Ch. 14 Pregnancy and Lactation (tegrity)

Question 1

Nutrition before pregnancy

Answer 1

Achieve and maintain a healthy weight (men and women)
Choose an adequate balanced diet
Be physically active
Get regular medical checkups
Manage chronic conditions
Avoid harmful substances and behaviors

Question 2

Growth and Development

Answer 2

Besides the fetus, there is also the placenta, amniotic sac, and umbilical cord

Question 3

What factors can increase the risk for neural tube defects?

Answer 3

Family history of neural tube defect
Maternal diabetes
Certain medication use
Folate deficiency or problem processing
Maternal obesity

Question 4

When did we start enriching grain products to reduce the risk for neural tube defects?

Answer 4

1995

Question 5

Chronic Disease in Offspring

Answer 5

Maternal malnutrition = linked to offspring with type 2 diabetes and metabolic syndrome

Decreased growth during placental development = link to offspring with HTN
–placental development occurs extremely early, before women even know they’re pregnant

Question 6

Fetal Programming

Answer 6

Mother’s nutrition may change gene expression in fetus

–ex: mother consumes a lot of added sugar, gene expression adapts to help baby deal with excess sugar

Question 7

Maternal Weight

Answer 7

Birth weight is most reliable indicator of infant’s health

Maternal weight prior to conception:

• -influences fetal growth
• -underweight - increased rates of preterm births, infant deaths
• -overweight and obesity (medical complications and risks for infant)

Question 8

Weight Gain

Answer 8

Indicates fetal growth and maternal health

Correlated with fetal birth weight

Question 9

Weight Gain patterns

Answer 9

3.5 pounds in 1st trimester
1 pound per week after 1st trimester
–average birthweight in US = 7.5 pounds
–mother’s fat stores: varies in every pregnant woman

Large weight gain over short time
–preeclampsia

Question 10

Weight loss after pregnancy

Answer 10

Retain a couple of pounds with each pregnancy
Seven or more pounds: BMI increases 1 unit
–diabetes and HTN
–chronic diseases later in life

Question 11

Meeting energy and nutrient needs

Answer 11

Make careful selections - nutrient density
Body maximizes absorption [through gut]
Body minimizes losses [through kidneys]

Question 12

Energy

Answer 12

NO INCREASE IN THE FIRST TRIMESTER
–you do NOT need to eat for two

15 to 20% more energy than before pregnancy

Question 13

Macronutrients during Pregnancy

Answer 13

CHO:
–necessary for fuel of the developing fetus (fetus prefers to run on glucose)

PRO:
–additional 25 grams per day

Essential fatty acids:
–Omega-3 and Omega-6 fatty acids for brain development

Question 14

Blood production and cell growth

Answer 14

Fetal growth and development
Maternal RBC mass
Need for synthesis of DNA and new cells
Increases need for:
--folate, vitamin B12, iron, zinc

Question 15

Women who made good food choices typically do not require supplements. What is the exception to this statement?

Answer 15

Iron

Question 16

Prenatal supplements

Answer 16

Great source of folate and iron

Poor source of calcium and vitamin D

Question 17

Benefits of use

Answer 17

Decreased low birth weights and birth defects

Most effect seen in high risk mothers (substance abuse, multiple fetuses [twins, triplets…])

Question 18

Low birth weight (LBW)

Answer 18

5.5 pounds or less
Risk of complications are much greater
Strong relationship with socioeconomic status (SES)

Question 19

Gestational age: Preterm

Answer 19

Before 37 weeks gestation, but appropriate weight

Can “catch up” with growth and development

Most cause for concern if baby is delivered before lungs are adequately developed

Question 20

Gestational age: Small-for-gestational-age

Answer 20

Growth failure in uterus

Typically do to “catch up” well

Question 21

Malnutrition

Answer 21

Effects on early pregnancy

• -impaired placenta development
• -dysfunctional placenta = poorly nourished fetus (can lead to miscarriage)

Effects on fetal development
–growth retardation, birth defects, miscarriage, preterm birth, and LBW

Question 22

Preexisting Diabetes

Answer 22

Preconception: unmanaged diabetes leads to infertility

Those with diabetes: extreme blood sugar fluctuations, preterm labor, pregnancy related to HTN

Question 23

Gestational Diabetes

Answer 23

1 in 25 women develop it (very common)
Common consequences:
–high birth weight = macrosomia
–uncontrolled: birth defects

Dietary recommendations

• -first line of treatment
• -consistent CHO throughout the day
• ->minimizes blood sugar fluctuations
• -only use of insulin if necessary to control hyperglycemia
• ->extremely rare to use a pill for gestational diabetes

Question 24

Chronic HTN

Answer 24

Risks to mother: stroke and heart attack

Risk to fetus: separation of placenta from uterus prior to delivery = fetal death

Question 25

Gestational HTN

Answer 25

High BP in the 2nd trimester and on Typically BP returns to normal following delivery Can progress to preeclampsia

Question 26

Preeclampsia

Answer 26

high BP and protein in urine Risks for mother: decreased blood flow to organs Risks for fetus: - -decreased blood flow to placenta = decreased fetal growth - -increased risk of miscarriage

Question 27

Eclampsia

Answer 27

Sudden seizures or coma Develops from preeclampsia Treatment first includes decreasing BP and controlling seizure Labor is induced, perhaps requiring a C-section

Question 28

What is the highest cause for fetal and maternal deaths during childbirth?

Answer 28

BP issues

Question 29

Maternal Age: Adolescents

Answer 29

Compete for nutritions for growth and fetal development Decreased risk of pregnancy with early prenatal care Weight gain = normal adolescent weight gain + pregnancy weight gain --significantly greater weight gains

Question 30

Maternal Age: Older women (≥ 35)

Answer 30

Complications often reflect chronic conditions C-section rates 2x as high as younger women Maternal death rates are higher Risks for fetus - -increased rate of preterm birth and children with genetic abnormalities - -fetal death is twice as high

Question 31

Lactation: A Physiological Process

Answer 31

Hormones promote growth and branching of duct system and milk-producing cells Prolactin: milk production Oxytocin: milk ejection Triggered by infant demand for milk 99% of women are capable of lactation and milk production

Question 32

Breastfeeding: a learned behavior

Answer 32

Lactation is an automatic, physiological process Breastfeeding is a learned behavior Factors influencing breastfeeding and its success: - -partner's support - -adequate nutrition and rest

Question 33

Who requires more energy: a lactating mother or a pregnant mother?

Answer 33

Lactating mother It takes more energy to make breast milk than to make a baby and be pregnant

Question 34

A lactating mother requires how much energy intake?

Answer 34

Almost 500 extra kcal per day

Question 35

Lactation: energy nutrients

Answer 35

Recommendations increase for CHO and fiber | Protein and fats stay roughly the same as during pregnancy

Question 36

Lactation: vitamins and minerals

Answer 36

Inadequacies reduce the quantity, not the quality of breast milk Prolonged inadequate intakes lead to inadequacies