Pregnancy & Lactation Flashcards
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
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)
Assessing preconception nutrition status in pregnancy
- identify women at nutritional risk
- preconception history
- provide appropriate nutrition intervention
What should the preconception history in pregnant women include?
Weight status
Dietary practices
Use of harmful substances
Weight gain during pregnancy
- birth weight is influenced by mothers PREPREGNANCY weight & overall weight gain
- base recommendations for weight gain on prepregnancy BMI
Why is weight gain important during pregnancy?
- influences fetal growth & length of gestation
- inadequate weight gain is associated with increased prematurity rate & LBW
What is a major determinant for infant mortality and morbidity?
LBW
LBW is related to an increased risk of what?
- CVD
- DM
- HTN
- obesity later in life
BMI <18.5; what is the recommended weight gain during pregnancy?
28 - 40 lbs
BMI 18.5 - 24.9; what is the recommended weight gain during pregnancy?
25 - 35 lb
BMI 25 - 29.9; what is the recommended weight gain during pregnancy?
15 - 25 lb
BMI >30; what is the recommended weight gain during pregnancy?
11 - 20 lb
What is the recommended weight gain with twin pregnancies?
25 - 45 lb
What is the recommended weight gain for someone having triplets?
Overall gain of 50 lb
What can excessive maternal weight lead to?
- gestational diabetes, HTN, T2D
- risk of fetal macrosomia, shoulder dystocia, childhood obesity
What increases the risk of neural tube defects independently of ____ intakes?
Obesity; folate
Bringing weight into a healthy range before pregnancy can help with what?
- conception easier
- improves pregnancy outcomes
- may enhance lactation productivity
What are energy needs during the 2nd and 3rd trimester?
Additional 100 - 300kcal/day in older adults
500kcal/day in young adolescents (<14)
What are the protein needs during pregnancy?
Additional 10-13g
Approx 71g/day
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
