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NuFS 106A > Pregnancy Ch 4-5 > Flashcards

Pregnancy Ch 4-5 Flashcards

1
Q

What are the factors that increase infant mortality risk?

A

general health
socioeconomic status of a population
↓ in mortality related to improvements in…
-social circumstances, safe & nutritious food availability, & infectious disease control

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2
Q

What is the difference between gestational age and menstrual age?

A

GESTATIONAL AGE: Assessed fm date of conception; avg pregnancy = 38 wks
MENSTRUAL AGE: Assessed fm onset of last menstrual period; avg pregnancy = 40 wks

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3
Q

What are the physiological changes that normally occur during pregnancy?

A

2 phases of changes:

  1. Maternal anabolic changes
    - in 1st half of pregnancy
    - Builds the capacity of the mother’s body to deliver
  2. Maternal catabolic changes
    - in the 2nd half of pregnancy
    - Fetal growth (90%)
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4
Q

What are maternal anabolic and catabolic phases?

A 
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
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5
Q

What is the catabolic phase?

A

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
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6
Q

How pregnancy affects the carbohydrate metabolism?

A

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

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7
Q

How pregnancy affects blood lipid levels?

A

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)

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8
Q

What are the placenta functions? (3)

A
  1. Hormone & enzyme production
  2. Nutrient & gas exchange
    - Nutrient Transfer: fetus is not a parasite
  3. Remove waste from fetus
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9
Q

!what is the placenta?

A

Double lining of cells separating maternal & fetal blood

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10
Q

preterm babies are @ risk for… (4)

A
  • death
  • neurological problems
  • congenital malformations
  • chronic health problems
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11
Q

What is the recommended weight gain ranges for women who enter pregnancy underweight, normal weight, overweight, and obese?

A 
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
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12
Q

What is the relationship between nutrition and preterm delivery / what increases & decreases the risks?

A

↓ risk:

  • multivita supps or folate intake
  • 1-3 fish meals / wk

↑ risk:

  • underwt & obesity
  • elevated blood lipids
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13
Q

Describe nutrition related developmental programming of later disease risk

A

Fetal exposure to certain levels of energy & nutrients modify function of genes in ways that affect metabolism & development of diseases in later life

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14
Q

What is the energy requirement during pregnancy? (1st/2nd/3rd trimesters)

A

1st: same
2nd trimester: +340 kcal/d
3rd trimester: +452 kcal/d

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15
Q

Describe the relationship between folate and pregnancy outcomes (2). Functions (2)

A

-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

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16
Q

! relationship w/ folate & abnormalities?

A

NTDs = Neural Tube Defects
Malformations of the spinal cord and brain
3 major types
1. Spina bifida 2. Anencephaly 3. Encephalocele

17
Q

What are food sources of folate? (3)
how has folate status in W improved?
Recommended intake of folate?

A

Fruits, vegetables, whole grains

improved w/ fortified cereals and supplements

600 mcg DFE (dietary folate equivalents)

18
Q

Discuss the importance of iron during pregnancy.

A

Iron-deficiency anemia in pregnancy:

  • Early pregnancy: risk of preterm delivery, LBW
  • Late pregnancy: lower scores on intelligence, language, gross motor and attention tests
19
Q

What are the pros (2) and cons (3) of iron supplementation?

A

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

20
Q

What are the main food safety issues during pregnancy?

A
  1. FOOD BORNE ILLNESS
    - Listeria monocytogenes
    - Toxoplasma gondii
  2. 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
21
Q

How do you assess nutritional status during pregnancy?

A

DIETARY ASSESSMENT: usual intake, supplement use, wt gain progress

NUTRITION BIOMARKER ASSESSMENT – iron and other vitamins and minerals, triglycerides

22
Q

Describe the common health problems during pregnancy? (hyperemesis gravidarium, heartburn, constipation)
What are the dietary interventions for their treatment or amelioration?

A

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

23
Q

Describe the relationship between pre-pregnancy obesity and infant outcomes (4)

A

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
24
Q

What are the nutrition-related recommendations intended for women who enter pregnancy obese? (5)

A
  • Meet nutrient needs
  • Consume a variety of basic foods
  • Participate in physical activity
  • Maintain appropriate rates of wt gain
    • Weight loss is NOT recommended
25
Q

Diagnosis of gestational diabetes

A

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

26
Q

consequences of gestational diabetes

A
  1. Elevated glucose from mother -> risk of adverse outcomes:
    - Spontaneous abortion, stillbirth, neonatal death
    - Congenital anomalies
    - ↑ insulin -> ↑ glucose uptake & triglyceride formation in fetus
  2. fetal changes ↑ likelihood later in life:
    - Insulin resistance and/or Type 2 diabetes
    - High blood pressure
    - Obesity
27
Q

management of gestational diabetes

A

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
28
Q

!what is the main reason for big babies (macrosomia) in W w/ GDM?

A

↑ blood glucose levels is the main factor for macrosomia

29
Q

Describe the characteristics of preeclampsia

A
  • 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.
30
Q

what is preeclampsia-eclampsia

A

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
31
Q

management of preeclampsia

A 
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
32
Q

pre-term, term, post-term,

A

PRE: <37 wks
TERM: 38-40 2 wks
POST: 42 wks

33
Q

pica?

A

eating disorder: Eat non-food substances

  • Pagophagia: ice or freezer frost
  • Geophagia: clay or dirt
  • Amylophagia: cornstarch or laundry starch
34
Q

macrosomia.

A

newborn with an excessive birth weight

birth wt: 8 lb 13 oz - 9 lb 15 oz

35
Q

amenorrhea

A

absence of menstruation (1 or more missed menstrual periods)
-missing 3 menstrual periods in a row = amenorrhea
most common cause of amenorrhea is pregnancy

36
Q

teratogenic

A

an agent or factor that causes malformation of an embryo

37
Q

hemodilution

A

↓ concentration of cells and solids in the blood resulting from gain of fluid

NuFS 106A (15 decks)

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