Nutrition and Pregnancy

Question 1

significant increase in DNA content (cell number) before birth (undernourished children had decreased increase), levels off after birth; Protein content (cell size) continually increases before and after birth

Answer 1

Human brain

Question 2

Liver increases throughout life, Kidney increases after birth but stops at about 3-4 months

Answer 2

Tissue DNA content (cell size)

Question 3

->only carbohydrate transported across the placenta by facilitated diffusion
(concentration greater on the mother’s size)

Answer 3

Glucose

Question 4

• > transported as acetyl CoA and free FA across the placenta
• > species differences in ease of transport

-> in humans the main source of this for fetuses is glucose

Answer 4

Fat

Question 5

-> cross by pinocytosis
(small section of maternal cells is swallowed into vacuole and released into cell on fetal side)
-> the rate is inversely proportional to square root of MW for:
~albumin
~fibrinogen
~gamma-globulins
~transferrin
-> GH, insulin and TSH DO NOT cross (protects)
-> fetus gets 10-15% of daily requirement from drinking amniotic fluid
(fetuses with swallowing difficulties suffer growth retardation)

Answer 5

Proteins

Question 6

> cross by active transport

• > concentration is highest on fetal side
• > only L type cross, NOT D

Answer 6

AA

Question 7

more surface area causes increased weight of fetuses -> obese mothers have highest placental weight

Answer 7

Placental size

Question 8

the fattest fetus at birth of all species

Answer 8

Humans

Question 9

first the mother increases levels, fetus will increase levels after a delay then exponentially

Answer 9

Fat

Question 10

5g more protein, 
0.8MJ more energy
30mg more of ascorbic acid, 
700mg more of calcium, 
3 more mg of iron

Answer 10

Daily dietary requirements for pregnancy in 3rd trimester

Question 11

actually need more than during pregnancy of protein and energy (same for ascorbic acid, calcium and iron)

Answer 11

Lactation

Question 12

optimal BMI for conceiving children

Answer 12

20-26

Question 13

key to pregnancy nutrition -> basic principles during pregnancy are the same -> it is likely to provide the micronutrients needed, it should include enough portions of fruits and vegetables

Answer 13

Eating a balanced diet

Question 14

no increase in the first trimester -> 300 increase per day in 2nd and 3rd trimester, increase should come from nutrient dense foods -> need for increase depends on physical activity, age and weight

Answer 14

Calories

Question 15

most of the energy will come from this source, mostly complex starch -> whole grain foods are good because they are high in B vitamins and high in trace minerals such as zinc, selenium, chromium, magnesium

Answer 15

Carbohydrates

Question 16

required for hyperplasia and hypertrophy of maternal tissues and to meet fetal needs

• > intake for pregnancy is about 70 g/day
• > greatest demand during the last half of pregnancy when the fetal growth is greatest

Answer 16

Protein

Question 17

essential fatty acids are important for infant growth, especially omega 3 and omega 6 FAs (DHA) -> seafood is good source of protein and iron and omega 3 which helps baby’s brain development

Answer 17

Fat

Question 18

women should not consume these fish because of potential damage to baby’s developing nervous system -> swordfish, shark, king mackerel, tilefish

Answer 18

Mercury

Question 19

deficiency can cause neural tube defects

Answer 19

Folic acid

Question 20

deficiency can cause anemia and hemorrhage

Answer 20

Iron

Question 21

deficiency can cause cretinism

Answer 21

Iodine

Question 22

deficiency can cause anemia and low birth weight

Answer 22

Zinc

Question 23

deficiency can cause neonatal hypocalcemia, poor infant bone formation

Answer 23

Vitamin D

Question 24

deficiency can cause hemorrhage

Answer 24

Vitamin K

Question 25

deficiency can cause anemia, anencephaly, low birth weight

Answer 25

Copper

Question 26

caused by incomplete development of the brain and spinal cord and/or their protective covering -> spina bifida is most common (also anencephaly and encephaloceles) -> no cures

Answer 26

Neural tube defects

Question 27

spine fails to close properly during first few weeks of pregnancy causing damage to the nerves and spinal cord -> severe cases can result in full or partial paralysis and other problems such as hydrocephalus, bowel and bladder problems and learning disabilities

Answer 27

Spina bifida

Question 28

strong evidence that this supplement will prevent NTD's -> need 400 micrograms/day for all woman in childbearing age, - >1000 micro g/day in pregnant women (MAX), - >4mg/day in women with history of Neural tube defect deliveries - > should take supplement 1 month prior to conception and during first trimester

Answer 28

Folic acid

Question 29

needed during pregnancy due to increased maternal blood volume -> good stores before pregnancy protect against deficiency anemias (increases risk of preterm delivery and low birth weight) -> a 30mg supplement/day is recommended during the 2nd and 3rd trimester (about twice normal)

Answer 29

Iron

Question 30

- > increased need can be met through changes in metabolism during pregnancy - >resulting in increased absorption and release from bones - > appears to be replaced after pregnancy in women who have adequate intake of this and vitamin D

Answer 30

Calcium

Question 31

1.4 to 2.2kg weight gain

Answer 31

1st trimester

Question 32

0.5kg weight gain per week

Answer 32

2nd and 3rd trimester

Question 33

11-14kg (distributed) - > 5 for fetus/placenta/amniotic fluid, -> 1 for uterus, - > 2 for increased blood volume, - > 1.5 to breast tissue - > 1.5-2.5 maternal fat stores

Answer 33

Average weight gain during pregnancy

Question 34

``` underweight = 13-18Kg normal = 11-14, overweight = 9-11, obese = at least 7, twins = 16-21kg ```

Answer 34

Recommended weight gain

Question 35

metabolic rate drops if low maternal nutrition -> mothers become more efficient at metabolizing fat (don't have a lot to use in malnourished areas)

Answer 35

Fetal growth is protected against malnutrition

Question 36

carries risks such as gestational diabetes and high blood pressure (however, pregnancy is no time for dieting)

Answer 36

Excess weight

Question 37

not necessary during pregnancy as long as a balanced diet is maintained -> except for maybe iron, folate, vitamin D + DHA BUT note: Vit D supplement recommendation for pregnant and gen. pop is the same

Answer 37

Nutritional supplements

Question 38

mix cereals with legumes to get extra proteins -> may be need for supplements, especially iron, vitamin B12 and vitamin D

Answer 38

Vegetarian Diets

Question 39

significant increase in stillbirths, premature babies, neonatal deaths, low birth weight babies and a significant decrease in mean birth weight all together (but still average more than 2.5kg -> incredible capacity of mother to protect fetus from malnutrition)

Answer 39

During famine

Question 40

varies in response to energy intake -> additional adaptations in Gambian women = reduced diet induced thermogenesis and reduced activity (decreased basal metabolic rate in the mother's tissues)

Answer 40

Energy cost of pregnancy

Question 41

adjusts to protect the fetus when food is in short supply -> long term consequences?

Answer 41

Maternal metabolism

Question 42

will only be effective if there are situations compromising fetal growth (ex. malaria) -> will significantly help undernourished with hemoglobin levels and birth weight -> extra energy is beneficial but extra protein can have negative effects

Answer 42

Food supplement