week 2 chapter 12 maternal nutrition Flashcards
Neural tube defects (NTD) and folic acid
Neural tube defects (NTD) (failure in closure of the neural tube) are more common in infants of mothers with poor folic acid intake
-Proper closure of the neural tube is required for normal formation of the spinal cord. The neural tube begins to close within the first month of gestation, often before the patient realizes they are pregnant.
-Patients should be advised to maintain a healthy folate-rich diet. In addition, folic acid/multivitamin supplementation may be needed to achieve the red blood cell (RBC) folate levels associated with maximal protection against NTD
Foods with folic acid
-liver, chicken, turkey, goose, lamb, veal, pork, large egg (cooked)
-lentils, cooked
-beans, cranberry
-vegemite, marmite
-edamame
-organe or orange juice
-bread
-potato with skin
-lettuce, spinach, corn
water in pregnancy
the recommended daily intake of fluid is 2.2 litres (9 cups). Water, milk, decaffeinated tea, and juices are good sources, although pregnant patients should limit their intake of fruit juice, as it can be high in calories and therefore lead to extra weight gain. Foods in the diet should supply an additional 700mL or more of fluid. Dehydration may increase the risk of cramping, contractions, hyperemesis gravidarum, and preterm labour.
-A good fluid intake promotes regular bowel function; without it, constipation can become a concern, especially during pregnancy.
-avoid energy drinks
energy drinks in pregnancy and children
Energy drinks are not recommended for children or for pregnant or breastfeeding patients. Energy drinks contain high levels of caffeine and added vitamins, minerals, amino acids, and herbs. Some of the caffeine in energy drinks may come from herbs, such as guarana and yerba maté.
omega- 3 fatty acids
Omega-3 fatty acids are important for overall health, providing benefits such as lowering the risk of heart disease. They are transferred across the placenta and play an important role in the growth and development of the fetus. The long-chain polyunsaturated fatty acids (LC-PUFAs) docosahexaenoic acid (DHA) and arachidonic acid (AA) are considered essential to fetal brain development and neurological function. Supplementation of omega-3 (n-3) LC-PUFA during pregnancy has been associated with reduced risk for preterm birth and improved neurological and visual development in the offspring.
-shellfish, fish, oil supplements, omega-3-enriched eggs.
mercury in pregnancy
High levels of mercury can harm the developing nervous system of the fetus or young child. Certain fish are especially high in mercury content.
-larger fish that eat smaller fish are usually higher in mercury content
iron in pregnancy
Iron is needed both to allow the transfer of adequate iron to the fetus and to permit expansion of the maternal RBC mass.
Anemic patients may be unable to tolerate a hemorrhage if it occurs at the time of birth. In addition, patients who have iron-deficiency anemia during early pregnancy are at increased risk for preterm birth and LBW infants
dosage of iron in pregnancy
Health Canada recommends that all pregnant patients take a daily multivitamin with 16 to 20mg of iron
-Pregnant patients who eat a plant-based diet may need an increased amount of iron.
iron supplements teaching
-Vitamin C (in citrus fruits, tomatoes, peppers, melons, and strawberries) increases the absorption of iron
-Heme iron (found in meats) is better absorbed than non-heme sources of iron (vegetable sources)
-Bran, tea, coffee, milk, oxalates (in spinach and Swiss chard), and egg yolk decrease iron absorption. Avoid consuming them at the same time as an iron source.
-Iron supplements are absorbed best if taken when the stomach is empty (i.e., take it between meals with a beverage other than tea, coffee, or milk).
-can be taken at bedtime if abdominal discomfort occurs when taken during the day with meals
-If an iron dose is missed, take it as soon as it is remembered if that is within 13 hours of the scheduled dose. Do not double up on the dose.
-iron may cause stool to be black or dark green
-constipation is common- a diet high in fibre with enough fluid intake is recommended
bone meal safety alert
Bone meal, which is sometimes used as a calcium source by pregnant patients, is frequently contaminated with lead. Lead freely crosses the placenta; thus regular maternal intake of bone meal may result in high levels of lead in the fetus.
vitamin A and pregnancy
Vitamin A analogues such as isotretinoin (Accutane), which are prescribed for the treatment of cystic acne, are of special concern. Isotretinoin use during early pregnancy has been associated with an increased incidence of heart malformations, facial abnormalities, cleft palate, hydrocephalus, and deafness and blindness in the infant, as well as an increased risk of miscarriage. Topical agents such as tretinoin (Retin-A, Avita) do not appear to enter the circulation in any substantial amounts, but their safety in pregnancy has not been confirmed.
weight gain in pregnancy
Whenever possible, the patient should achieve a weight in the normal range for their height before pregnancy.
weight and pregnancy
patient should achieve a weight in the normal range for their height before pregnancy. Maternal and fetal risks in pregnancy are increased when the mother is significantly underweight or overweight before pregnancy and when weight gain during pregnancy is either too low or too high. Underweight patients (BMI <18.5) are more likely to have preterm birth, small-for-gestational-age (SGA) babies, and an increased risk of spontaneous miscarriage.
Both normal-weight and underweight patients with inadequate weight gain have an increased risk for giving birth to an infant with intrauterine growth restriction (IUGR).
during first and second trimesters, growth takes place primarily in maternal issues; during the third trimester growth occurs primarily in fetal tissues
over weight and pregnancy
Greater-than-expected weight gain during pregnancy may occur for many reasons, including multiple gestation, edema, gestational hypertension, and overeating. When obesity is present (either pre-existing obesity or obesity that develops during pregnancy), there is an increased likelihood of macrosomia and fetopelvic disproportion; operative vaginal birth; emergency Caesarean birth; postpartum hemorrhage; wound, genital tract, or urinary tract infection; birth trauma; and late fetal death. Patients with obesity are more likely to have pre-eclampsia and gestational diabetes
BMI chart
*less than 18.5, underweight or low;
*18.5 to 24.9, normal;
*25 to 29.9, overweight or high; and
*greater than 30, obese.
Vitamin B12
Vitamin B12 is involved in the production of nucleic acids and
proteins; it is especially important in the formation of RBCs and neural functioning.
Vitamin B12 is only found in
animal food sources; therefore, patients following a fully plant-based diet will need to ensure that their multivitamin supplement contains
how to calculate the BMI?
BMI= weight / height2
caffeine in pregnancy
Caffeine in moderate amounts has not been proven to cause adverse effects during pregnancy. However, patients who consume more than 300 mg of caffeine daily (equivalent to a li le more than 2 cups of coffee) may be at increased risk of miscarriage and giving birth to infants with IUGR. The ill effects of caffeine are thought to result from vasoconstriction of the blood vessels supplying the uterus or from interference with cell division in the developing fetus.
includes coffee, tea, and soft drinks
what is Pica?
Pica is an eating disorder characterized by the consumption of nonfood substances (e.g., clay, dirt, chalk, soap, and laundry starch) or excessive amounts of foodstuffs low in nutritional value (e.g., cornstarch, ice or freezer frost, baking powder, and baking soda). Pica has been associated with mineral deficiencies (e.g., iron deficiency)
-Lead contamination of soils and soil-based products has caused high levels of lead in both pregnant patients and their newborns.
management of N &V
- Eat small amounts of food every 1 to 2 hours, as this will help balance blood sugar levels, and do not eat or drink too much at one time.
-Try not to mix food and drinks. Drink liquids 20 to 30 minutes before or after you eat. Do not drink alcohol at all.
-do not skip meals
-eat pregnant safe foods that are appealing
-avoid strong odours
-avoid making sudden movements. get out of bed slowly and eat soon after getting up
-try salty and tart foods (e.g., potato chips and lemonade)
-sucking a lemon slice may help
-keep environment well ventilated (open a widow)
-eat foods severed at room or cool temperatures and foods that give off little aroma
-try candies, gums, and lozenges to help minimize the metallic taste
-avoid brushing your teeth after eating - Consider discontinuing iron-containing prenatal vitamins during the first trimester and substitute them with folic acid
Hyperemesis gravidarum
Hyperemesis gravidarum, or severe and persistent vomiting causing weight loss, dehydration, and electrolyte imbalances, occurs in about 1% of pregnant patients. Intravenous fluid and electrolyte replacement, enteral tube feeding, and in some instances total parenteral nutrition have been used to nourish patients with hyperemesis gravidarum.
constipation in pregnancy
The recommendation for pregnant patients for fibre is 28 g/day. An adequate fluid intake (at least 2.2 L/day) helps hydrate the fibre and increase the bulk of the stool. Warm or hot fluids may increase peristalsis more than cold fluids. Making a habit of regular exercise that uses large muscle groups (walking, swimming, cycling) also helps stimulate bowel motility. Laxatives should not be taken unless first discussed with a health care provider.
heartburn in pregnancy
Heartburn, or pyrosis, is usually caused by reflux of gastric contents into the esophagus
strategies to reduce heartburn
* Eat small, frequent meals, rather than two or three larger meals, daily.
* Add a source of protein to each snack.
* Avoid drinking fluids with a meal as fluids increase the distension of the stomach.
* Avoid eating foods that are high in fat, spicy foods, acidic foods, as well as chocolate and mint.
* Avoid lying down immediately after eating.
may take antacids to help with heartburn.- must check with HCP prior to use
