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Lifecycle Nutrition > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Gestational age

A

Assessed from the date of conception

Average pregnancy is 38 weeks

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2
Q

Menstrual age

A

Assessed from onset of last menstrual period
Average pregnancy is 40 weeks
40 weeks conceptualization includes 2 non-pregnant weeks

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3
Q

Embryo-fetal development period

A

Week 1-2: implantation
Week 3-8: embryonic period
Week 9-38: fetal period

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4
Q

Maternal body composition changes sequence

A 
Maternal plasma volume
Maternal nutrient stores
Placental weight
Uterine blood flow
Fetal weight
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5
Q

Maternal anabolic changes

A

Occur during first half of pregnancy
Ananbolic hormones: Insulin, GH, IGF, anabolic steroids

Blood volume expansion
Increased cardiac output
Build-up of fat, nutrient, and liver glycogen stores
Growth of some maternal organs
Increased appetite, food intake
Decreased exercise tolerance
Increased levels of anabolic hormones
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6
Q

Maternal catabolic changes

A

Occurs in second half of pregnancy when most fetal growth occurs, catabolic changes make nutrients available to fetus
Catabolic hormones: Adrenaline, cortisol, Glucagon, epinephrine, noreprinephrine

Mobilization of fat and nutrient stores
Increased production and blood levels of glucose, triglycerides, fatty acids
Decreased liver glycogen stores- glycogenolysis
Accelerated fasting metabolism
Increased levels of catabolic hormones

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7
Q

Fluid volume in pregnancy

A 
Increases from ~7 L to 10 L
Increased blood volume
Increased body tissues
Increased extracellular volume
Amniotic fluid

Edema (in 60-75% of women)

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8
Q

Hormonal changes in pregnancy

A

Human chorionic gonadotrophin (hCG)

Progesterone

Estrogen

Human chorionic somatotrophin (hCS)

1st trimester: Placenta secretes hCG, Ovaries secrete estrogen and progesterone
2nd trimester: Placenta secreates hCG, estrogen, progesterone, Ovaries secrete estrogen and progesterone
3rd trimester: Placenta alone secretes hCG, estrogen, and progesterone

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9
Q

Human chorionic gonadotrophin (hCG)

A
  • Stimulates production of estrogen and progesterone
  • Stimulates growth of endometrium
  • Secreted by placenta
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10
Q

Progesterone

A
  • Maintains the implant
  • Stimulates growth of the endometrium and its nutrient secretion
  • Stimulates breast development
  • Promotes lipid deposition
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11
Q

Estrogen

A
  • Increases lipid formation and storage, protein synthesis, uterine blood flow
  • Prompts uterine and breast duct development
  • Promotes ligament flexibility
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12
Q

Human Chorionic Somatotrophin (hCS)

A
  • Increases insulin resistance (in order to maintain higher blood glucose levels for fetal use)
  • Promotes protein synthesis
  • Promotes fat breakdown for maternal energy
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13
Q

Maternal nutrient metabolism

A

Accelerated fasting metabolism
Insulin resistance, altered blood glucose regulation
Reduced nitrogen excretion and conservation of amino acids
Accumulation of maternal fat stores, enhanced fat mobilization
Altered mineral metabolism

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14
Q

Accelerated fasting metabolism

A

Increases in:
Glucogenic amino acid utilization
Fat oxidation, lipolysis
Production of ketones

During fasting, allows for:
Maternal use of stored fat
Sparing of glucose and amino acids for fetus

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15
Q

Carbohydrate metabolism

A

Early pregnancy: High estrogen & progesterone stimulate insulin which increases glucose>glycogen & fat

Late pregnancy: Human chorionic somatotropin (hCS) & prolactin inhibit the conversion of glucose to glycogen & fat

Diabetogenic effect of pregnancy:
Mother goes into transient insulin resistance during pregnancy in order to keep blood sugars higher for the fetus which is the preferred fuel

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16
Q

Protein metabolism

A
  • Aim to ensure nitrogen conservation for fetal growth during the last quarter of pregnancy
  • Decreases in nitrogen excretion in later pregnancy
  • Conservation of amino acids for tissue synthesis
  • Protein is not stored during early gestation for later use
  • Increased protein needs must be met by physiological adjustments that enhance dietary protein utilization
17
Q

Fat metabolism

A

Fat stores:

  • Accumulate in first half of pregnancy
  • Enhanced fat mobilization in last half, fat stores broken down (lipolysis)

Blood lipid levels increase
Increased cholesterol is substrate for steroid hormone synthesis

18
Q

Mineral metabolism

A

Calcium
-Increased bone turnover & reformation

Sodium

  • Accumulation in mother, placenta, & fetus
  • Restriction of sodium potentially harmful
19
Q

Functions of the placenta

A

Hormone and enzyme production
Nutrient and gas exchange
Removal of waste from fetus

Nutrient Transfer Priorities:

  1. Maternal needs
  2. Placental needs
  3. Fetal needs
20
Q

Newborn weight

A

Determined by:

  • Energy, nutrient & oxygen availability
  • Genetics
  • Insulin-like growth factor (IGF-1)

Weight classifications:

  • Normal = 5lb 8 oz- 9lb, 4oz
  • LBW: Low Birth Weight (< 5 lbs 8 oz)
  • VLBW: Very Low Birth Weigh (< 3 lbs 4 oz)
  • SGA: small for gestational age (<10th percentile)
  • LGA: large for gestational age (>90th percentile)
21
Q

Weight gain in pregnancy

A
  • Low weight gain during first trimester (~5 lbs)
  • Gain of a little less than 1 lb per week for the 2nd and 3rd trimesters
  • No weight loss is recommended, even in obese

Fetus is only ~1/3 of weight, the remainder is a combination of:

  • breast tissue
  • fluid volume
  • placenta
  • uterus and supporting muscles
  • amniotic fluid
  • fat stores
22
Q

Postpartum weight loss

A

~15lbs lost at delivery

Lactation reset hypothesis

23
Q

Prenatal energy and nutrient needs

A 
Caloric needs:
-1st trimester: little to no increase
-2nd trimester: ~340 kcal/day
-3rd trimester: ~450 kcal/day
Protein needs: 
-Increase by 25 grams/day (71g/day)
Fat needs:
-Slightly increased needs for essential fatty acids, DHA and EPA, n-6
Fiber needs: 
-Increases from 25 to 28 grams/day
24
Q

Folate

A

Deficiency leads to:
Impaired DNA synthesis, gene expression, gene regulation
Leads to abnormal cell division and tissue formation

Accumulation of homocysteine (a metabolite) and shortage of methionine may cause placenta rupture, stillbirth, preterm labor, preeclampsia, structural abnormalities
(Methionine gets converted to homocysteine, when levels of homocysteine are too high in the body, will convert back to methionine with the use of B12 and folate. If not enough folate, build-up of homocysteine)

25
Q

Choline

A

Component of phospholipids in cell membranes
Precursor of intracellular messengers
Source of methyl groups needed for DNA regulation, brain development

26
Q

Vitamin A

A

Involved in cell differentiation
Deficiency is rare, excess is a concern (medications: Accutane, Retin-A)
Teratogenic

27
Q

Iron

A

+1000mg additional iron needed during pregnancy (over all of pregnancy, not per day)
300 mg for fetus and placenta
250 mg lost at delivery
450 mg to increase RBC mass

12% of women enter pregnancy with iron deficiency
Increased risk for preterm delivery and LBW
Impaired cognitive development in offspring

Low iron during pregnancy = newborn with low iron stores

28
Q

Hypertension

A

Hypertension (HTN) is defined as blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic blood pressure
Affects 6 to 10% of pregnancies
Contributes to stillbirths, fetal & newborn deaths, & other adverse conditions

HTN in pregnancy is related to:
Chronic inflammation
Oxidative stress
Damage to the endothelium of blood vessels

Consequences of endothelial dysfunction:
Impaired blood flow
Increased tendency to clot
Plaque formation

29
Q

Chronic Hypertension

A

HTN present before pregnancy or diagnosed <20 weeks

More common in:
African American, obese, >35 years of age, or history of HTN with previous pregnancy

Associated with increased risk of:
preterm delivery, fetal growth retardation, placenta abruption, Cesarean delivery

30
Q

Gestational Hypertension

A

Hypertension diagnosed for first time after mid-pregnancy

No proteinuria

Tend to be overweight or obese with excess central body fat

31
Q

Recommendations for Hypertension

A

Intervention should aim to achieve adequate & balanced diets for pregnancy

Weight gain is same as for other pregnant women

Continue Na reduction required for blood pressure control without too little that could impair fetal growth

32
Q

Preeclampsia-Eclampsia

A

A pregnancy-specific syndrome occurring >20 weeks gestation accompanied by proteinuria

Proteinuria—urinary excretion of ≥0.3 gram protein in 24-hour urine sample (or >30 mg/dL protein or ≥2 on dipstick reading)

Eclampsia—occurrence of seizures not attributed to other causes

Oxidative stress, inflammation, & endothelial dysfunction
Platelet aggregation & blood coagulation due to deficits in prostacyclin relative to thromboxane
Blood vessel spasms & constriction
Increased blood pressure
Insulin resistance
Adverse maternal immune system responses to the placenta
Elevated blood levels of triglycerides, free fatty acids and cholesterol

33
Q

Recommendations for Preeclampsia-Eclampsia

A 
Adequate calcium intake
Adequate vitamin D status
Use of multi-vitamin/minerals if needed
>5 servings of colorful vegetables and fruits daily
Adequate fiber intake (>21 grams/day)
Basic foods from MyPlate recommendations
Moderate exercise 
Recommended weight gain
34
Q

Obesity

A

Obesity increases risk for:

  • Stillbirth
  • LGA
  • Cesarean section
  • Offspring overweight and type II diabetes
35
Q

Recommendations for Obesity

A 
Meet nutrient needs
Consume a variety of basic foods
Participate in physical activity
Maintain appropriate rates of weight gain
Weight loss is not recommended
36
Q

Gestational Diabetes

A

Women developing gestational diabetes appear to be predisposed to insulin resistance, and have impaired insulin production

Related to metabolic changes favoring oxidative stress and elevated blood glucose

Elevated glucose from mother – risk of adverse outcomes.

  • Spontaneous abortion, stillbirth, neonatal death
  • Congenital anomalies
  • Glucose uptake & triglyceride formation in fetus

Fetal changes increase likelihood later in life:

  • Insulin resistance and/or Type 2 diabetes
  • High blood pressure
  • Obesity
37
Q

Recommendations for Gestational Diabetes

A

First approach is medical nutrition therapy to normalize blood glucose levels with diet & exercise
Blood glucose levels can be brought down with low calorie intake – avoid elevated ketones
Oral medication metformin (glyburide) used to decrease insulin resistance
Regular aerobic exercise
Assess dietary & exercise habits
Develop individualized diet & exercise plan
Monitor weight gain
Interpret blood glucose & urinary ketone results
Ensure follow-up during & after pregnancy

38
Q

Fetal Alcohol Spectrum Disorders (FASD)

A

Alcohol-related neurodevelopment disorder (ARND)

  • No overt physical features
  • Intellectual disabilities
  • Problems with behavior, learning, coping, impulse control, attention

Alcohol-related birth defects (ARBD)
-Abnormalities of the heart, kidneys, bones, or hearing

Fetal alcohol syndrome (FAS)

  • Most severe form
  • Abnormal facial features
  • Growth problems
  • CNS abnormalities
  • Problems with social skills, learning, memory, attention span, communication, vision, hearing

Lifecycle Nutrition (4 decks)

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