Pregnancy and Lactation Flashcards
1
Q
What is the zygote?
A
The union of the sperm and the egg
2
Q
What happens 2-4 days after fertilization?
A
Division and moving through fallopain tubes
3
Q
What happens 4-5 days after fertilization?
A
Blastocyst reaches uterus
4
Q
What happens 5-9 days after fertilization?
A
Blastocyst implants in the uterus
5
Q
Three stages of development after fertilization?
A
Zygote, embryo, fetus
6
Q
When is the embryo stage?
A
After 5 weeks
7
Q
When is the fetus stage?
A
At 11 weeks
8
Q
Placenta can be compared to
A
Villi in the gut, the maternal side of the placental villi is bathed in nutrient-rich maternal blood.
The placental villi absorb the nutrient molecules and release them to the fetus via fetal capillaries
9
Q
What is “rich chyme”?
A
Nutrient-rich maternal blood
10
Q
What is the name of the connection between fetus blood and the placenta
A
Umbrical cord
11
Q
Are placental villi connected to maternal portion of placenta?
A
No, just exchange, no connection
12
Q
The placenta performs what role for the embryo?
A
Respiratory(lungs),absorptive (GI tract) and excretory system( kidney)
13
Q
What can cross the placenta?
A
Oxygen, nutrients,drugs ( alcohol,medications) from the mother
Extra waste from the fetus to the mother
14
Q
What does the fetus have by the end of 8 th week
A
Most of the internal organs, external body structures( central nervous system, heart,digestive system,fingers,toes)
15
Q
How the weight and the length of the child change from the fetus stage to the moment it was born.+usual length of the new-born
A
The infant is 20 times longer and 50 times heavier .
Usual length is 50 cm
16
Q
When does the major weight gain happen for the child?
A
second and third trimester
17
Q
How long usual pregnancy last?
A
38-42 weeks
18
Q
What is the critical period and its characteristic
A
When each organ grows and develops rapidly. If the development of an organ is limited during a critical period, recovery is impossible
19
Q
When is the most critical phase for most organs?
A
Embryo stage ( 2-8 weeks)
20
Q
What are 5 guidelines for a healthy pregnancy?
A
- Appropriate weight gain
- Good nutrition
- Prenatal supplement
- Avoidance of harmful substances
- Physical activity
21
Q
Maternal weight gain depends on
A
The starting weight
22
Q
If BMI of the woman is less than 18.5 how much she should gain in total and in 2nd/3rd trimesters?
A
12.5-18 kg(28-40 pounds) in general
during 2nd and 3rd trimester 0.5 kg/week(1 pound/week)
23
Q
If BMI of the woman is in normal range zone(18.5-24.9) how much she should gain in total and in 2nd/3rd trimesters?
A
11.5-16 kg in total(25-35 pounds)
during 2nd and 3 rd trimester 0.4 kg/week (1 pound/week)
24
Q
If BMI of the woman is in overweight zone (25-29.9) how much she should gain in total and in 2nd/3rd trimesters?
A
7-11.5 kg in general (15-25 pounds)
0.3 kg/week( 0.6 pound/week)
25
If BMI of the woman is obese category (>30) how much she should gain in total and in 2nd/3rd trimesters?
5-9 kg(11-20 pounds)
| 0.2 kg/week(0.5 lbs/week)
26
How much women do not meet their requirement for the weight gain and what are the consequences ?
2/3 women are going beyond
| It increases risks of complications during pregnancy and decrease the chance of successive weight loss after the labor
27
Is the weight of the baby included in the weight gain of the mother?
Yes
28
How much should the normal woman gain each week during pregnancy?
3. 5 pounds (1.5 kg/week) during first trimester
| 0. 5 kg(1 pound/week) during 2nd and 3rd
29
How much should the underweight woman gain each week during pregnancy?
2.5 kg(5 pounds/week) during 1st trimester
| 1 pound/ week( 0.5 kg) during second and third
30
How much should the overweight woman gain each week during pregnancy?
```
1 kg/week( 2 pounds/week) in the first trimester
330 grams (2/3 pound)/week in 2nd and 3rd
```
31
The weight of the mother is closely related to
The weight of the child and as a consequence the health out come
32
3.1-3.6 kg is the_____ for the baby's weight
Appropriate for gestational age
33
What is the weight of the child who is large for gestational age
Bigger than 4.0-4.5 kg
| >90 th percentile for age
34
What is the weight for SGA?
Small for gestational age. <2.5 kg
| Weight is <10th percentile for age
35
What is the risk for children who is smaller for their gestational age?
At a higher risk of having physical and mental disorders, contracting diseases and die earlier in life
36
How children can become LGA?
Of the mother had uncontrolled weight gain
| Diabetic mother-> child has uncontrolled level of glucose coming
37
What is the percentage of the total weight gain by woman is the weight of the fetus?
20-30%
38
Why women gain 20% of fat during pregnancy?
Helpful for delivery and lactation
39
How much the volume of the blood increases?
By 50 %
40
Should women restrict calories during pregnancy if she wants to lose weight?
No, if you want to lose weight, lose it before pregnancy. Restricting calories can exclude some nutrients necessary for the fetus
41
Factors placing pregnant women at nutritional risk?
1. Pre-existing
2. Age
3. Lifestyle/social factors
4. Conditions of Pregnancy
42
Explain in detail pre-existing health conditions
The specific needs for some nutrient that were before the pregnancy+ the needs for the pregnancy
43
Explain in detail lifestyle/social factors
- Alcohol/smoking/drug use
- Poor financial status ( how much money you have to spend on nutritious food)
- Little family support
- Low level of education (do you know what are you needs during pregnancy)
- Too little or too much weight gain during pregnancy
44
Explain age risks
Adolescence have higher nutrient demands than normal woman, so we need to meet the basic requirements+ the requirements of the pregnancy
Low education as well
45
Explain conditions of pregnancy
- Many previous pregnancies ( the nutrient pools of some nutrients are very low, the baby will take the advantage, the risk for the mother, for example calcium stores will be depleted for bone development ->osteoporosis )
- Short intervals between the pregnancies
- History of poor pregnancy outcomes ( gestational diabetes)
- Pregnant with multiples ( increased needs)
46
How much calories per day should be added during each trimester?
1st trimester- 0 kcal/day
2nd trimester-340 kcal/day
3 rd trimester-450 kcal/day
47
What are the increased macronutrient requirements during pregnancy ?
Protein(+25 g/day)
Carbohydrates (>175 g/day, but not less than 135 g/day)
Fat ( no change,but focus on EFAs)
48
Do usual women need to increase the protein intake during pregnancy?
No, they in the normal diet we have enough
| However, vegetarians and vegans should consider
49
How to lower nausea and heart-burn during pregnancy ?
Eating smaller portions , but frequently, can help
50
Though all micronutrient needs increase during pregnancy, what are nutrients that increased in particular? Should you take supplements for them?
Zinc, Iodine, Iron,Folate
For Fe and Folate supplementation is recommended
For iodine and zinc - not specifically supplementation
51
What are the role of folate and its requirements during pregnancy
Key role in synthesis of new cells, prevention of neural tube defects( beginning of the central nervous system)
0.4 mg of folic acids from supplements and ensure intake of folate-rich food
52
What are the roles of vitamin B 12 during pregnancy and requirements
Assists folate in the synthesis of new cells.
| Supplement for vegans and vegetarians
53
The roles of Fe during pregnancy and requirements
Supports enlarged blood volume and provides for placental and fetal needs
Supplementation containing 16-20 mg
54
The roles of Ca and vitamin D and their requirements during pregnancy
Maintain integrity of maternal bones, while providing for the skeletal development of the fetus and the production of breast milk
-Ensure intake of calcium-rich food. Supplements conatining 600 IU or 2000 IU vitamin D
55
The requirements for EPA and DHA and their roles
Fetal brain development
| 2 servings of low Hg fish per week
56
What are the roles of zinc and iodine during pregnancy
Iodine -fetal brain development
| Zinc- Key role in protein synthesis and cell development
57
Why is it important to take enough iron during pregnancy
The fetus is building up the stores of iron for the first 4-6 month, because the breast milk is not rich in iron+ the needs of the mom
58
The critical period for CNS?
17-30 days
59
What are the recommendations for the food during pregnancy?
Eat more nutrient dense foods, because there a re more needs in nutrients than in energy, minimize empty calories
60
Can you be vegetarian and vegan during pregnancy?
Yes, just well-planned
61
Prenatal supplements are usually high in
Folate, B12, Fe,Ca compare to the normal supplements
62
Supplementation during pregnancy is especially beneficial to
Women carrying twins or triplets
Cigarette smokers
Alcohol and drug abuse
However, the supplementation cannot prevent the vast majority of destruction from tobacco, alcohol, drugs
63
Is there a safe amount alcohol during pregnancy?
No
64
If you are planning to become pregnant you should
Stop drinking, smoking, taking drugs
65
Threatens of alcohol during pregnancy
- Irreversible brain damage
- Growth retardation
- Mental retardation
- Facial abnormalities
- Vision abnormalities
66
What is FASD
Fetal alcohol spectrum disorder-An umbrella diagnostic term describing the range of effects that can occur in an individual who was prenatally exposed to alcohol
67
Some signs of FASD
Small head, short nose, flat midface, small eye openings
68
What you should consider with caffeine, sugar and cannabis
Caffeine- limit to 2-3 cups a day( less than 300 mg)- not only coffee has caffeine
Sugar- no excess artificial sugar consumption, replace with nutrient-dense food
Cannabis- not sure about the effect, but can be associated with LBW, cognition, academic achievement, etc. Stop to smoke
69
What are pros and cons of fish
Pros- omega 3 FA for brain development, protein , vitamin D, zinc
Cons - Hg move across the placenta->damage to fetal nervous system, food safety
70
What common discomforts during pregnancy can be solved with food?
Nausea, morning sickness, heartburn,constipation
71
How to avoid nausea during pregnancy?
* On waking, rise slowly.
* Eat dry toast or crackers.
* Chew gum or suck hard candies.
* Eat small, frequent meals.
* Avoid foods with offensive odours.
72
How to avoid heartburn during pregnancy?
* Relax and eat slowly.
* Eat small, frequent meals.
* Avoid spicy or greasy foods.
* Sit up while eating; elevate the head while sleeping.
* Wait 3 hours after eating before lying down.
* Wait 2 hours after eating before exercising.
73
How to avoid constipation?
* Eat foods high in fibre
* Exercise regularly.
* Drink at least eight glasses of liquids a day.
• Use laxatives only as prescribed by a physician
74
The positive aspects of exercising during pregnancy
- Better sleep and mood
- Help to reduce common complaints during pregnancy
- Promotes strength, muscle tine and endurance-> for labor and recovery
75
What you should do for the exercise during pregnancy?
Swimming,aerobics,Scandinavian walk( so the temperature of the body is cool)
- at least 3 times a week
- Drink water before, during and after
- Eat more to meet your energy needs for the exercise
76
What you should not do for the exercise exercise during pregnancy
Avoid balance exercise
- if you feel any pain or discomfort, stop
- Not very long
- Not in hot place
- No exercise that will harm the abdomen
- Do not exercise when you feel sick
77
What screening should be done to the mother during pregnancy ?
Gestational Diabetes
HTN, Preeclampsia( a type of hypertension when there is an extra impact on organs-kidneys)
-Hemoglobin
-Weight gain
78
What is done as screening to the fetus?
- Fetal growth-Ultrasounds
| - NTDs-Aminocentesis- check for the defects of the neural tube, not done for everyone, because the risk of miscarriage
79
What are the recommendations for the breastfeeding
Breast milk and/or formula only for the first 4 to 6 month of life exclusively and continue for up to 2 years as complementary
80
What are the energy requirements to produce milk and how it influences energy requirements of the mom
+500 kcal.day( to non-pregnant EER)- for production of milk
330 kcal/day to add from food
170 kcal to lose weight from the fat storage
81
Why after 6 month of lactation the requirements for extra calories are only 400 kcal?
Because from 7-12 month not exclusively breastfeeding
82
How much women who are breastfeeding should drink?
3.8 L, food-20%
Water-12 cups
Drink at every meal and at every breastfeeding
83
How many times a day the baby should be breastfed
8-12 time
| Every 2-3 hours
84
What happens to the micronutrient requirements during lactation?
They are even higher than during pregnancy( exception Fe and Folate)
Vitamin supplements depends on intake ( nutrient dense vs poor), vegetarian/vegan
Iron,calcium , vitamin D and B 12- the stores are depleted , a need to refill
85
Nutrition during lactation
- Nutrient-dense foods from all CFG groups
- Eating a variety of different foods-> change in breast milk-> improved acceptance of solid food after
- Limit( HG fish, caffeine 300 mg/day,alcohol,illicit drugs-cannabis)
86
What happens to the milk if the mom is not meeting the energy requirements?
Less milk, but the quality stays the same, will be kept to the expense of the mother ( calcium will be given to the child)
87
Benefits of breastfeeding
- Immunity of the child, protects against allergies, nutrient-dense food
- Cost savings
- May protect against breast cancer, contracts uterus, delays the return of regular menstruation
88
What happens with the weight of the child during the first year of life?
Triple their weight, they will never grow with such speed after
89
What is the heart rate of the infant comparing to the adult
Infant -120-140
| Adults- 70 to 80
90
What is the respiration rate of the infant comparing to the adult
Infant-20-40
| Adults-15-20
91
What are the energy needs of the infant comparing to the adult
Infant- 100 kcal/kg
| Adults <40 kcal/kg
92
What is the composition of the breast milk?
39% - CHO
55%-fat
6%-protein
93
Why milk is so high in fat
Babies ->small stomach-> need a lot calories-> fat is energy-dense+ EFAs for the brain
94
Infants need 10 times more vitamin D , so they need
Drops of vitamin D to meet the needs
95
What is the difference between the formula and breast fed infants requirements for vit D
Breastfed infants need extra supplementation of vitamin d, but the formula already fortified
96
Breastfed and formula fed infants after 6 month require
Iron and fluoride from complementary food
97
What is the name of the milk at 2-3 days and its function
Colostrum
Antibodies->Immunity
Good gut bacteria
Help transition of the first poop(muconia)
98
What is the name of the milk at 4-14 days and after 14 days
Transition milk
| Mature milk
99
Advantages of the formula feeding
Vitamin D fortified
| Other family members can feed as well
100
Why cow milk is the inappropriate replacement
- Provides low iron low Vitamin C,high in Ca( competition for Fe absorption )
- Infant's GI may sensitive to cow milk proteins
- Stresses om immature kidneys
101
After 12 month of age you can add
2/3 of daily energy from cereals, vegetables, fruits and other food
Whole cow's milk, fortified with vit D and A
102
The rate of breastfeeding initiation and continuity
High at the beginning, but only about 25% stay until 6 month
103
Global breastfeeding statisctics
- 3 out of 5 are not breastfeed within the first hour
| - Only 23 countries have the rate of >60% for exclusive breastfeeding
104
What should be done to increase breastfeeding rates?
- Education
- Support for 6 month and complementary beyond
- Hospitals: early initiation, support, demand
105
What are the procedures for the milk donor
- Only from the consent of the parent
- Screening on HIV, hepatitis B and C, leukemia
- Should be pasteurized and kept according to Canadian Food Inspection Agency
106
When you should introduce solid foods to he child?
Curiosity
Can swallow
Sit up with support
Good neck and head control
107
What food you should introduce first to the child
- Pureed, mashed,
| - Iron fortified foods+ vitamin C to improve absorption
108
Should you decide how much the baby eats
No, let them decide on their own
109
When honey can be introduced?
After 1 year
110
Infant feeding avoid
-Sweets
-Bottle at bedtime
Force feeding
Choking hazards
111
Infant feeding do's
Feed self
- Try new food
- Stress-free meals
- Healthy eating habits
