pregnancy nutrition

Question 1

why does optimum nutrition in pregnancy matter?

Answer 1

optimum fetal growth
optimum fetal well being
optimum maternal health

Question 2

what are some causes of low birth weight?

Answer 2

preterm birth:
- multiple birth
- previous preterm 
- previous TOP 
- smoking
- stress 
- infection 
poor fetal growth: 
- alcohol/smoking
- poor nutrition 
- being under weight before pregnancy 
- mothers age
- genetic abnormality 
- poverty

Question 3

what makes up the weight gain in pregnancy?

Answer 3

fetus 
placenta 
amniotic fluid 
extracellular fluìd 
fat tissue 
uterus and breast increase 
blood volume increase

Question 4

how much more should a pregnant woman eat?

Answer 4

in 1st ad 2nd trimester eat as normal

3rd trimester eat 200kcal more

Question 5

what can Vit D deficiency cause?

Answer 5

bone fragility, rickets, obstetric complications = pre-eclampsia
why = responsible for enhancing intestinal absorption of calcium and phosphate
therefore give 10mcg per day of cholecalciferol during pregnancy and while breastfeeding
at risk = obese, limited sun exposure, malnutrition

Question 6

what are healthy start vitamins.vouchers?

Answer 6

one healthy start voucher/week worth £3.10 and a vitamin voucher (folic acid, C, D) to improve the health of low-income pregnancy women o benefits

Question 7

why is folic acid supplementation given?

Answer 7

to reduce the risk of rural tube defects
as folate acts as cofactor for enzymes involved in DNA and RNA biosynthesis
400mcg for all women
5mg for women with raised BMI >30 or previous NTD

Question 8

what foods should be avoided in pregnancy?

Answer 8

pate 
soft cheeses / soft blue cheese 
uncooked eggs/non-lion code eggs 
unpasteurised milk 
rare meats 
no more than 2 portions of oily fish a week (mercury) 
vit A suppléments 
caffeine = 200mg a day  2 instant coffees 
alcohol

Question 9

what are the features of fetal alcohol syndrome?

Answer 9

short palpebral fissure 
flat mid face 
short nose 
indistinct philtrium 
thin upper lip 
epicentral folds 
low nasal bridge 
micrognathia

Question 10

what can breastfeeding reduce?

Answer 10

for child = acute otitis media, gastroenteritis, severe lower respiratory tract infections, dental malocclusions, obesity, T1/2DM, SIDS, NEC
for mother = breast cancer, ovarian cancer, postnatal depression, another pregnancy too close together

Question 11

what savings could be made to NHS if more mothers breast fed?

Answer 11

865 fewer cases of breast cancer

£21 million savings

Question 12

what are the breast feeding rates in the UK like?

Answer 12

65% at birth
40% at 6wks
20% at 6 months
10-15% at 9months

Question 13

what is the milk produced?

Answer 13

days 1-3 = colostrum
days 3-14 = transitional milk
days 14 onwards = mature milk

Question 14

what is colostrum?

Answer 14

thicker and more concentrated than breast milk
yellowish or clear
small volume to allow baby to get rid of excess tissue fluid without overloading kidneys
higher concentrations of antibodies, white blood cells and other anti-infective proteins than mature milk
mild laxative effect
rich in growth factors
richer in vit A and K than mature milk
creates acidic envirnoment

Question 15

what is the volume/fat gradient of breastfeed?

Answer 15

at the start = high volume low fat milk

at end = low volume high fat milk

Question 16

what immunoglobulins are present in breastmilk?

Answer 16

IgA

Question 17

what is lactoferrin?

Answer 17

a multifunctional protein of the transferrin family, a globular glycoprotein widely represented in secretory fluids such as milk

Question 18

what do lysosomes do?

Answer 18

bactericidal and anti-inflammatory action
contributes to the destruction of Ecoli and some salmonella strains
production increases with age of infant

Question 19

what are risk factors for gesture-enteritis if baby is formula fed?

Answer 19

free iron in gut = bacteria thrive on 
no lactoferrin 
no bifidus factor = increase pH conductive to bacterial growth 
no secretory IgA 
no white cells 
no lysosome
no epidermal growth factor

Question 20

what is the prolactin response?

Answer 20

baby suckles -> sensory impulses pass from nipple to brain -> prolactin secreted by anterior pituitary gland goes via bloodstream to the breasts -> lactocytes produce milk
more secreted at night
suppresses ovulation by suppressing GnRH
levels peak after feed to produce milk for next feed
makes mother feel more relaxed and sometime sleepy

Question 21

what is the prolactin receptor theory?

Answer 21

surges of prolactin prime the receptor sites -> expulsion of placenta opens receptor sites -> unprimed receptor sites shut down reducing potential for milk production
frequent prolactin release maximises long-term milk supply

Question 22

how can a mother stimulate the prolactin receptor sites?

Answer 22

skin-to-skin
early feeds
expression of breast milk

Question 23

what is the oxytocin reflex?

Answer 23

baby suckles -> sensory impulses pass from the nipple to the brain -> oxytocin secreted by posterior pituitary gland goes via bloodstream to the breast -> myo-epithelial cells contract and expel milk
helped by sight, sound and smell of baby
becomes conditioned over time
hindered by anxiety/stress
works before/during feed

Question 24

what is the feedback inhibitor of lactation (FIL)?

Answer 24

a protein that causes the lactocytes to ignore the signals from prolactin when the breast is full
if only little milk is removed/long gap between feeds = milk production will slow down
more frequent sucking/feeds = less effect the FIL will have

Question 25

why is correct positioning and attachment important?

Answer 25

ensures efficient milk transfer
ensures sufficient milk supply
prevents mothers nipples becoming sore

Question 26

what can affect breastfeeding resilience ?

Answer 26

support at home
how she was fed herself
previous experience 
access to skilled help 
skills/knowledge 
social norms 
peer group/family pressure 
self esteem/self efficacy

Question 27

what does NOSH stand for?

Answer 27

nourishing start for health