Pregnancy

Question 1

Human gestation

Answer 1

40 weeks

3 trimesters

Question 2

Placenta

Answer 2

Supplies nutrients + removes waste
Barrier to potentially harmful agents
Key endocrine organ
Barred - water-soluble, active transport
Cross - fat-soluble, toxins, teratogens

Question 3

Second trimester

Answer 3

Growth
Mass: 25-900g

By end - foetus viable, many organ systems immature

Question 4

Third trimester

Answer 4

Growth rapid
Maturation of all organ systems
28-40wks

Foetus quadruples weight

• truncal growth
• fat stores
• other nutrients

Question 5

Weight gain

Answer 5

Average = 12.5kg
Most in second half
Important predictor of pregnancy outcome
Insufficient or excessive -> poor outcomes
In range that optimises maternal survival

Question 6

Energy requirements
Needed for…
Decrease of…
Recommend…

Answer 6

Needed for

• increase mass uterus
• formation foetus
• formation placenta
• expanded blood volume
• deposition extra adipose tissue (lactation)

Decrease

• food intake
• BMR
• physical activity

Recommend
- 200kcal/d more EAR only 3rd trimester (exceptions: underweight + high P.A)

Question 7

Protein requirements

Answer 7

For growth of foetus + maternal tissue
Excess -> health risks
6g more than DRV - current UK intake excess

Question 8

LCPs

Answer 8

Pro + anti-inflammatory eicosenoids + module cell signalling pathways
Involved in gene expression
Heavily concentrated brain + retina
Transfer to foetus : rate correlated with maternal intake (meat, eggs, fish)

Question 9

DHA depletion

Answer 9

Decreased visual function
Learning defects
Intervention - cod liver oil supplements from 2nd trimester

Question 10

Lipids

Answer 10

Adequate supply critical to neurodevelopment

Foetal + neonatal brain has high demand for arachidonic acid + DHA

Question 11

Vit C

Answer 11

Foetal demand especially 3rd trimester

Increase RNI by 10mg/d

Question 12

Vit D

Answer 12

10ug/d supplements

Deficiency can be passed to baby

Question 13

Calcium

Answer 13

No additional requirement - mobilisation stores + increased absorption
Supplements for adolescent pregnancy
Medical conditions can influence, e.g. celiac

Question 14

Zinc

Answer 14

No additional requirements

Adaptive response

Question 15

Magnesium

Answer 15

Adaptive response

Release from maternal stores

Question 16

Iron

Answer 16

No additional requirements

• menstruation stops
• mobilisation of stores
• increased intestinal absorption

Supplements can contribute to constipation

Question 17

Aversions
Early pregnancy…
Late pregnancy…

Answer 17

Early - tea, coffee, alcohol, fried foods, eggs

Late - sweet foods

Question 18

Cravings

Answer 18

Random + variable
Compulsive urge for food not previously desired (in excess)
Rarely adversely affects overall nutrition

Question 19

Pica

Answer 19

Desire for non-food substances - dirt, clay, starch
High prevalence in rural areas or family history

Consequences - toxicity, malnutrition, obesity, intestinal obstruction, interference with mineral absorption

Question 20

Nausea + vomiting

Answer 20

Mostly 1st trimester

Recommend - stay hydrated, small frequent meals, crackers, avoid: tea, coffee, spicy + fatty foods

Question 21

Hyperemesis gravidarum
Definition…
Complications…
Management…

Answer 21

Persistent vomiting before 20th week

Complications

• weight loss
• dehydration
• acidosis
• poor micro + macro nutrients

Management

• anti-emetics
• nutrition support
• fluid + electrolyte replacement

Question 22

Pre-eclampsia

Characteristics
Risk factors
Prevention

Answer 22

Inc seizures or coma

Characteristics - hypertension, proteinuria, oedema

Risk factors - 20-40yrs, high BMI, family history, num children had

Prevention - possibly antioxidants

Question 23

Heartburn
Increased...
Progesterone...
Exacerbated by...
Common...
Recommendations...

Answer 23

Increased abdominal pressure from enlarged uterus pushing up against stomach

Progesterone decreases integrity sphincter muscle

Exacerbated by - spicy, fizzy, fatty, acidic foods, lying down

Common in 3rd trimester

Recommendations - milk, antacids, eat slowly, small/frequent meals

Question 24

Constipation
Caused by… (2)
Increase…

Answer 24

Enlarging uterus displaces internal organs
Progesterone slows peristaltic action SM in bowel

Increase fluid, fibre + P.A

Question 25

Gestational diabetes

Answer 25

Pregnant women with no prior history
Mostly resolves after birth

Associated with - high prematurity incidences, peri-natal mortality

Treatment - low sugar/high fibre diet, occasionally insulin injections req.

Question 26

Smoking

Answer 26

34% all mothers UK smoke before/during pregnancy
Higher % in lower social class
Has decreased 1/3 last 15yrs

Question 27

Alcohol can cause

Answer 27

Spontaneous abortion
Birth defects
Foetal alcohol syndrome
Attachment disorders
Suicide + depression
Difficulties in social situations

Question 28

Food safety: Toxoplasmosis

Answer 28

Parasite infection
Foetal abnormalities, blindness + mental retardation
Avoid - raw/uncooked meat, unwashed F+V, unpasteurised goats milk, cat faeces

Question 29

Food safety: Listerosis

Answer 29

Results in brain damage
Food poisoning monocyte
Sources - raw/uncooked meat, unpasteurised milk/cheese

Question 30

Developmental origins of health + disease

Answer 30

Events in foetal + early life may contribute to occurrence of diseases in adulthood

E.g. circulatory, respiratory, diabetes

Question 31

1st trimester

Answer 31

embryo vulnerable

establish supporting placenta