Lecture 6b: Maternal Nutrition

Question 1

What is iodine essential for?

Answer 1

The production of thyroid hormones

Question 2

What are thyroid hormones required for?

Answer 2

• Regulating body’s metabolism
• Normal growth
• Neurocognitive development of fetus/infant

Question 3

What does severe iodine deficiency cause?

Answer 3

Intellectual disability

Question 4

What does NZ iodine fortification look like?

Answer 4

Mandatory iodine in bread flour

Question 5

What does WHO recommend for prevention of iodine deficiency?

Answer 5

Universal salt iodisation

Question 6

What is the RDI for non-pregnant VS pregnant women?

Answer 6

100 vs 160

Question 7

When should a women take iodine?

Answer 7

As soon as a women becomes aware she is pregnant - throughout entire pregnancy and breastfeeding

Question 8

What is Vitamin A important for?

Answer 8

Cell differentiation - recommended intakes increase by 10% in pregnancy

Question 9

How common is Vitamin A deficiency?

Answer 9

Rare in industrialised countries - major problem in developing nations

Question 10

What can Vitamin A deficiency cause?

Answer 10

Malformations in:
- Fetal lungs
- Urinary tract
- Heart

Question 11

What is the UL for Vitamin A intake?

Answer 11

> 3000 RE per day (10,000 IU)

Question 12

No more than 100g of ?? should be eaten once a week during pregnancy

Answer 12

Liver

Question 13

What can excessive intake of Vitamin A cause?

Answer 13

Fetal abnormalities

Question 14

What forms can vitamin A be taken in excessive intakes?

Answer 14

Retinol or Retinoic Acid (not beta-caotene)

Question 15

Why is excessive vitamin A easily done?

Answer 15

A number of supplements taken by pregnant women contain Vitamin A, so can be taking too much very easily

Question 16

What is retinoic acid syndrome?

Answer 16

Collection of birth defects including:
- Craniofacial
- Cardiovascular
- Thymus dysfunction
- Microcephaly

Question 17

What is a common defect from retinoic acid syndrome?

Answer 17

Small ears or no ears, abnormal or missing ear canals

Question 18

When is Vitamin D deficiency at increased risk for pregnant women?

Answer 18

• Dark skin tone
• Live south of Nelson during winter or spring
• Limited time outdoors
• Minimal sun exposure

Question 19

What are sources of Vitamin D?

Answer 19

Sunlight, only a few foods

Question 20

What is maternal vitamin D insufficiency linked to?

Answer 20

• Gestational diabetes
• Pre-eclampsia

Question 21

What is infantile vitamin D insufficiency linked to?

Answer 21

• LBW
• Dental decay
• Acute respiratory infections

Question 22

What are food safety considerations during pregnancy?

Answer 22

• Listeriosis
• Toxoplasmosis

Question 23

What is listeriosis?

Answer 23

Develops as a result of infection with listeria monocytogenes - usually from a food

Question 24

What does listeriosis cause?

Answer 24

Influenze type symptoms and can result in premature labour and reduced fetal movements

Question 25

What happens if listerosis is not treated?

Answer 25

Life-threatening to fetus via infection of: - Placenta - Membranes - Amniotic fluid Causes: - Sepsis and death

Question 26

What are precautions for listeria?

Answer 26

- Foods heated thoroughly to steaming hot (>70) - Avoid unsafe foods

Question 27

What are unsafe foods for listeria?

Answer 27

- Uncooked, smoked or ready to eat seafood - Pate, hummus, spreads - Pre-cooked meat products - Pre-prepared/stored salads - Unpasteurised milk - Soft-serve ice cream - Soft, semi-soft cheese

Question 28

How many listeria infections are reported per year?

Answer 28

19-30

Question 29

How many cases of listeria had the infection spread to fetus?

Answer 29

96% of cases

Question 30

How many causes of listeria saw major foetal or neonatal complications?

Answer 30

In 83% of infants of infected mothers

Question 31

What is toxoplasmosis?

Answer 31

A parasitic disease caused by toxoplasma gondii

Question 32

What can toxoplasmosis cause?

Answer 32

Eye or brain damage in unborn babies

Question 33

What can a toxoplasmosis infection come from?

Answer 33

- Unwashed vegetables - Undercooked meat - Ready to eat meats - Unpasteurised milk - Cross-contamination of cat faeces

Question 34

How does alcohol pass through the fetus?

Answer 34

Alcohol readily passes the placenta such as fetal blood alcohol levels will be similar to maternal blood alcohol levels

Question 35

What is the most recognisable outcome of maternal alcohol drinking?

Answer 35

Fetal Alcohol Syndrome (FAS)

Question 36

What are features of FAS?

Answer 36

- Growth deficiency/Development delays - CNS dysfunction - Facial characteristics

Question 37

What are examples of CNS dysfunction?

Answer 37

- Microcephaly - Delayed development hyperactivity - Attention deficits - Learning disabilities - Intellectual deficits

Question 38

What are the facial characteristics of FAS?

Answer 38

- Short palpebral fissures - Thin upper lip - Underdeveloped jaw - Smooth and/or long philtrum

Question 39

What is does the Fetal Alcohol Spectrum Disorder (FASD) include?

Answer 39

- Full FAS - Alcohol related neurodevelopment disorder (ARND) - Alcohol related birth defects (ARBD)

Question 40

When is the full spectrum of FAS seen?

Answer 40

Only seen with heavy drinking during pregnancy regularly OR high concentrations at critical development periods

Question 41

What are the alcohol recommendations during pregnancy in NZ?

Answer 41

- Stop drinking if you could be or are pregnant - Fermented drinks that may contain low levels should be avoided

Question 42

What packaged alcohol contains a pregnancy warning label?

Answer 42

Containing more than 1.15%

Question 43

What is the gold standard of evidence assessment?

Answer 43

Meta-analyses

Question 44

What is the order of quality of evidence?

Answer 44

1. Critical Appraisal 2. Experimental studies 3. Observational studies

Question 45

What are examples of critical appraisal?

Answer 45

- Meta analyses - Systematic reviews - Critically appraised literature

Question 46

What are examples of experimental studies?

Answer 46

- RCT - Non-randomised CT

Question 47

What are examples of observation studies?

Answer 47

- Cohort studies - Case studies - Individual case reports