Pregnancy Ch 4-5 Flashcards
What are the factors that increase infant mortality risk?
general health
socioeconomic status of a population
↓ in mortality related to improvements in…
-social circumstances, safe & nutritious food availability, & infectious disease control
What is the difference between gestational age and menstrual age?
GESTATIONAL AGE: Assessed fm date of conception; avg pregnancy = 38 wks
MENSTRUAL AGE: Assessed fm onset of last menstrual period; avg pregnancy = 40 wks
What are the physiological changes that normally occur during pregnancy?
2 phases of changes:
- Maternal anabolic changes
- in 1st half of pregnancy
- Builds the capacity of the mother’s body to deliver - Maternal catabolic changes
- in the 2nd half of pregnancy
- Fetal growth (90%)
What are maternal anabolic and catabolic phases?
ANABOLIC: -blood volume explansion -↑ cardiac output buildup of fat, nutrient, & liver glycogen stores -growth of some maternal organs -↑appetite & food intake (+ caloric balance) -↓ exercise tolerance -↑ levels of anabolic hormones
What is the catabolic phase?
CATABOLIC (20+ wks)
- mobilization of fat & nutrient stores
- ↑inc production & blood levels of glucose, triglycerides, & fatty acids
- ↓ liver stores
- accelerated fasting metabolism
- ↑ appetite & food intake ↓ somewhat near term
- ↑ levels of catabolic hormones
How pregnancy affects the carbohydrate metabolism?
Glucose is preferred fuel for fetus
Diabetogenic effect of pregnancy” results from maternal IR
EARLY PREGO
-High estrogen & progesterone stimulates insulin
production
-↑ conversion of glucose -> glycogen & fat
LATE PREGO
-Human chorionic somatotropin (hCS) & prolactin inhibit conversion of glucose -> glycogen & fat
How pregnancy affects blood lipid levels?
Fat stores:
- Accumulate in first half of pregnancy
- Enhanced fat mobilization in last half
Blood lipid levels ↑
-↑ cholesterol: substrate for steroid hormone synthesis & nerve and cell-membrane formation (fetus)
What are the placenta functions? (3)
- Hormone & enzyme production
- Nutrient & gas exchange
- Nutrient Transfer: fetus is not a parasite - Remove waste from fetus
!what is the placenta?
Double lining of cells separating maternal & fetal blood
preterm babies are @ risk for… (4)
- death
- neurological problems
- congenital malformations
- chronic health problems
What is the recommended weight gain ranges for women who enter pregnancy underweight, normal weight, overweight, and obese?
UNDERWT: 28-40 lb NORMAL: 18.5-24.9 => 25-35 lb OVERWT: 25-29.9 => 15-25 lb OBESE: ≥30 => 11-20 lb TWINS: 25-54 lb
What is the relationship between nutrition and preterm delivery / what increases & decreases the risks?
↓ risk:
- multivita supps or folate intake
- 1-3 fish meals / wk
↑ risk:
- underwt & obesity
- elevated blood lipids
Describe nutrition related developmental programming of later disease risk
Fetal exposure to certain levels of energy & nutrients modify function of genes in ways that affect metabolism & development of diseases in later life
What is the energy requirement during pregnancy? (1st/2nd/3rd trimesters)
1st: same
2nd trimester: +340 kcal/d
3rd trimester: +452 kcal/d
Describe the relationship between folate and pregnancy outcomes (2). Functions (2)
-folate is asso w/ anemia and reduced fetal growth
-Folate requirements ↑ - extensive organ and tissue growth
FUNCTIONS of FOLATE
1. Metabolic reactions
2. Deficiencies lead to abnormal cell division and tissue formation
! relationship w/ folate & abnormalities?
NTDs = Neural Tube Defects
Malformations of the spinal cord and brain
3 major types
1. Spina bifida 2. Anencephaly 3. Encephalocele
What are food sources of folate? (3)
how has folate status in W improved?
Recommended intake of folate?
Fruits, vegetables, whole grains
improved w/ fortified cereals and supplements
600 mcg DFE (dietary folate equivalents)
Discuss the importance of iron during pregnancy.
Iron-deficiency anemia in pregnancy:
- Early pregnancy: risk of preterm delivery, LBW
- Late pregnancy: lower scores on intelligence, language, gross motor and attention tests
What are the pros (2) and cons (3) of iron supplementation?
PROS:
-Iron is absorbed better fm supps containing IRON
ONLY than when mixed with other minerals
-Amount absorbed depends on the need and the amount of iron in the supplement
CONS:
-Side effects (nausea, cramps, gas & constipation
- >free radicals in GI tract (cause inflammation & mitochondrial damage to cells)
-May interfere with zinc absorption
What are the main food safety issues during pregnancy?
- FOOD BORNE ILLNESS
- Listeria monocytogenes
- Toxoplasma gondii - MERCURY CONTAMINATION
- High levels in large, long-lived predatory fish
- Lower content in boqom feeders
- Avoid shark, swordfish, king mackerel, tile fish, albacore tuna, walleye, pickerel, bass
How do you assess nutritional status during pregnancy?
DIETARY ASSESSMENT: usual intake, supplement use, wt gain progress
NUTRITION BIOMARKER ASSESSMENT – iron and other vitamins and minerals, triglycerides
Describe the common health problems during pregnancy? (hyperemesis gravidarium, heartburn, constipation)
What are the dietary interventions for their treatment or amelioration?
NAUSEA & VOMITTING:
-hyperemesis gravidarium: severe N/V during most of pregnancy
- Management of n/v
Separate liquid & food intake
Avoid odors and foods that trigger N/V
-Dietary supplements for the treatment of n/v
Vitamin B6, multivitas, & ginger
HEARTBURN
- Management of heartburn
Ingest small meals frequently
Do not go to bed with a full stomach
Avoid foods that make heartburn worse
CONSTIPATION
- prevention
Consume dietary fiber (30 grams/day)
Drink water along with the fiber
Laxative pills are NOT recommended
Describe the relationship between pre-pregnancy obesity and infant outcomes (4)
Obesity associated with higher rates of:
- stillbirth
- LGA newborns
- Cesarean-section delivery
- May ↑ risk of child becoming overwt or having Type 2 diabetes later in life
What are the nutrition-related recommendations intended for women who enter pregnancy obese? (5)
- Meet nutrient needs
- Consume a variety of basic foods
- Participate in physical activity
- Maintain appropriate rates of wt gain
- Weight loss is NOT recommended
Diagnosis of gestational diabetes
Gestational diabetes: carb-intolerance w/ 1st onset during pregnancy
All prego should be screened @ 1st prenatal visit for undiagnosed diabetes:
1 confirmed + result is diagnosis of diabetes:
-Hemoglobin A1c (A1c) >6.5%
-Fasting plasma glucose >126 mg/dL (7.0 mmol/L)
-2-hour glucose >200 mg/dL aier 75 g oral load
-Random plasma glucose >200 mg/dL
——-
All prego W w/o diabetes should be tested for GDM by a 75-gm oral glucose tolerance test at 24-28 weeks.
Diagnosis cutpoints: W w/ 1 elevated plasma glucose levels are diagnosed with GDM:
-Fasting plasma glucose >92 mg/dL
-1-hr plasma glucose >180 mg/dL
-2-hr plasma glucose >153 mg/dL
consequences of gestational diabetes
- Elevated glucose from mother -> risk of adverse outcomes:
- Spontaneous abortion, stillbirth, neonatal death
- Congenital anomalies
- ↑ insulin -> ↑ glucose uptake & triglyceride formation in fetus - fetal changes ↑ likelihood later in life:
- Insulin resistance and/or Type 2 diabetes
- High blood pressure
- Obesity
management of gestational diabetes
First approach is medical nutrition therapy to normalize blood glucose levels w/ diet & exercise
- Blood glucose levels can be brought ↓ w/ low calorie intake ( avoid elevated ketones )
- Oral medication meuormin (glyburide) used to↓ insulin resistance
!what is the main reason for big babies (macrosomia) in W w/ GDM?
↑ blood glucose levels is the main factor for macrosomia
Describe the characteristics of preeclampsia
- Oxidative stress, inflammation, & endothelial dysfunction
- Increased blood pressure
- Insulin resistance
- Adverse maternal immune system responses to the placenta
- Elevated blood levels of triglycerides, free fatty acids & cholesterol
- Signs, symptoms, &health consequences of preeclampsia range from mild to severe
- Cause is unknown, but appears to originate from:
- Abnormal implantation & vascularization of placenta w/ poor blood flow.
what is preeclampsia-eclampsia
pregnancy-specific syndrome occurring >20 weeks gestation accompanied by proteinuria
- Proteinuria:urinary excretion of ≥0.3 gram protein in 24- hour urine sample
- Eclampsia—occurrence of seizures not attributed to other causes, but just bc one is prego
management of preeclampsia
Adequate calcium intake Adequate vitamin D status Use of multivita /minerals if needed >5 servings of colorful vegetables and fruits daily Adequate fiber intake (>21 grams/day) Basic foods from MyPlate recommendations Moderate exercise Recommended wt gain
pre-term, term, post-term,
PRE: <37 wks
TERM: 38-40 2 wks
POST: 42 wks
pica?
eating disorder: Eat non-food substances
- Pagophagia: ice or freezer frost
- Geophagia: clay or dirt
- Amylophagia: cornstarch or laundry starch
macrosomia.
newborn with an excessive birth weight
birth wt: 8 lb 13 oz - 9 lb 15 oz
amenorrhea
absence of menstruation (1 or more missed menstrual periods)
-missing 3 menstrual periods in a row = amenorrhea
most common cause of amenorrhea is pregnancy
teratogenic
an agent or factor that causes malformation of an embryo
hemodilution
↓ concentration of cells and solids in the blood resulting from gain of fluid
