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HUNT 243 exam > Pregnancy & Infancy > Flashcards

Pregnancy & Infancy Flashcards

1
Q

What are the 9 major stages of the human lifecycle?

A 
1. Preconception

2. Pregnancy

3. Lactation

4. Infancy

5. Toddler years

6. Childhood

7. adolescence

8. Adulthood

9. Senior years
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2
Q

What is the definition of ageing?

A

the physiological changes that the body undergoes over the course of a lifetime (psychosocial, personal, moral, cognitive & spiritual growth & development)

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3
Q

What are the 4 ways to define ‘old’?

A

biologically, psychologically, socially & chronologically (65y +)

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4
Q

How will new Zealand’s ageing population change in by 2043?

A
  1. number of people aged 65+ will double

2. number of people aged 85+ will triple

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5
Q

What does it mean to consider ageing as a disease?

A

Focus on preventing & treating

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6
Q

What is ageing due to?

A

errors in their DNA accumulating into tissue damage


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7
Q

What factors influence the rate ageing occurs?

A

Genetic & environmental factors

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8
Q

What is the majority of a baby health determined by?

A

The environment

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9
Q

What is the minority of a baby health determined by?

A

Genes

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10
Q

What is the critical window of opportunity for healthy brain development, healthy growth & a strong immune system?

A

First 1000 days (pregnancy + 2 years)

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11
Q

What is preconception?

A

The period before pregnancy

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12
Q

What is periconception?

A

The period immediately following human conception

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13
Q

What are the 5 stages of reproductive reproduction?

A
  1. Gametogenesis
  2. fertilisation
  3. implantation
  4. embryogenesis
  5. placentation
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14
Q

What lifestyle factors that contribute to long term health prior to conception?

A

Supplement iodine & folic acid, cease smoking, restore normal weight, follow a healthy diet, optimise health

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15
Q

What is the cost of reproduction?

A

Greater energy expenditure due to nourishing offspring

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16
Q

What does inadequate body fat cause or a 10-15% decrease in body fat?

A

Low luteinising hormone & estradiol = hypothalamic amenorrhea

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17
Q

What is low levels of body fat during adolescence is related to

A

Delay in the age of menstruation onset

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18
Q

What risk factors arise from undernutrition in early pregnancy?

A

Poor glucose metabolism, obesity, poor lipid profile, blood coagulation, coronary heart disease, breast cancer, stress responsiveness, cognition, depression

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19
Q

What risk factors arise from undernutrition in mid pregnancy?

A

Altered Glucose metabolism, lung-disease, altered renal function

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20
Q

What risk factors arise from undernutrition in late pregnancy?

A

Altered glucose metabolism

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21
Q

What were children of pregnant women exposed to famine more susceptible of?

A

diabetes, obesity, CVD, microalbuminuria; epigenetic changes passed down through generations

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22
Q

What risks are associated with over supplementation of folic acid?

A

increased risk of asthma, atopic dermatitis, obesity & metabolic syndrome


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23
Q

What is an imbalance between folic acid & b12 associated with?

A

intrauterine, growth restriction, reduced cognitive function & increased risk of adiposity & diabetes

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24
Q

What is the Barker hypothesis?

A

Foetal undernutrition in middle to late gestation, which leads to disproportionate foetal growth associated with later coronary heart disease

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25
Q

What is thrifty phenotype hypothesis?

A

During periods of starvation foetus reduces insulin secretion, increases peripheral insulin resistance, directing more glucose to the brain & heart & less to muscle

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26
Q

What is the thrift gene hypothesis?

A

One gene fosters survival in both feast & famine conditions, and as in modern society people only tend to suffer from “feast” conditions, so natural selection is reducing ability to reproduce in obese etc..

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27
Q

Why is over-nutrition associated with sub fertility?

A

females have higher levels of oestrogen, androgens & leptin which cause menstrual cycle irregularity, ovulatory failure & amenorrhea

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28
Q

What influence does obesity have on male hormones & the effects on fertility?

A

lower levels of testosterone, Increased oestrogen & leptin = reduce sperm production & increase erectile dysfunction’

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29
Q

How does periconceptional choline status affect health?

A

affects brain Development

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30
Q

How does periconceptional folic acid status affect health?

A

prevents first & second occurrence of neural tube defects; congenital malformations, preeclampsia, autism spectrum disorder, increased sperm count & viability


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31
Q

What is the main challenge regarding folic acid?

A

how do we increase awareness, knowledge & uptake?

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32
Q

What is the advice for folic consumption 4 weeks prepregnancy and 12 weeks peripregnancy?

A

800mcg

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33
Q

How do we make sure the population get enough folic acid prepregnancy if the pregnancy is unplanned?

A

Flour & rice & bread fortified but 2012 NZ withdrew programme)

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34
Q

What are the safety concerns regarding folic acid fortification?

A

folic acid fortification good for some, may cause harm, associated with reduced risk of colon cancer, cost?

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35
Q

How does periconceptional multivitamins status affect health?

A

Neural tube defects, congenital heart defect, urinary tract defect, limb reduction defect, preeclampsia

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36
Q

How does periconceptional zinc status affect health?

A

preterm birth; placental function

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37
Q

How does periconceptional omega-3 & B12 status affect health?

A

altered lipid metabolism

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38
Q

How does periconceptional iodine status affect health?

A

Neurocognitive

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39
Q

How does periconceptional iron status affect health?

A

iron deficiency anaemia, delayed development, preterm birth, infections & postpartum haemorrhage

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40
Q

What is associated with greater gestational weight gain?

A

High BMI

Low education

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41
Q

What % of women have excess weight gain during pregnancy?

A

74%

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42
Q

What is greater gestational weight gain associated with?

A

Higher risk of obesity

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43
Q

What is a healthy amount of gestational weight gain?

A

12-18 kilograms

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44
Q

How much does diet & exercise lower the risk of excess gestational weight gain?

A

20%

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45
Q

What do the Healthy eating for pregnant women guidelines show?

A

How many fruit, veges, grains, milk products etc… are required for healthy pregnancy

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46
Q

What are the pros & cons of using ginger for nausea & vomitting?

A

Pros:decreases both from 80-33%
Cons:
1. short term adverse effects; income outcome measurements & underpowered study
2. spotting may occur after 17 weeks of use
3. increases risk of haemorrhage

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47
Q

What are symptoms of hysteria monocytes?

A

Nausea, diarrhoea, achy muscles, fever (takes day to months)

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48
Q

What precaution should be taken to avoid developing hysteria monocytes?

A

Heat food above 70C; avoid ready to eat foods & unsafe foods (deli meats, fruit, veges, salads, soft cheeses & fish)

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49
Q

What is the % chance a baby will get hysteria through placenta?

A

100%

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50
Q

What is infertility?

A

failure to achieve pregnancy after 12 month of unprotected & routine sexual intercourse

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51
Q

What is the prevalence of infertility?

A

15%

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52
Q

What is the prevalence of infertility at 38?

A

26% women & 22% of men infertile

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53
Q

What are causes of infertility in men?

A
  1. Failed vasectomy removal

  2. Retrograde ejaculation

  3. Blocked ducts

  4. Absence of Vans deferent

  5. Undescended testes in childhood
    
6. Autoimmune disorders

  6. Age: no. of sperm & quality decrease with age (increased risk of birth defects)

  7. Excess weight: reduced sperm quality
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54
Q

What are causes of infertility in women?

A
  1. Tubal problems

  2. Endometriosis

  3. Ovulation disorder
z
  4. Polycystic ovaries
    
5. Recurrent miscarriage
    
6. Hormonal problems
    
7. Auto immune disorders
    
8. Biological clock (chance of pregnancy decreases from 25% to 5% by 42 & risk of miscarriage + abnormalities increases)
 10% women experience menopause 5years earlier; 1% experience it 10years earlier

  5. Excess weight: BMI > 35 reduces chances by 26-49%
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55
Q

What % of babies are born through assisted reproduction?

A

25%

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56
Q

How much does each cycle of IVF cost?

A

$20,000 +

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57
Q

How does smoking affect reproduction?

A

reduces no. & quality off eggs, reduce blood flow, also effect sperm production & quality, miscarriage more like, half chance of IVF working

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58
Q

How does caffeine affect reproduction?

A

CONTROVERSIAL but may reduce chances of pregnancy

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59
Q

How does alcohol affect chances of pregnancy?

A

impact foetal development; drugs: damaging to unborn babies; reduce chances of successful fertility

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60
Q

How do medications affect chances of pregnancy?

A

some interfere with fertility, aspirin may enhance fertility

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61
Q

What complementary theories may help with pregnancy?

A

aromatherapy, naturopathy, reflexology

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62
Q

How does stress effect reproduction?

A

infertility can be stressful; negatively affect ovulation, can take 29% longer to get pregnant

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63
Q

What are the benefits of following a Mediterranean diet?

A

+ improves insulin resistances
+ reduces metabolic disturbances
+ reduces obesity risk
+ decreases infertility

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64
Q

What is the composition of a Mediterranean diet?

A

minimise process foods, less red meat, move veggies, fruit, liquid oils, fish, beans/ legumes, nuts, seeds, poultry

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65
Q

What are some sources of calcium?

A

reduced fat dairy products (unsweetened) or fortified soy milk (most lactose intolerant cam eat yoghurt & cheese) also include broccoli, green veggies, almonds, chia seeds, dried fruit, beans & lentils & tinned fish


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66
Q

What is PCOS?

A

higher testosterone & insulin resistance leading to irregular ovulation & menstruation (stops release so eggs build up in ovaries)

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67
Q

What % of people does PCOS affect?

A

1 in 12

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68
Q

What % of people with PCOS are obese?

A

30-70%

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69
Q

What are the symptoms of PCOS?

A

irregular/infrequent periods; difficulty becoming pregnant; multiple cysts on ovaries, acne, excess hair, hair loss & thinning; overweight; mood changes, anxiety, depression, Increased risk of T2DM, high BP, CVD, fatigue & sleep apnoea


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70
Q

How are PCOS symptoms managed?

A
  1. Balanced diet
  2. active lifestyle
  3. maintaining health + weight
  4. minimise smoking & drinking
  5. manage symptoms with medication
  6. emotional wellbeing
  7. 
Myo-inositol (restore spontaneous ovarian activity)
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71
Q

What are the 9 stages of pregnancy?

A
  1. Conception
    
2 Fetal development (4 weeks) -> positive pregnancy test

  2. Fetal development (8 weeks) -> eyelids limbs, fingers forming
    
4. Fetal development (12 weeks) 2.5 inch, starts to move & uterus starts to expand; can detect heart beat; can detect sexuality
    
5. Fetal development (16 weeks) increase growth, 4.3-4.6 weeks
    
6. Fetal development (20 weeks) -> feel them move
    
7. 24 weeks: well formed, can feel hiccups, inner ear fully formed so can feel upside down

  3. 28 weeks: 2 pounds 6 ounces; changes position frequently, can survive

  4. 32 weeks: 4lbs; layers of fat starts to form;
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72
Q

What is an amniotic sac?

A

contains H20, Protein, CHO, lipids< phospholipids, urea and electrolytes to protect foetus from impact, infection, temp changes, dehydration


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73
Q

When does the amniotic sac develop?

A

2 weeks after conception

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74
Q

When is the amniotic sac the greatest?

A

34 weeks –> 800ml

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75
Q

When is the placenta formed (0.5kg)?

A

By 18 weeks

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76
Q

What is the role of the placenta?

A

Carries oxygen, nutrients to foetus & waste materials including CO2 from foetus to mother (placenta controls hormones)


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77
Q

How is the embryo connected to the placenta?

A

Umbilical cord

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78
Q

What is hCg (Human chorionic gonadotropin)?

A

stops menstrual cycle, stimulates the ovaries to produce oestrogen & progesterone

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79
Q

What hormone do pregnancy tests detect?

A

hCg

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80
Q

When is progesterone secreted during pregnancy?

A

Secreted by placenta after 12 weeks

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81
Q

What is the role of relaxin?

A

acts with progesterone to maintain pregnancy & relaxes pelvic ligaments at end of gestation

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82
Q

What does human placental lactogens promote?

A

Mammary gland growth

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83
Q

What nutrients travel into the placenta via passive diffusion?

A

important nutrients (O, CO2, fatty acids, fat-soluble vitamins, steroids, nucleosides)

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84
Q

What nutrients travel into the placenta via facilitated diffusion?

A

Sugars

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85
Q

What travels into the placenta via active transport?

A

amino acids, ca2+, Fe, Iodine, phosphate, water soluble vitamins

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86
Q

What is assessed during a placenta examination?

A
  1. Size, shape & completeness
2. Presence of accessory lobes, placenta infarcts, haemorrhage, tumours noduled
3. Measure umbilical cord & no. of vessels
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87
Q

What does a placenta examination show?

A

Shows how healthy pregnancy is

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88
Q

What is placental cultural rules?

A

In Western world most often incinerated; maori bury placenta to emphasis the connection between them & the earth


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89
Q

What are tetragens?

A

any agent that can disturb the development of an embryo or foetus; potentially causing a birth defect or halting pregnancy


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90
Q

What are 4 classes of tetragens?

A
  1. radiation
  2. maternal infections
  3. chemicals
  4. drugs
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91
Q

What % of adults have excess weight?

A

39%

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92
Q

What % of pacific, Maori, European & asian are overweight respectively?

A

63% pacific; 48% Mori; 29% European; 16% Asian

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93
Q

Why is maternal obesity a medical problem?

A

+ Manifest as metabolic/ reproductive complications
+ increases pregnancy risk
+ INCREASES COSTS

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94
Q

What are the 5 main implications of obesity on the mother?

A
  1. Pregnancy- induced hypertension: High BP, protein in urine & edema (toxemia or pre-clampsia)
  2. Increases risk of thromboembolism: blood clot in vein (can travel to heart or lungs)
  3. Delivery complications
  4. Increased obesity risk for offspring
    Gestation diabetes mellitus
  5. Increases risk of congenital abnormalities (birth defects)
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95
Q

What are congenital abnormalities?

A

CV defects, orofacial clefts (gap in palate/ lip), hydrocephalus (Cerebral fluid accumulated in brain

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96
Q

Why do congenital abnormalities occur?

A

Altered glucose metabolism, dieting or poor maternal diet

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97
Q

What percentile is classified as small for gestational age?

A

below the 10th percentile

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98
Q

What percentile is classified as large for gestational age?

A

above the 90th percentile or over 4kg

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99
Q

What is large for gestational age called?

A

macrosomia (increases risk of C-section delivery, fetal hypoglycaemia & shoulder dystocia (shoulder gets stuck behind pelvic bone (20% suffer injury – fractured clavicle, breathing, etc))

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100
Q

What are the odds of an obese women who gained excess weight during pregnancy having an overweight child (at 7years)

A

48%

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101
Q

What are possible mechanisms behind the association between gestational weight gain and overweight children?

A

Excessive GWG & hyperglycaemia overstimulates Beta cells leading to hyperinsulinemia (Growth hormone = higher BW) results in hyperphagia & weight gain

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102
Q

What does gut microbiome imbalance lead to?

A

diverse diseases such as allergic immune mediated diseases

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103
Q

What does a good gut microbiome lead to?

A

benefits immune system (provides defence against infections)

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104
Q

How do infants get a microbial inoculation?

A

After rupture of amniotic sac they receive microbial inoculation from delivery as there bacteria in placenta & stool in amniotic fluid

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105
Q

How should we build up the gut microbiome of children who got C-sections?

A

Innoculate with bacteria from mothers vagina

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106
Q

What are the 3 trimesters in weeks?

A

1st : 1-12 weeks
2nd : 13-28 weeks
3rd : 28 – birth

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107
Q

What is the survival chance 24 weeks?

A

50% survival chance

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108
Q

What are the short-term complications of pregnancy at 24 weeks?

A
  1. Respiratory distress syndrome
  2. heart: patent ductus arteriosus
  3. Brain: intraventricular haemorrhage
  4. GI: Necrotizing enterocolitis (inflammation of immature gut -> shuts down organs)
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109
Q

What are the long-term complications of pregnancy at 24 weeks?

A

Cognitive, vision, hearing, ADHD, anxiety, asthma, SIDS

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110
Q

What physical changes occur during pregnancy?

A
  1. 12-15Kgs are gained due to fat disposition
  2. growth of the reproductive organs & foetal tissues
  3. increased requirement for nutrients is given by foetal growth
  4. fat disposition
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111
Q

What hormonal changes occur during pregnancy?

A
  1. Progesterone & estrogen continue to rise & supress the menstrual cycle & this stimulates prolactin which helps mature mammary glands.
  2. Parathyroid hormone increases with pregnancy to build the skeleton of the baby (increases CA2+ uptake & reabsorption & stimulate osteoclasts)
  3. HCG (peaks around 10 weeks) from embryo itself
  4. Hormonal placental Lactogen: Produced by the placenta (decreases maternal insulin sensitivity & decrease mothers glucose use to help with fetal nutrition)
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112
Q

What can hormonal placental lalactogen cause?

A

Can lead to chronic hyperglycaemia & high blood glucose can lead to gestational diabetes

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113
Q

What metabolic changes occur during pregnancy?

A
  1. Maternal insulin resistance increase liver metabolism is also seen with increased glucogenesis to increase maternal glucose levels
  2. Renal plasma flow increases as does aldosterone & erythopieyen production
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114
Q

What cardiovascular changes occur during pregnancy?

A
  1. Cardiac Output increases 30% - 50%
  2. HR increases to 90 bpm
  3. BP drops in the 2nd trimester
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115
Q

Why does Blood pressure drop during pregnancy?

A

Due to increased Cardiac Output, renin & angiotensin

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116
Q

What risk does an increased heart rate during pregnancy pose?

A

risk of hypertension

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117
Q

What respiratory changes occur in pregnancy?

A

Increased tidal volume
Increased minute volume
Lower CO2

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118
Q

Why do respiratory changes occur in pregnancy?

A

Progesterone signals cause the brain to lower CO2

Uterus pushes on lung

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119
Q

What haematological changes occur during pregnancy?

A

BV increases by 40-50% (followed by RBC increase)

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120
Q

Why does blood volume increase during pregnancy?

A

Blood flow to uterus, metabolic needs of fetus & increased perfusion of other organs
Reduce the impact of maternal blood loss at delivery

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121
Q

What gastrointestinal changes occur during pregnancy?

A
  1. enlarged uterus pushes on GI tract & colon potentially causing constipation & decreased GI motility due to elevates progesterone levels (relax smooth muscles)
  2. Heart burn is common from delayed emptying
  3. HCL decreases (ulcers become less severe)
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122
Q

What is nausea & vomiting associated with?

A

HCG (from 5-18 weeks)

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123
Q

How do you manage nausea & vommiting during pregnanacy?

A

diet (eat slowly & small amounts ever 1-2 hours, avoid a full & empty stomach; protein-predominant snacks decrease nausea (ginger & B6)

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124
Q

How much weight gained during pregnancy is fluid, fat stores and the foetus?

A

3.2 kg fluid; 3.5kg fat stores; 3.5kg baby

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125
Q

How is gestational weight gain distributed?

A

1/3rd in 2nd ; 2/3 in 3rd trimester

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126
Q

What % of gestational weight gain is water, fat mass & lean mass respectively?

A

62% water
Fat mass: 30%
Lean mass: 8%

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127
Q

What does weight gain during the 1st & 2nd trimester reflect?

A

expansion of maternal tissue

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128
Q

What does weight gain during the 3rd trimester reflect?

A

Reflects primarily fetal growth, placental growth & accumulation of amniotic fluid

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129
Q

How much does accretion cost?

A

150 kcal/day

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130
Q

How much does basal energy expenditure increase?

A

100-180 kcal/day

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131
Q

How much does energy needs increase in each trimester?

A

1st trimester -> extra energy not required
2nd trimester -> 340 kcal day
3rd trimester -> 452 kcal day

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132
Q

Why are LCPUFAs essential during pregnancy?

A

They are essential for normal fetal development, particularly neural and visual function

  1. DHA is a critical component of cell membranes
  2. AA is a membrane component and a precursor to potent signalling molecules
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133
Q

How does Foetal LCPUFA accumulate during pregnancy?

A

n-3 fatty acid deposition occurs slowly then rapidly in the last trimester of pregnancy

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134
Q

What are dietary sources of omega 6?

A

+ Linoleic acid: soybean, vegetable oils, green veges, nuts & seeds
+ AA: Egg yolk, meats
+ GLA: evening primrose; black current oils

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135
Q

What are dietary sources of omega 3?

A

+ Alpha linolenic acid: soybean, canola, flaxseed & walnut oils, nuts & seeds
+ AA: Fish oils & oily fish
+ GLA: Fish oils & oily fish

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136
Q

Why do we need an equal ratio of omega 3 to omega 6?

A

Higher DHA = increased GA & heavier infants (high AA = opposite)

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137
Q

What concerns are associated with methyl mercury at low levels during pregnancy?

A

+ impact on LCFUs on child’s intelligence

+ Neurodevelopment consequences

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138
Q

What is the mean intake of DHA & EPA?

A

128 mg/day

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139
Q

What is DHA associated with?

A

Child cognition & visual acuity

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140
Q

How much DHA is recommended & what is the upper limit?

A

200-300 mg/day

UL: 3g/day

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141
Q

How much DHA is needed during pregnancy?

A

+ development potential is unknown currently on individual level
+ enhanced DNA is not expected have a benefit over their need
+ functional measure shows amount for optimal brain development

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142
Q

How much iron is needed to meet pregnancy demands?

A

1000mg

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143
Q

Why are iron needs increased during pregnancy?

A

to create more blood for mother & baby’s increased BV & blood loss at birth

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144
Q

How much is iron absorption enhanced during pregnancy?

A

from 1.2 mg/day to 5.6 mg/day

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145
Q

How much iron does a pregnant women need to consume compared to a not pregnant women?

A

27 mg/day from 21 mg/day

146
Q

What does a 60mg iron supplementation help with?

A

Low birth weight

147
Q

When should iron be screened?

A

First booking & 28 weeks

148
Q

What Hb concentration suggests that oral iron supplementation is urgent?

A

<100

149
Q

What are the side effects of iron medications?

A

nausea, vomiting, constipation, diarrhea

150
Q

Why should we give iron tablets to iron replete women?

A

Increases the chance of gestational diabetes

151
Q

Why is it important that babies have built up large iron stores?

A

Breast milk has very low iron

152
Q

What are 3 interventions for low iron?

A
  1. Fortifying staple foods
  2. Deworming
  3. Improve sanitation
153
Q

What risk does iron depletion pose?

A

Increases risk of cardiac failure or death from peripartum hemorrhage

154
Q

What is iodine essential for?

A

For the production of thyroid hormones

155
Q

What are the roles of thyroid hormones?

A
  1. regulating the body’s metabolism
  2. Normal growth
  3. neurocognitive development of fetus, infant and child
156
Q

What is severe iron deficiency during pregnancy associated with??

A

maternal and foetal hypothyroidism (congenital anomalies, decreased intelligence, and cretinism (physical deformity + learning difficulties) as well as maternal and foetal goitre)

157
Q

What is mild maternal iodine deficiency associated with?

A

mild maternal thyroid hypofunction and decreased child cognition

158
Q

Why are pregnant women more susceptible to iron deficiency?

A

Much higher requirements:

EAR 160 mcg/d, RDA 220 mcg/d

159
Q

What are foetal levels of alcohol compared to maternal levels?

A

The same

160
Q

What withdrawal symptoms may infants expose to alcohol in utero experience?

A

hyperactivity, excessive crying, irritability, weak sucking, disturbed sleep, hyperphagia, seizures

161
Q

What are the main features of metal alcohol syndrome?

A
  1. Growth deficiency of prenatal onset
  2. CNS dysfunction (microcephaly, delayed development, hyperactivity, attention deficits, learning disabilities, intellectual; deficits)
  3. specific pattern of facial characteristics (short palpebral fissures, thin upper lip; smooth/ long philtrum)
162
Q

What are the 3 components of fetal alcohol disorder spectrum?ohol related

A
  1. Full FAS occurs with regular heavy alcohol intake or very high alcohol concentrations
  2. Alcohol related neurodevelopment disorder (difficulties with math, memory, attention, school, impulse control & judgement)
  3. Alcohol related birth defects (issues with heart, kidneys, bones & hearing)
163
Q

What nutrients are most at risk of inadequacy with alcohol consumption in pregnancy?

A
  1. folate
  2. vitamin A
  3. Vitamin C
  4. thiamin
  5. calcium
  6. iron
  7. fibre
164
Q

What % of women consumed alcohol during pregnancy & what & are binge drinkers?

A

30-40%

10-12%

165
Q

What is heavy episodic drinking defined as?

A

Defined as consuming > 4 standard drinks on one occasion

166
Q

What is heavy episodic drinking in early pregnancy associated with?

A

preterm birth; lower BW; craniofacial defects; sudden infant death syndrome; sleeping problems and difficult temperament; adolescent antisocial behaviour, school problems and self- perceived learning difficulties

167
Q

When did prepreganncy health labels become mandatory?

A

July 2020

168
Q

What is gestational diabetes defined as?

A

any degree of glucose intolerance with onset or first recognition during pregnancy

169
Q

What is hyperglycaemia associated with?

A

An increase in the risk of intrauterine fetal death during the last 4–8 weeks of gestation

170
Q

What does gestational diabetes mellitus associated with?

A

Fetal macrosomia

171
Q

What are long term complications of gestational diabetes in the mother?

A

Increased risk of type 2 diabetes (enhanced by obesity & other factors that promote insulin)

172
Q

What are long term complications of gestational diabetes in the offspring?

A

At increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood.

173
Q

What are risk factors for gestational diabetes?

A 
\+ 35 years+
\+ family history
\+ previous history
previous large baby
\+ excess weight
\+ PCOS
174
Q

When should pregnant women be screened for gestational diabetes

A
  1. before 20 weeks (HbA1c > 50 = diabetes)

2. 24-28 weeks (75g oral test is HbA1c = 41-49 mol/mo or 50g if <40l)

175
Q

What glucose concentration requires further testing and immediate refer during 28 week screening?

A 
>11.1 = immediate referral
7.8-11 = two hour OGTT
176
Q

How should gestational diabetes be managed?

A
  1. receive nutritional counselling (adequate nutrition)
  2. ultrasounds to assess fetal growth
  3. metformin + insulin might be required
    4.
177
Q

What are the issue with carbohydrate restriction proposed for gestational diabetes?

A
  1. higher fat intake

2. excaberates maternal insulin resistance

178
Q

Why do we reduce fat intake to 30-40% of calories?

A

To limit postprandial hyperglycaemia = decreases fatal glucose exposure & lessens the risk for macrosomia

179
Q

What follow up should be taken for gestational diabetes?

A
  1. informed about risks of developing type 2 diabetes or gestational diabetes in future pregnancies
  2. HbA1c 3 months postpartum & annually (unless = 41-49 then annual)
180
Q

What are alveoli?

A

functional units of the mammary gland

181
Q

What is each alveolus composed of?

A

cluster of secretory cells) with a duct in the centre to secrete milk arranged like branches of a tree with each smaller duct leading to 6-10 larger collecting ducts leading to nipple
These are surrounded by my-epithelial cells

182
Q

What is the role of my-epithelial cells in lactation?

A

contract under influence of oxytocin and cause milk to be ejected into ducts

183
Q

How many lobes is a mammary gland made up of?

A

15-25

184
Q

How many lobules is a lobe of a mammary gland made up of?

A

20-40

185
Q

What allows oxytocin to reach alveoli?

A

Good vascularisation

186
Q

When do ovaries mature & increase in oestrogen & progesterone?

A

12-18 months after menarche

187
Q

How do the mammary glands develop during puberty?

A
  1. ductal system matures
  2. nipples grow & pigmentation change
  3. fibrous & fatty tissue increase around the duct
188
Q

How do the maaary glands develop during pregnancy?

A
  1. Human chorionic gonadotropin and placenta lactogens help preparation
  2. oestrogen stimulates gland development
  3. progesterone elongates the tubules & duplicates epithelial cells
189
Q

What are the two lactation hormones?

A
  1. Prolactin: Stimulates milk production

2. Oxytoxin: stimulates ejection of milk from glands into ducks (letdown)

190
Q

Why does oxytoxin act in uterus during & after delivery?

A

causing it to contract, seal blood vessels and shrink in size

191
Q

What are the 3 stages of lactogenesis?

A
  1. Lactogenesis 1: last trimester to few days postpartum
  2. Lactogenesis 1: 2-5d postpartum (increases in volume/ changes composition)
  3. Lactogenesis 3: 10 days postpartum: stable milk composition
192
Q

What is colostrum?

A 
Concentrated milk  in lactogenesis 1 containing: 
\+ Lymphocytes
\+ IgA, IgM, IgM
\+ High protein (low fat)
\+ Vitamins & minerals
193
Q

When is breast feeding first initiated?

A

Within the first hour of birth

194
Q

What reflexes are healthy infants born with to help them feed?

A
  1. Suck & swallow (gag reflex)
  2. Oral search reflex
  3. Rooting reflex
195
Q

What is the oral search reflex?

A

Open mouth wide in proximity to breast & thrusting tongue forward

196
Q

What is the rooting reflex?

A

Turns head when lip is stimulated

197
Q

What are the mechanics of breastfeeding (steps)?

A
  1. suction elengates nipple & areola
  2. baby compresses areola (milk travels down ducts)
  3. baby carries out peristaltic motions forming a grove in the tongue to carry milk to throat
  4. Receptors initiate swallowing
198
Q

What are some ways to help establish breastfeeding

A
  1. Skin-to-skin contact
  2. Staying hydrated
  3. Responsive feeding
  4. Emptying breasts – removal signals production
199
Q

What is typical milk production?

A

1st month:600 ml

4-5 month: 750-800 ml

200
Q

What are the 10 components of milk?

A
  1. water
  2. Protein
  3. Carbs/ lactose
  4. fats
  5. antibodies
  6. vitamins & minerals
  7. oligosaccharides
  8. bacteria
  9. immune cells
  10. hormones
201
Q

Why don’t baby need water?

A

Breastmilk is 88% water

202
Q

How much energy is in breastmilk?

A

0.65-0.7 kcal/ml

203
Q

What is the macronutrient composition of milk?

A
  1. Fat is low in fore milk & high in hind milk (provide half the energy & cholesterol)
  2. protein content = low
  3. Carbohydrates: lactose enhance calcium absorption (also glucose & gut bacteria)
204
Q

What are human milk oligosaccharides?

A

Complex, indigestible, medium-length CHO with lactose on one end that act as a prebiotic to Stimulate growth of Bifidus bacteria and inhibits Escherichia coli
to Prevent binding of pathogenic microorganisms to the surface receptors of their target cell

205
Q

What vitamins & minerals are not sufficient in human milk?

A
  1. B-vitamins if maternal intake is low
  2. Vitamin D
  3. Iron – low but high bioavailability
206
Q

What is the average iron consumption of human milk?

A

0.35 mg/L

207
Q

Why is iron in breastmilk more bioavailable?

A
  1. Lower Ca
  2. Lower Phosphorus
  3. Lower protein
  4. high concentration of action
  5. high concentration of iron-binding protein
  6. High lactoferrin
208
Q

How much iron is absorbed in BM compared to infant formulas?

A

50% vs 10%

209
Q

What is lactoferrin?

A

Globular glycoprotein of the transferrin family

210
Q

What is the role of lactoferrin?

A
  1. Mediates iron absorption via a lactoferrin receptor `
  2. Withhold iron from pathogens
  3. regulate cell growth
  4. activate DNA sequences
  5. NK activation
  6. anti-tumour activity
  7. help digest viral DNA
  8. lactoferricins have antimicrobial, antiviral, anti tumour & immunological function
211
Q

What is a major determinant of anaemia risk during infancy?

A

Infants iron reserves at birth

212
Q

What is sustained iron deficiency anaemia associated with in infants?

A
  1. irreversible and detrimental effects on intellectual and motor performance
  2. restricted linear growth
213
Q

How much vitamin D is available in breast milk compared to formula?

A

20-70 IU/L
vs
200 IU/L

214
Q

How can we increase the vitamin D content of breastmilk?

A

Mother must consume a high dose supplest of vitamin D (1% of what consumed in breastmilk)

215
Q

What Supplementation of vitamin D is recommended in different countries?

A

France/ Finland = 100 UI
Canada, U.S, U.K.: 400 IU
NZ: no policy

216
Q

what are the risk factors for vitamin d deficiency?

A
  1. Naturally dark skin
  2. Sibling diagnosed with rickets
    or hypocalcaemic seizures
  3. Mother who is deficient in vitamin D or is at higher risk of becoming deficient
  4. All preterm infants < 2.5 kg
  5. Infants BF over winter months
217
Q

How can vitamin D be administered to baby?

A
  1. directly to Childs mouth
  2. added to food/ drink
  3. on nipple
218
Q

What is world breastfeeding week?

A

Campaign to

  1. inform people about importance of BF
  2. Anchor BF support at public health responsibility
  3. Engage with individuals & organisations
  4. excite action on protecting BF
219
Q

What are the WHO recommendations for BF?

A
  1. Infants should be exclusively BF in the first 6 months

2. complementary food past 6 months

220
Q

What does exclusive Breastfeeding protect against?

A
  1. Diarrhoea
  2. Respiratory illness
  3. Decreased Breast cancer risk
  4. Increased in IQ in child
  5. Decreased childhood obesity
221
Q

What are the three primary benefits of exclusive BF for the mother?

A
  1. prolongs the duration of lactational amenorrhea
  2. Accelerates weight loss
  3. Lowers the risk of breast cancer
222
Q

What are the two primary benefits of exclusive BF for the child?

A
  1. Protective against gastrointestinal infections

2. Potential enhanced motor development

223
Q

What is the challenge of exclusive BF?

A
  1. 38% infants exclusively breastfeed (rates have stopped declining)
  2. formula-fed in unhygienic conditions 6-25X more likely to die from disease
  3. 25% increase in mortality in formula fed
224
Q

What are the main reasons mothers do not breast fed

A
  1. Returning to work
  2. social perception
  3. lack of knowledge about expressing & storing
  4. factors associated with obesity
225
Q

Why are obese women less likely to breast fed?

A
  1. have lower milk production 2. greater latch difficulties
  2. High rate of ‘medicalized’ pregnancy and childbirth
  3. Perceived insufficiency of milk supply
  4. Body image issues with feeding in public = early cessation
226
Q

What is the international baby friendly hospital initiative?

A

All maternities become centres of BF supporting by:

  1. does not accept free breast milk substitutes
  2. feeding bottles or treats
  3. implanted 10 steps to support BF
227
Q

What are the 10 steps to successful BF?

A
  1. written/ communicated BF policy
  2. Train staff to implement policy
  3. Inform pregnant women about benefits & management of BF
  4. Help mothers initiate BF within 30min
  5. Show mothers had to BF
  6. no food/drink for first 6m
  7. allow mothers & infants to remain together
  8. encourage BF on demand
  9. No artificial teats or pacifiers
  10. Foster the establishment of BF support groups
228
Q

What are some BF challenges?

A
  1. Baby won’t BF
  2. Sore & cracked nipple
  3. engorgement/ breast fulls
  4. Mastitis
  5. Baby biting breast
  6. Low milk supply
  7. Blocked milk ducts
  8. Babies with tongue-tie
229
Q

What are issues with preparation?

A
  1. flat/ Inverted nipple (pumping elongates; nipple shields)
  2. Breast Surgery
  3. no issues with breast size (larger needs less frequent feeds)
230
Q

How does alcohol affect Breast feeding?

A

+ It inhibits release
+ affects milk production & infants sleeping/ eating patterns
+ affects brain development

231
Q

How long does it take a women to get rid of the alcohol from 1 standard drink?

A

2 hours on average

232
Q

What are the 3 types of infant formula?

A
  1. Infant formula (0-12m)
  2. Follow-on formula (6-12m)
  3. Formula for dietary use
233
Q

How is infant formula regulated?

A
  1. Codex reviews evidence to set mins & maxes
  2. Must comply 2.91 (composition & safety requirements)
  3. Mandatory nutrient content
  4. labelling requirements
  5. controls additives
234
Q

What is home made infant formula made up of?

A

Liver, cod liver oil, bone broth

235
Q

What is the issue with homemade infant formula?

A

Bad for immature kidneys
Bad for GI tract
Microbiological risk

236
Q

What is the casein: whey ratio of breast milk, whey dominant formula & casein dominant formula?

A

BM: 40:60
Whey dominant: 40:60
caesin dominant: 80:20

237
Q

Both BM & whey dominant formula have a casein: whey ratio of 40:60; what is the difference?

A

Whey protein is alpha in BM; Beta in Cows

Caesin protein is Beta in BM & goat; alpha in cows

238
Q

How much protein does BM & infant formula have per 100kcal, respectively?

A

BM: 1.5g/100kcal
Formula: 2.2g/100kcal

239
Q

What is the early protein hypothesis?

A

More protein = more circulating amino acids and greater insulin & growth factor secretion (IGF-1 which are anabolic

240
Q

What is a higher protein intake during infancy associated with?

A
  1. Greater weight
  2. Increased risk of obesity
  3. High weight persisted during school
241
Q

What is minimum protein requirement for formula?

A

0.38 g /100 kJ (proposed to be 0.45)

242
Q

What is the main carbohydrate in breast milk?

A

Lactose

243
Q

What does lactase enzyme deficiency cause?

A

diarrhoea, cramps, bloating, vomiting, gas

244
Q

What carbohydrate do lactose free formula’s typically use?

A

Corn syrup, sucrose or fructose

245
Q

What fat ratio in milk affects it digestibility?

A

Ratio of PUFA to saturated fat

246
Q

What type of fat must infant formula contain

A

Linoleic acid

Alpha-linolenic acid

247
Q

What type of fat is assed to formula at a cost?

A

LCPUFS

248
Q

What is the max % of trans fatty acids in infant formula?

A

3%

249
Q

What is taurine associated with/ why is added to formula?

A

Associated with Neuro- & Retinal development

250
Q

What is chloride associated with/ why is it added to formula?

A

To prevent hypochloremic alkalosis (associated with cognitive delays, language disorders, impaired/ visual motor skills)

251
Q

What are the minimum & maximum quantities of chloride in infant formula?

A
  1. Minimum 55 to 65 mg/100 kcal

2. Maximum of 150 mg/100 kcal

252
Q

Starter formula is ____ based; Follow on formula is ______ based.

A

Whey

Caesin

253
Q

What are the 4 major categories of infants formulas?

A
  1. Cows milk
    (hydrolysed used if intolerant to enact proteins or lactose free if lactose intolerant)
  2. Soy: if lactose intolerant or have galactosemia
  3. Goat: cultural reasons
  4. Specialised ( preterm, GI reflux, inborn errors of metabolism)
254
Q

What benefits are proposed by adding prebiotics, probiotics, nucleotides & oligosaccharides to formula?

A
  1. Prebiotic: Help gut macrobiotic (weak evidence) Greater impact on pre-term
  2. Probiotics: Beneficial live microorganisms
  3. Nucleotides: GI tract & immunity
255
Q

What is the issue with specialised ingredients in infant formula?

A

Lack of regulatory codes & health claims

256
Q

What is the difference between teats for older and younger children?

A

Teats for older children have multiple & faster flow

257
Q

How do we administer infant formula?

A
  1. sterilise bottles & teat
  2. warming is not necessary (don’t heat in microwave!)
  3. use within 2h
258
Q

How frequently should infants be feed formula

A

6-8 times a day

259
Q

What shows readiness to feed?

A
  1. can reach for spoon
  2. clenches fist
  3. Moves tongue side to side
  4. support head & body upright
    5, reach for stuff while sitting upright
260
Q

Motor development occurs top down and _____ to ______ (proximodistally)

A

centrally; peripherally

261
Q

When do first teeth erupt & when do infants have a full set?

A

Between 6 & 9 weeks (full set by 3 years)

262
Q

What are the 5 developmental stages of feeding?

A
  1. 6 months: suck, swallow, extrusion reflex & move liquid
  2. 6-7 months: side to side movements (manipulate)
  3. 7-8 months: can eat thick/puree & mashed lumps
  4. 8-12 months: Chew & swallow soft, mashed, minced, grated, chopped foods
  5. 12-24 months: consumes 3meals & 2 snack
263
Q

How does calorie intake and feeding frequency change over infancy?

A

6-7 months: 200 kcal/ day 2-3x day
(milks given before food)

8-12 months: 3 x a day with one nutritious snack ~ 686 kcal/day

12-24 months: 12-24 months: 3 meals + 2 snacks (~890 kcal/day)

264
Q

What are some of the first foods that can be introduced during complementary feeding?

A
  1. Cooked & pureed fruit & veges
  2. Uncooked mashed banana & avocado, carrots etc..
  3. Cooked & pureed vegetarian alternatives: 4. hummus, baked beans, lentils, soaked/ cooked/ dried beans/ peas
265
Q

What is responsive feeding?

A

Listen to babies hunger & stately cues

Parent chooses when & what

266
Q

How many times do you need to expose infant to a new food before they accept it?

A

8-15 times

267
Q

What shouldn’t be added to home prepared infant food?

A

fat, salt, sugar & honey

268
Q

What liquids should be avoided in infancy?

A

No juice, soft drinks, tea (including herbal tea)

269
Q

What factors affect food acceptance?

A
  1. taste + smell (prefer sweat; reject bitter)
  2. tactile stimulation + texture
  3. visual appearance
270
Q

How do we promote better acceptance of new foods?

A

Introduced to a variety of foods frequently (large range of tastes + textures)

271
Q

when does sucking become under voluntary control?

A

4 months

272
Q

At what age do babies begin chewing?

A

6 months

273
Q

When is the sensitive period of introduction of lumpy foods?

A

before 10 months (otherwise difficulties at 15 months)

274
Q

how often should meat, poultry, fish & eggs should be eaten?

A

daily

275
Q

What is neophobia?

A

reluctance to try new foods

276
Q

What is baby led-weaning?

A
  1. Give softened family foods from 6 months
277
Q

What demographic is likely to use baby-led weaning?

A

Higher income; higher educated mums

278
Q

What are the issues and advantages of baby led weaning?

A

Issues:

  1. A lot of food waste
  2. concern if getting enough nutrients
  3. more risk of nutritional inadequacies

advantages:
Helps with exposure, motor skills 7 acceptance

279
Q

What age is it acceptable to give cows milk to an infant & why not earlier?

A

Acceptable after 1 year old

  1. The high protein content may cause gastrointestinal blood low
  2. low iron & bioavailability
280
Q

What is the max amount of milk that should be given to an infant & why?

A

low iron and it fills baby up (includes BM)

281
Q

What is the international code of marketing breast-milk substitutes?

A

Marketing of substitutes is restricted to prevent discouraging BF

282
Q

What makes up the international code of marketing breast-milk substitutes?

A
  1. forbids advertisement/ marketing
  2. forbids claiming health benefits
  3. forbids contact between representatives and medical personal/mothers
  4. no distribution of free samples in hospitals & public health services
  5. baby food adverts may not target under 6 months
  6. no promotional distribution of pacifiers/ bottles
  7. manufactures may not distribute promotional gifts
  8. can’t put images of mother/ children on labelling
  9. Labels must state BF is best
283
Q

In New Zealand international code of marketing breast-milk substitutes mandatory?

A

Not voluntary, self-regulatory

284
Q

What is the international baby food action network?

A

Monitors baby food marketing in 69 countries

285
Q

What does atopic disease include?

A

includes food allergies, atopic dermatitis, asthma

286
Q

What does atopic disease in infants & children cause to be produced?

A

Produce IgE antibodies after exposure to allergens (occurs when the immune system is dysregulated)

287
Q

when do children with asthma typically develop symptoms?

A
  1. By 6 years

2. 1/3 of children who develop wheezing before 3

288
Q

What are food allergies?

A

immunologically mediated hypersensitivity reaction to any food

289
Q

What are the 2 types of food allergies?

A
  1. IgE mediated

2. adverse non Ige immune reactions

290
Q

How long may the response be of immune related non-mediated food allergies?

A

Up to 2 days

291
Q

What is Atopic dermatitis (eczema)?

A

a chronic inflammatory skin disease

292
Q

What is the first atopic disease to manifest; what may it progress too?

A

Eczema progresses to asthma or rhino conjunctivitis

293
Q

What is Eosinophilic Oesophagitis?

A

inflammation in a part of the GI system

294
Q

What are the symptoms of an Immune related non-mediated IgE food allergies?

A

+ upset stomach (difficulting swallowing, vomiting, diarrhoea)
+ may lead to poor nutrient absorption; failure to thrive

295
Q

How do you diagnosis Immune related non-mediated IgE food allergies?

A

has to use elimination/ re-introduction diet

296
Q

what are symptoms of a food allergy?

A

tingling/ itching of mouth; itchy red rash, swelling, wheezing, sick, vomiting, shortness of breath, abdominal pain,

297
Q

What is coeliac disease?

A

Immune system produces antibodies which inflames & damages the lining of the small intestinal tract as a reaction to gluten
stopping nutrient absorption

298
Q

What are food intolerances?

A

immediate & delayed adverse reaction to foods that does not involve the immune system

299
Q

What are some symptoms of food intolerances?

A

diarrhea, nausea, cramping & headache

300
Q

How many reported food allergies are there?

A

160

301
Q

What are the 6 most common allergies?

A
  1. Cows milk & egg white 3%
  2. Peanut: 0.8%
  3. Tree nuts (almonds, brazil nuts, cashew…) 0.2%
  4. Soy: 2%
  5. Wheat: common allergy in
  6. childhood but usually resolves
302
Q

What is the most common allergen for infants & how many outgrow?

A

Cows milk & egg white

70% outgrow

303
Q

What % of infants that react to Cows milk & egg white also react to goat & soy respectively?

A

92% also react to goat

17-47% also react to soy

304
Q

When performing a skin prick risk what size wheel diameter indicate an allergy?

A

3mm

305
Q

What % of children & adults experience atopic disease?

A

6-8% children; 2-4% adults

306
Q

How has atopic disease prevalence changed over the last 2 decades?

A
  1. Asthma has increased 160% (NZ 2nd highest rate in world)
  2. Atopic dermatitis has increased 2 to 3 fold
  3. peanut allergy doubled due to avoidance of common allergens
307
Q

What are the causes of atopic disease?

A

+ genetic link

+ environmental factors (migration differences; environment = important determinant -> window of opportunity)

308
Q

What contributes to the development of allergies during utero?

A
  1. Adverse life effects
  2. smoking
  3. air pollution
  4. medicines
  5. microbial farm environments
  6. c-section
  7. winter babies
309
Q

Do dietary restrictions prevent allergy development during pregnancy?

A

No

310
Q

What helps prevent atopic disease?

A

Exclusive Breast feeding

311
Q

What is the evidence to date on the role of human milk on atopic disease?

A

no RCT

no evidence that should avoid anything (advantageous to expose!)

312
Q

If an infant is at a high risk for atopic disease and not able to breastfed, what should we feed the the infant?

A

Feed high-risk infants, a protein- hydrolysed formula to lower risk of developing eczema and cows milk allergy

313
Q

How do allergies affect quality of life?

A

They are hard to avoid, can cause activity avoidance & bullying

314
Q

How is the food environment managed for allergens

A
  1. Infor must be accurate
  2. Allergens must be listed (bolded)
  3. Contain statements
  4. May contain statements (cross-contamination)
  5. needs to be able to provide info on request
315
Q

What is the food allergen portal?

A

resources & training protocols to set up establishments properly

316
Q

How much has food allergy rates risen?

A

Increased prevalence by 50% (peanut allergy tripled)

317
Q

Why have food allergy rates risen?

A
  1. avoidance common allergen foods
  2. Vitamin D (no evidence)
  3. hygiene hypothesis: reduced exposure to infectious diseases & microbial products has reduced immune deviation along with increased antibiotics
318
Q

What is the evidence behind the hygiene hypothesis?

A
  1. countries who didn’t avoid allergen containing foods had less allergies
  2. Dual allergen exposure:
    Skin exposure can cause allergic reaction if haven’t developed oral exposure tolerance
  3. exclusion for 1y = 74x more likely to develop allergy
319
Q

What shows there its a time & dose effect of early allergen introduction?

A

67% lower relative risk of food allergy overall in early intro group

320
Q

What are 6 steps to prevent allergy & atopic disease?

A

+ exclusive BF for at least 4 months
+ delayed introduction of complementary foods
+ sustaining exposure
+ get things with gluten before 7 months (BM provides immunological umbrella)

321
Q

How much does birth weight increase in the first 4 months?

A

Doubles

322
Q

How much does birth length increase by 12 months?

A

1.5x

323
Q

How much does head circumference increase in the first year (cm)?

A

~11cm

324
Q

What is the Apgar scoring system?

A

A system that scores infants on 0, 1 & 2 for muscle tone, pulse, grimace (reflex irritability), appearance (skin colour) & respiration

325
Q

What are average birth weight & birth length?

A

3290g & 50cm

326
Q

What measurement should not be taken at birth?

A

Head circumference

327
Q

What is the role of a child growth assessment & how is it performed?

A

Role: Determining if a child is growing normally or has growth abnormalities

How: Compare measurements to age standards/ references and monitor growth velocity

328
Q

______ is a good indicator of acute changes
______ reflects long-term nutrition
________ reflects brain growth

A

Weight
Height
Head circumference

329
Q

When is increase in head circumference reflective of brain growth until?

A

1 year

330
Q

How do we measure infant weight?

A
  1. Remove clothing + nappy up to 2 years

2. Children 2y + minimal clothing, remove shoes & empty bladder; before a meal

331
Q

What do we record weight too?

A

Nearest 10g

332
Q

How do we measure infant length?

A
  1. Use calibrated length board with fixed headboard & moveable foot piece
  2. Straighten out legs, placed on back, toes should be pointing (length to nearest 0.1cm)
  3. take average of 3 measurement

++ use 2/ 3 trained people

333
Q

How do you measure an infant’s head circumference?

A

flexible, non-stretchable tape above the ears and around the biggest part of the back of the head
(take average of 3 measurements)

334
Q

Where do you take mid upper arm circumference?

A

measured over the left upper arm, at a point marked midway between the acromion (shoulder) and olecranon (elbow) with arm at right angle

335
Q

What are some normative growth references?

A
  1. Tanner growth charts (effected by wartime malnutrition) -> accounting for variations in child’s tempo of growth (1960)
  2. US National Center Health Statistics (only measured every 3 months) (1977)
  3. NZ Growth Charts (Maori & pacific were underrepresented; not optimal growth; inc. BF & FF)
  4. WHO funded child growth standards
336
Q

What was the goal of WHO funded child growth standards?

A

Provide a single international standard that represents the best description of physiological growth for children up to 5 years (breastfed only as normative)

337
Q

What type of studies was the WHO funded child growth standards made from?

A
  1. Longitudinal from birth to 2 years

2. cross-sectional data from 18 months to 6 years

338
Q

What were the conditions to be included in WHO child growth standards ?

A
  1. Favourable SES
  2. EBF for at least 4 months in longitudinal
  3. Complementary food introduced at 6 month
  4. BF to 12 months
  5. No maternal smoking
  6. LBW included
339
Q

What was measure in the development of the WHO child growth standards ?

A

Developmental milestones measure and anthropometrics

340
Q

How often were Developmental milestones measure and anthropometrics measured in the WHO child growth standards ?

A
  1. fortnightly to 2 months
  2. 1 month to 13 months
  3. 2 months till 2 years
341
Q

What are the innovative aspects of the WHO child growth standards ?

A

+ prescriptive approach
+ Breastfed is normative model
+ international sample
+ reference data for assessing childhood obesity

342
Q

What growth standards have been produced?

A
  1. weight for growth
  2. length/height for age
  3. weight for length/ height
  4. BMI for age
  5. MUACF for age
  6. skinfolds for age
  7. Head circumference for age
343
Q

What is the variation in growth curves of individuals compared to groups?

A

70% vs 3% (No difference between ethnicities)

344
Q

What growth standard should be used before 10, and after respectively?

A

Weight for Age

BMI

345
Q

What % full between +1 & -1; 2SD & what % fall between -2 and +2?

A

67%

95%

346
Q

How do we interpret height-for-age Z scores?

A 
Below -2 = stunte
Below -3 severly stunted
\+3 flags endocrine disorder
\+2 overweight
\+3 obese
-2 wasted
-3 severly wasted
347
Q

What is oedema?

A

Fluid collection in tissue due to malnutrition?

348
Q

What clinical assessment is used to diagnose oedema?

A

Apply pressure with thumb for 3 seconds – if

dent is seen or felt then oedema is present

349
Q

What was the second object of the WHO child growth standards ?

A

to assess motor milestones relevant to age and sex, and in contrast to physical growth

350
Q

What has the WHO child growth standards show about motor milestones?

A

+ no difference between healthy kids of different sizes
+ undernourished children will experience delays
+ age variation high
+ dependant on opportunity, genetic & cultural differences

351
Q

What Growth charts does NZ use?

A

WHO growth Charts
+ 9 percentiles from 0.4 to 99.6
+ starts at 2 weeks (babies lose weight first)

352
Q

Babies typically lose weight in the first two weeks due to the low volume of colostrum, when should the parent worry?

A

Above 10% weight loss or producing less than 7 wet nappies daily

353
Q

What are plunket milestones?

A

Milestones that represent what children can do at a certain age in terms of movement, hearing, sight & communications (correct & prevent delays in development)

354
Q

What is the issue without incorrect length at birth?

A
  1. looks like in utero growth & postnatal growth faltering

2. Can impact management (receive unnecessary treatments which can impact BF)

355
Q

What age do we stop measuring head circumference?

A

1 year

356
Q

When should we measure infants?

A

Within 1/2 weeks 1,2,4,6,9,12,18,24 months

357
Q

What percentile is classified as overweight & very overweight?

A

91

98

358
Q

When do we observe a shift in percentile line & why?

A

2 years because measurement method changes

359
Q

What does a Drop or rise in head circumference indicate?

A

Problems such as Cerebral spinal fluid in brain

360
Q

When should BMI be used?

A
  1. Above the 99.6th centile on weight chart
  2. Below the 0.4th centile on weight chart
  3. OR if their growth crosses two percentile spaces downward

HUNT 243 exam (3 decks)

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