D supplement
Mineral content is lower that cow’s milk, which contributes to breast milk’s low renal solute load
Iron content is low, but the iron that is present has high bioavailability
Vitamin B12 content of breast milk is not affected by maternal diet
Compared to mature milk, colostrum has LOWER concentrations of:
Lactose
Protein
Sodium and potassium
Antibodies
Lactose
Which of the following statements about the nitrogen content of human milk is FALSE?
Contains taurine which is essential in brain development and fat digestion
Contains functional peptides and proteins that confer immune protection
About 25% is non-protein nitrogen, which includes urea
It is not well digested in the newborn infant due to a lack of pepsin
It is not well digested in the newborn infant due to a lack of pepsin
Which of the following correctly describes the function of oxytocin?
Secreted from the hypothalamus in response to suckling
Stimulates maturation of the breast in pregnancy
Stimulates breast to synthesize milk
Stimulates myoepithelial cells to contract and release milk
Stimulates myoepithelial cells to contract and release milk
All of the following explain why human milk is the ideal nutrition for infants, EXCEPT:
Contains >50% energy from fat to provide an energy dense source of nutrition
Contains higher amounts of most minerals to ensure adequate supplies for the infant
Isotonic with plasma so that infants do not require additional water
Provides adequate amounts of almost all vitamins
Contains higher amounts of most minerals to ensure adequate supplies for the infant
Which of the following nutrient requirements increase in lactation compared to the pregnancy?
Vitamin C
Vitamin B12
Folic acid
Iron
Vitamin C
Yvonne is 3 months postpartum and exclusively breastfeeding. She weighs 60 kg and has an EER of ~ 2500 kcal/d.
If she consumes ~100 g of protein daily would she meet the recommendations for protein intake?
(The RDA for lactation is 1.3 g/kg/d.)
No, she would not meet either the AMDR nor RDA for protein
Yes, she would meet both the AMDR and RDA for protein
She would meet the RDA but not the AMDR for protein
She would meet the AMDR but not the RDA for protein
Yes, she would meet both the AMDR and RDA for protein
Which of the following is NOT a newborn feeding reflex?
Rooting when the cheek is touched
Sucking and swallowing when something enters the mouth
Gagging when something touches the back of the mouth
Reaching when objects are within their sightline and placing them in their mouths
Extrusion when something touches the lips
Reaching when objects are within their sightline and placing them in their mouths
In the transition from fetus to newborn, the newborn must begin to do all of the following EXCEPT:
Ingesting and digesting food
Breathing
Voluntary skeletal muscle movement
Excreting wastes
Thermoregulation
Voluntary skeletal muscle movement
Which of the following is TRUE regarding protein recommendations for infants 7-12 months of age?
Recommendations are set as an EAR and RDA based on the factorial method
Recommendations are set as an EAR and RDA based on amounts in milk
Recommendations are set as as AI based on amounts in milk
Recommendations are set as an EAR and RDA based on the nitrogen balance method
Recommendations are set as an EAR and RDA based on the factorial method
What supplementary nutrients are recommended for exclusively breastfed infants?
Vitamin K once at birth, vitamin D daily
Only vitamin D daily
Vitamin D daily, possibly omega-3 fatty acids
Vitamin K once at birth, vitamin D daily, possibly iron
Vitamin K once at birth, vitamin D daily
Which of these foods should not be introduced until after one year of age?
Cow’s milk
Potential allergens such as peanuts
Honey
Potential choking hazards, such as grapes
Honey
What would be the recommended first food for a baby, assuming there are no dietary restrictions in the family?
Sweet potato boiled to a soft texture and cut into sticks
Minced or pureed meat
Infant cereal
Mashed banana
Minced or pureed meat
Jolene has noticed that her baby’s skin color is turning yellow. Originally the yellow only extended to her trunk but now her arms and legs have become yellow as well. Her baby is lethargic and not feeding well. What is your diagnosis and recommendation?
Physiological jaundice - increase breastfeeding and monitor
Pathological jaundice - this baby likely needs phototherapy
Pathological jaundice - increase breastfeeding and supplement with formula if needed
Pathological jaundice - increase breastfeeding and supplement with formula if needed
Pathological jaundice - this baby likely needs phototherapy
What does the “first 1000 days” refer to?
Why is nutrition during this time more important than any other life stage?
First 1000 days = time from conception to 2nd birthday
Many critical periods of development occur during this time. If a nutritional insult occurs, effects cannot be reversed with good nutrition later on.
Cora is 28 weeks pregnant. She has not gained sufficient weight during pregnancy - it is apparent even without weighing her - and her fundal height measurements are low.
Why might we be concerned about too little weight gain in pregnancy?
Insufficient weight gain means the mother is not getting adequate energy (and possible not enough nutrients as well).
Without adequate energy her nutrient stores can be depleted and her newborn is at increased risk for low birth weight.
Cora’s blood pressure is currently 142/94, she is experiencing mild swelling in her legs only, and there is no protein in her urine.
What would be your diagnosis of this? Given this information, what is your biggest concern and what signs would you be watching out for?
Gestational hypertension.
Concern that she would develop pre-eclampsia or eclampsia.
Monitor for edema (swelling) particularly of the face, visual disturbances, headaches and protein in urine.
Zinnia is unsure if she should breastfeed, so you want to make sure she is fully informed.
List three benefits of breastfeeding for the breastfeeding parent.
Bonding with infant
Promotes involution of the uterus
Convenience - once established
Suppression of ovulation (family spacing in many countries)
Decreased risk of breast cancer and other chronic disease
Generally less expensive to buy additional food for mother (vs cost of formula)
May reduce risk of postpartum depression
List three factors that influence the composition of human milk and describe how each is beneficial for the infant.
Maternal diet. Maternal diet influences the fatty acid and vitamin composition of milk. A well-nourished parent can provide adequate nutrients for the baby.
Changes with the age of the infant to match infant needs. Eg. colostrum has more protein and antibodies than mature milk.
Changes with length of feed. Fat content increases towards the end of a feed to promote satiation.
Responds to pathogens in environment. Lactating parent develops antibodies to pathogens in the environment. These are transferred in milk to offer protection to the infant.
Jenna is unsure when or how to feed her baby, so she just feeds her every 2 hours.
Is Jenna’s strategy correct? If not, what should she be doing?
No. Jenna should be feeding on demand.
She should look for hunger cues such as stirring, rooting, mouth opening, increased physical activity, and putting hand to mouth. An agitated or crying baby is too hungry and needs to be calmed before feeding.
If Jenna chooses not to breastfeed (or cannot breastfeed) what are her next options, in order of preference?
- Mother’s own milk - expressed and fed via bottle
- Pasteurized donor milk
- Infant formula
Jenna has chosen formula, but is unsure how to navigate the infant formula aisle at the store.
What advice can you provide to Jenna regarding choosing an appropriate formula?
All formulas are regulated in Canada, so it really comes down to cost and preference - there is no “best” brand.
What would be your key nutritional concern for an infant who had not been fed solids until 10 months of age?
The infant needs a source of iron, as iron stores only last until about 6 months.
What advice would you provide for someone who is about to start solids with their baby but is concerned about allergies?
Introduce potential allergens early and continue to introduce them often.
This advice also holds true if the infant is at high risk for allergies.
Why is DNA methylation considered a key mechanism for the Developmental Origins Theory?
Methylation patterns strongly influence the closing of the neural tube, which is why folate is required in early pregnancy
Methylation patterns are set in early development and can influence gene expression throughout life
Methylation patterns are set at conception and can alter gene expression during critical phases of development
Methylation is strongly influenced by dietary intakes of folate and vitamin B12, nutrients which most people are low in
Methylation patterns are set in early development and can influence gene expression throughout life
If Kim’s last menstrual period was 9 weeks ago, which of the following is true?
The fetal age in 9 weeks
Her estimated due date is in 33 weeks
Her gestational age is 11 weeks
Her estimated due date is in 31 weeks
Her estimated due date is in 31 weeks
Six weeks after fertilization, the “product of conception” is known as a (an):
Inner cell mass
Blastocyst
Embryo
Fetus
Zygote
Embryo
Which of the following statements is incorrect?
All major organs are formed in the fetal period
The neural tube forms in the embryonic period
Implantation occurs near the end of the germinal stage
The zygote is formed in the uterine tubes
All major organs are formed in the fetal period
Alcohol crosses the placenta via:
Alcohol does not cross the placenta
Facilitated diffusion
Passive diffusion
Active transport
Passive diffusion
Which of the following is NOT true of the placenta?
Very few substances can actually cross the placenta
The placenta will fulfill its own needs for glucose/energy before nutrients are available to the fetus
Transfer across the placenta depends on size, charge, solubility, and concentration of nutrients
Placental dysfunction can influence the health of both the baby and pregnant person
Very few substances can actually cross the placenta
V is in her second trimester. Which of the following measurements would be most concerning to you?
Blood pressure is lower than when V is not pregnant
Her ferritin (iron stores) are low
The concentration of water soluble vitamins in her blood is lower than pre-pregnancy
Her hematocrit (red blood cell volume) is lower than in the non-pregnant state
Her ferritin (iron stores) are low
Which of the following best explains the increased need to urinate in the first trimester of pregnancy?
The glomerular filtration rate (GFR) increases
The fetus puts pressure on the bladder
Respiration rate increases
Blood volume decreases
The glomerular filtration rate (GFR) increases
Noor is 33 weeks pregnant, which of the following would be true of her current state?
She would be experiencing the peak of her nausea and vomiting
Her major organs would start growing
Her baby is currently called an embryo
She would be building fat stores
She would be in a more catabolic state and using her fat stores
She would be in a more catabolic state and using her fat stores
What advice would you provide for someone regarding protein intake in pregnancy?
Choose animal based proteins more often, as plant based diets are insufficient for pregnancy
The total amount of protein consumed is more important than the protein quality (amino acid content)
Choose iron-rich sources of protein to ensure adequate intakes of iron
Choose calcium-rich sources of protein, such as dairy, to ensure needs for calcium are met
Consume ~25 g more protein, or ~1 extra serving of protein-rich sources per day
Consume ~25 g more protein, or ~1 extra serving of protein-rich sources per day
Which of the following is TRUE of vitamin A needs in pregnancy?
Vitamin A requirements do not change in pregnancy
Vitamin A requirements increase substantially in pregnancy to support cell division in the fetus
Vitamin A requirements decrease slightly in pregnancy because excess can be teratogenic
Vitamin A requirements increase slightly in pregnancy but excess can be teratogenic
Vitamin A requirements do not increase and excess can be teratogenic
Vitamin A requirements increase slightly in pregnancy but excess can be teratogenic
Health Canada recommendations suggest that all pregnant people take a supplement containing:
Iron, vitamin D, and calcium
Iron, folic acid, vitamin D
Iron, folic acid and omega-3 fatty acids
Iron and folic acid
Iron, folic acid, and vitamin B12
Iron and folic acid
Which types of fish are considered safe in pregnancy?
All fish is considered safe but fresh tuna, shark and swordfish should be limited to less than 150 g/ month
Fresh tuna, shark and swordfish should be avoided in pregnancy to limit mercury intake
All fish is considered safe but fresh or canned tuna, shark and swordfish should be limited to less than 150 g/ month
All cooked fish is considered safe in pregnancy with no limits, but raw fish should be avoided
All fish is considered safe but fresh tuna, shark and swordfish should be limited to less than 150 g/ month
Which of the following is NOT a concern with folate in pregnancy?
Few females take a pre-conceptional folic acid supplement
Folic acid is needed for closure of the neural tube before most people recognize they are pregnant
Fortification of flour with folic acid has led to adverse outcomes
Many females consume higher than needed amounts of folic acid in pregnancy
Fortification of flour with folic acid has led to adverse outcomes
The WHO promotes breastfeeding through the:
Baby Friendly Hospital Initiative
Human Milk Donor Bank Initiatives
Breastfeeding Friendly Hospital Initiative
Declaration of the Rights of Lactating Women
Baby Friendly Hospital Initiative
The most common reason for the discontinuation of breastfeeding in Canada is:
Return to work
Difficulty with breastfeeding
Medical condition in baby
Not enough milk (perceived or real)
Not enough milk (perceived or real)
Which of the following is NOT a clear benefit of breastfeeding for the mother?
Convenience, once established
Some reduced cost compared to bottle feeding
Helps uterus return to pre-pregnancy size
Quick and easy loss of weight gained during pregnancy
Quick and easy loss of weight gained during pregnancy
What is the function of myoepithelial cells of the breast?
Stimulate contraction of alveoli and secretion of milk
Carry milk through ducts to the nipple
Secrete oxytocin that stimulates the let down response
Synthesis and secretion of milk
Stimulate contraction of alveoli and secretion of milk
Recommendations for which of the following nutrients does not increase in either pregnancy or lactation?
Vitamin A
Choline
Vitamin B12
Calcium
Vitamin C
Calcium
Li is 8 months postpartum. She consumes a varied diet following Canada’s Food Guide and does not exclude any foods or food groups.
She is still breastfeeding but not exclusively and her menstrual cycles resumed about 1 month ago.
Would you recommend any supplements for Li?
No, supplements are not needed in lactation
Yes, folic acid as she could become pregnant
Yes, a prenatal vitamin should be continued through lactation
Yes, she needs calcium and vitamin D to support milk production
Yes, folic acid as she could become pregnant
Why is early and frequent breastfeeding critical for establishing a breastmilk supply?
Promotes bonding between baby and parent
Promotes progesterone release, which stimulates breast maturation
Promotes oxytocin release, which stimulates breast milk synthesis
Promotes prolactin release, which stimulates breast milk production
Promotes prolactin release, which stimulates breast milk production
What key indicators are assessed in monitoring infant growth?
Weight and length only
Weight, length, head circumference, weight-for-length, and head circumference-for-length
Weight, length, and head circumference
Weight, length, head circumference, and weight-for-length
Weight, length, head circumference, and weight-for-length
Which of the following is true of infant growth and development?
In the first year, more skeletal growth occurs in the skull than the rest of the body
Newborn’s heads make up a smaller proportion of total body weight than adult heads
Newborns have substantially more body fat (as a % body weight) than adults
Newborns have substantially more water (as a % body weight) than adults
Newborns have substantially more water (as a % body weight) than adults
Which of the following is TRUE regarding omega-3 and omega-6 fatty acids for infants?
An AI was set for EPA and DHA based on amounts secreted in milk
Breastmilk is often low in omega-6 and omega-3 fatty acids and infants should be monitored for deficiency
An EAR was set for essential omega-3 and omega-6 fatty acids based on amounts in milk
An AI was set for essential omega-3 and omega-6 fatty acids based on amounts in milk
An AI was set for essential omega-3 and omega-6 fatty acids based on amounts in milk
Which of the following is TRUE of vitamin K for infants?
A 1 mg oral dose at birth is recommended for all infants to prevent vitamin K deficiency bleeding
A 1 mg injection at birth is recommended for all infants to prevent vitamin K deficiency bleeding
A daily 1 mg dose is recommended for all infants because vitamin K is low in breastmilk and the infant’s gut microbiome is immature
A 1 mg injection at birth is recommended for infants who will be breastfed but not those who will be formula fed
A 1 mg injection at birth is recommended for all infants to prevent vitamin K deficiency bleeding
When selecting first complementary foods for the infant, all of the following need to be considered EXCEPT:
Serve a variety of “family” foods
Serve foods with a soft texture or minced/ground/pureed to prevent choking
Choose foods with low likelihood of allergic reaction
Choose foods rich in iron
Choose foods with low likelihood of allergic reaction
When the infant is 9-12 months of age and eating a variety of complementary foods, the following can be introduced:
Plant based milks fortified with calcium and vitamin D
Two or more of these
Skim or partially skimmed cow’s milk
Whole cow’s milk
Cow’s milk based infant formula
Whole cow’s milk
Danica is 34 weeks pregnant and her baby is measuring large-for-gestational age.
What are the key risk factors for and concerns with a large-for-gestational age infant?
Risk factors:
history of previous LGA births
poorly controlled diabetes
maternal obesity or excessive weight gain during pregnancy
Concerns:
Difficult delivery, higher risk of complications after birth
At 26 weeks, Danica did an oral glucose tolerance test and was diagnosed with gestational diabetes.
What would be the first-line treatment for this?
What are your key concerns for the baby regarding gestational diabetes?
First line treatment - counselling on diet and exercise (medications are rarely needed)
Concerns for the baby:
macrosomia - (large for gestational age)
may develop severe hypoglycemia after birth
increased risk of perinatal mortality (stillbirth)
Fast forward 6 weeks and Danica has given birth to a healthy baby. She has decided to breastfeed because she heard that it may increase her baby’s IQ (or at least reduce the risk of her baby having a low IQ).
Provide one hypotheses to explain the mechanism for this association.
Describe one potential confounder in this relationship.
Hypotheses could include:
Nutritional content of human milk (omega-3 fatty acids, other lipids) improves brain development
Parent-child interaction of breastfeeding improves brain development
Confounders could include:
- SES - parents with higher SES are more likely to breastfeed and high SES is also associated with higher IQ.
Describe how the carbohydrate in human milk is uniquely suited to the newborn needs.
Contains lactose as the primary carbohydrate, as infants have a limited capacity to digest starch.
Contains lactose instead of glucose to reduce the insulin spike after feeding
Contains oligosaccharides to promote development of the gut microbiome.
What is a milk fat globule?
How does this confer benefits to the infant?
Milk fat is secreted by exocytosis, therefore, the fat is surrounded by a membrane forming a “globule”.
Unique complex lipids are delivered in the milk fat membrane, such as sphingolipids, phospholipids and glycolipids.
Danica has been breastfeeding for a few days but she is unsure if she is feeding her baby correctly.
What advice you would provide to help her support her baby correctly and check for a good latch?
Hold baby “Tummy to mummy”, head free to move and supporting bottom for to help baby feel secure
When attached lips should flange and breast tissue should be deep in mouth.
Listen and look for signs of swallowing
Shortly after birth, Danica notices that her baby is turning yellow.
What is the name of this condition?
When would this be cause for concern?
Neonatal jaundice
Cause for concern when yellowing extends to the limbs (arms and legs), baby is lethargic and loses more than 10% of body weight.
Danica wants to know if her baby is growing adequately.
Explain three key factors you consider when evaluating infant growth using growth charts.
Between 3rd and 97th percentiles
Similar percentiles for weight and length
Tracking consistent percentiles over time (although some crossing in the first years is ok).
Danica decides to stop breastfeeding when her baby is 6 months. Her and her family follow a vegetarian diet and plan to do the same for their infant.
What is your recommendation regarding milk feeding at 6 months of age? (Should she be using a formula or other milk at this stage? If so which one?)
What do you recommend as a key first food to introduce and why?
In place of breastmilk, she should feed her infant with soy-based infant formula.
For the first food, she should include iron-fortified infant cereal as the infant needs iron rich foods from 6 months and beyond.
