Pregnancy Nutrition Flashcards

1
Q

Define periconceptional (time)

A

-4 to 4 weeks

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2
Q

Define preterm (time)

A

less than 37 weeks

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3
Q

Define postterm (time)

A

more than 42 weeks

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4
Q

Define very preterm (time)

A

less than 34 weeks

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5
Q

Define term (time)

A

38-42 weeks

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6
Q

Define embryo (time)

A

weeks 0-8

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7
Q

Define fetus (time)

A

weeks 8-40

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8
Q

Define neonatal/neonate/newborn (time)

A

month 1

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9
Q

Define postneonatal (time)

A

more than 1 month

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10
Q

Define miscarriage (time)

A

0-20 weeks

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11
Q

Define fetal death/stillbirth (time)

A

20-40 weeks

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12
Q

Define perinatal (time)

A

20 weeks to 7 days post delivery

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13
Q

Define low birthweight

A

less than 2500g or 5 lb 8 oz

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14
Q

Define very low birthweight

A

less than 1500g or 3 lb 4 oz

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15
Q

What are natality statistics?

A

summarize info about:
pregnancy complications and harmful behaviors
infant mortality and morbidity

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16
Q

What type of events lead to declines in infant mortality?

A

improvements in social circumstances
infectious disease control
availability of safe and nutritious foods
tech advances in medicine (less important)

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17
Q

Define liveborn infant

A

completely expelled or extracted fetus breathes or shows other signs of life whether or not the cord has been cut

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18
Q

What advantages do newborns weighing 3500-4500 grams have?

A

least likely to die within first year of life or gestation stages, less likely to develop heart disease, diabetes, lung disease, hypertension and others

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19
Q

What is the difference between gestational age and menstrual age?

A

gestational age - weeks from conception
menstrual age - weeks from LMP
important difference for calculating nutrition events

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20
Q

What is the sequence of tissue development and approximate week of maximal change?

A
  1. maternal plasma volume - 20
  2. maternal nutrient stores - 20
  3. placental weight - 31
  4. uterine blood flow - 37
  5. fetal weight - 37
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21
Q

What do the physiological changes during the first half of pregnancy do?

A

“maternal anabolic”
build capacity to deliver blood, oxygen and nutrients
10% of fetal growth

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22
Q

What do the physiological changes during the second half of pregnancy do?

A

“maternal catabolic”
energy and nutrient stores and capacity to deliver dominate
90% of fetal growth

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23
Q

What changes occur during the maternal metabolic phase?

A

expanded blood volume, increased cardiac output
buildup of fat, nutrient and liver glycogen stores
growth of some maternal organs
increased appetite and food intake
decreased exercise tolerance
increased levels of anabolic hormones

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24
Q

What changes occur during the maternal catabolic phase?

A
mobilization of fat and nutrient stores
increased production and blood levels of glucose, triglycerides, and fatty acids
decreased liver glycogen stores
accelerated fasting metabolism
increased levels of catabolic hormones
increased appetite declines near term
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25
Q

What are some changes related to energy and nutrient needs?

A

body water changes, hormonal changes, maternal nutrient metabolism

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26
Q

How does the increase in body water impact vitamin status?

A

dilution effect

blood levels of fat-soluble vitamins tend to increase and water-soluble vitamins tend to decrease

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27
Q

Define placenta

A

organ of nutrient and gas interchange between mother and fetus

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28
Q

How does CHO metabolism change during pregnancy?

A

first half - increases in insulin prod. and conversation of glucose to glycogen and fat
second half - inhibit conversion of glucose, increase insulin resistance so she relies more on fats for energy

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29
Q

Why does CHO metabolism change?

A

promote maternal insulin resistance so there is a continued supply of glucose for the fetus

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30
Q

Why does metabolism change to accelerate fasting?

A

allows pregnant women to primarily use stored fats for energy so the fetus can use the glucose and amino acids

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31
Q

Define ketones

A

metabolic by-products of the breakdown of fatty acids in energy formation

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32
Q

Define glucogenic amino acids

A

amino acids that can be converted to glucose

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33
Q

Why does protein metabolism change?

A

nitrogen and protein are needed in increasing amounts to synthesis new tissues, this comes from food intake rather than stores

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34
Q

How is the increased need for protein met?

A

reduced levels of nitrogen excretion

conversion of amino acids

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35
Q

Why does fat metabolism change?

A

promote the accumulation of maternal fat stores in the first half and enhance fat mobilization in the second half

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36
Q

How does calcium metabolism change?

A

increased rate of bone turnover and reformation
increased absorption from food
decreased excretion in urine

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37
Q

How does sodium metabolism change?

A

mother has an increased requirement due to increased body water, needs to accumulate in mother, placenta and fetus
change in kidneys help retain sodium

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38
Q

What are the functions of the placenta?

A

hormone and enzyme production
nutrient and gas exchange b/t mother and fetus
removal of waste products from fetus

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39
Q

How does nutrient transfer from the placenta occur?

A

placenta fulfills its needs before supplying the fetus
depends on concentration of nutrients in maternal and fetal blood, molecule size and charge, and lipid solubility
some substances are more regulated than others

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40
Q

What are the mechanisms of nutrient transport across the placenta?

A

passive diffusion
facilitated diffusion
active transport
endcytosis

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41
Q

What is the difference between growth and development?

A

growth - increase in size through cell multiplication and enlargement of cells
development - progression of physical and mental capabilities through growth and differentiation of organs and tissues and integration of functions

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42
Q

Define differentiation

A

cells acquire one or more characteristics or functions different from the original cells

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43
Q

Define critical periods

A

preprogrammed time periods during embryonic and fetal development when specific things are formed or integrated

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44
Q

Define hyperplasia

A

increase in cell multiplication

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45
Q

Which organ develops first in humans and gets priority access to nutrients, oxygen and energy?

A

the brain

followed by heart and adrenal glands

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46
Q

Define hypertrophy

A

increased size of cells

mainly through accumulation of lipids and protein in cells

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47
Q

What is the sequence of growth and development?

A

first just hyperplasia, then rate of hyperplasia slows
hyperplasia-hypertrophy phase
hypertrophy only
*specialized functions occur at the same time
maturation - stabilization of cell number and size

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48
Q

What is the general trend of fetal body composition?

A

progressive increases in fat, protein and mineral content

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49
Q

What is IGF-1?

A

insulin-like growth factor-1
primary growth stimulator of fetus
promotes uptake of nutrients and inhibits fetal tissue breakdown
levels are sensitive to maternal nutrition

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50
Q

What is IUGR?

A

intrauterine growth retardation

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51
Q

What can cause reduced fetal growth?

A
prepregnancy underweight and shortness
low weight gain
poor diet
smoking, drug abuse
certain clinical complications
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52
Q

Define SGA

A

small for gestational age

newborns whose weight is less than the 10th percentile for gestational age

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53
Q

Define dSGA

A

disproportionately small for gestational age

normal length and head circumference

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54
Q

Define pSGA

A

proportionately small for gestational age

weight, length and head circumference are all less than 10th percentile for gestational age

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55
Q

Define LGA

A

large for gestational age

newborns with weights greater than 90th percentile for gestational age

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56
Q

Why does dSGA usually occur?

A

malnutrition in the third trimester (maternal weight loss or low weight gain late in pregnancy)
compromised liver glycogen and fat storage
compromised energy, nutrient and oxygen availability

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57
Q

What are dSGA infants at risk of?

A

hypoglycemia, hypocalcemia, hypomagnesiumenia, hypothermia
tend to preform less well in academics
greater risk for heart disease, hypertension, type 2 diabetes

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58
Q

Why does pSGA usually occur?

A

long-term malnutrition in utero (pre pregnancy underweight, consistently low rate of weight gain, inadequate diet, chronic exposure to alcohol)

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59
Q

What are pSGA infants at risk of?

A

reduced number of cells
fewer problems at birth, but catch-up growth is poorer
remain shorter and lighter with smaller heads

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60
Q

What might cause LGA?

A

pre-pregnancy obesity, poorly controlled diabetes, excessive weight gain, other factors
*don’t know for sure

61
Q

What are maternal complications from LGA babies?

A
delivery and postpartum 
increased rates of operative delivery
shoulder dystocia (blockage of delivery)
postpartum hemorrhage
62
Q

What nutritional factors are related to an increased risk of miscarriage?

A

pre-pregnancy underweight

elevated cholesterol, triglycerides, inflammation markers

63
Q

What are preterm infants at greater risk of?

A

death, neurological problems, low IQ, congenital malformations, chronic health problems (ex: cerebral palsy)
problems with growth, digestion and respiration

64
Q

What nutritional factors are related to risk of preterm delivery?

A

underweight women who gain less than the recommended amount
obese women to a lesser extent
possibly women entering pregnancy with elevated blood lipids, high inflammation markers, and oxidative stress

65
Q

What is the fetal-origins hypothesis?

A

theory that exposure to adverse nutritional and other conditions during critical periods can permanently affect body structures and functions and predispose people to certain diseases and disorders

66
Q

Define developmental plasticity

A

the concept that development is not strictly determined by genetics, but also by environmental conditions

67
Q

Define epigenetics

A

biological mechanisms that change gene function without changing the structure of DNA; they are affected by environmental factors

68
Q

What are the recommended weight gains for the different weight statuses?

A

underweight - 28-40 lbs
normal - 25-35 lbs
overweight - 15-25 lbs
obese - 11-20 lbs

69
Q

What influences birth weight?

A

maternal weight gain, gestational duration, smoking, maternal health status, gravida, parity

70
Q

Define gravida

A

number of pregnancies

71
Q

Define parity

A

number of previous deliveries
nulliparous - none
primiparous - one
multiparous - 2+

72
Q

What is the general pattern of maternal weight gain?

A
3-5 pounds in the first trimester
gradual and consistent after that
highest rate is mid-pregnancy
rate slows a bit a few weeks prior to delivery
*weight should not be lost
73
Q

What is the composition of weight gain?

A

only about 1/3 goes to the fetus, the rest goes to maternal tissues and fat stores

74
Q

Why do energy requirements increase during pregnancy?

A

increased maternal body mass and fetal growth

increased cardiac and respiratory work; added breast and uterine muscle/tissue; placenta; fetus

75
Q

How much does energy requirement increase on average?

A

300 kcal per day
340 kcal/day in the second trimester
452 kcal/day in the third trimester

76
Q

What are the recommendations for CHO, PRO, and FAT intake?

A

CHO: 50-60% of kcal, min. 175 g
PRO: 71 g day (25 additional g)
FAT: 13g of linoleic acid; 1.4 g alpha-linolenic acid

77
Q

What are the effects of alcohol intake during pregnancy?

A

abnormal mental development and growth

lifelong deficits

78
Q

Which nutrients are of concern in vegetarian diets?

A

protein (mainly vegans), B12, D, calcium, iron, zinc, omega-3 fatty acids

79
Q

What is linoleic acid?

A

essential fatty acid: omega-6
long chain polyunsaturated fatty acid
sources: safflower, corn, sunflower, soy oil
structural component of cell membranes

80
Q

What is alpha-linolenic acid?

A

essential fatty acid: omega-3 (DHA and EPA)
long chain polyunsaturated fatty acid
sources: flaxseed, walnut, soybean, canola, leafy greens
structural component of cell membranes

81
Q

What are eicosanoids?

A

synthesized from fatty acids

regulate numerous cell and organ functions

82
Q

What is EPA?

A

eicosapentaenoic acid
an omega-3 fatty acid
very important in pregnancy
small amount can be derived from food sources of alpha-linolenic acid

83
Q

What is DHA?

A

docosahexaenoic acid
an omega-3 fatty acid
very important in pregnancy
small amount can be derived from food sources of alpha-linolenic acid

84
Q

What are food sources of EPA and DHA?

A

fish and seafood - richest sources
egg yolk
fortified eggs and beverages
human milk

85
Q

What role does EPA play?

A

reduce inflammation
dilute blood vessels
reduce blood clotting
heart, immune systems

86
Q

What role does DHA play?

A

major structural component of phospholipids in cell membranes in the central nervous system
brain, eyes, CNS

87
Q

How does sufficient intake of EPA and DHA impact birth outcomes?

A

somewhat higher levels of intelligence
better vision
more mature central nervous system functions
prolong gestation by an average of 4 days
decrease the risk of preterm delivery

88
Q

What is the recommended intake of EPA and DHA?

A

250 mg or more per day

don’t exceed 3 g per day

89
Q

What is the recommendation on fish consumption?

A

no more than 12oz per week
no more than 6oz per week of albacore tuna
should be ones that are good sources of EPA and DHA and contain low levels of mercury and other contaminants

90
Q

What types of fish are high in mercury?

A

swordfish, king mackerel, tilefish, shark

91
Q

What are the functions of folate?

A

synthesis of DNA, gene expression, gene regulation, conversion of homocysteine to methionine

92
Q

What are the risks of high cellular and plasma levels of homocysteine?

A

increased risk of placenta rupture, stillbirth, preterm delivery, preeclampsia, structural abnormalities, reduced birth weight

93
Q

Define preeclampsia

A

increased blood pressure and protein in the urine
results in decreased blood flow to maternal organs and through the placenta
usually occurs after 20 weeks

94
Q

What are the 3 types of neural tube defects?

A
  1. spina bifida - failure of spinal cord to close
  2. anencephaly - absence of brain or spinal cord
  3. encephalocele - protrusion of brain through the skull
95
Q

What is the crucial period for adequate folate availability?

A

21-27 days after conception

96
Q

What are food sources of folate?

A

oranges and orange juice, pineapple juice, papaya juice, dried beans
fortified cereals and grains

97
Q

What is the recommended intake of folate?

A

600 mcg of dietary folate equivalent per day
400 from fortified foods or supplements
200 from fruits and vegetables
UL is 1000 mcg per day (so it doesn’t mask the symptoms of B12 deficiency)

98
Q

What is the role of choline?

A

component of phospholipids
precursor to intracellular messangers
can be converted to betaine to regulate gene function, neural-tube and brain development, and convert homocysteine to methionine

99
Q

What is the RDA for choline?

A

450 mg per day
average intake is low
sources: eggs and meat

100
Q

What role does vitamin A play?

A

reactions involved in cell differentiation

101
Q

What is the impact of vitamin A deficiency early in pregnancy?

A

malformations of the heart, lungs, and urinary tract

102
Q

What is the impact of excess vitamin A in the retinol or retinoic acid form?

A
fetal abnormalities
small or no ears
abnormal or missing ear canals
brain malformation
heart defects
103
Q

What role does vitamin D play?

A

supports fetal growth, the addition of calcium to bone, and tooth and enamel formation, normal functioning of the immune system and inhibit inflammation

104
Q

What adverse outcomes are possibly linked to vitamin D deficiency?

A

miscarriage, preeclampsia, preterm birth, maternal infection, childhood development of type 1 diabetes and asthma

105
Q

What are risk factors for vitamin D deficiency?

A

vegan, obese, dark skin, limited exposure to direct sunlight (without sun block), low dietary intake of milk

106
Q

What is the recommended intake of vitamin D?

A

5 mcg (200 IU) daily
UL - 50 mcg (2000 IU)
*recommendations are being revised

107
Q

What is the impact of inadequate calcium intake?

A

increased blood pressure (mom and infant)
decreased subsequent bone remineralization
decreased breast-milk concentration of Ca

108
Q

What is the link between calcium and lead?

A

lead is contained in bone tissue, demineralization of bone to provide calcium also releases lead into the bloodstream

109
Q

What are the symptoms of iron deficiency?

A

weakness, fatigue, irritability, short attention span, poor appetite, increased susceptibility to infection

110
Q

What are the additional symptoms of iron deficiency anemia?

A

paleness, rapid heart beat, exhaustion

111
Q

What is the impact of iron deficiency anemia in pregnancy?

A

increased risk (2-3x) of preterm delivery and low birth weight

112
Q

What is the impact of iron deficiency in pregnancy?

A

lower scores on intelligence, language, gross motor, and attention tests
iron deficiency in the infant from inadequate stores at birth
associated with higher maternal mortality
postpartum maternal iron status impacts

113
Q

What are the recommendations for iron supplementation?

A

30 mg daily after the 12th week
60-180 mg daily in women with iron deficiency anemia
1/2 of women enter pregnancy with inadequate stores

114
Q

What is the recommended intake of iron?

A

an additional 3.7 mg absorbed
total need is 5.5 mg absorbed daily (27 mg)
UL is 45 mg per day consumed

115
Q

What is the role of iodine?

A

thyroid function, energy production, fetal brain development

116
Q

What is the result of iodine deficiency in early pregnancy?

A

hypothyroidism - growth impairment, mental retardation, deafness
higher incidence of infant mortality

117
Q

What is the recommended intake of iodine?

A

220 mcg daily
UL - 1100 mcg daily
salt in processed foods usually isn’t iodized - has been an issue as more processed foods are consumed in developed countries

118
Q

Define bioactive food components

A

constituents of foods other than those needed to meet basic human health nutritional needs that are responsible for changes in health status
ex) phytochemicals, antioxidants, caffeine

119
Q

Who might benefit from multivitamins and mineral supplements?

A
people with an inadequate diet
multifetal pregnancy
smoke, drink, or use drugs
vegans
iron deficiency anemia
diagnosed nutrient deficiency
120
Q

Why are pregnant women more susceptible to food borne illness?

A

The increased progesterone levels decrease the ability to resist infectious disease

121
Q

Which food borne illnesses are of greatest concern?

A

listeria

toxoplasma gondii

122
Q

What are the possible effects of listeriosis?

A

spontaneous abortion and stillbirth (1/3)

mild infection in mother

123
Q

What foods are associated with listeria?

A

raw or smoked fish, oysters, unpasteurized cheese, raw or undercooked meat, unpasteurized milk
processed meats need to be stored correctly and heated throughly

124
Q

What can toxoplasma gondii cause?

A

mental retardation, blindness, seizures, death

125
Q

What are food sources of T.gondii?

A

raw and undercooked meats, surface of fruits and vegetables, cat litter

126
Q

What are the impacts of mercury exposure?

A

mild to severe effects on brain development
mental retardation, hearing loss, numbness, seizures
accumulates in mothers tissues

127
Q

What are common health problems during pregnancy?

A

nausea and vomiting
heartburn
constipation

128
Q

What is hyperemesis gravidarum?

A

severe nausea and vomiting lasting through much of the pregnancy, can be debilitating
concerns - weight loss, dehydration, electrolyte imbalance, headache, jaundice
1-2% of pregnancies
may require hospitalization for IV or TPN

129
Q

What dietary interventions can be used to manage nausea and vomiting?

A
continue to gain weight
separate liquid and solid food intake
avoid odors and foods that trigger nausea
select foods that are well tolerated
supplements - B6, multivitamins, ginger
130
Q

Why is heartburn common in pregnancy?

A

progesterone causes the muscles of the gastrointestinal tract to relax so food is more likely to be pushed through the lower esophageal sphincter and into the esophagus

131
Q

What dietary interventions can be used to manage heartburn?

A

eat small meals frequently
don’t go to bed with a full stomach
avoid foods that make it worse
antacid tablets are ok

132
Q

Why is constipation common in pregnancy?

A

relaxed gastrointestinal muscle tone

133
Q

What dietary interventions can be used to manage constipation?

A

consume 30 g of fiber daily

laxatives aren’t recommended

134
Q

What are inhibitors of iron bioavailability and absorption?

A

polyphenols, calcium, chlorogenic acid (coffee), phytates

taking it as part of a multivitamin

135
Q

What are enhancers of iron bioavailability and absorption?

A

ascorbic acid, alcohol

136
Q

Why does the US have worse birth outcomes than many other developed countries?

A

healthcare access

higher c-section rate (elective, litigation)

137
Q

What are the parts of an APGAR score?

A

How ready is this child?

heart rate, respiration, irritability, tone, color

138
Q

What are normal anatomical changes in the first trimester?

A

pressure on bladdar, lifts later

139
Q

What are normal anatomical changes in the second trimester?

A

weight starts shifting back - pushing on spine and causing constipation and low back pain

140
Q

What are normal anatomical changes in the third trimester?

A

weight shifting up - presses on stomach - feel full quickly and heartburn, harder to breath
swelling in feet and legs - blood vessels compressed

141
Q

What is relaxin?

A

promotes angiogenesis
relaxes ligaments
softens and enlarges the cervix

142
Q

What is hCS?

A

human chorionic somatotropin
increases maternal insulin resistance
promotes breakdown of fat for energy

143
Q

What is hCG?

A

human chorionic gonadotropin
stimulates CL to produce E and P
stimulates endometrium

144
Q

What is the distribution of weight gain in a normal pregnancy?

A
breasts - 1-2 pounds
baby - 6-8 pounds
placenta - 1-2 pounds
uterus - 1-2 pounds
amniotic fluid - 2-3 pounds
your blood - 3-4 pounds
your protein and fat storage - 8-10 pounds
your body fluids - 3-4 pounds
145
Q

Why do energy needs increase during pregnancy and my how much?

A

increased body mass and fetal growth
only by about 300 kcal per day
3-5 pounds in first trimester, 1-2 pounds/week after that

146
Q

Why do iron needs increase?

A

fetal iron requirements
increased RBC mass
compensation for losses at delivery

147
Q

What is the recommended amount of exercise for most pregnant women?

A

30 minutes of moderate exercise most or all days of the week

148
Q

What are the benefits of exercise during pregnancy?

A

reduce and prevent lower back pain, lower liquid retention, reduced CVS stress and risk of GDM, prevent thrombosis and varicose veins, control weight gain, improve sleep, improve self-esteem, possibly reduce PPD