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Nutrition in Pregnancy Flashcards

1
Q

inclusion of what in diet pre conception is vital to health in pregnancy

A 
Iron
Folic acid
Calcium
Iodine
Vit D
Polyunsaturated fatty acids
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2
Q

what vitamins should all women be recommended pre, during and post pregnancy

A

400 micrograms / day folic acid pre conception and during first trimester (1st 12 weeks)
10 micrograms throughout pregnancy and breast feeding

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3
Q

when should women aim to reach their optimal weight

A

pre conception

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4
Q

how many extra calories do you need during pregancy

A

first trim 70
260 2nd
500 3rd

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5
Q

what groups are most at risk (through diet) during pregnancy

A

exclusion diets: vegan, vegetarian, gluten free
underweight/ overweight
adolescents (improper mobilisation of fat pre natally)
multiple pregnancies (depletion of maternal reserves)
low income families
previous poor pregnancy outcome
smokers

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6
Q

what is folic acid important for

A

biosynthesis of DNA and RNA, amino acid metabolism

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7
Q

who should get higher folic acid doses

A

obese women, diabetics, Hx of baby with NTD or FH, on AED should get 5 milligrams

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8
Q

what foods are folates high in

A

green leafy veg
fruits (oranges)
cereals
offal

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9
Q

why is iron important in pregnancy

A

involved in enzyme processes
if low increases risk of still birth
role in oxygen transfer
anaemia

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10
Q

who is at risk of iron deficiency

A

young mothers
repeated pregnancies
multiple pregnancies

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11
Q

how do you manage iron deficiency

A

optimise age of first pregnancy/ increase baby intervals
improve diet - meat, fish, legumes, green leafy veg
supplementation

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12
Q

what extra requirements during breast feeding

A

640 extra calories
vit D
calcium
less iron

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13
Q

how much protein during pregnancy

A

1st trim +1g/day
2nd trirm +8g/day
3rd + 26g/day

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14
Q

what is required for calcium metabolism

A

vit D

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15
Q

what is the bioavailablity of calcium highest in

A

milk and its derivatives

mineral water

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16
Q

what is DHA and what is it in

A 
Docosahexaenoic Acid (DHA: is the major polyunsaturated fatty acid contained in the human brain and retinal rods)
2  to 3 servings of fish per week during pregnancy
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17
Q

why is vit D important

A

regulation of cytokine metabolism and in the modulation of the immune system, thereby contributing to the embryo implantation and regulating the secretion of several hormones

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18
Q

how can you maintain vit D in pregnancy

A

Vitamin D supplement 10micrograms /day

deficiency worse in A/W, more pigmented skin tones, obesity, alcohol abuse, previous deficiency, bone pain

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19
Q

what are the maternal risks of vit D deficiency

A

Osteomalacia, Pre-eclampsia, Gestational diabetes, Caesarean section, Bacteria vaginosis

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20
Q

what are the fetal risks of vit D deficiency

A

SGA, Neonatal Hypocalcaemia ,Asthma/Respiratory Infection, Rickets

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21
Q

what are the key food related infections pregnancy women are at risk of

A

listeria
toxoplasmosis
salmonella

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22
Q

what food and drinks should you avoid in pregnancy

A 
Soft cheese
Undercooked meat, cured meats, game
Tuna
Raw/partially cooked eggs
Pate
Liver 
Vitamin & Fish Oil Supplements
alcohol 
caffeine 
water if abroad
23
Q

what is the healthy start scheme

A

available to pregnant women on benefits/ <18
vit supplements: c, D and folic acid
voucher for food

24
Q

what are the risks in pregnancy of low BMI

A

Maternal- nutritional depletion esp if hyperemesis develops
Fetal- Intrauterine growth restriction
Preterm Labour
Low Birthweight

25
Q

what is the antenatal management for maternal low BMI

A

Exclude eating disorders- manage appropriately

USS for growth 28, 32, 36 weeks

26
Q

what do you need to adjust in labour if mother has low BMI

A

be aware of blood loss - normal volume may be large amount for her
dosage of drugs

27
Q

what BMI is obese

A

> /= 30

28
Q

what BMI is overweight

A

> /= 25

29
Q

what BMI is underweight

A

<18.5

30
Q

how does weight affect fertility

A

decreased in both low and high BMIs

31
Q

what are the maternal risks of obesity

A

Risk of miscarriage (OR 1.31 95% CI 1.18 – 1.46)
Risk of gestational diabetes (4 – 9-fold)
Risk of pre-eclampsia (3 – 10-fold
Risk of thromboembolic disease ↑
Risk of infection ↑
Risk of labour dystocia ↑
Risk of shoulder dystocia ↑
Risk of C/S/operative delivery increased ↑
Risk of PPH ↑
Risk of infection↑
Risk for depression/MH issues ( social isolation, loss of confidence, unemployment) ↑
Reduced breastfeeding rates↑

32
Q

what are the fetal risks of obesity

A 
Fetal anomalies ↑
Miscarriage ↑
Macrosomia ↑
Still Birth ↑
NICU admission ↑
Neonatal Death ↑
Less likely to be breastfed
↑Later life risks- Type 2 diabetes, Cardiovascular disease
33
Q

what is the antenatal management of obesity in pregnancy

A

High risk pregnancy (Red Pathway)
Counselling about risks and scan difficulties
Optimum Programme
-Nutritional advice and regular exercise
-Weight monitoring
Folic Acid 5mg till 12 weeks
Vitamin D 10mg ( healthy start vitamins – Vit C, Vit D, Folic acid 400ug)
Low Dose Aspirin ( 150 mg daily from 12/40 until delivery)
VTE score- (fragmin from booking/28 weeks – beware BMI>50)
OGTT 24-28 weeks
USS growth from 28 weeks
Anaesthetic review in third trimester ( 34 weeks) if BMI 40 or more
MDT in third trimester if BMI>50 or more

34
Q

what is the intrapartum management of obesity in pregnancy

A

Consultant Led Unit esp BMI>35
Fetal monitoring difficult
Determine presentation with USS
IV access
FBC, G&S
Anaesthetic review- early epidural
MDT plan review- incl plan for manual handling
Bariatric beds/ avoid lithotomy on Labour bed- will tip
Ranitidine regulary- water /isotonic fluids (reduces stomach acid, heart burn)
CTG- FSE on fetal scalp
Active third stage- IM syntometrine – deep muscle covered by fat so use other muscle eg deltoid/ IV oxytocin (prevents PPH)

35
Q

what needs to be done for operative delivery in obese women

A

Consultant Obstetrician and Anesthetist if BMI 40 or more
More assistants may be required
Extra antibiotics- preop and after
Anticipate problems- IV access, difficult spinal, airway problems, abdominal entry
Extra equipment- table extentions, Alexis O retractor
Anticipate PPH

36
Q

what might be needed post partum for obesity in pregnancy

A 
extra monitoring if sleep apnoea
Thromboprophylaxis
 TEDs usually don’t fit
Fragmin Dose weight dependent
Usually for 6 weeks postnatal
Support breastfeeding
Weight management
Wound problems
37
Q

what needs to be considered in women who have had bariatric surgery

A

advise delaying pregnancy until weight stable
nutritional complications and deficiencies (bypass and sleeve gastrectomy affect absorption) (vit D, B12, folate, Fe)
deflate gastric bands
hyperemesis think thiamine deficiency
high risk of GDM

38
Q

what is the management for maternal bariatric surgery

A 
Fetal abnormalities Reported
Neural tube defects ( folic acid def)
micropthlamia due to Vit A deficiency
Hypocalcaemia
Cerebral haemorrhage ( Vit K def)
Supplements 
A-Z supplements- use beta carotene
Adcal D3 1Tablet BD
Vit D 25mcg
Ferrous gluconate 300mg/ IV Fe
Thiamine B12 50-100mg 
Folic acid 5mg 
Vit B12 1mg IM  3 monthly

Contraception- avoid oral (impaired absorption)

39
Q

should muslim women avoid fasting in ramadan

A

yes but support them if they want to

40
Q

what sources of iron for vegetarians/ vegans

A

Pulses
dark green vegetables
wholemeal bread
eggs(for vegetarians who include them in their diet)
fortified breakfast cereals (with added iron)
dried fruit, such as apricots

41
Q

what sources of vit B 12 for vegetarians/ vegans

A 
Milk, 
cheese, 
eggs,
 fortified breakfast cereals
Fortified unsweetend soya drinks 
Fortified plant spreads
Yeast extract
Supplementation of Vit B12
42
Q

what sources of vit D for vegetarians/ vegans

A 
Direct sunlight 
Egg yolk
Some breakfast cereals
Winter milk
Most plant based spreads 
Some breakfast cereals
Supplementation of Vit D (10micrograms for pregnancy per day
43
Q

what sources of calcium for vegans

A 
dark green leafy vegetables
pulses
fortified unsweetened soya, rice and oat drinks
brown and white bread
calcium-set tofu
sesame seeds and tahini
dried fruit
44
Q

how is the majority (80%) of GDM managed

A

diet alone

45
Q

what are the diagnostic values for GDM

A

5.1 fasting and 8.5 after OGTT

46
Q

when should GDM monitor BG

A

4x per day, before meals and before bed

47
Q

what should GDM do after a big meal

A

go for a walk

48
Q

what advice for fruit and veg in GDM

A

5-a-day
Fruit have natural sugars in them (aim for 2 per day)
Try to have more veg than fruit
1 portion of fruit= 1 palm
Avoid dried fruit and fruit juices, since high in sugars and in a more rapidly absorbed format
Don’t eat all at one go, sparse them during the day
Increase veg consumption to help reduce amount of CHOs

49
Q

what advice for complex carbs in GDM

A

Required at all meal times
Reduced portion size of 30-50g/ meal
Avoid 2 sources of CHO
Wholemeal options provide same amount of CHO and cals but in a different format- sustaining bloods between meals

50
Q

what advice for fats and spreads in GDM

A 
high in calories
unsaturated better (plant based)
51
Q

what advice for airy and alternatives in pregnancy

A

Naturally occurring sugars in milk and yogurt
None in cheese or soya/ nut milk
Some pregnant women can use milk for heartburn, which will impact on BGs
Limit to 150mls/ day and switch to low fat greek style yogurt, which has less sugars

52
Q

foods with how much sugar should you avoid

A

more than 25.5 g per 100g

53
Q

what advice for exercise in pregnancy

A

all women should walk 30 mins per day
low impact exercise
high impact can harden pelvic floor, cause anaerobic metabolism and high temps which are harmful to baby, can rupture membranes

54
Q

why is exercise good in GDM

A
  1. Increases amount of glucose used by muscles for energy= lowers BGs
  2. Insulin used more efficiently- BGs are maintained/ lower
  3. Helps prevent weight gain and helps reduce weight

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