Routine Antenatal Care Flashcards
What is the guidance for supplementation for
Folic acid
At least 0.4mg daily
If increased risk 5mg for:
Increased risk – anticonvulsants, T1/2 DM, Prev child with NTD, FHx NTD, BMI over 30
or Risk malabsorption
Increased risk folate deficiency (haemolytic anaemia, multiple pregnancies) monitor Hb
1 month preconception and for the first 12/40
Reduce NTD
What is the guidance for supplementation for
B12
Vegetarians and vegans should have B12 supplementation in pregnancy (RDI 2.6mcg/day) and lactation (2.8mcg/day)
Untreated B12 deficiency causes neurological sequelae in breast fed infants
Hyperhomocysteinaemia is the commonest of the thrombophilias – 1.5% of the pop is homozygous for the MTHFR mutation and 25% heterozygous
The thrombotic tendancy is minimised by adequate folate, riboflavin, B6 and B12 – some clinicans say all woman should have adequate amounts of these vitamins
What is the guidance for supplementation for
Vit D
Test At risk woman :
(i) those with reduced sunlight skin exposure e.g. veiled women,
(ii) those who use sunscreen on a regular basis,
(iii) dark-skinned women,
(iv) mothers of infants with rickets
(v) women with a BMI >30.
For pregnant women with levels 30–49 nmol/L, commence 1,000 IU (25μg)/day.
Pregnant women with levels < 30 nmol/L should commence 2,000 IU (50μg)/day.
Repeat the Vitamin D level at 28 weeks gestation.
Pregnant women with Vitamin D level above 50nmol/L These women should take 400 iu Vitamin D daily as part of a pregnancy multivitamin
Why give Vit D supplementation
Low maternal serum levels of Vitamin D in pregnancy are associated with low neonatal Vitamin D serum levels.
Vitamin D deficiency in the neonate and the infant is associated with impaired skeletal development and an increased incidence of hypocalcaemic seizures.
From the mother’s perspective Vitamin D deficiency is known to be an important risk factor for the development of osteoporosis in later life.
What is the guidance for supplementation for
Vitamin K
Cholestasis of pregnancy
It is also recommended for women on enzyme inducing anticonvulsant medication, although recent evidence casts doubt on the need for this.
What is the guidance for supplementation for
Calcium
RDI 1300mg 14-18yo
1000mg 19-50yo
If the woman avoids dairy and does not consume high calcium food she should have 1000mg supplementation / day
What is the guidance for supplementation for
Iodine
150mcg / day
Considering pregnancy / pregnant/ breastfeeding
Who should take omega 3 fatty acids
Dietary intake is low – little seafood should consider a dietary supplementation (fish oil or preg vitamins)
Waht are the guidelines about fish intake/?
Note fish guidelines:
While there are many nutritional benefits from eating fish in pregnancy, concerns have been raised regarding the intake of environmental pollutants, particularly mercury. This concern has prompted guidelines from Food Standards Australia New Zealand to recommend no more than 2-3 serves (150g / serve) of fish per week for pregnant women.
Further, for large long living fish there are additional restrictions advised, for example one serve of shark per fortnight is recommended, with no other fish intake for the fortnight.
What is the benefit of omega 3 ?
Omega-3 fatty acids are known to be critically important building blocks for the developing fetal brain and retina. Their essential source is dietary intake, principally vegetable oils and seafood. Seafood is the richest source of the most biologically active Omega-3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
While some studies have shown a benefit of dietary supplementation with fish oil during pregnancy with regard to improvement of neurodevelopmental outcome and reduction of pre-term labour, other studies have not. No conclusive evidence of benefit using fish oil supplements in pregnancy is yet confirmed and further meta-analysis and well powered, high quality trials are needed
Should we give Vitamin A,C,E supplementation?
What about Mg, zinc or flouride?
nope no evidence
