Nutrition in Reproduction

Question 1

What is essential in ensuring maternal well-being and favourable pregnancy outcomes?

Answer 1

Consumption of a varied and balanced diet in the pre-conception period

Question 2

What are some micronutrients that are commonly deficient during pregnancy?

Answer 2

Iron, folic acid, calcium, iodine, vitamin D, polyunsaturated fatty acids

Question 3

What are the recommendations for achieving a healthy weight?

Answer 3

Meals based on starchy foods, fibre rich foods, low fat diet, reduce fried foods and refined sugars, reduce portion size, increase physical activity

Question 4

What micronutrients are prescribed to all women during pregnancy?

Answer 4

Folic acid = 400mcg preconception and first trimester

Vitamin D = 10mcg through pregnancy and if breastfeeding

Question 5

What are the groups most at risk of having a nutritional deficiency during pregnancy?

Answer 5

Exclusion diets = vegetarian, vegan, gluten free
Underweight/overweight or smokers
Multiple pregnancies or low family incomes
Previous poor pregnancy outcome or adolescent

Question 6

What are the normal roles of folates?

Answer 6

Play crucial role in many metabolic reactions such as biosynthesis of DNA and RNA

Question 7

When would you give 5mg of folic acid, rather than the usual 400mcg?

Answer 7

Obese women, diabetics, history of baby with NTD or FH, taking anti-epileptics

Question 8

What are some natural sources of folic acid?

Answer 8

Green leafy vegetables, fruit, cereals, offal

Question 9

What are some natural sources of iron?

Answer 9

Meat, fish, legumes, green leafy vegetables

Question 10

What is the normal role of iron?

Answer 10

Involved in numerous enzymatic processes and plays essential roles in transfer of oxygen to tissues

Question 11

What can iron supplements increase the risk of?

Answer 11

Stillbirth

Question 12

What does iron deficiency cause?

Answer 12

Anaemia = affects 22% of women of childbearing age in Europe

Question 13

What groups are most at risk of iron deficiency?

Answer 13

Young age at first pregnancy, repeated pregnancies, multiple pregnancies

Question 14

What are some ways to lower risk of iron deficiency?

Answer 14

Increase interpregnancy intervals and improve dietary intake

Question 15

How many extra calories should be consumed during pregnancy?

Answer 15

70 kcal/day in first trimester
260 kcal/day in second trimester
500 kcal/day in third trimester

Question 16

How many extra calories should be consumed while breastfeeding?

Answer 16

500 kcal/day during first 6 months of exclusive breastfeeding

Question 17

How much should protein intake increase by during pregnancy?

Answer 17

Increase RDA by 1 g/day in first trimester, 8 g/day in second trimester and 26 g/day in third trimester

Question 18

What is DHA?

Answer 18

Major polyunsaturated fatty acid in human brain and retinal rods

Question 19

How much DHA is recommended during pregnancy?

Answer 19

2-3 servings of fish per week

Question 20

Why is vitamin D important during pregnancy?

Answer 20

Involved in regulation of cytokines and immune modulation = contributes to embryo implantation and regulates secretion of several hormones

Question 21

What are some risk factors for vitamin D deficiency?

Answer 21

Autumn/winter months, pigmented/covered skin, obesity, bone pain, GITY disease, previous deficiency, alcohol abuse

Question 22

What are the maternal risks associated with vitamin D deficiency?

Answer 22

Osteomalacia, pre-eclampsia, gestational diabetes, C-section, bacterial vaginosis

Question 23

What are the foetal risks associated with vitamin D deficiency?

Answer 23

SGA, neonatal hypocalcaemia, asthma, respiratory infection, Rickett’s

Question 24

What are some foods to avoid during pregnancy?

Answer 24

Soft cheese, tuna, undercooked meats, cured meats, raw/partially cooked eggs, pate, liver, vitamin and fish oil supplements

Question 25

What women have access to the Healthy Start scheme?

Answer 25

Pregnant women on benefits or under age 18

Question 26

What supplements are given under the Healthy Start scheme?

Answer 26

70mg vitamin C, 10mcg vitamin D and 400mcg of folic acid

Question 27

How much money in vouchers is given under the Healthy Start scheme?

Answer 27

£3.10 per week for pregnant women £6.20 per week for babies <1 year £3.10 per week for children added 1-4 years

Question 28

What does nutrient need during breastfeeding depend on?

Answer 28

Volume and composition of milk produced | Mother's nutrient needs and nutritional status

Question 29

What micronutrients do women need when they are breastfeeding?

Answer 29

Vitamin D and calcium, but need less iron

Question 30

What effect does being underweight have on fertility?

Answer 30

Reduces fertility = twice as likely to take more than 1 year to conceive if BMI <= 18.5

Question 31

What are the risk of being underweight during pregnancy?

Answer 31

Maternal nutritional depletion, foetal intrauterine growth restriction, preterm labour, low birth weight

Question 32

What is the antenatal management for underweight women?

Answer 32

Exclude eating disorder | US for growth at 28, 32 and 36 weeks gestation

Question 33

What is the labour management for underweight women?

Answer 33

Usually normal but beware of "normal blood loss" | May need dose adjustments = 2500iu fragmin if booking weight <50kg

Question 34

What are the maternal risks of obesity during pregnancy?

Answer 34

Ovulatory dysfunction, miscarriage, gestational diabetes, pre-eclampsia, thromboembolic disease, infection, labour/shoulder dystocia, C-section, PPH, depression, reduced rate of breastfeeding

Question 35

What are the foetal risks of obesity during pregnancy?

Answer 35

Foetal anomalies, miscarriage, macrosomia, stillbirth, NICU admission, neonatal death, type 2 diabetes and CV disease in later life

Question 36

What is the antenatal management for obese women?

Answer 36

``` Red pathway for high risk pregnancy Regular exercise and weight monitoring VTE score and OGTT at 24-28 weeks USS for growth from 28 weeks Anaesthetic review at 34 weeks if BMI >=40 ```

Question 37

What is given to obese women antenatally?

Answer 37

5mg folic acid until 12 weeks gestation 10mcg vitamin D 150mg aspirin daily from 12 weeks until delivery

Question 38

What is the intrapartum management for obese women during pregnancy?

Answer 38

Consultant led unit = especially if BMI >35 IV access and USS to determine presentation Foetal monitoring difficult = CTG-FSE on foetal scalp Early epidural, bariatric beds and regular ranitidine IM syntometrine for active third stage of labour

Question 39

What is the postpartum management for obese women?

Answer 39

Extra monitoring if sleep apnoea present | Thromboprophylaxis with fragmin for 6 weeks postnatally = dose is weight dependent

Question 40

What are the features of the operative delivery for an obese woman?

Answer 40

Consultant obstetrician and anaesthetist is BMI >=40 Need extra antibiotics and additional staff May have airway problems and anticipate PPH

Question 41

What are women advised to do following bariatric surgery in regards to conception?

Answer 41

Delay conception until weight stable = 1-2 years

Question 42

What are the types of bariatric surgery?

Answer 42

Gastric bypass, sleeve gastrectomy, gastric banding

Question 43

What types of bariatric surgery are associated with a high risk of deficiency?

Answer 43

Bypass and sleeve gastrectomy = deficiency of vitamin D, folate, B12 and iron common

Question 44

What are some foetal anomalies associated with bariatric surgery?

Answer 44

Neural tube defects = folic acid deficiency Hypocalcaemia Microphthalmia = vitamin A deficiency Cerebral haemorrhage = vitamin K deficiency

Question 45

What type of contraception should be avoided in women who have had bariatric surgery?

Answer 45

Oral contraception

Question 46

What supplements are given following bariatric surgery?

Answer 46

A-Z supplements = Adcal D3 twice daily, 25mcg vitamin D, 300mg ferrous gluconate, 50-100mg B12, 5mg folic acid

Question 47

Why should Muslim women avoid fasting during Ramadan?

Answer 47

Higher risk of ketosis

Question 48

How are most women with gestational diabetes managed?

Answer 48

Most can be managed by diet alone (80%)

Question 49

What are some sources of iron for women following a vegetarian diet?

Answer 49

Pulses, dark green vegetables, wholemeal bread, eggs, fortified breakfast cereals, dried fruits

Question 50

What are some sources of vitamin B12 for women following a vegetarian diet?

Answer 50

Milk, cheese, eggs, fortified breakfast cereals and unsweetened soya drinks

Question 51

What are some sources of vitamin D for women following a vegetarian diet?

Answer 51

Direct sunlight, egg yolk, some breakfast cereals, winter milk, most plant based spreads

Question 52

What are some sources of iron for women following a vegan diet?

Answer 52

Pulses, dark green vegetables, wholemeal bread, fortified breakfast cereal, dried fruit

Question 53

What are some sources of calcium for women following a vegan diet?

Answer 53

Dark green leafy vegetables, pulses, fortified unsweetened soya and oat drinks, brown and white bread, calcium set tofu, dried fruit, sesame seeds, tahini

Question 54

What are some sources of vitamin B12 for women following a vegan diet?

Answer 54

Fortified breakfast cereals and plant based spreads, yeast extract, fortified unsweetened soya drinks, supplements

Question 55

What are some sources of vitamin D for women following a vegan diet?

Answer 55

Direct sunlight, fortified plant spreads, some breakfast cereals, supplements

Question 56

What are the recommendations for fruit and vegetable intake during pregnancy?

Answer 56

5-a-day = aim for more veg than fruit as fruit has natural sugars Avoid dried fruits and fruit juices = high in sugar 1 portion of fruit = 1 palm

Question 57

What are the recommendations for complex carbohydrate intake during pregnancy?

Answer 57

Required at all meals = portion of 30-50g per meal Avoid having 2 sources in one meal Wholemeal better = sustains bloods between meals

Question 58

What are the recommendations for fats and spreads during pregnancy?

Answer 58

High in calories so take small amounts | Unsaturated fats better for healthy heart

Question 59

What are the recommendations for dairy and its alternatives?

Answer 59

Cheese and soya/nut milk better = avoid natural sugars present in milk and yogurt Limit to 150ml/day and switch to low fat greek yogurt

Question 60

What food group is best to avoid/limit intake from?

Answer 60

Foods high in fat, salt or sugar = avoid anything with 25.5g of sugar or more per 100g

Question 61

Why is exercise beneficial for gestational diabetes?

Answer 61

Increases amount of glucose used by muscles for energy = lowers blood glucose Insulin used more efficiently Helps prevent weight gain and reduces weight