Pregnancy & Lactation Flashcards by Chelsea Luedtke

Metabolic influences during early pregnancy

increased glycogen storage
increased glucose utilization
increased insulin response to glucose
hypoglycemia can be a problem in pregnancies complicated by diabetes
hyperemesis & food intolerance related to HCG
increased nutrient absorption
increased fat deposition
increase of blood volume (2nd trimester)
elevation of basal metabolic rate

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Metabolic influences during late gestation

increased insulin resistance related to HPL & estrogen
accelerated growth of fetus
more rapid diversion to fat metabolism in fasting state (accelerated starvation)
higher free FA & ketone production (increased DKA)

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Assessing preconception nutrition status in pregnancy

identify women at nutritional risk
preconception history
provide appropriate nutrition intervention

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What should the preconception history in pregnant women include?

Weight status
Dietary practices
Use of harmful substances

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Weight gain during pregnancy

birth weight is influenced by mothers PREPREGNANCY weight & overall weight gain
base recommendations for weight gain on prepregnancy BMI

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Why is weight gain important during pregnancy?

influences fetal growth & length of gestation

- inadequate weight gain is associated with increased prematurity rate & LBW

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What is a major determinant for infant mortality and morbidity?

LBW

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LBW is related to an increased risk of what?

CVD
DM
HTN
obesity later in life

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BMI <18.5; what is the recommended weight gain during pregnancy?

28 - 40 lbs

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BMI 18.5 - 24.9; what is the recommended weight gain during pregnancy?

25 - 35 lb

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BMI 25 - 29.9; what is the recommended weight gain during pregnancy?

15 - 25 lb

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BMI >30; what is the recommended weight gain during pregnancy?

11 - 20 lb

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What is the recommended weight gain with twin pregnancies?

25 - 45 lb

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What is the recommended weight gain for someone having triplets?

Overall gain of 50 lb

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What can excessive maternal weight lead to?

gestational diabetes, HTN, T2D

- risk of fetal macrosomia, shoulder dystocia, childhood obesity

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What increases the risk of neural tube defects independently of ____ intakes?

Obesity; folate

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Bringing weight into a healthy range before pregnancy can help with what?

conception easier
improves pregnancy outcomes
may enhance lactation productivity

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What are energy needs during the 2nd and 3rd trimester?

Additional 100 - 300kcal/day in older adults

500kcal/day in young adolescents (<14)

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What are the protein needs during pregnancy?

Additional 10-13g

Approx 71g/day

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Calculating needs for pregnancy

consult RD and pharmacy for TPN

- Use basal energy expenditure x 1.4 activity factor (BEE)

RDA for folic acid in pregnancy

600mcg during pregnancy

500mcg during lactation

Folic acid prepregnancy

400mcg recommended supplementation to prevent neural tube defects

T/F insulin dependent diabetes in high risk pregnancy need a lower than average amount of folic acid

False!

Much higher!!

Vegans and folic acid

Should also take B12

- low folate and B12 are independent risk factors for neural tube defects

Foods rich in folate

- legumes - green leafy veggies - liver - citrus fruits - whole wheat bread - fortified foods and supplements

Iron in pregnancy

- increased in 2nd and 3rd trimester (27mg) | - lower during lactation (10)

Food sources of iron

Lean red meat, fish, poultry, dried fruits, iron fortified cereals

Calcium during pregnancy

1300mg age 14-18 1000mg age 19-50 3-4 servings per day

Vitamin D during pregnancy

- Important for fetal development - can prevent congenital rickets - predictor of infant size

Choline during pregnancy

- key role in fetal brain development | - influences neurotransmission with effects on brain, heart, muscle, GI tract

Foods to enhance choline

- eggs, beef steak, salmon, lean ground beef, green leafy veggies. Low fat milk

Mega doses of which vitamin during early pregnancy can cause birth defects?

Vitamin A

Sodium in pregnancy

No restrictions unless on low sodium diet

Caffeine and pregnancy

- crosses placenta - can affect fetal HR and breathing - may increase risk of spontaneous abortion and low birth weight <300mg/day

Alcohol and pregnancy

No safe level established at any stage

Tobacco/drugs and pregnancy

- limits oxygen supply to fetus | - related to LBW, increase preterm delivery and perinatal mortality

Artificial sweeteners and pregnancy

- recognized as safe | - does not cross placenta (only saccharin)

Mercury and pregnancy

- can damage nervous system, lungs, kidneys, vision and hearing - avoid high mercury! 12oz/week of light tuna and other fish

Listeria and pregnancy

- serious bacterial infection - may result in stillbirth, septicemia, meningitis - avoid feta, blue cheese, lunch meat, smoked seafood, raw cheese Sources must be cooked!!!

Healthy eating during pregnancy

- choose variety of foods - low fat/low saturated fat - increase grains, fruits, veggies - moderate use of sweets, sugars and soft drinks - salt as directed - 30 min moderate activity most days

N/V in pregnancy

- consume small meals frequently - avoid offensive odors - drink enough fluids - get adequate fresh air - crackers (higher CHO)

Heartburn and pregnancy

- result of slowing movement of food through GI tract - avoid laying down after eating - sleep with head slightly elevated - consume small frequent meals - avoid known irritants (caffeine, chocolate, seasoned foods)

Constipation and pregnancy

- may be due to high doses of iron or part of normal digestive changes - more high fiber - increase fluids - regular exercise

Food cravings, aversions and pica and pregnancy

- common | - be alert to abnormal cravings for non-food items and food items

Complications of diabetes in early pregnancy

- Risk for pre-gestational diabetes only | - congenital abnormalities and spontaneous abortion

Complications of diabetes later in pregnancy

- hypoglycemia in neonate - macrosomia - stillbirth - RDS - increase rate of obesity and diabetes - hypocalcemia, hyperbilirubinemia, polycythemia

Insulin and pregnancy

Give during even if they weren’t on insulin before pregnancy!

Nutrition guidelines for diabetes

- match insulin to food - consistent CHO vs CHO to insulin ratio - 3 meals/day with snacks - bedtime snack to prevent ketosis

Treatment of diabetes during pregnancy

- appropriate prenatal nutrition - adequate prenatal weight gain - maintenance of normal blood sugars - prevent frequent hypoglycemia - manage diabetes related complications