Pregnancy and Lactation Flashcards
True/False: the fetus is unaffected in obese women who lose weight during pregnancy
False. Obese women who lost weight during pregnancy had twofold greater odds of having a LBW infant and 1.8 greater odds of having an SGA infant
How many additional kcals are added for 1st, 2nd, and 3rd trimester?
0 kcal for 1st trimester
340 kcal for 2nd trimester
452 kcal for 3rd trimester
Protein recommendations for pregnancy
Singleton: maintenance protein requirements +25 gm/day
Multiples: maintenance protein requirements +50 gm/day or 20% total kcal
Factors that contribute to the development of gestational diabetes
During the 2nd trimester, progesterone, estrogen, human placental lactogen, growth hormone, and cortisol levels all rise, which may lead to increased insulin resistance and decreased insulin sensitivity
Glucose control goals for women with T1DM or gestational diabetes
Target fasting BG = 95 mg/dL or lower
1-hour postprandial BG = 140 mg/dL or less
2-hour postprandial BG = 120 mg/dL or less
Examples of situations when EN might be used in pregnancy
Hyperemesis gravidarum, multiple gestation, trauma, critical illness
Why does a nasoenteric tube carry the risk of reflux and aspiration in pregnant women?
Gastric emptying is delated and lower esophageal sphincter tone is decreased in pregnancy. Nasoenteric tube will prevent the LES from closing completely, allowing for reflux of gastric contents into the esophagus
How does the process for selecting an enteral formula for the pregnant patient differ from nonpregnant patients?
It doesn’t. Polymeric formula is appropriate for patient with adequate digestive and absorptive capacity. Consider fiber containing formula since constipation is often a problem in pregnancy
Should peripheral or central PN be used in pregnancy?
Central, allows for provision of full energy and protein needs in a reduced volume
Micronutrients of concern in PN?
IV preparations of standard multivitamins and trace elements may not be adequate to meet 100% of pregnancy requirements. Nutrients of concern include vitamin D, vitamin K, folic acid, calcium, magnesium, iron, iodine, and selenium
What normal acid-base changes should clinicians be aware of during pregnancy while monitoring EN/PN tolerance?
A chronic state of compensated respiratory alkalosis exists and buffering capacity is decreased in pregnancy.
Energy and protein requirements for lactation:
Energy: Pre-pregnancy EER + 330 kcal for first 6 months postpartum; Pre-pregnancy EER + 400 for 2nd 6 months postpartum
Protein: 1.3 gm/kg or add 25 gm/day to maintenance requirements
What conditions are women with hyperemesis gravidarum at risk for?
Wernicke’s encephalopathy, AKI, liver dysfunction, esophageal rupture, malnutrition
