pregnancy nutrition and lactation Flashcards
what is SGA, APA, LGA
SGA - small for gestational age
APA = appropriate for gestational age
LGA = low fo gestational age
what is the fundal height measurement?
Fundal height is generally defined as the distance from the pubic bone to the top of the uterus measured in centimeters.
what are risk factors for preterm brith
multiple birth pervious preterm birth smoking street and lack of support infection stressful working conditions
what are causes of poor fatal growth?
Use of alcohol, drugs and smoking Poor nutrition Being under weight before becoming pregnant Mothers age Genetic abnormalities Stress, exhaustion, abuse Living in poverty
what amount of weight gain is acceptable during pregnancy?
if pre pregnancy BMI is:
underweight 13-18 kg
normal weight 11-16kg
overweight 7-11kg
obese 5-9kg
how can protein energy supplementation during pregnancy affect fatal growth in woman with energy or protein deficit?
improve fatal growth
increase brith weight and height
decrease the percentage of low birth weight
however excess protein in woman with diet that already has adequate protein may conversely impair the fatal growth
what was the dutch winter famine study?
Transgenerational effects of prenatal exposure to the Dutch famine on neonatal adiposity and health in later life
Children of the pregnant women were smaller, more susceptible to diabetes, obesity and cardiovascular disease and more likely to have smaller children themselves
vitamin D deficiency during pregnancy?
it can cause bone fragility, rickets, obstetric complications
it happened because VD is responsible for enhancing intestinal absorption of calcium and phosphate
people who are at risk: obese, limited exposure to sun, south asian, African, Caribbean or middle easter descent, malnutrition
action: 10 micrograms per day (cholecalciferol) during pregnancy and while breast-feeding
what are healthy start vitamins who are vouchers given to?
What: one Healthy Start voucher a week worth £3.10 and a
voucher for vitamins (folic acid, C and D)
Why: improve the health of low-income pregnant women and families on benefits and tax credits.
Who: pregnant women (>10 weeks) and parents of under 4yr olds who are on means tested benefits
Action: inform, advise and provide application
Why is folic acid recommended during pregnancy?
What: to reduce the risk of neural tube
defect (NTD)
Why: Folate acts as a cofactor for enzymes involved in DNA and RNA biosynthesis.
Who: all women planning a pregnancy and up to 12 weeks or more. Obese women and those with epilepsy require higher dose
Action: 400 micrograms for all, 5mg for women with raised BMI >30 or previous NTD
what foods should be avoided during pregnancy ?
pate soft cheese such as brie or camembert soft blue cheese uncooked eggs unpasteurised milk rare meats
no more than 2portions of oily fish
limit amount of tuna
should woman take vitamin A supplements during pregnancy ?
NO
what can breastfeeding prevent in the child?
Acute Otitis Media • Non-specific Gastroenteritis Severe lower respiratory tract infectionsDental malocclusion Obesity Type 1 & Type 2 Diabetes SIDS Necrotising Enterocolitis
what can breast feeding prevent in the mother?
Type 2 Diabetes • Breast Cancer • Ovarian Cancer • Postnatal Depression • Breastfeeding - still the most widespread form of birth spacing globally means - smaller family size - more children survive - enhanced maternal health
what is colostrum?
days 1-3 breast milk
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 Vitamins A and K than mature milk
Creates an acidic environment
how is there IgA in breast milk?
Maternal mucosal surfaces encounter microbes in her own and baby’s environment
- -> Maternal lymphocytes at mucosal surfaces stimulated by microbes to produce specific IgA
- -> Maternal lymphocytes migrate to breast
- ->Maternal lymphocytes produce specific IgA against microbes encountered which is then secreted into breastmilk
what are lysosyme?
Bacteriocidal and anti-inflammatory action
contributes to the destruction of E Coli
why do babies who are formula fed have increased risk of gastroenteritis?
free iron in the gut (which bacteria feed on)
no lactoferrin (mops up free iron)
no bifidus factor ( so pH conducive to bacterial growth)
no oligosaccharides (to inhibit attachment of pathogens)
no secretory IgA
no entero/broncho-mammary pathway (for antibody production )
no white cells (to destroy bacteria)
no lysozyme (to destroy bacteria)
no viral fragments (to stimulate antibody response and trigger babys own immune system)
no anti-inflammatory molecules (to moderate response to pathogens )
no stem checks
what is the prolactin response?
baby sucks
sensory impulses pass from the nipple to the brain
prolactin secreted by anterior pituitary glad goes via blood stream to breasts
Lactocytes produce milk
what is prolactin?
- Directs the lactocytes to produce milk
- Levels remain high for 90 minutes after a feed
- More sucking makes more milk
- Levels are higher at night
- Makes mother feel more relaxed and sometimes sleepy
- Suppresses the release of gonadotrophin, therefore inhibits ovulation
what is the prolactin receptor theory
expulsion of placenta opens receptor sites
surges of prolactin prime the receptor sites
mothers can stimulate receptor sites by:
skin to skin contact
early feeds
explosion of breast milk
what is oxytocin
- Directs the myo-epithelial cells
- Makes the milk flow
- Helps the uterus to contract
- Can start working before the baby suckles
- Easily affected by the mother’s thoughts, feelings and sensations
- Triggers calmness, mothering instinct and feelings of love
what is the oxytocin reflex?
baby suckers
sensory impulses pass from the nipple to the brain
oxytocin secreted by posterior pituitary gland goes via blood stream to breast
mayo-epithelial cell contract and expel milk
helped by sight
becomes conditioned over time
hindered by anxiety, stress, pain and doubt
what are the feedback inhibitors of lactation?
• Breast milk contains a protein (FIL) that causes the lactocytes to ignore the signals from prolactin when the breast is full.
• If only a little milk is removed or there is a long gap between feeds, milk production will slow down.
• More frequent sucking/feeds (the more milk baby removes) – the less effect the FIL will have.
Frequent, effective breastfeeding will help to ensure sufficient milk production
