Nutrition in Pregnancy Flashcards

Question

what is the antenatal management for maternal low BMI

Answer 1

Exclude eating disorders- manage appropriately | USS for growth 28, 32, 36 weeks

Answer 2

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

Answer 3

decreased in both low and high BMIs

Answer 4

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↑

Answer 5

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

Answer 6

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

Answer 7

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)

Answer 8

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

Answer 9

``` 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 ```

Answer 10

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

Answer 11

``` 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)

Answer 12

yes but support them if they want to

Answer 13

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

Answer 14

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

Answer 15

``` 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 ```

Answer 16

``` 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 ```

Answer 17

diet alone

Answer 18

5.1 fasting and 8.5 after OGTT

Answer 19

4x per day, before meals and before bed

Answer 20

go for a walk

Answer 21

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

Answer 22

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

Answer 23

``` high in calories unsaturated better (plant based) ```

Answer 24

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

Answer 25

more than 25.5 g per 100g

Answer 26

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

Answer 27

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

Nutrition in Pregnancy Flashcards

(54 cards)