Pregnancy Flashcards
(28 cards)
Foetal growth stages
- Blastogenesis stage (2 weeks): Fertilised
ovum divides and implants itself in the uterus. - Embryonic stage: Principal organs / membranes develop. Drugs,
alcohol, nutrient deficiency can cause problems in development. - Foetal stage (3rd month til term): The most rapid period of growth.
Pregnancy is often divided into trimesters (13 week periods).
Common pregnancy symptoms
- Cramping pains in the first trimester (like menstrual cramps) due to
the embryo implanting in the uterus, as well as the uterus growing. - Cramping that is worsening or painful, or cramping associated
with any vaginal bleeding may be a sign of ectopic
pregnancy, threatened abortion, or missed abortion. - Other common pregnancy symptoms include:
nausea, vomiting, heartburn, increase in abdominal
girth, changes in bowel habits, increased urinary
frequency, vaginal discharge, palpitations, ankle
swelling, fatigue and shortness of breath.
Pregnancy energy and nutritional needs
Pregnancy increases energy and nutritional needs ― most of
which can be obtained from a healthy, balanced whole food diet.
* Undernutrition during pregnancy epigenetically
increases the risk of diabetes mellitus and
cardiovascular disease.
* Excess and unbalanced food choices lead
to higher birth weight, increasing the risk of
obesity, cancer and asthma later in life.
* Maternal high-fat diets can cause epigenetic DNA
modifications passed on to future generations.
* Postpartum dietary changes may not reverse original foetal insult.
Food to be avoided
- Paté, soft and blue cheeses — listeria risk (miscarriage,
stillbirth, pre-term labour, illness, new born deaths). - Raw eggs — salmonella risk (infection of
amniotic fluid leading to miscarriage) - Raw fish — parasite risk. Smoking fish removes parasites.
- Green or sprouting potatoes — contain alpha-solanine and
alpha-chaconine, which have been linked to neural tube defects. - Undercooked meat — salmonella, parasite risk.
- Soft ice cream and ‘squirty’ fresh cream from dispensers.
Go organic and wash all fruit and vegetables thoroughly.
Hydration
Adequate intake of pure filtered water is important.
* It is vital to accommodate increases in blood volume
during pregnancy and to replenish the amniotic fluid
(around 32 ounces surround the baby, replaced every third hour).
* Proper hydration helps to reduce the risk of pregnancy-
related problems, such as morning sickness, pre-eclampsia
and constipation. Dehydration can cause temperature
dysregulation, fatigue, cystitis, miscarriage and premature labour.
* Ensure clients are drinking eight glasses of water or
other beneficial fluids each day at regular intervals.
Herbs during pregnancy:
- Most herbs should be avoided during pregnancy and
lactation without specialist supervision. Nutrition and
homeopathy are safer options for common pregnancy ailments. - Herbal teas safe for pregnancy (in small doses) include ginger,
peppermint and chamomile. These will stimulate the uterus. - Avoid emmenagogue herbs (e.g., parsley, rosemary, basil, yarrow,
pennyroyal, angelica, mug-wort, wormwood, black cohosh.
They can stimulate the uterus and cause spontaneous abortions. - Elderberry is a safe herb to take in pregnancy for colds and flu.
- Red raspberry leaf tea is a uterine tonic which can be used
in the last month of pregnancy to encourage parturition
Toxoplasmosis
Toxoplasmosis is an infection caused by a protozoan parasite
found in cat faeces. It can also be present in raw / undercooked
meat and soil left on unwashed fruit and vegetables.
* Although rare, toxoplasmosis can be passed to the
unborn baby, which can cause serious problems such as
miscarriage, stillbirth, damage to baby’s brain and organs.
* To reduce the risk, avoid: Unwashed raw fruit and
vegetables, handling / eating raw or undercooked
meat, cured meats such as salami, unpasteurised
goat’s milk or goat’s cheese, contact with soil or faeces
that might contain toxoplasmosis (e.g., cat litter trays)
Prescription drugs
NICE guidelines recommend that “prescription medicines should
be used as little as possible during pregnancy and should be
limited to circumstances in which the benefit outweighs the risk”.
* Antibiotics can cause miscarriage and teratogenesis.
* Antidepressants can cause congenital defects
Smoking
- Significantly increases the chance of premature delivery and low
birth weight, and increases the child’s chance of being overweight. - Smoking is also associated with cleft lip / palate, some childhood
cancer and Sudden Infant Death Syndrome (SIDS)
Protein
Needed to support foetal, placental
and maternal tissue growth.
* Restricted protein intake can
lead to the development of
dyslipidaemia, obesity, hypertension,
hyperinsulinemia in offspring.
E.g., beans, lentils,
quinoa, wild fish,
organic eggs etc.
Extra 6–10 g / day
for foetal and
maternal tissue
Calcium:
1000 mg
daily
needed in
pregnancy
- Important for: Ossification of the foetal
skeleton, teeth and neural development,
and protection of maternal bones. - Low maternal levels are
associated with ↑ risk of pre-eclampsia.
E.g., kale, okra,
green beans,
sesame seeds, figs,
red kidney beans,
sardines etc.
Magnesium:
360–400 mg
daily.
- Increased need in pregnancy
and lactation. - Deficiency increases risk of
pre-eclampsia, foetal growth
retardation, pre-term labour, metabolic
dysregulation and SIDS
E.g., almonds,
pumpkin seeds,
spinach, barley,
brewer’s yeast,
cashews, kelp,
legumes, eggs, etc.
Iron
Increased requirements to meet the
growth demands of the foetus and
placenta, and to support increased
material production of erythrocytes.
* Essential for oxygen transport.
E.g., spinach,
quinoa, legumes,
pumpkin seeds,
clams, beef, oysters
etc.
Vitamin A
- Required for foetal growth, development
of vision, hearing, immune
and respiratory functions. - It is neurogenesis in the
embryo and control of neural plasticity. - Pre-formed vitamin A in excess of 10,000
IU has teratogenic effects so source from
beta-carotene in pregnancy. - Approximately 50% have reduced
BCO1 activity. BCO1 is needed to
convert beta carotene to retinol
E.g., apricots,
barley, carrots,
green leafy
vegetables,
kohlrabi, spinach,
sweet potatoes.
Ensure optimal
vitamin A status
before conception.
> 5000 IU / day.
Vitamin D
- The foetus and newborn are dependent
on the mother for vitamin D. - In pregnancy, vitamin D is especially
important for calcium homeostasis, cell
differentiation and immune function. - Inadequate levels during perinatal life can
affect a child’s bone health, brain
development, ↑ risk of heart disease and
Type 1 diabetes, insulin resistance, dental
issues and ↓ muscle mass. - Low vitamin D can ↑ pre-eclampsia risk.
Sunlight
exposure,
mushrooms, egg
yolk, wild-caught
oily fish, etc.
2000 IU needed /
day in pregnancy
EPA and
DHA
Adequate levels of EPA and DHA are
especially important for neurodevelopment and
are associated with:
* Healthy birth weight.
* Increased gestational length.
* Healthier BMI.
* Improved infant visual performance
* Lowered allergic response.
* Better mental processing.
Maternal fish oil supplementation ↓ food
allergy, IgE associated eczema / asthma risk.
SMASH fish 2 x
weekly, eggs. Flax
and chia seeds.
Fish oil 200–300
mg DHA + EPA
during pregnancy.
Reduce 4 weeks
before due date
due to anti-
coagulant effect.
Gut flora in pregnancy and birth
- The newborn gut is first colonised by microbes from
the mother as the baby moves through the birth canal. - Birth method will influence the baby’s microbiome (vaginal birth
vs. caesarean) as well as perinatal care (e.g., breastfeeding). - Excessive pre-pregnancy weight or excessive weight gain during
pregnancy can lead to gut flora changes (↑ bacteriodes, ↑ E.coli,
↓ bifido.) → these alterations can predispose the child to obesity. - Supplementation of 10 billion Lactobacillus rhamnosus GG 4
weeks before labour to 6 months postpartum can moderate weight
gain and reduce eczema development in the infant in later life
Probiotics and optimising gut flora
- Probiotic supplementation of Lactobacillus rhamnosus GG and
Bifidobacterium lactis has a protective effect against allergy
development in family history of allergic mothers. - It has helped to prevent allergies in infants delivered by caesarean.
Other ways to encourage optimal gut flora: - Natural childbirth and breastfeeding.
- Avoidance of antibiotic use.
- Pets in the home.
- Avoidance of hyperclean environment (‘hygiene hypothesis’).
- Outdoor activities — let children play outside and eat dirt!
exercise
- For the first trimester, brisk walking or low-impact
exercise classes are the most suitable solutions. - Once into the second and third trimesters, more
gentle forms of exercise, such as pregnancy yoga,
gentle walking or aqua-natal classes. - Encourage rest and relaxation, optimal sleep
and stress management techniques. - Continue to avoid endocrine disruptors
or exposure to toxins.
Morning sickness
Morning sickness is characterised by nausea and vomiting,
aversions to certain foods, a metallic taste in the mouth, hunger
even when nauseous, and relief from nausea by eating.
* Symptoms can occur at any time of the day and are most
common between week 5 of pregnancy until the 2nd trimester.
Possible contributing factors include:
* Rising hCG levels in first trimester (higher in women with twins or
with hyperemesis gravidarum (severe / prolonged vomiting).
* High oestrogen (oestradiol).
* Enhanced sense of smell.
* Poor nutritional status and poor blood sugar control
To alleviate morning sickness:
* Take supplements with food.
* Stay hydrated.
* Make time to relax and sleep during the day.
* Try acupressure at the P6 point on the wrist.
* Try sepia 30C or Nux. vomica 30C (or see a homeopath).
* 25mg of vitamin B6, three times a day for four days.
* Ginger (e.g., ginger tea).
* Eat smaller, frequent meals including
protein and carbohydrates
Pre-eclampsia
Pre-eclampsia: Pregnancy-induced hypertension
associated with protein in urine and oedema.
* Affects women around 20 weeks of pregnancy.
* Risk factors include: Advanced maternal age (40+),
first pregnancy, twin pregnancy, family history,
hypertension, chronic autoimmune disease, BMI >35.
* Symptoms include: Water retention, severe
headaches, vision problems, pain below ribs.
* Orthodox treatment is to give birth between 37–38 weeks.
* Complications: Poor foetal growth, eclampsia (fits), stroke,
organ problems, liver and blood clotting disorder HELLP.
HELLP =
H— haemolysis
EL— elevated liver enzymes
LP— low platelet count
Pre-eclampsia required nutrients
Pre-eclampsia:
* Low serum levels of calcium, magnesium,
zinc, vitamin D and omega-3s have been
associated with ↑ risk of pre-eclampsia.
Focus on foods rich in these nutrients.
* Get adequate rest and manage stress.
Pre-eclampsia supplementation
Supplementation suggestions:
* 2 g calcium in second and third trimester.
* 200 mg CoQ10 from week 20 onwards.
* 500–750 magnesium (although reduce in third
trimester as it can interfere with contractions).
Also support methylation as
elevated homocysteine is
associated with abnormal
placental vasculature —
increasing pre-eclampsia risk
Gestational diabetes mellitus (GDM)
- Affects 2–5% of pregnant women and occurs when
pregnancy hormones make the body insulin resistant. - It has been associated with ↑ chance of mother
and infant developing diabetes mellitus. - Increases risk of larger birth weight, caesarean
birth and neonatal hypoglycaemia. - Risk factors include family history of diabetes
and obesity, history of large birth weight. - Low GI diet, daily exercise (e.g., a walk after meals) and possible
supplementation of 4–8 mcg x kg of chromium picolinate
