Pregnancy nutrition + lactation

Question 1

Why does nutrition in pregnancy matter

Answer 1

Optimum fetal growth
Optimul fetal wellbeing
Optimum maternal health

Question 2

What factors contribute to low birth weight

Answer 2

Preterm birth- multiple birth, previous preterm birth, smoking, stress, infection
Poor fetal growth- alcohol/drugs/smoking, poor nutrition, underweight, maternal age, genetic abnormalities, stress

Question 3

How much weight is normally gained during pregnancy

Answer 3

Blood 1250g
Uterus + breast 1375g
Fat 3345g
Extracellular fluid 1680g
Amnitoic fluid 800g
Placenta 650g
Fetus 3400g

Question 4

What were the findings of Liberato et al (2013)

Answer 4

Protein supplementation given to women with energy/protein defecit improved fetal growth, but given to women with adequate protein may impair growth

Question 5

What are the effects of Vitamin D deficiency

Answer 5

Bone fragility, rickets, obstetric complications eg. preeclampsia
Vitamin D responsible for enhancing intestinal absorption of calcium + phosphate
Most at risk- obese, limited exposure to sunlight, malnutrition
Supplement with 10mcg daily

Question 6

What are healthy start vitamins

Answer 6

Vouchers/vitamins given to low income pregnancy women on benefits or tax credits to improve their health

Question 7

Why is folic acid supplementation important

Answer 7

Reduced risk of neural tube defect
Folate = cofactor for enzymes involved in DNA + RNA biosynthesis
should be given to all women, higher dose to obese

Question 8

What foods should be avoided in pregnancy

Answer 8

Pate, soft cheese, uncooked eggs, unpasteurised milk, rare meats.
No more than 2 portions oily fish

Question 9

Should vitamin A supplements be given?

Answer 9

No

teratogenic

Question 10

Can caffeine be consumed during pregnancy

Answer 10

Yes but limit to 200mg

Risk of LBW + miscarriage

Question 11

Why is breast milk important

Answer 11

Promotes healthy gut microbiota

Provides selective metabolic substrates for beneficial bacteria

Question 12

Benefits of breastmilk for child

Answer 12

Lower incidence of: acute otitis media, gastroenteritis, lower respiratory tract infections, dental malocclusion, obesity, diabetes, SIDS, necrotising enterocolitis

Question 13

Benefits of breastmilk for mother

Answer 13

Lower incidence of: type 2 diabetes, breast cancer, ovarian cancer, postnatal depression

Question 14

Describe the changes in breast milk

Answer 14

Day 1-3 colostrum
Day 3-14 transitional
Day 14+ mature

Question 15

Describe colostrum

Answer 15

Thicker, more concentrated than mature milk
Yellow/clear
Small volume
Higher concentration of antibodies, white blood cells, anti-infective protein
Mild laxative effect
Growth factors
More vitamin A + K
Acidic environment

Question 16

What factors influence milk composition

Answer 16

Stage of lactation
Gestational age of infant
Stage of feed
Frequency of demand
Degree of fullness of breast

Question 17

What is the role of immunoglobulin in breast milk

Answer 17

Maternal lymphocytes produce IgA, migrate to breast, secrete into breast milk
Secretory IgA major immunoglobulin in all human secretions
IgA and IgE present in breast milk

Question 18

What is the role of lactoferrin in breast milk

Answer 18

Iron binding glyoprotein
Abundant in colostrum
Major role in antimicrobial action

Question 19

What is the role of lysozyme in breast milk

Answer 19

Bacteriocidal and antiinflammatory action
Destruction of E coli _ salmonella
Production increases with age of infant

Question 20

What are some important molecules in breast milk

Answer 20

IgA, IgE, lactoferrin, lysozyme, epidermal gut factor, viral fragments

Question 21

What are the risk factors for gastroentiritis when formula feeding

Answer 21

Free iron in the gut is substrate for bacteria
No lactoferrin
No bifida factor
No oligosaccharides- inhibit attachment of pathogens
No IgA
No entero/broncho-mammary pathway for antibody production
No white cells
No lysozyme
No epidermal gut factor
No viral fragments

Question 22

Describe the prolactin response

Answer 22

Baby suckles
Sensory impulses from nipple to brain
Prolactin secreted by anterior pituitary via bloodstream to breasts
Lactocytes produce milk

Question 23

What is prolactin

Answer 23

Directs lactocytes to produce milk
Levels high for 90min after feeding, higher at night
Suppresses release of gonadotrophin, inhibits ovulation

Question 24

Describe the prolactin receptor theory

Answer 24

Surges of prolactin prime the receptor sites
Expulsion of placenta opens receptor sites
Unprimed receptor sites shut down, reduce potential for milk production
Frequent prolactin release maximises long term milk supply

Question 25

Describe the oxytocin reflex

Answer 25

Baby suckles
Sensory impulses from nipple to brain
Oxytocin secreted by posterior pituitary gland via bloodstream to breasts
Myoepithlial cells contract and expel milk

Question 26

What is oxytocin

Answer 26

Directs myoepithelial cells to help milk flow

Also involved in uterus contractions

Question 27

What is the feedback inhibitor of lactation

Answer 27

Protein- FIL
Causes lactocytes to ignore signals from prolactin when breast is full
If only little milk removed, milk production will slow down
More frequent feeds = less effect of FIL
FIL secreted into milk, presence inhibits further milk production

Question 28

Why is the correct positioning and attachment important in breastfeeding

Answer 28

Ensures efficient milk transfer and supply

Prevents soreness

Question 29

What factors can affect a womans breastfeeding resilience

Answer 29

Support at home
How she was fed
Previous experiences
Access to help
Skills/knowledge
Social norms
Peer/family pressure
Self esteem