Pregnancy Flashcards
Pregnancy summary
40 weeks
0-12 weeks
13-27 weeks
28-40 weeks
Week 0-2
Fertilisation of egg makes the embryonic disk
High rate of lethality
Week 3-8 of Pregnancy
Most sensitive to teratogenesis
Brain formation
3-28 weeks
Heart formation
3-6 weeks
Lungs
5-24/28 weeks
When does GI tract develop
3-24 weeks
Liver
3/4-12 weeks
Kidneys
4/5-12 weeks
Limbs
4/5 - 8 weeks
Eyes
3 - 20/24 weeks
Genitals
5 -7 weeks
Spinal
3/4 weeks
Physiological changes pregnancy
Weight gain Blood volume and cardiovascular changes Renal changes Respiratory Changes Gastrointestinal changes Metabolic adaptions
Blood volume expansion pregnancy
Needs to expand to make sure nutrients gets to baby
1-1.5litre increase of body water
Plasma volume increases by 40-50% resulting in less plasma proteins (albumin)
despite increase in red blood cells and haemoglobin does not increase as much as plasma.
Hard to notice anaemia as lower concn of iron
Renal Changes Pregnancy
Kidneys - support cardiovascular changes
Better capacity for excreting metabolic rate
Urine production actually decreases to 80%
Respiratory Changes Pregnancy
Gas exchange becomes more efficient
Maternal diaphragm greater movement and ribs increase outwards
As pregnancy goes on size of foetus limits this but respiration efficiency maintain as pregnant women breathe more rapidly
Metabolic Adaptions
Insulin resistance
2nd and 3rd trimester insulin secreted at 2-2.5 times higher
Gastrointestinal changes
Progesterone and oestrogen increases causing gut absorptive capacity to increase
Increased availability to mum and baby
Reduction in secretion of gastric juice
Gastric emptying slowed
Motility of small and large intestine reduced
Weight Gain Pregnancy
Foetus, placenta and amniotic fluid (4.8kg)
Mammary glands, uterus (1.4kg)
Lean body mass, fat (3.3kg)
Plasma volume and extracellular body water (2.9kg)
Underweight Weight gain during pregnancy
12.5kg-18kg
Healthy weigh gain during pregnancy
11.5-16kg
Overweight weight gain during pregnancy
7-11.5kg
Obese weight gain during pregnancy
6.8kg
Gastrointestinal Changes Pregnancy
Progesterone and oestrogen increase - causing gut absorptive capacity to increase
Reduction in secretion of gastric juice
Gastric emptying slowed
Motility of small and large intestine
Factorial Method for assessment of requirement during pregnancy
Pregnant require = Non-pregnant + Increased requirement - Reduced requirement
Energy requirements during pregnancy
No need to increase energy intake till last few weeks
Increase intake EAR is by 200kCal a day
However, if underweight at start of pregnancy or active then may require more
Protein Requirements during pregancy
Gain almost 1kg of protein during pregnancy (mostly 1st and 2nd)
DRV states and additional 6g/day (RNI is 51g/day)
After 20 weeks foetal liver can synthesis non-essential
Lipid intake During pregnancy
Crucial for fpetal development - membrane and brain made up of them
Depletion of DHA is associated with reduced visual function
High intake of n-3 increased gestation, birth weight and reduce risk of premmie.
Need to be cautious though as fish and fish oils may be contaminated with mercury
Which Vitamin Requirements Increase during pregnancy
Vitamin A
Vitamin C
Vitamin D
Vitamin A and Pregnancy
Increase requirement by 100ug
However, most mothers consume enough
If consume more than 8000ug can increase chance of birth defects
No Vit A supplement
Vitamin C and Pregnancy
Increase RNI by 10mg/day in third trimester
Vitamin D and Pregnancy
10ug/day supplement
Minerals and Pregnancy
Often with minerals need increases but ability to uptake increases due to GI changes so no additional requirement is needed
Aversion during pregnancy
Strong disliking’s during pregnancy
Early - tea, coffee, alcohol, fried food, eggs
Later - sweet
Cravings during pregnancy
Compulsive urge for food not previously desired in excess
Pica
Craving for a non-food substance
May indicate nutrient deficiency
Higher prevalence in rural areas
Leads to toxicity or malnutrition
Morning Sickness
Nausea and Vomiting in the first trimester
Recommended to eat cracker, toast and dry cereals
Small frequent meals
Keep hydrates
Avoid tea and coffee
Avoid or limit fatty and spicy foods
Ginger
Has been found to improve mild to moderate nausea
Hypermis Gravidarum
Persistent Vomiting
3 episodes of vomiting a day
Lose at least 3kg or 5% body weight
Leads to Dehydration, acidosis and alkalosis
Requires fluid and electrolyte replacement
If not treatment can be life threatening
Oesophageal rupture
Pre-eclampsia
Hypertension proteinuria Oedema Lead to haemolysis Elevated liver enzymes Low platelets
Prevention - magnesium sulphate, calcium
Heartburn and pregnancy
Increased abdominal pressure caused by enlarge uterus pushing against GI
Progesterone decreases integrity of cardiac sphincter resulting in mor acid reflux
Common in third trimester
Small frequent snacks, eat slowly, milk and yogurt, avoid lying down after eating
Constipation and Haemorrhoids
Progesterone slows peristaltic action of smooth muscles in bowel
Enlarged uterus displaces internal organs
Increase fluid intake
High fibre diet
Increased physical activity
Gestational Diabetes
Pregnant women with no prior history of diabetes
Mostly resolves after birth
Associated with increased incidence of premmie and pre-natal motility
Low sugar
High Fibre
Regular snacks
Smoking and pregnancy
6% women currently smoke at the end of pregnancy
Alcohol and pregnancy
Alcohol can pass through placenta
Can lead to spontaneous abortion Nervous system impairment Birth defects Foetal alcohol syndrome Attachment disorder Difficulty socialising
Food safety and pregnancy
Toxoplasmosis - abnormalities, blindness, mental retardation
Listeriosis - brain damage
Obesity during pregnancy
Higher risk of
Gestation diabetes
pre-eclampsia and childhood obesity for baby.
Exposes foetus to bad uterus environement (changing reward pathway to prefer high fat and saturated foods)
