Pregnancy nutrition + lactation Flashcards
Why does nutrition in pregnancy matter
Optimum fetal growth
Optimul fetal wellbeing
Optimum maternal health
What factors contribute to low birth weight
Preterm birth- multiple birth, previous preterm birth, smoking, stress, infection
Poor fetal growth- alcohol/drugs/smoking, poor nutrition, underweight, maternal age, genetic abnormalities, stress
How much weight is normally gained during pregnancy
Blood 1250g Uterus + breast 1375g Fat 3345g Extracellular fluid 1680g Amnitoic fluid 800g Placenta 650g Fetus 3400g
What were the findings of Liberato et al (2013)
Protein supplementation given to women with energy/protein defecit improved fetal growth, but given to women with adequate protein may impair growth
What are the effects of Vitamin D deficiency
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
What are healthy start vitamins
Vouchers/vitamins given to low income pregnancy women on benefits or tax credits to improve their health
Why is folic acid supplementation important
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
What foods should be avoided in pregnancy
Pate, soft cheese, uncooked eggs, unpasteurised milk, rare meats.
No more than 2 portions oily fish
Should vitamin A supplements be given?
No
teratogenic
Can caffeine be consumed during pregnancy
Yes but limit to 200mg
Risk of LBW + miscarriage
Why is breast milk important
Promotes healthy gut microbiota
Provides selective metabolic substrates for beneficial bacteria
Benefits of breastmilk for child
Lower incidence of: acute otitis media, gastroenteritis, lower respiratory tract infections, dental malocclusion, obesity, diabetes, SIDS, necrotising enterocolitis
Benefits of breastmilk for mother
Lower incidence of: type 2 diabetes, breast cancer, ovarian cancer, postnatal depression
Describe the changes in breast milk
Day 1-3 colostrum
Day 3-14 transitional
Day 14+ mature
Describe colostrum
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
What factors influence milk composition
Stage of lactation Gestational age of infant Stage of feed Frequency of demand Degree of fullness of breast
What is the role of immunoglobulin in breast milk
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
What is the role of lactoferrin in breast milk
Iron binding glyoprotein
Abundant in colostrum
Major role in antimicrobial action
What is the role of lysozyme in breast milk
Bacteriocidal and antiinflammatory action
Destruction of E coli _ salmonella
Production increases with age of infant
What are some important molecules in breast milk
IgA, IgE, lactoferrin, lysozyme, epidermal gut factor, viral fragments
What are the risk factors for gastroentiritis when formula feeding
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
Describe the prolactin response
Baby suckles
Sensory impulses from nipple to brain
Prolactin secreted by anterior pituitary via bloodstream to breasts
Lactocytes produce milk
What is prolactin
Directs lactocytes to produce milk
Levels high for 90min after feeding, higher at night
Suppresses release of gonadotrophin, inhibits ovulation
Describe the prolactin receptor theory
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
