Pregnancy and lactation

Question 1

List risk factors for low birth weight and preterm birth.

Answer 1

• Low birth rate: <2500 g
• Mother was underweight before pregnancy
• Low pregnancy weight gain in mother
• Iron deficiency anemia early in pregnancy
• Certain maternal infections
• Smoking during pregnancy
• Alcohol and drug use during pregnancy
• Poorly controlled chronic diseases in mother (diabetes, HT, kidney disease)
• Maternal age (older and younger mothers at higher risk)
• Multifetal pregnancies

Question 2

Discuss potential negative effects of low birth weight for the infant later in life

Answer 2

• Central adiposity
• Metabolic syndrome
• High BP
• Diabetes
• Cardiovascular disease
• Stroke

Question 3

Describe factors to consider when making weight gain recommendations during pregnancy.

Answer 3

• Young adolescents who are normal or underweight should strive for gains at upper end of recommended
• normal: 25-25 lbs (1 lb/week)

Question 4

List disadvantages of maternal weight gain that is less than or greater than the recommended range

Answer 4

Below recommendations: increases chance of LBW

Excessive gains:
o Gestational diabetes
o Gestational HT
o Preeclampsia (can lead to seizures)
o Complications during labor and birth: large infants (macrosomia), Cesarean deliveries
o Increased likelihood of retaining weight

Question 5

Describe examples of nutrition-related congenital anomalies, with emphasis on folate deficiency.

Answer 5

• Iodine deficiency → cretinism
• Vitamin A deficiency → blindness, depressed immune function, higher morbidity and mortality related to infectious diseases
• Vitamin A toxicity → cleft palate, heart defects
• Folic acid deficiency → anencephaly, spina bifida, LBW, preterm birth,
o Elevated homocysteine (from folate deficiency) → preeclampsia, spontaneous abortion
o Neural tube defects because closure 18-30 days after conception
o Mandatory grain folic acid fortification
• Recommend 600 mcg folic acid in addition to food folate for pregnant women (400 mcg for women capable of becoming pregnant)
• Alcohol→ FASD
o Small for age, facial abnormalities, poor coordination, hyperactive behavior, learning disabilities, developmental disabilities, mental retardation, poor reasoning and judgment skills, sleep and sucking disturbances in infancy

Question 6

Compare energy, protein, and fluid requirements in pregnancy (both singleton and multiples), and lactation (do not memorize numbers).

Answer 6

• No increase in energy needs the first trimester
• Recommendations for 2nd and 3rd trimesters:
Calories: +300
Protein (g): +25

For lactating women:
o +500 kcal/day for 1st six months
o After 6 months, variable energy needs, depending on weaning/rates of milk production
o Higher fluid needs: additional 1 L fluid/day

Question 7

Discuss recommendations for vitamin and mineral supplementation in pregnancy and lactation

Answer 7

Not necessary if eat according to recommendations and has adequate weight gain

Supplement if:
o Multi-fetal pregnancies
o Frequent gestations (<3 months between)
o Tobacco or alcohol users
o Women with severe nausea and vomiting
o Women who have strict dietary limitations
o Prior history of LBW babies or inadequate weight gain
o Women with chronic illness

• Iron: 30 mg/d if anemic
• Calcium: same 1000 mg/ requirement, supplement if inadequate diet
• Folic acid: supplement before and during pregnancy (400 mcg/d)

Question 8

Describe recommendations for consumption of alcohol, caffeine, and fish during pregnancy, as well as guidelines to avoid listeriosis.

Answer 8

Alcohol: none
Caffeine: limit to 200-300 mg/d since can cross placenta
Fish: 12 oz low-mercury fish/week or 6 oz/week albacore tuna since methyl-mercury can interfere with neural development
o Avoid high-mercury fish: shark, swordfish, king mackerel, tilefish

Listeriosis: bacteria that causes food poisoning and can increase chances of miscarriage, premature birth, and stillbirth
o Reheat to steaming or avoid hot dogs, luncheon meats,fermented or dried sausage, deli-style meats
o Avoid soft cheeses like feta, Brie, Camembert, blue-veined, or Mexican style cheese unless they are made from pasteurized milk
o No refrigerated smoked seafood, meat spreads, or patés, unless cooked or canned
o Cook meat and poultry thoroughly
o Avoid unpasteurized (raw) milk
o Thoroughly reheat all leftovers
o Observe all expiration dates for precooked or ready-to-eat items
o Scrub melons and consume or refrigerate promptly

Question 9

List risk factors for gestational diabetes.

Answer 9

• Personal or family history of GDM or Type 2 DM
• Maternal HT
• Overweight or obese
• Older maternal age
• High risk ethnic group (Hispanic, black, Native American, Asian)
• Excess pregnancy weight gain
• Previously large infant (>9 lbs.)
• Previous infant with congenital anomaly or fetal demise

Question 10

Describe treatment of gestational diabetes.

Answer 10

• (Diet management similar to Type 2 DM)
• Moderate CHO intake distributed throughout day
• Controlled weight gain, no weight loss
• Nutrient-rich, high fiber foods
• Regular exercise, if permitted
• Oral agents or insulin may be necessary

Question 11

Discuss the benefits of and barriers to breastfeeding.

Answer 11

Goal: exclusive breast feeding until 6 months, and then continued until 12 months with supplementary foods

Benefits:
To infant:
• Protects against infections (GI, respiratory tract, otitis media)
• Decreases infant mortality
• Enhanced performance on cognitive/developmental tests
• Lower rates of overweight and obesity as children
• Protection against chronic illness as adult
To mother:
• Loss of weight, earlier return to pre-pregnancy weight
• Less postpartum blood loss due to increased oxytocin levels
• Reduction in pre-menopausal breast cancer and risk of ovarian cancer
• Improved bone re-mineralization postpartum

Barriers:
o	Low cultural acceptance or family support
o	Short maternity leave
o	Inflexible work hours
o	Lack of privacy to feed or pump