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FN 3344 assessment > pregnancy and lactation > Flashcards

pregnancy and lactation Flashcards

1
Q

what to consider in medical hx

A

obstetrical hx
chronic disease
pregnancy related disorders
family hx

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2
Q

what is parity

A

number of times a female has given birth to a tetus

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3
Q

what is gravida

A

number of times a female get pregnant

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4
Q

what is macrosomic and microsomic

A

macrosomic= birth weight > 4000g
microsomic= birth weight < 2500g

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5
Q

what is IUGR

A

intrauterine growth restriction 宫内发育迟缓

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6
Q

子宫

A

uterus

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7
Q

what is the possible result of bed rest and at risk pregnancy

A

likely to deliver baby early

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8
Q

common pregnancy-related disorders in later stages

A

reflux or heartburn

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9
Q

what is antacids (Tums) for

A

heartburn/reflux

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10
Q

what is diclectic for

A

nausea/vomiting

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11
Q

what can ginger help

A

relief morning sickness

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12
Q

normal range for pre-pregnancy BMI

A

18.5-24.9

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13
Q

normal weight gain range for normal pre-pregnancy weight class

A

25-35 lbs

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14
Q

mean weight gain range for normal pre-pregnancy group in 2nd and 3rd trimesters (lbs/wk)

A

0.8-1.0 lbs/wk

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15
Q

normal weight gain for 1st trimester

A

1.1-4.4 lbs

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16
Q

the cycle of obesity affects both mother and children

A

correctr

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17
Q

high BMI for maternal complications

A
  1. Reduced fertility
  2. Impaired glucose tolerance & Gestational diabetes
  3. Increased risk miscarriage
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18
Q

high BMI for fetal complications

A
  1. fetal congenital abnormalities
  2. fetal growth restriction
  3. stillbirth
  4. increased risk of morbidity in later life
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19
Q

what is CBC in biochemical lab datas

A

complete blood count

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20
Q

what is the trend for Hb change during pregnancy

A

Hb decrease along the way, 3rd the lowest

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21
Q

what is the difference between Hb and Hct

A

Hb=hemoglobin=protein to carry oxigen
Hct= hematocrit=% of RBC in blood

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22
Q

what is the function of ferritin

A

stores and release iron, a maker for patients iron reserve

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23
Q

what is the function of transferrin

A

binds iron and transfers iron, shows the ability to mobilize iron

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24
Q

transferrin increase or decrease during pregnancy?

A

increase

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25
Q

what is GDM

A

gestational diabetes

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26
Q

methods to diagnosis prediabetes and GDM

A
  1. fasting plasma blood glucose
  2. OGTT oral glucose tolerance test
  3. Hb A1c
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27
Q

what counts for hypoglycemia

A

< 3 mmol/L

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28
Q

what is Hb A1c

A

a glycated hemoglobin, Glucose binds to hemoglobin at a steady rate
Reflective of how much glucose has been in the plasma over the last 2-3 months
Can be affected by conditions that affect the lifespan of the RBC

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29
Q

universal screening time for GDM

A

24-28 weeks of gestational age

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30
Q

what is GA

A

gestational age

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31
Q

screen earlier if risk factors appear

A

physical inactivity/ sedentary behavior
previous GDM
prediabetes
BMI>30 kg/m2
insulin resistance
age>35
macrosomic (current or history)

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32
Q

Sedentary behavior and physical inactivity are risk factors for GDM

A

both before or during pregnancy

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33
Q

what is PG/FPG in OGTT

A

FPG=fasting plasma glucose
PG=post glucose plasma glucose

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34
Q

in an OGTT, which step needs to be done when fasted

A

the test after challenge ie the 75g one

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35
Q

in an OGTT, which step does not need to be done when fasted

A

50g glucose challenge test

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36
Q

why diagnose and treat GDM

A

lots of risks related to GDM

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37
Q

risks related to GDM

A

macrosomia, shoulder dystocia (难产), preterm delivery,
increased risk for offspring obesity and diabetes

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38
Q

pregnancy has a insulin resistance response, is it normal?

A

it is normal, due to a reduction in insulin sensitivity

39
Q

clinical examination data

A

muscle mass and fat depositions
fluid status
micronutrient status
Ask if GI discomforts or complaints

40
Q

energy need during pregnancy

A

2nd trimester: add 340 cals daily
3rd trimester: add 450 cals daily

41
Q

Eating for two?

A

eating for two is a myth, should be eating twice as healthy, using smaller balanced diet, helpful for blood glucose control

42
Q

protein needs during pregnancy

A

1.1g/kg or additional 25g/d

43
Q

most women in north america do not need to add protein rich foods to their diets since they already exceed

A
44
Q

folate needs for pregnancy

A
  1. 400 ug folic acid with VB12 3 months prior to and throughout pregnancy
  2. for increased NTD risk individuals, 1 mg (1000 ug) FA instead
45
Q

why is folate important

A

important role in preventing neural tube defects

46
Q

the process of neural tube development

A

early weeks of pregnancy are critical period, around 6 wks, neural tubes are normally closed.
Neural tubes= brain and spinal cord

47
Q

iron needs for pregnancy

A

average daily demand: 4.4 mg/d
increase:
1st: +0.8 mg/d
2nd: +3.7 mg/d
3rd: +7.5 mg/d

48
Q

during pregnancy, the body avidly conserves iron, how does that work?

A

menstruation ceases and absorption of iron increase up to threefold,
even these conservation measures, iron stores dwindle still, the developing fetus draws heavily on mother’s iron, can get them through the first 3-6 months of life

49
Q

iron deficiency demography

A

5-10% women have iron deficiency in U.S.A.
Estimated >50% women have inadequate iron stores in USA (iron depletion)
~1/3 pregnant women who do not take supplements have IDA in U.S.A.

50
Q

what is IDA

A

iron deficiency anemia

51
Q

why Even women with inadequate iron stores transfer significant amounts of iron to the fetus

A

the iron needs of the fetus have priority over those of the mother

52
Q

factors contribute to the iron loss for pregnant women

A
  1. the iron needs for fetus make mothers transfer iron to fetus
  2. maternal blood loss during delivery, especially when having cesarean section
53
Q

iron supplymentation for pregnancy

A
  1. daily iron supplement with 16-20 mg iron throughout pregnancy
  2. 30mg during 2nd or 3rd trimester for all healthy pregnant women
  3. when low Hb or Hct is confirmed, more than 30mg of iron may be prescribed
54
Q

intestinal calcium absorption doubles early in pregnancy

A

true, thoes calcium is then stored in mother’s bone

55
Q

choline need during pregnancy and lactation

A

450 mg/d
for lactation, 550 mg/d

56
Q

function of choline 胆碱

A

important for both pregnancy and lactation
role as a neurotransmitter,
also been shown to optimize memory and hippocampal function in the developing brain

57
Q

most people are not meeting the requirment of choline

A

yes

58
Q

what is the function of DHA during pregnancy

A

retinal development and gray matter in brain in fetus

59
Q

recommendations for DHA

A

not well established, 150 g cooked fish or ≤ 3 g/d EPA+DHA

60
Q

role of vitamin D

A

helpful for bone mineralization and Ca uptake

61
Q

recommendation of vitamin D

A

600 IU/d

62
Q

there are differences for certain nutrients RDAs and ULs between pregnancy and lactation, besides what

A

calcium and VD

63
Q

recommended supplements during pregnancy

A

multivitamins contains folic acid
iron supplyments

64
Q

food components to be mindful with

A

caffeine, alcohol, herbal products
sweeteners
food safety

65
Q

in case of food safety, what kind of food should avoid

A

unpasteurized milk/juice, deli meats, raw sprouts, undercooked meat, raw eggs
since they: Contaminants bacteria, heavy metals, pollutants

66
Q

what to do for dietary assessment

A
  1. supplements and dietary components
  2. eating pattern
  3. appetite
  4. GI issues
  5. if diets are modified
67
Q

what to consider for eatting pattern

A
  1. usual daily intake: variety, balance and regularity
  2. intolerances, preferences, restrictions, aversions and cravings
  3. disordered eatingsL binge eating and pica
68
Q

factors affect preganat women’s appitite

A

nausea, vomiting, stressm hyperemesis gravidarum (severe N/V weight loss, electrolyte disturbance)

69
Q

common GI issues during pregnancy

A
  1. consitipation
  2. heartburn/GERD (gastroesophageal reflux disease)
70
Q

exercise recommendations for pregnant women

A
  1. all woment without contraindication should be physically active throughout pregnancy
  2. accumulate at least 150 min moderate-insensity physical activity each week
  3. PA should be accumulated over a minium of 3 days/week, being active everyday is encouraged
71
Q

5 A for a healthy pregnancy weight gain

A

ask
assess
advise
agree
assist

72
Q

what is ask in 5 A

A

ask for permission to discuss weight

73
Q

what is ‘‘assess” in 5 A

A

assess potential root causes of guideline-discordant weight gain

74
Q

what is “advise” in 5 A

A

advise on pregnancy weight gain risk and management options

75
Q

what is “agree” in 5 A

A

agree on a realistic smart plan to achieve behavior outcomes

76
Q

what is assist in 5A

A

assist women in identifying barriers and facilltators, educate, refer and arrange follow-up

77
Q

what is DOHaD

A

Developmental Origins of Health and Disease framework

78
Q

what does DOHaD work

A

(DOHaD) framework suggests that health and disease outcomes throughout an individual’s life are influenced by environmental factors during critical periods of development, particularly in utero and early childhood. It highlights how early-life exposures can have lasting effects on physiology, metabolism, and disease risk.
1. Genetic predisposition
2. Epigenetic modifications
3. Gestational experience: smoking, weight gain & trimester, gestational diabetes, diet, drugs, stress, multivitamins, environmental insults

79
Q

what is Dutch Famine Study

A

Impaired glucose tolerance with any exposure
Increased risk of obesity, type II diabetes, CVD in those with early gestational exposure
Decreased methylation of insulin-like growth factor II in those conceived during famine but not those exposed in late gestation

80
Q

breastfeeding recommendation

A

exclusive breastfeeding is recommended for the first 6 months of life and sustained for up to 2 years

81
Q

body weight decreases along the way of lactation

A
82
Q

benefits of breast milk

A
  1. breast milk contains lots of nutritents and special components
  2. it is associated with enhanced cognitive development and stronger immune system
83
Q

what does breast milk contain

A
  1. specific nutrients eg lactoferrin
    2.anti-infective immunoglobulins
  2. WBC
  3. compounds taht stimulate maturation of small intestine
  4. compounds that aid in digestion and absorption of nutrients
84
Q

what is lactoferrin

A

helps iron absorption and has antimicrobial properties

85
Q

breastfeeding in Canada

A
  1. initiation increased
  2. mothers who initiate BF close to 25% stop before their infant is 1 mos old
  3. Only 26% Canadian mothers exclusively BF their infants to 6 mos
86
Q

Mothers most at risk of not following recommendations for BF include

A
  1. less educated
  2. not married
  3. lower SES
87
Q

most common reason for stopping BF

A

not enough breastmilk
it is rare, its perceived rather than real

88
Q

vitamin D recommendations for infants

A

400 IU/d
usually 1 drop of the supplement

89
Q

energy requirments during lactation

A

0-6 months postpartum=EER+330kcal/d
7-12 months postpartum=EER+400 kcal/d

90
Q

fluid requirments during lactation

A

+1.1-1.5 L/d (3.8)

91
Q

protein requirments

A

1.3 g/kg/d

92
Q

omega-3 requirments for lactating women

A

1.3 g/d

93
Q

multivitamin for lactating woman

A

400 ug folic acid
Fe 10 mg
B12 2.8mcg/d
Choline 550 mg/d

FN 3344 assessment (3 decks)

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