Pregnancy

Question 1

What is the duration of pregnancy and from when is it calculated?

Answer 1

40 weeks

Measured from 1st day of last menstrual period

Question 2

What are the % increases of blood volume and plasma volume during pregnancy?

Answer 2

Blood volume increases 20%

Plasma volume increases 50%

Question 3

What percentage of women experience oedema?

Answer 3

60-75%

Question 4

Do blood lipid levels increase or decrease during pregnancy?

Answer 4

Increase

Question 5

Which maternal organs and tissues show the greatest degree of enlargement?

Answer 5

Heart, Thyroid, Liver, Kidneys, Uterus, Breasts, Adipose Tissue

Question 6

What changes take place to cardiac output, stroke volume and heart rate during pregnancy?

Answer 6

Cardiac output increases due to

a) increased stroke volume (30-50%)
b) increased heart rate (16% or 6 bpm)

Question 7

Describe the changes seen in blood pressure throughout pregnancy

Answer 7

Initial decrease in first half of pregnancy (29%) followed by return to non-pregnancy levels for second half

Question 8

By what percentage does tidal volume increase during pregnancy?

Answer 8

30-40%

Question 9

What are the 4 main GI issues associated with pregnancy?

Answer 9

Nausea (70%)
Vomiting (30%)
Heartburn
Constipation

Question 10

What kidney changes take place throughout pregnancy?

Answer 10

50-60% increase in glomerular filtration
Increased sodium conservation
Increased nutrient spillage into urine
Increased risk of UTI

Question 11

What is the role of Human Chorionic Gonadotropin (hCG)?

Answer 11

a) Stimulates the corpus luteum to produce estrogen and progesterone which maintains early pregnancy (after 2 months placenta takes over)
b) Stimulates growth of the endometrium.

Question 12

What is the role of Progesterone in pregnancy?

Answer 12

a) Maintains the implant
b) Stimulates growth of the endometrium and its secretion of nutrients
c) Relaxes smooth muscles of the uterine blood vessels and gastrointestinal tract
d) Stimulates breast development
e) Promotes lipid deposition.

Question 13

What role does oetrogen play during pregnancy?

Answer 13

a) Increases lipid formation and storage, protein synthesis, and uterine blood flow
b) Prompts uterine and breast duct development

Question 14

What is the role of Human Chorionic Somatotropin (hCS) in pregnancy?

Answer 14

a) Increases maternal insulin resistance to maintain glucose availability for fetal use
b) Promotes protein synthesis and the breakdown of fat for energy for maternal use

Question 15

What role does leptin play in pregnancy?

Answer 15

May participate in the regulation of appetite and lipid metabolism, weight gain, and utilization of fat stores.

Question 16

List the increases in weight (kg) for each of the following:

1. Foetus
2. Placenta
3. Uterus
4. Amniotic Fluid
5. Breast Tissue
6. Blood Supply
7. Extracellular Fluid
8. Maternal Fat Stores
9. Total Weight Gain

Answer 16

1. Foetus - 3.4kg
2. Placenta - 0.7kg
3. Uterus - 0.9kg
4. Amniotic Fluid - 0.9kg
5. Breast Tissue - 0.9kg
6. Blood Supply - 1.8kg
7. Extracellular Fluid - 1.8kg
8. Maternal Fat Stores - 3.2kg
9. Total Weight Gain - 13.6kg

Question 17

Approximately how many grams of protein are accumulated throughout pregnancy?

Answer 17

925g

Question 18

What is increased cholesterol supply utilised for during pregnancy?

Answer 18

steroid hormone synthesis (placenta)

nerve and cell membrane formation (foetus)

Question 19

Which hormones stimulate an increase in insulin production in the 1st half of pregnancy?

Answer 19

Oestrogen and Progesterone

Question 20

In the 2nd half of pregnancy, rising levels of hCS and prolactin inhibit what process?

Answer 20

Conversion of glucose to glycogen and fat

Question 21

Explain the changes in mineral metabolism during pregnancy

Answer 21

Calcium for bone formation
- maternal absorption of calcium
- the rate of calcium mobilization from bone increases
Sodium metabolism is balanced

Question 22

Describe the 3 main functions of the placenta

Answer 22

1. hormone and enzyme production
2. nutrient and gas exchange between mother and foetus
3. removal of waste products from the foetus (acts as the lungs, kidneys and digestive system until birth)

Question 23

What are the additional energy needs for each trimester?

Answer 23

No additional requirements in 1st trimester
+ 1,400kJ per day 2nd trimester
+ 1,900kJ per day 3rd trimester

Question 24

How many additional grams of protein are recommended per day during pregnancy?

Answer 24

14g

Question 25

Which foods should be avoided during pregnancy?

Answer 25

Listeria - soft cheeses, unpasteurised dairy products, cold meats, pre-prepared cut fruits and vegetables Mercury - large, long-living fish, and predatory fish Other - undercooked fish or meat, soft yolk eggs, raw sprouts

Question 26

What are the recommendations on cigarette smoking during pregnancy?

Answer 26

Both parents cease smoking prior to conception

Question 27

What are the general safe levels of recommendations regarding caffeine consumption?

Answer 27

1-3 cups per day (~300mg per day)

Question 28

What is the optimal age range for pregnancy?

Answer 28

20-25

Question 29

What are common complications concerning teen pregnancies?

Answer 29

Iron-deficiency anaemia Prolonged labour and increased chance of caesarean Higher risk of low birthweight Pre-eclampsia higher energy needs if still growing themselves Reduced financial security Interruption of schooling/education Possible time for experimenting with alcohol and drugs

Question 30

What are common complications concerning older mothers?

Answer 30

``` Higher risk of caesarean delivery Higher rates of preterm delivery Higher rate of birth defects e.g. genetic abnormalities, such as down syndrome - 1 in 100 for 40 year old - 1 in 300 for 35 year old - 1 in 10,000 for 20 year old Foetal death twice as likely ```

Question 31

What are the benefits of exercise whilst pregnant?

Answer 31

``` Reduce pregnancy discomfort Prevent lower back pain Shorten labour Reduce excess fat mass gains Prevention of gestational diabetes and preeclampsia ```

Question 32

What type of exercise should be avoided during pregnancy?

Answer 32

Exercise that can cause impacts such as falling or possible contact with hard objects, or very high intensity activities should be avoided

Question 33

What are the 3 most common symptoms during pregnancy?

Answer 33

Morning sickness Constipation/haemorrhoids Heartburn

Question 34

What are the risks associated with pre-existing diabetes during pregnancies?

Answer 34

infertility pregnancy related hypertension large birth weights possible infant abnormalities

Question 35

What percentage of women develop gestational diabetes?

Answer 35

3-8%

Question 36

What are the risk factors of gestational diabetes?

Answer 36

>30 y/o Family Hx Overweight

Question 37

What are the common consequences of gestational diabetes?

Answer 37

``` high infant birth weight complications during labour and delivery birth defects (heart damage, limb deformities and neural tube defects) ```

Question 38

What is the OGTT?

Answer 38

75 g oral glucose tolerance test OGTT at 24-28 weeks Fasting glucose: <95 mg/dL (<5.3 mmol/L) 1-hour postprandial: <140 mg/dL (<7.8/dL) 2-hour postprandial: <120 mg/dL (<6.7 mmol/L)

Question 39

What are the dietary recommendations for gestational diabetes?

Answer 39

Normal pregnancy guidelines Regulate blood glucose levels Monitoring carbohydrate intake (restrict to 35-40% EI) Eliminate processed high sugar foods and beverages Limit weight gain, especially if overweight Moderate exercise Last line of defence is medication to avoid birth complications

Question 40

Is sodium restriction recommended to prevent transient hypertension?

Answer 40

Current guidelines do not recommend a sodium restriction during pregnancy to prevent gestational hypertension or the development of preeclampsia

Question 41

What blood pressure readings are indicative of pre-eclampsia?

Answer 41

≥140 mm Hg systolic | ≥90 mm Hg diastolic

Question 42

What are the warning signs of pre-eclampsia?

Answer 42

headache, blurred vision, abdominal pain, protein in the urine, low platelet count, and weight gain from generalised oedema

Question 43

Should women with pre-eclampsia take high-dose iron supplements?

Answer 43

Iron supplements, in high doses, may aggravate inflammation by increasing the body’s free-radical load. Women with preeclampsia should not be given high-dose iron supplements

Question 44

How does alcohol consumption affect foetal development?

Answer 44

The presence of alcohol causes damage in two ways: 1. deprives the developing foetus of oxygen from intoxication 2. deprives foetus of nutrients from poor dietary habits of drinkers

Question 45

What are the neurodevelopmental symptoms of FAS?

Answer 45

Prenatal and postnatal growth retardation Impairment of the brain and central nervous system, with consequent mental retardation, poor motor skills, poor coordination, and hyperactivity

Question 46

What are the physical symptoms of FAS?

Answer 46

A smooth ridge between the nose and upper lip Narrow openings between the upper and lower eyelids and drooping eyelids A thin border on the upper edge of the lip Underdeveloped jaw and receding chin Abnormal ear shape and form