pregnancy and lactation Flashcards
what to consider in medical hx
obstetrical hx
chronic disease
pregnancy related disorders
family hx
what is parity
number of times a female has given birth to a tetus
what is gravida
number of times a female get pregnant
what is macrosomic and microsomic
macrosomic= birth weight > 4000g
microsomic= birth weight < 2500g
what is IUGR
intrauterine growth restriction 宫内发育迟缓
子宫
uterus
what is the possible result of bed rest and at risk pregnancy
likely to deliver baby early
common pregnancy-related disorders in later stages
reflux or heartburn
what is antacids (Tums) for
heartburn/reflux
what is diclectic for
nausea/vomiting
what can ginger help
relief morning sickness
normal range for pre-pregnancy BMI
18.5-24.9
normal weight gain range for normal pre-pregnancy weight class
25-35 lbs
mean weight gain range for normal pre-pregnancy group in 2nd and 3rd trimesters (lbs/wk)
0.8-1.0 lbs/wk
normal weight gain for 1st trimester
1.1-4.4 lbs
the cycle of obesity affects both mother and children
correctr
high BMI for maternal complications
- Reduced fertility
- Impaired glucose tolerance & Gestational diabetes
- Increased risk miscarriage
high BMI for fetal complications
- fetal congenital abnormalities
- fetal growth restriction
- stillbirth
- increased risk of morbidity in later life
what is CBC in biochemical lab datas
complete blood count
what is the trend for Hb change during pregnancy
Hb decrease along the way, 3rd the lowest
what is the difference between Hb and Hct
Hb=hemoglobin=protein to carry oxigen
Hct= hematocrit=% of RBC in blood
what is the function of ferritin
stores and release iron, a maker for patients iron reserve
what is the function of transferrin
binds iron and transfers iron, shows the ability to mobilize iron
transferrin increase or decrease during pregnancy?
increase
what is GDM
gestational diabetes
methods to diagnosis prediabetes and GDM
- fasting plasma blood glucose
- OGTT oral glucose tolerance test
- Hb A1c
what counts for hypoglycemia
< 3 mmol/L
what is Hb A1c
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
universal screening time for GDM
24-28 weeks of gestational age
what is GA
gestational age
screen earlier if risk factors appear
physical inactivity/ sedentary behavior
previous GDM
prediabetes
BMI>30 kg/m2
insulin resistance
age>35
macrosomic (current or history)
Sedentary behavior and physical inactivity are risk factors for GDM
both before or during pregnancy
what is PG/FPG in OGTT
FPG=fasting plasma glucose
PG=post glucose plasma glucose
in an OGTT, which step needs to be done when fasted
the test after challenge ie the 75g one
in an OGTT, which step does not need to be done when fasted
50g glucose challenge test
why diagnose and treat GDM
lots of risks related to GDM
risks related to GDM
macrosomia, shoulder dystocia (难产), preterm delivery,
increased risk for offspring obesity and diabetes
pregnancy has a insulin resistance response, is it normal?
it is normal, due to a reduction in insulin sensitivity
clinical examination data
muscle mass and fat depositions
fluid status
micronutrient status
Ask if GI discomforts or complaints
energy need during pregnancy
2nd trimester: add 340 cals daily
3rd trimester: add 450 cals daily
Eating for two?
eating for two is a myth, should be eating twice as healthy, using smaller balanced diet, helpful for blood glucose control
protein needs during pregnancy
1.1g/kg or additional 25g/d
most women in north america do not need to add protein rich foods to their diets since they already exceed
folate needs for pregnancy
- 400 ug folic acid with VB12 3 months prior to and throughout pregnancy
- for increased NTD risk individuals, 1 mg (1000 ug) FA instead
why is folate important
important role in preventing neural tube defects
the process of neural tube development
early weeks of pregnancy are critical period, around 6 wks, neural tubes are normally closed.
Neural tubes= brain and spinal cord
iron needs for pregnancy
average daily demand: 4.4 mg/d
increase:
1st: +0.8 mg/d
2nd: +3.7 mg/d
3rd: +7.5 mg/d
during pregnancy, the body avidly conserves iron, how does that work?
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
iron deficiency demography
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.
what is IDA
iron deficiency anemia
why Even women with inadequate iron stores transfer significant amounts of iron to the fetus
the iron needs of the fetus have priority over those of the mother
factors contribute to the iron loss for pregnant women
- the iron needs for fetus make mothers transfer iron to fetus
- maternal blood loss during delivery, especially when having cesarean section
iron supplymentation for pregnancy
- daily iron supplement with 16-20 mg iron throughout pregnancy
- 30mg during 2nd or 3rd trimester for all healthy pregnant women
- when low Hb or Hct is confirmed, more than 30mg of iron may be prescribed
intestinal calcium absorption doubles early in pregnancy
true, thoes calcium is then stored in mother’s bone
choline need during pregnancy and lactation
450 mg/d
for lactation, 550 mg/d
function of choline 胆碱
important for both pregnancy and lactation
role as a neurotransmitter,
also been shown to optimize memory and hippocampal function in the developing brain
most people are not meeting the requirment of choline
yes
what is the function of DHA during pregnancy
retinal development and gray matter in brain in fetus
recommendations for DHA
not well established, 150 g cooked fish or ≤ 3 g/d EPA+DHA
role of vitamin D
helpful for bone mineralization and Ca uptake
recommendation of vitamin D
600 IU/d
there are differences for certain nutrients RDAs and ULs between pregnancy and lactation, besides what
calcium and VD
recommended supplements during pregnancy
multivitamins contains folic acid
iron supplyments
food components to be mindful with
caffeine, alcohol, herbal products
sweeteners
food safety
in case of food safety, what kind of food should avoid
unpasteurized milk/juice, deli meats, raw sprouts, undercooked meat, raw eggs
since they: Contaminants bacteria, heavy metals, pollutants
what to do for dietary assessment
- supplements and dietary components
- eating pattern
- appetite
- GI issues
- if diets are modified
what to consider for eatting pattern
- usual daily intake: variety, balance and regularity
- intolerances, preferences, restrictions, aversions and cravings
- disordered eatingsL binge eating and pica
factors affect preganat women’s appitite
nausea, vomiting, stressm hyperemesis gravidarum (severe N/V weight loss, electrolyte disturbance)
common GI issues during pregnancy
- consitipation
- heartburn/GERD (gastroesophageal reflux disease)
exercise recommendations for pregnant women
- all woment without contraindication should be physically active throughout pregnancy
- accumulate at least 150 min moderate-insensity physical activity each week
- PA should be accumulated over a minium of 3 days/week, being active everyday is encouraged
5 A for a healthy pregnancy weight gain
ask
assess
advise
agree
assist
what is ask in 5 A
ask for permission to discuss weight
what is ‘‘assess” in 5 A
assess potential root causes of guideline-discordant weight gain
what is “advise” in 5 A
advise on pregnancy weight gain risk and management options
what is “agree” in 5 A
agree on a realistic smart plan to achieve behavior outcomes
what is assist in 5A
assist women in identifying barriers and facilltators, educate, refer and arrange follow-up
what is DOHaD
Developmental Origins of Health and Disease framework
what does DOHaD work
(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
what is Dutch Famine Study
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
breastfeeding recommendation
exclusive breastfeeding is recommended for the first 6 months of life and sustained for up to 2 years
body weight decreases along the way of lactation
benefits of breast milk
- breast milk contains lots of nutritents and special components
- it is associated with enhanced cognitive development and stronger immune system
what does breast milk contain
- specific nutrients eg lactoferrin
2.anti-infective immunoglobulins - WBC
- compounds taht stimulate maturation of small intestine
- compounds that aid in digestion and absorption of nutrients
what is lactoferrin
helps iron absorption and has antimicrobial properties
breastfeeding in Canada
- initiation increased
- mothers who initiate BF close to 25% stop before their infant is 1 mos old
- Only 26% Canadian mothers exclusively BF their infants to 6 mos
Mothers most at risk of not following recommendations for BF include
- less educated
- not married
- lower SES
most common reason for stopping BF
not enough breastmilk
it is rare, its perceived rather than real
vitamin D recommendations for infants
400 IU/d
usually 1 drop of the supplement
energy requirments during lactation
0-6 months postpartum=EER+330kcal/d
7-12 months postpartum=EER+400 kcal/d
fluid requirments during lactation
+1.1-1.5 L/d (3.8)
protein requirments
1.3 g/kg/d
omega-3 requirments for lactating women
1.3 g/d
multivitamin for lactating woman
400 ug folic acid
Fe 10 mg
B12 2.8mcg/d
Choline 550 mg/d
