Pregnancy and lactation Flashcards
Before pregnancy, both men and women should (6)
- maintain healthy body weight (BMI)
- adequate and balanced diet
- be physically active
- regular medical care
- manage chronic conditions
- avoid harmful influences
Trimester 1, 2, 3
1: 12 weeks or less (first 3 months)
2: 13-28 weeks (about 3 months)
3. 28 to delivery (about 3 months)
Preterm baby vs at term baby vs full term
preterm: 10-36 weeks (>30 weeks = better chances of survival)
- at term: >37 weeks
- 40 weeks = full term (9 months)
Fetus entirely dependent on mother’s (2) systems to (2)
respiratory and excretion –> get nutrients + get rid of waste
Placenta
- metabolically ?
- what is it?
- connected to baby via ?
- function (2)
- metabolically active
- a new organ
- connected to baby via umbilical cord
- supply nutrients and waste-removal system through mother’s blood + produces hormones that maintain pregnancy and get mother’s body ready for lactation
Does mother’s blood mix with baby’s blood? how does it work?
No. maternal blood vessels lie side by side fetal blood vessels –> exchange of O2, nutrients (glucose, aa, FA), and waste products
Poor maternal health will impact (which organ) –> impacts ? (2)
impacts placenta –> impacts babies’ health and generations to come
Stages of embryonic and fetal development:
- 1 week (3)
- 5 weeks (3)
- 8 weeks (1)
- 11 weeks (3)
- 9 months (1)
- 1 week: zygote, cells divide and become a blastocyst ready for implantation
- 5 weeks: placenta develops after implantation –> embryo, heart starts to form
- 8 weeks: heart beats
- 11 weeks: fetus = viable, living entity, over an inch long
- 9 months: new born infant
Times of intense development and rapid cell division –> when?
Critical periods of development
- first 2 months, up to 12 weeks
Full recovery possible if adverse effect during critical period? ex. VS non-critical period
- examples of adverse stimulus
No! neural tube defect –> folate deficiency at 17-30 days of gestation
- non-critical period: continued development, some damage but can be recovered
- alcohol, drugs, nutrient deficiency
Neural tube defect: anencephaly VS spina bifida VS encephalocoele
- anencephaly: brain either missing or fails to develop
- spina bifida: incomplete closure of spinal cord + bony encasement –> may be born but malformation and issues
- ancephalocoele: brain and skull malformed
Public health strategy to decrease neural tube defect?
fortification of wheat products
Folate recs for pregnancy
natural vs supplemental form?
- 400mg of folate/day 1 month before starting to conceive + continue throughout first trimester
- natural = folate
- supplemental = folic acid
Increased energy needs for pregnant women:
- 1st trimester
- 2nd:
- 3rd:
- 1st trimester: no additional energy required
- 2nd: 340 extra cals/days
- 3rd: 450 extra cals/day
how much carbs per day for pregnant women? why?
- 175g or more/day. no less than 135g
- fetus needs glucose to grow (brain)
Protein recs for pregnant women?
increase by 25g/day
Fat recs for pregnant women? how to meet? be mindful of what?
- no recs for overall fat
- brain needs w3 and w6 FA –> around 200mg DHA/day
- 5 ox fish per week
- mindful of mercury form big fish
Calcium recs for pregnant women
- absorption
- met with
- how?
same DRI but more absorption because pregnant (absorption doubles because of bone and teeth formation)
- should be met with calcium rich foods
- small and frequent intakes
Iron recs for pregnant women
- DRI
- absorption
- fetus
- DRI higher –> mostly met through prenatal supplements
- absorption triples during pregnancy. best absorbed taken btw meals or at bedtime
- iron needs of fetus takes priority
What should pregnant women NOT supplement with?
vitamine A –> teratogenic
Factors placing pregnant women at health risk (9)
- young women
- too old
- pregnant with multiples
- many previous pregnancies
- history of poor outcomes
- chronic disease
- too low/high weight gain during pregnancy
- socio economic factors
- smoking/tobacco
older women + older men –> why risk for pregnancy?
- how to test?
- women: complication from chronic disease, maternal death rates higher, risk of preterm birth + LBW
- men: more risk of preterm birth (quality of sperm)
- genetic testing –> amniocentesis = screening test –> amniotic fluid –> test for mutations
why smoking bad for pregnant women? (4)
- restricts blood supply to fetus
- interfere with lung growth, increase respiratory infections, asthma
- might increase risk sudden infant death syndrome
- reduced infant brain size
Use of illicit drugs effect on pregnant women. (3)
cross placenta, toxic, complications of use
Food safety/disease concern during pregnancy
- what?
- how affects mom and infant
- protection?
Listeriosis –> intestinal infection from listeria
- vomiting, diarrhea for mom
- can cause severe brain or infection in infant
- avoid soft cheeses, use pasteurized products, thoroughly cooked meat, no smoked meats
Why alcohol bad for pregnant women? (6) effects on fetus
- crosses placenta, directly toxic to fetus
- impacts growth and dev. + limits oxygen delivery to fetus + slows cell division + reduce number of cells organs produce
Alcohol increases risk of 3 syndromes in pregnant women
- Fetal alcohol syndrome –> outward signs of malformation (smaller hear, short nose, jaw, chin, small eyes)
- alcohol-related neurodevelopmental disorder: behavior, cognitive and nervous system abnormalities
- alcohol related birth defects: malformation in skeletal and organ systems
How much alcohol is too much? for pregnant women
- 1 drink/day: neurological dev and behaviors affected
- 4 drinks/day: physical malformations likely
underweight mother prior to conception –> increases what? due to ?
increase preterm births and infant deaths –> due to inadequate supply of nutrients
overweight mother prior to conception –> increases (3)
- risk of gestational diabetes + hypertension
- risk of medical complications during childbirth
- health risk for infant (heart problems)
How much weight should be gained by normal weight pregnant women?
1st: 3.5lbs
2nd and 3rd: 1 pound per week
total gain: 25-35 lbs by term
how much weight gain for underweight and overweight pregnant women?
underweight:
- 1st: 5 lbs
- after: 1 pound per week
total gain: 28-40 lbs by term
overweight:
- 2 lbs in 1st trimester
- 2/3 lbs per week after
- total gain: 15-25 pounds
ok to gain less weight then recommended for pregnant women?
- depends how infant is growing
- if obese and too much weight gain –> complications in birth and hard to lose after
where does gained weight go for pregnant women? (7)
- breast
- fluid volume
- placenta
- blood supply in placenta
- amniotic fluid
- infant at birth
- increase size in uterus and supporting muscle
Exercise during pregnancy
- encouraged?
- avoid?
- benefits (4)
- encouraged!
- avoid too high intensity (high temp and dehydration)
- improves fitness, prevents/manages gestational diabetes, facilitates labor, reduces stress
Low birth weight = most important indicator for ?
- what weight?
- infant’s future health –> higher risk of birth-related complications, disease or death
- less than 5.5 lbs
Gestational diabetes
- develops when?
- leads to (2)
- resolves?
- 2nd half of pregnancy
- complication during labor + high infant birth weight due to higher glucose available
- yes after labor but can increase risk of T2D later in life
existing hypertension in pregnant mother
- mechanism to infant (3)
- risk to mother (2)
- risk to infant (4)
- arteries constricting –> higher pressure –> less blood to infant
- heart attack, stroke during birth
- LBW, still birth, decrease flow to placenta, inadequate transfer of nutrients
Gestational hypertension in pregnant mother:
- when?
- can lead to ? –> what is it? can progress to ? –> action taken?
- 2nd half of pregnancy
- preeclampsia –> gestational hypertension + protein in urine (state of dismetabolism) –> diminished blood flow = poor fetal development
- can progress to eclampsia –> risk to mother of convulsion and death –> induce birth!
Lactation regulated by? –> sends signal to what that secretes what?
hypothalamus!
- pituitary gland:
1. prolactin: milk production
2. oxytocin: milk release
what glands secrete milk?
Mammary glands
how do hormones influence lactation? (2)
- promote growth and branching of duct system
- development of milk producing cells
What stimulates hormone release for lactation?
Suckling on tit –> demand for milk
Lactogenesis?
what is necessary to maintain it?
Milk production
- regular feeding/pumping
Nutrients from breastmilk
- 5
- what is low?
- Energy
- carbs (lactose)
- low protein (lactalbumin)
- high fat: essential for baby’d brain dev. essential FA
- vits and minerals
- low vit D
Colostrum? properties (3)
- thicker and more yellow than mature milk
- serum with antibodies and white blood cells –> inactivated disease-causing bacteria
- strong immune factors bc baby will be exposed to lots of stuff
Immune function of breast milk
can detect immune fct of baby –> modify content/nutrients of milk
Canadian recs for breast milk
- exclusive breastfeeding for first 6 months of life
- 6-12 months –> breastfeeding + food
Energy cost of lactation for mother = _____ cal
- how much cals form food? how much from fat stores?
- 500cal/day over women’s needs
- 330 cals from food
- 170 cals from stores accumulated during pregnancy
Weight loss for breastfeeding women?
studies show accelerated weight loss in women who breastfeed for 3+months
Nutritional deprivation of breastfeeding mom
- effects?
- reduces quantity, not quality of milk
- milk quality maintained at expense of maternal stores
(3) things to avoid for breastfeeding women –> effects?
- alcohol –> enters breast milk –> infant will drink less + inhibits oxytocin
- medicinal drugs –> can suppress lactation + some secreted into breast milk
- smoking: reduces milk volume
Main difference between formula feedings and breastmilk (2)
- no same immune properties
- no change in milk composition depending on baby’s health status
Risk of formula feedings
nursing bottle tooth decay risk –> pooling of formula if baby falls asleep with bottle
Why can’t we transition to cow milk before _____ months? difference between the 2
12 months
- before1 year old = bleeding in GI tract bc casein (protein in milk) difficult to digest
- cow milk = high in protein + low in carb
