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Growth and Metabolism > Pre-pregnancy and pregnancy > Flashcards

Pre-pregnancy and pregnancy Flashcards

1
Q

Who is the man behind the systematic reviews of all relevant RCTs of health care?

A

Archie Cochrane

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2
Q

In pre-pregnancy, why is body fat important

A

body fat is an important source of oestrogen required for egg maturation
- influences oestrogen metabolism

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3
Q

Define fertility:

A

capacity of a women to produce normal ovum periodically and of a man to produce normal sperm, the ability to reproduce

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4
Q

Define conception:

A

the union of male sperm and female ovum; fertilisation

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5
Q

define placenta:

A

organ that develops inside uterus in early pregnancy, through which the foetus receives nutrients and oxygen and returns carbon dioxide and other waste products to be excreted

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6
Q

What habits must a women establish prior to pregnancy?

A
  1. Maintain healthy body weight
  2. Adequate/balanced diet
  3. Be physically active
  4. Manage chronic conditions
  5. Avoid harmful influences
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7
Q

In terms of body weight prior to pregnancy, what happens in excess or low body fat?

A

excess = disrupts menstrual regularity and ovarian hormone productions

low = higher pituitary hormone control over ovulation

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8
Q

In terms of body weight prior to pregnancy, what happens if the men are overweight/obese?

A

low sperm counts, hormonal changes would reduce fertility

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9
Q

What happens once the visceral hindbrain detects info regarding fuel availability?

A

sends indirect and direct projections to regions of forebrain playing important roles in regulation of energy balance + reproductive function

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10
Q

What results from ingestion of harmful substances prior to pregnancy?

A
  • cause abnormalities
  • alter gene expression
  • interfere with fertility
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11
Q

Why is there an issue of high retinol intake?

A

intake during first trimester of pregnancy, there’s higher incidence of babies with birth defects. teratogenic effects

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12
Q

What are the advises given to pre-conceptual/pregnant women regarding intakes?

A
  • no supplements containing retinol
  • don’t eat liver (100g liver)
  • carotene-containing foods allowed freely
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13
Q

What are the effects of zinc deficiency prior to pregnancy?

A
  • congenital/foetal malformations
  • linked with sperm viability
  • contraceptive pill decreases circulating zinc (and folate, Vit. B6)
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14
Q

Can infection and inflammation decrease plasma zinc?

A

yes

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15
Q

What are the key structures developed in early pregnancy?

A
  1. Placenta in uterus
  2. Amniotic sac
  3. Umbilical cord
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16
Q

What is the amniotic sac?

A

fluid-filled ballon-like structure, houses the fetus

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17
Q

What is the umbilical cord?

A

rope-like structure containing fetal blood vessels that extends through fetus’ belly button (aka umbilicus) to placenta

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18
Q

What is the placenta?

A
  • metabolically active (by 10th week of gestation)
  • interwoven maternal and foetal blood vessels
  • exchange nutrients, oxygen, waste products
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19
Q

What general functions does the placenta perform?

A
  • respiratory
  • absorptive
  • excretory
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20
Q

What are the steps from zygote to a new born infant?

A
  1. Newly fertilised ovum, zygote. Cells rapidly divide in less than a week, ready for implantation
  2. Placenta develops, provide nutrient for embryo 5 weeks after fertilisation
  3. Fetus is just over an inch long, 11 weeks after development
  4. Newborn infant after 9 months, 20 times longer, 50 times heavier
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21
Q

What happens in weeks 0 to 8?

A

fertilised egg moves slowly along fallopian tube after 3 weeks, towards womb for development of major organs

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22
Q

What happens from weeks 9 to 12?

A
  • formation
  • the heart fully forms
  • bones harden but skull bones stay soft
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23
Q

How many beats per minute is the fetus heart rate at around 9-12 weeks?

A

180 beats/min

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24
Q

Why do the skull bones stay soft around 9-12 weeks?

A

separated to make the journey through birth canal easier

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25
Q

When are the critical periods of the fetal development?

A

during the early period and rapid cell division

- cellular activities can occur only at these times

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26
Q

What happens if cell division and number are limited during critical period

A

full recovery not possible

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27
Q

What does the neural tube structure eventual become?

A

brain and spinal cord

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28
Q

What days of gestation is the critical period for neural tube development?

A

17 to 30 days

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29
Q

What are the types of neural tube defects?

A
  1. Anencephaly
  2. Encephalocele
  3. Spina bifida
  4. Damage to nerves and muscles
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30
Q

What is anencephaly?

A
  • brain missing or fails to develop
  • pregnancies affected often end in miscarriage
  • infants born die shortly after death
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31
Q

What is encephalocele?

A

protrusion of the brain

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32
Q

what is spina bifida?

A

incomplete closure of the spinal cord and bony encasement

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33
Q

What might be the cause of neural tube defects (NTDs)?

A

diet (folic acid supplementation would prevent NTDs)

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34
Q

What factors make NTDs more likely?

A
  • previous pregnancy affected by NTD
  • maternal diabetes (type 1) OR obesity
  • maternal use of antiseizure medications
  • exposure to high temperatures early in pregnancy
  • race/ethnicity (more common among whites/Hispanics)
  • low socioeconomic status
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35
Q

How much folate supplementation is recommended daily?

A

0.4g

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36
Q

If a women had an infant with NTD, what is the recommended intake daily?

A

5mg/day (10x larger)

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37
Q

High doses of folate might mask symptoms of?

A

pernicious anaemia of vit. B12 deficiency (so anything about 1mg folate requires B12 prescription)

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38
Q

What happens from weeks 13 to 16?

A

honeymoon period

  • ovaries or testes fully developed inside body
  • foetus starts to hear, body grows (85mm, 25g)
39
Q

What happens from weeks 17 to 20?

A

skin development, nervous system

  • movement starts
  • 150g
40
Q

What happens from weeks 21 to 24?

A

foetus has chance of survival if born

- 350g

41
Q

What happens from weeks 25 to 28?

A

foetus has chance of survival if born

- follow pattern for waking and sleeping (diff. pattern from mother)

42
Q

What happens from weeks 29 to 32?

A

foetus very active

  • suckling reflex
  • brain and nervous system developing
  • extra weight starts accumulating
  • breathless feeling
  • leg cramps
  • difficulty sleeping
  • “Braxton Hicks” contractions
43
Q

What happens from weeks 33 to 36?

A

brain and nervous system full developed

  • bones harden (skull bone stays soft)
  • digestive system ready, lungs fully formed
  • mother = tiredness, backaches, sleeplessness
44
Q

What percentage of babies arrive on their due date?

A

5%

45
Q

What happens from weeks 37 to 40?

A

37 weeks is the full-term pregnancy

  • amniotic fluid turns into waste, meconium, in babies intestines
  • baby is ready to be born
46
Q

How much does the BMR increase in 2nd half of pregnancy %?

A

15%

47
Q

What influences infant birthweight?

A
  • mother’s weight prior to conception

- weight gain during pregnancy

48
Q

What happens to the baby if mother is underweight prior to conception?

A
  • high risk of low infant birthweight

- rates of preterm births/infant deaths are higher

49
Q

What happens to the baby if mother is overweight/obese prior to conception?

A
  • high risk medical complications
  • preeclampsia, gestational diabetes etc)
  • labour and delivery complications (post-term caesarean section, birth trauma)
50
Q

Is weight-loss dieting during pregnancy advisable?

A

No, never

51
Q

What is the estimated weight gained during pregnancy?

A

13.6kg OR 30 lbs

52
Q

What passes through the placenta to the foetus?

A

glucose, amino acids, FFA, ketones

53
Q

What doesn’t pass through the placenta to the foetus?

A

insulin, glucagon

54
Q

What is the rate at which foetus uses glucose?

A

6mg/kg/min at term

55
Q

What is an important precursor of glucose in gluconeogenesis of the foetus?

A

maternal hypoaminoacidemia

56
Q

What are the changes in the body physiology of GI system of the mother during pregnancy?

A
  • motility slowed down, muscle walls relax
  • gastric acid secretion reduced
  • foetus is pushing mother’s stomach
57
Q

What is the advantage of GI muscle walls relaxing?

A
  • increases time available for digestion

- maximises absorption of nutrients

58
Q

What is the advantage of GI reduced acid secretion?

A

may improve absorption of Ca and Fe

59
Q

What is the results of foetus is pushing mother’s stomach?

A

causes reflux of gastric contents into oesophagus

60
Q

What is the dietary advice given to mothers since there are all these GI changes?

A
  • small frequent meals
  • milk/yoghurt relieves symptoms
  • avoid spicy, fatty foods, citrus fruit
  • no unripe bananas and fizzy drinks
61
Q

How much blood is required from the mom for a full term placenta?

A

625ml

62
Q

What does cardiomyocytes increase and decrease in cardiac metabolism of the baby?

A

increase utilisation of fatty acids

decreases glucose utilisation

63
Q

How much increase is there in plasma volume of CV system during the physiology changes of pregnancy?

A

1250-1500ml

64
Q

how much increase in red cell mass is there during the physiology changes of pregnancy?

A

240ml

65
Q

What are the changes in physiology of pulmonary system during pregnancy?

A
  • O2 demand!!
  • O2 consumption increases 25%
  • progesterone will increase sensitivity of chemoreceptors to CO2
  • pCO2 decrease to increase placental-maternal CO2 transfer
  • pressure on diaphragm from uterus
66
Q

What are the changes in physiology of urinary system during pregnancy?

A
  • aldosterone expands plasma volume, more water/salt retention @ kidneys
  • increased kidney size/glomerular filtration rate
  • urine output elevated
  • pregnant uterus compresses bladder + reduce capacity = frequent urination
  • progesterone-induced muscle hypotonia (incontinence)
67
Q

What are some complications of pregnancy on the mother?-

A
  • mild to annoying discomforts, sometimes life-threatening illnesses
  • maternal morbidity
  • hyperemesis gravidarum
  • anaemia
  • gestational diabetes
  • pre-eclampsia
68
Q

What increases the burden in complications of pregnancy?

A
  • increase in maternal age
  • pre-pregnancy obesity
  • pre-existing chronic medical conditions
69
Q

What is hyperemesis gravidarum?

A

severe, persistent nausea and vomiting during pregnancy which may require intensive treatment

70
Q

How many women are possibly affected?

A

2%

71
Q

What is involved in the hyperemesis gravidarum in 1st trimester?

A

placenta and human chorionic gonadotrophin (HCG) hormone, it’s associated with nausea or vomiting

72
Q

What are the symptoms and results of hyperemesis gravidarum?

A
  • ketonuria
  • dehydration
  • fluid-electrolyte imbalance (hypokalaemia)
  • nutritional deficiencies
  • weight loss
73
Q

What diet is recommended for hyperemesis gravidarum?

A
  • dry diet (bread, pasta, rice, porridge, bananas)
  • fluid in small quantities, 30mins after meal
  • litter protein added slowly
  • avoid spicy food, strong smells
74
Q

What do pregnant women with anaemia feel like?

A

weak, tired

75
Q

What happens in gestational diabetes?

A
  • hyperglycaemia occur temporarily
  • increase in production of hormonal anatagonists to insulin
  • failing pancreas, can’t meet demands
  • insulin needed in last trimester
  • lead to large babies, difficult labours
  • greater childhood obesity risk, and insulin resistance
76
Q

What are the risk factors of gestational diabetes?

A
  • age >25yo
  • BMI >25
  • previous pregnancy complications
  • family history of diabetes
  • hispanic, black, native american, south/east asian, pacific islander, indigenous australian
77
Q

What is pre-eclampsia?

A

hypertension, proteinuria, edema, happens in 3rd trimester

- decreased uterine blood flow, reducing fetal nourishment

78
Q

What are the risk factors of pre-eclampsia?

A

first pregnancy OR protein/Ca deficiency

79
Q

Who are the vulnerable groups for pre-eclampsia?

A
  • adolescent mothers
  • immigrant women, consume inadequate diet
  • vegans/vegetarians
  • women with limited budgets
  • parents with alcohol or drug problems
  • women with bizarre, restricted diets
80
Q

What is SACN?

A

Scientific advisory committee on nutrition

81
Q

What is the dietary advice by SACN regarding fish?

A
  • 2 portions of fish (one oily fish)

- avoid marlin, swordfish, shark, lesser extent tuna (due to methyl-mercury contamination)

82
Q

What amount of fish for maternal intake would be harmful to foetus?

A

> 3.3μg/kg body weight mm per week

83
Q

What is the dietary requirement of vit. D to prevent rickets in the baby?

A

10mcg/day

84
Q

What are fatty acids are essential for normal development esp. neutral tube?

A
  • arachidonic acid (AA)

- docosahexaenoic acid (DHA)

85
Q

What increases breast milk ALNA and EPA (not DHA)?

A

consumption of α-linolenic acid (ALNA)

86
Q

Recommendations during lactation:

A
  • Balanced diet - high proportions of nutrient-dense foods
  • No reducing diets
  • Moderate exercise
  • High fluid intake (6-8 drinks/day)
  • Limited caffeine and spicy foods
  • No smoking and avoid alcohol
87
Q

What are the benefits of prolonging pospartum amenorrhoea?

A
  • assist in maintenance of maternal Fe status

- assist maternal weight loss, not consistent though

88
Q

What are the risks of prolonging pospartum amenorrhoea?

A
  • obesity, changes in eating patterns

- risk of osteoporosis

89
Q

What mineral is drained from pregnancy and lactation?

A

Ca2+

90
Q

How can the drained Ca2+ demand be met during pregnancy and lactation?

A
  • increased Ca in diet (DRV + 550mg/day)
  • increased efficiency of Ca absorption
  • conservation of renal Ca
  • increased bone Ca2+ mobilisation with net loss of bone
91
Q

Is the macronutrient content of milk from well-nourished and undernourished women very similar?

A

Yes

92
Q

Is it true that fat soluble vitamins and minerals are less responsive due to buffering effects of maternal stores and carrier proteins?

A

True.

93
Q

What are the symptoms of postpartum depression?

A
  • low mood, last > 2 weeks
  • struggle to look after self and baby
  • simple tasks difficult to manage
  • feel distressed, guilty
  • PND starts within 1-2 months of giving birth
94
Q

What does the foetal alcohol syndrome (FAS) include?

A

poor growth and learning/behavioural difficulties

Growth and Metabolism (12 decks)

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