Pre-pregnancy-infancy: Nutritional principles

Question 1

(8) Health habits that contribute to pregnancy.

Answer 1

1. Man’s fertility
2. Achieve & maintain healthy body weight
3. Adequate & balanced diet
4. Be physically active
5. Receive regular medical care
6. Manage chronic conditions
7. Avoid harmful influences; alcohol, drugs, environment (lead)
8. Ensure adequate folate consumption: required for cell division

Question 2

A primary supplement recommended for women wanting to get pregnant. Purpose?

Answer 2

Folate; 1 month prior to pregnancy, 3 months after pregnancy.
Cell division; required to adequate development for foetus.

Question 3

Exercise DOs during pregnancy

Answer 3

• begin gradually
• most days of the week
• warm up 5-10mins with light activity
• 30mins moderate activity
• coll down 5-10mins slow activity/stretching
• stay hydrated
• eat enough to support pregnancy + exercise
• rest adequately

Question 4

Exercise DONTs during pregnancy.

Answer 4

• vigorous exercise after long period of inactivity
• exercise in hot/humid weather
• exercise when sick with fever
• exercise while lying on back after 1st trimester
• stand motionless for prolonged periods
• exercise if experiencing pain, discomfort, fatigue
• participate in activities that may harm the abdomen
• participate in jerky, bouncy movements
• scuba dive

Question 5

How Maternal Weight affects infants weight

Answer 5

Underweight
- lower birth weight babies
- higher rates of preterm (<38 weeks) & infant death
Overweight
- born post term (>42 weeks), >4kg
- more difficult labour
- higher risk of neural tube defects, heart defects & other abnormalities

Question 6

Identify normal weight gain amounts in specific elements of pregnancy

Answer 6

foetus - 3.5kg
breast increase - 0.5kg
blood increase - 2kg
placenta - 0.5kg
amniotic fluid - 1kg
uterus increase - 1kg
maternal fat stores - 1.5-4.5kg

Total Avg. - 10-13kg

Question 7

Identify healthy, underweight, overweight & obese weight gain amounts in pregnancy

Answer 7

healthy: 11.5-16kg
underweight: >13kg
overweight: 7-11.5kg
obese: 5-9kg

Question 8

What is low birth weight (LBW) and what does it increase risks of?

Answer 8

<2.5kg
- developmental & learning disorders
- long-term adverse health outcomes: higher risk of high blood pressure & blood cholesterol in later life
- miscarriage, neonatal death, malformations

Question 9

What factors affect low birth weight?

Answer 9

• low pre-pregnant weight
• poor nutrition pre-conception
• low maternal weight gain
• poor gestational nutrition
• inherited conditions & perinatal insults
• smoking status

Question 10

Identify maternal structures critical to nutrition & safety of the foetus. Why are they critical?

Answer 10

umbilical cord, amniotic sac, placenta:
- size influence by maternal weight - determines amount of nutrition & birth weight of infant
- lower BW have lighter placentas - higher incidence of LBW & prematurity
- outcome improved with extra weight gain

Question 11

Four factors that affect birth outcome

Answer 11

1. Intrauterine Growth Retardation (IUR), CHD, stroke, diabetes, increased BP
2. prematures delivery: depends on growth rates post birth
3. Over nutrition in utero: Diabetes, CVD
4. intergenerational factors

Question 12

How does optimal birth weight and length impact pregnancy?

Answer 12

reduces morbidity & mortality initially and in the long term

Question 13

Identify the stages of Foetal growth in terms of development and nutritional needs.

Answer 13

0-2wks
- ovum divides & embeds in uterine wall
- folate prevents NTD & possible role of omega-3 FAs - DHA
2-6wks
- organs & tissues differentiate & develop
- nutrition extremely important: (DHA for neurological development)
- permanent effects on development (alcohol)
7-40wks
- rapid growth
- foetus concentrates nutrients to help through 1st 6 months (iron)
- energy & nutrient requirements increase; obtained from diet & body stores

Question 14

What are the energy needs during pregnancy?

Answer 14

• physical activity decrease
  2nd trimester: approx 1400kJ extra/day
  3rd trimester: approx 19000kj extra/day (tub yoghurt + 2 slice bread)

Question 15

What are the protein needs during the 2nd & 3rd trimester?

Answer 15

Increase of 12-14g/day, but usually already adequate
Regular intake - 46g/day
pregnant - 58-60g/day
NNS 83-127g/day

Question 16

What are the mineral requirements during pregnancy?

Answer 16

• slight increases for many
• calcium: +300mg 14-18yrs // otherwise none as you absorb more in pregnancy
• iron: +9-12mg (absorption increases - 7% 12wks > 66% 36wks)
• Zinc: +3mg
• Iodine: +70ug

Question 17

What are the vitamin requirements during pregnancy?

Answer 17

• general requirements increase but usually enough consumed
• vitamin B12 for strict vegans
• increased folate
• vitamin A - issues with toxicity

Question 18

What is the recommended dietary intake for Protein, Calcium, Iron, Folate for women 14-50yrs?

Answer 18

Protein 45-46g
Calcium 1000-1300mg
Iron 15-18mg
Folate 400ug

Question 19

What is the recommended dietary intake for Protein, Calcium, Iron, Folate for pregnant girls 14-18yrs?

Answer 19

Protein 58g
Calcium 1300mg
Iron 27mg
Folate 600ug

Question 20

What is the recommended dietary intake for Protein, Calcium, Iron, Folate for pregnant women 19-50yrs?

Answer 20

Protein - 60g
Calcium - 1000mg
Iron - 27mg
Folate 600ug

Question 21

Define the importance of Iron to pregnancy

Answer 21

Extra 800mg needed (15mg/day)
- increase in maternal blood supply
- active bone marrow (500mg)
- term foetus & placenta (300mg)

Question 22

What does iron supplementation depend on?

Answer 22

• iron status before pregnancy
• intake & absorption during (haemoglobin & ferritin;serum levels)
• anemia: 60-120mg of ferrious iron/day until normal levels then 30mg/day
• 15-20% iron in food absorbed - affected by factors (not in tea, milk, coffee)
• vitamin C increases absorption

Question 23

Calcium requirements during pregnancy, impact of low intake & inhibitors to absorption.

Answer 23

• extra after 12wks (foetal skeleton)
• 30g stored in skeleton; remainder stored for lactation
  Low intake:
• causes leaching from maternal skeleton (increased risk of osteomalacia)
• affects neonatal bone density
  Absorption inhibited by:
• oxalates, caffeine

Question 24

Why is Folate/ folic acid required during pregnancy, effects of deficiency, how supplementation helps

Answer 24

• demands double
• maternal erythropoiesis
• foetal & placental growth
  Deficiency
• causes reduction in DNA synthesis & miotic activity in individual cells
  = anencephaly/spina bifida
  Supplementation
• reduces risk of neural tube defects

Question 25

Recommendations for folate intake during pregnancy

Answer 25

• all women should be encouraged to increase intake of folate-rich foods
  Low risk women:
• 0.8mg 1 month prior
• 1mg 3 months after
  High risk women
• 5mg 1 month prior & 3 months

Question 26

How is folic acid supplemented in diet for unplanned pegnancies?

Answer 26

50% pregnancies unplanned = bready flour fortified with folic acid in Australia

Question 27

What are the Zinc requirements during pregnancy?
What impact do low levels have?
Who should supplement Zinc & Why?

Answer 27

• after 1st trimester
  Low levels:
• abnormal brain development
• congenital malformations
  Supplements:
• for women with low pre-pregnant weight; increase infant birth weight

Question 28

What inhibits Zinc absorption

Answer 28

Excess iron and fibre

Question 29

Iodine: requirements, effects of deficiencies; resolutions

Answer 29

• recommend 150mg/day (pregnant & lactating mums)
• for thyroid hormones
  inadequate
• deficinecies lead to stunted growth, diminished intelligence, retardation
• mild-moderate deficiencies across population
• 2009 = bread flour fortified with Iodine

Question 30

Why should pregnant mums avoid unpasteurised milk, soft cheeses and salad vegetables?

Answer 30

Listeria

Question 31

How should vegetarian diets be compensated during pregnancy?

Answer 31

• supplement: iron, vitamin B12, calcium, vitamin D (especially vegans)

Question 32

What substances should be avoided/limited during pregnancy?

Answer 32

Alcohol - FAS
Caffeine - tea & coffee limited to 3-4 cups per day

Question 33

What is foetal programming

Answer 33

phenomenon that substances (nutrients) alter gene expressions and influence the development of disease later in life
- impact being investigated as multi-generational

Question 34

How diets should be altered during early vs late pregnancy

Answer 34

early (morning sickness) = eat less, more often
late (indigestion, constipation) = follow apetite, plenty of fibre & fluids

Question 35

Important nutritional needs of lactation

Answer 35

Increased needs for:
- energy: +600kJ (14-18yrs) / +2500kj (19-50yrs) to produce 750mls/day (6months), 600mls (beyond)

• protein: 63-67 (OG 46)
• calcium (1000-1300mg)
• Vitamin C, A, B
• minerals P, I, Mg, Se, Zinc: 11-12 (OG 8)
• fluid intake
• folic acid: 500 (OG 400)

Question 36

Breastfeeding health advantages for mother

Answer 36

• early initiation promotes recovery from childbirth (accelerates uterine contraction & reduces risk of haemorrhaging)
• prolonged period of postpartum infertility
• may assist weightloss, return to OG weight
• reduced risk of premenopausal breast cancer & ovarian cancer

Question 37

Breastfeeding health advantages for child

Answer 37

• reduced incidence of diarrhoel illnesses
• protection against respiratory infection
• reduced prevalence of asthma
• reduced occurrence of otitis media
• protection against neonatal necrotising enterocolitis, meningitis, botulism, UTI
• reduced risk of autoimmune disease & diabetes (1) & IBD
• reduced risk of cows milk allergy
• reduced risk of adiposity later in childhood

a) Improved visual acuity & psychomotor development
b) Higher IQ
c) reduced malocclusion

Question 38

Signs the baby is getting enough or not enough breastmilk

Answer 38

ENOUGH
- wet / dirty nappies
- reasonably content
- good skin tone
- bright & alert
- gains in weight & length (plateau at 3 months)
- weight charts
- weight gains; avg. over month

NOT ENOUGH
- erratic weight gain/loss
- gain < 105g/week, over time