Pregnancy Flashcards
Excessive gestational weight gain (GWG) increases the risk of child overweight/obesity by what percentage?
30-40%
What exceeds smoking as the lifestyle-related risk factor causing greatest number of adverse pregnancy outcomes?
Weight related issues
What are the weight gain recommendations for each weight class?
Underweight - 28-40 lbs.; 1-1.3 lbs./week in 2/3 trimesters
Normal - 25-35 lbs.; 0.8-1 lb./week in 2/3 trimesters
Overweight - 15-25 lbs.; 0.5-0.7 lbs./week in 2/3 trimesters
Obese - 11-20 lbs.; 0.4-0.6 lbs./week in 2/3 trimesters
What are 2 contributing factors to future obesity and cardiometabolic risk?
- Entering pregnancy with a high BMI.
- Gaining too much weight during pregnancy.
Individuals who gain excessive weight during pregencay are at higher and lower risk of?
Higher risk of:
▫ Large for gestational age (LGA) baby.
▫ Macrosomia.
▫ Cesarean delivery.
Lower risk of:
▫ Small for gestational age (SGA) baby.
▫ Preterm birth.
▫ Increased birth weight.
Postpartum weight retention
Neonatal morbidity (associated with high birth weight).
Maternal morbidity (associated from higher body weight).
What are the 5 A’s of Healthy Pregnancy Weight Gain?
- ASK for permission to discuss weight
- ASSESS potentional root causes of weight gain
- ADVISE on pregnancy weight gain and management
- AGREE on a SMART goals to change behavior
- ASSIST women in identifying barries and how to facilitate change/educate
Calorie recommendations for each trimester?
- 1st trimester: No additional increase in calories needed.
- 2nd trimester: 340 additional kcal/day.
- 3rd trimester: 450 additional kcal/day
What macronutrient intake is of utmost importance during the last 6 months?
Protein
Protein recommendation during pregnancy?
1.1 g/kg of body weight (compared to 0.8 g/kg for non-pregnant women).
Carbohydrate recommendation during pregnancy?
175 g/day (compared to 130 g/day in non-pregnant women); of which 28 g should be from Fiber.
Fat recommendation during pregnancy?
Specific type and amount of fat that should be consumed is an ongoing research area.
Trans-Fatty Acids (TFA) should be avoided as they can be transported across the placental barrier and their presence can prevent normal metabolism of certain essential fatty acids.
What are the daily recommendations for iron, calcium, vitamin D, folic acid, and iodine?
▫ Iron: 27 mg.
▫ Calcium: 1000 mg (elemental calcium).
▫ Vitamin D: 200 to 600 IU.
▫ Folate: 0.4 to 1 mg.
▫ Iodine: 150 mcg.
Why is iron important during pregnancy?
What are 3 foods high in iron?
Important to decrease risk of anemia, fatigue, decreased work capacity, preterm birth, low infant birth weight, and increased perinatal mortality.
Foods with high iron content (3 to 12 mg) include:
▫ Clams (4 Large).
▫ Lentils (1/2 cup cooked).
▫ Spinach (1/2 cup cooked).
Why is calcium important during pregnancy?
What are 3 foods high in calcium?
Important role in the development of the skeletal system of the fetus. In total, the fetus will require 30g of calcium for optimal development, utilizing most during the 3rd trimester.
Foods with high calcium content include:
▫ 1 cup milk = 300 mg calcium.
▫ 1 cup yogurt = 400 mg calcium.
▫ 1 oz cheddar cheese = 200 mg calcium.
Why is folic acid important?
Important in the prevention of neural tube defects (NTD) and other folic acid-sensitive congenital anomalies.
▫ Daily recommendation 1 month prior to conception and during 1st trimester: 0.4 mg (if at low risk for NTD) and 1 mg (if at moderate risk of NTD).
▫ Daily recommendation in 2nd and 3rd trimesters: one multivitamin containing between 0.4 mg to 1 mg.
Why is choline important?
What is the daily recommendation?
What foods contain choline?
Important for the development of the brain and tissues of the fetus.
▫ Daily recommendation during pregnancy: 450 mg.
▫ Can be very low in prenatal vitamins hence the importance of consuming in food products.
Found in: Eggs, meats, fish and dairy.
Foods to avoid during pregnancy?
Alcohol
Amino acids supplements
Herbs (aloe, gingko, ginseng)
Foods that can have bacteria (raw meats, fish, or eggs, shellfish, unpasteurized milk and dairy products)
Foods to limit during pregnancy?
- Caffeine: Limit consumption to 300 mg/day.
- Beef liver: Limit to one serving (75 g) per week during first trimester.
- Fish (depending on level of mercury):
▫ High levels of methylmercury: less than 150g per month.
Fresh/frozen tuna, swordfish, marlin.
▫ Low levels of methyl mercury: 150 g per week.
Salmon, trout, haddock, canned light tuna, sole.
Benefits of physical activity during pregnancy?
- Maintain or improve cardiorespiratory endurance, muscular strength and endurance, and flexibility.
- Prevent or reduce severity low back pain.
- Reduce excessive gestational weight gain.
- Promote optimal maternal and fetal health, and reduce risk of:
- Birthweight extremes (large-for-gestational-age or small-for-gestational-age)
- Gestational diabetes
- Preeclampsia
- Cesarean delivery/pre-term birth
PA recommendations for pregnancy?
150 min/week of moderate intensity physical activity or 30-minutes on most days of the week.
What are RELATIVE contraindications to PA?
- Severe anemia.
- Unevaluated maternal cardiac arrhythmia.
- Chronic bronchitis.
- Poorly controlled type I diabetes.
- Extreme morbid obesity.
- Extreme underweight (BMI <12).
- History of extremely sedentary lifestyle.
- Intrauterine growth restriction in current pregnancy.
- Poorly controlled hypertension/preeclampsia.
- Orthopedic limitations.
- Poorly controlled seizure disorder.
- Poorly controlled thyroid disease.
- Heavy smoker.
What are ABSOLUTE contraindications to PA?
Hemodynamically significant heart disease.
Restrictive lung disease.
Incompetent cervix/cerclage.
Multiple gestation at risk for premature labor.
Persistent second or third trimester bleeding.
Placenta previa after 26 weeks gestation.
Premature labor during the current pregnancy.
Ruptured membranes.
Pregnancy induced hypertension.
Warning signs to terminate PA?
- Vaginal bleeding.
- Dyspnea before exertion.
- Dizziness.
- Headache.
- Chest pain.
- Muscle weakness.
- Calf pain or swelling.
- Preterm labor.
- Decrease fetal movement.
- Amniotic fluid leakage.
Exercises to avoid during pregnancy?
- Isometric exercises.
- Lifting using the Valsalva maneuver.
- Hot yoga.
- Exercises in the supine position after the 2nd trimester.
- High intensity exercise (> 90% HRmax).
- Exercises that have a high risk of falling.
- High-impact activities/sports.
- Activities that have quick changes in direction or excessive jumping/bouncing.
How long is breastfeeding recommended?
The American College of Obstetricians and Gynecologists (ACOG), the World Health Organization (WHO), the Academy of Pediatrics (AAP), and the United States Preventative Services Task Force strongly recommend breastfeeding for the** first six months of life.**
What are short and long term benefits of breastfeeding?
Short-term benefits:
-nutrition, host-defense, gastrointestinal function.
Long-term benefits:
-significant reduction in risk of obesity in children.
-increased duration of BF
-decreased risk of obesity (dose-dependent effect).
-reduced odds of OW and OB by 26%
Barriers to breastfeeding?
▫ Difficulties with breastfeeding (sore nipples).
▫ Maternal perception of inadequate milk supply.
▫ Maternal perception that BF is not meeting their infants’ needs
What are risk factors for early development of postpartum diabetes?
Maternal age.
Pre-Pregnancy weight.
Early GDM Diagnosis.
Insulin treatment during pregnancy.
High FPG on OGTT.
Ethnicity (Asian).
Postpartum depression affects approximately what percentage of all new mothers.
13%
What is macrosomia?
A condition where a newborn baby is significantly larger than average for their gestational age.
What percentage of all postpartum women meet the daily dietary guidelines?
2-16%
