Pregnancy Flashcards
(143 cards)
1
Q
Goal of Nutrition During Pregnancy
A
To provide nutrients needed to support fetal growth and development while supporting the pregnant person with the nutrients they need to maintain their own health
2
Q
Is the fetus a parasite?
A. Yes, it can essentially take whatever nutrients it needs from the maternal diet and maternal nutrient stores (at the pregnant person’s expense, if need be)
B. No, nutrients consumed in the maternal diet will be used to meet pregnant person’s needs first, and only the remainder would support fetal growth
A
B. No, nutrients consumed in the maternal diet will be used to meet pregnant person’s needs first, and only the remainder would support fetal growth
3
Q
Why is nutrition important during pregnancy?
A
Inadquate or excess nutrients or exposure to toxins can impact
- Development of embryo/fetus
- short and long term health
Fetus depends on pregnant person for all its nutrient ⇒ Must nourish pregnant person to maintain the pregnancy
Proper nutrition can reduce risk of **maternal mortality, infant mortality and low birth weight **– key indicators of population health
Nutrition in pregnancy sets the stage for a healthy baby and healthy parent
4
Q
What are ideal time for dietary advice?
A
- Dedicated health care provider and regular visits
- Time of change
- Motivation to change for both themselves and their child
5
Q
Maternal Mortality Ratio
A
maternal dealths/100 000 births
6
Q
What are contributing causes of maternal mortality in Canada?
A
- Age over 35 years
- Medical co-morbidities - pre existing conditions
- A growing refugee and immigrant population with different risks and resiliences - access to health care
7
Q
What are contributing causes of inequalities in infant mortality in Canada?
A
Leading causes of infant death:
- immaturity
- structural or functional birth defects
- severe lack of oxygen
- infection
- sudden infant death syndrome
Risk factors and conditions of infant dealth include:
- low maternal education
- inadequate housing
- poverty
- lack of access to health care
- food security
- unemployment
- socioeconomic status
Most materially deprived areas have rates of infant mortality 1.6x HIGHER than the rates of those living in the least deprived areas
adressing inequalities in education, income, material deprivation
8
Q
How does low birth contribute to risks?
A
higher risk of health complications
9
Q
Which of the following is FALSE?
A. The MMR is an indicator of population health
B. Since the 1990’s the MMR has decreased
C. The infant mortality rate is higher among Indigenous
communities
D. Low birth weights are increasing in Canada
E. Nutrition is important for the health of both the baby and
pregnant person
A
B. Since the 1990’s the MMR has decreased
10
Q
With regards to later risk of chronic disease (obesity, type 2 diabetes, heart disease), which group has a statistically higher risk of later disease?
A. Babies born small for their age
B. Babies born large for their age
C. Size at birth does not make a difference
A
A. Babies born small for their age
‘Thrifty phenotype’ - prioritizing energy storage and efficiency b/c of inadequate nutrients; socioeconomic factor
11
Q
With regards to later risk of chronic disease, the most vulnerable time in pregnancy is:
A. Pre-conception
B. Early pregnancy
C. Mid pregnancy
D. Late in pregnancy
A
B. Early pregnancy
12
Q
What is the developmental origins of adult disease hypothesis?
A
- Risk for heart disease, type 2 diabetes, high blood pressure may
depend on the environment the fetus experiences in utero - Poor maternal nutrition can affect likelihood that offspring will
experience health challenges decades later - Low-birth weight babies appear to be at higher risk
13
Q
The Dutch Famine (1944-45): Hongerwinter
A
- Nazi blockade of food transport during their occupation of the
Netherlands in the winter of 1944-45: rations reduced to as little as 500-800 kcal/d - Some survived by eating tulip bulbs and adding paper to soup
- Pregnancy rates dropped by 50% during famine
- Average birth weight dropped by 372 g
14
Q
How does early nutrition affects cell division & differentiation during critical periods?
A
Proliferation ⇒ insult during cell proliferation limits tissue growth and functional capacity ⇒ smaller mature tissue with fewer functional units
Differentiation ⇒ insult during cell differentiation limits functional capacity of the mature tissue⇒ mature tissue with fewer functional units
15
Q
How does early nutrition & DNA methykation affect pregnancy?
A
Epigenetic effect ⇒ heritable changes in gene expression; after DNA methylation of genes playing role in obesity and metabolic health development
16
Q
Was the association between maternal diet and IQ at 14 y
statistically significant? Clinically significant?
A. Yes, the results have statistical and clinical significance
B. Yes to statistical significance, probably not for clinical
significance
C. No to statistical significance, possibly yes for clinical
significance
D. No the results have neither statistical nor clinical
significance
A
B. Yes to statistical significance, probably not for clinical
significance
17
Q
What might be a confounder in the results of this study?
A
Diet in pregnancy ⇒ cultural background ⇒ IQ
- genetics
- stress
- age
- smoking
- healthcare
18
Q
On average, how long does pregnancy last?
A. 20 weeks
B. 35 weeks
C. 38 weeks
D. 40 weeks
E. 45 weeks
A
38-40 weeks
19
Q
Fetal age
A
Period of intrauterine development from conception to birth (approx. 38 weeks)
20
Q
Gestational age
A
Period of intrauterine development from the first day of the last menstrual cycle to birth (approx. 40 weeks)
21
Q
Andi’s physician just confirmed her pregnancy. Using the
gestational age method used in health care, Andi is
advised that she is 7 weeks pregnant.
For approximately how long has the “conceptus” been
growing/developing?
A. 5 weeks
B. 7 weeks
C. 9 weeks
D. This cannot be determined from the information
provided
A
A. 5 weeks
22
Q
Naegele’s rule
A
substract 3 months and 1 year + 7 days to calculate the estimated due date (EDD)
23
Q
If the first day of Andi’s last menstrual period was October
15, when is Andi’s estimated due date?
A. July 8
B. July 15
C. July 22
D. July 29
E. Aug 7
A
C. July 22
24
Q
Pregnancy Trimesters
A
1st trimester: date of first day of last menstrual period to end of week 13
2nd trimester: weeks 14 to 27
3rd trimester: weeks 28 to birth
25
What is a full-term birth?
37-42 weeks
26
Preterm birth
<37 weeks
27
Small for gestational age (SGA)
<2500 g (5.5 lbs)
28
Large for gestational age
>90th percentile for age and sex
>4000 g
29
What are associated with increased risk of Preterm Birth?
Respiratory distress
Lung disease
Asthma
CVD
30
What are risk factors for low birth weight?
1. Low weight gain
2. Low pre-pregnancy weight status
3. Premature birth
4. Multiple births (e.g. twins)
5. Health conditions during pregnancy
* E.g. poor placental growth, infections, diabetes, high BP,
chromosomal abnormality in fetus
6. Stress, poverty, lack of social support
7. Smoking or drug exposure
31
What are risk factors of large for gestational age (LGA)?
History of previous LGA births - genetics
Poorly controlled diabetes
- high blood glucose
Maternal obestiy
Excessive weight gain during pregnancy
- c section
Concerns for delivery and post-partum complications for mothers
32
JL was born at 38 weeks and weighed 2400 g. JL would be considered:
A. Preterm and SGA (small for gestational age)
B. Term and SGA
C. Preterm and normal birth weight
D. Term and normal birth weight
E. Term but large for gestational age
B. Term and SGA
33
How is nutrition & newborn maturity and body weight linked?
One of most important modifiable variables leading to birth of mature (term) infant with appropriate weight
34
Conception
Ovum + Sperm → Fertilized **“zygote”**
Fertilization takes place in uterine tubes/oviduct
Occurs ~day 14 of menstrual cycle = **day 0 of fetal stage**
35
Germinal stage
Zygote divides and moves from uterine tubes to the uterus
- zygote differentiates into a **blastocyst**. Implants into uterus. Placenta begins to form from conception to ~2 weeks
36
In the germinal stage, the cell mass differentiates into an outer mass (trophoblast) and inner mass. The trophoblast becomes the:
A. Nervous system
B. Skin
C. Digestive system
D. Placenta
E. Heart
D. Placenta
37
Embryonic stage
Embryo
- Formation of all major body systems
- Day 15 until end of 8th week
38
The embryo differentiates into three layers – ectoderm,
mesoderm, and endoderm. Which of the following layers are incorrectly matched with the tissue they form?
A. Ectoderm: skin, hair, nails
B. Ectoderm: nervous system
C. Ectoderm: bone and muscles
D. Mesoderm: heart, kidneys, gonads
E. Endoderm: digestive system and respiratory systems
C. Ectoderm: bone and muscles
39
Fetal stage
Fetus
- 9th week until birth
- Growth of baby and preparation for life outide the womb
40
Which of the following does the fetus do in utero? [Select all that apply]
A. Breathing via lungs
B. Digestion
C. Defecating (poop)
D. Urinating
E. Circulate blood through heart
B. Digestion
D. Urinating
E. Circulate blood through heart
41
Two fetal adaptations that occur to ensure the fetus receives oxygenated blood
Fetal heart
**Foramen ovale (open)**
- shunt blood from R atrium to L atrium bypassing the lungs
**Ductus arteriosus (open)**
- shunts blood from pulmmory artery to aorta bypassing lungs
Are usually closed in newborn heart
Fetal hemoglobin has a higher affinity for oxygen promoting transfer from placenta to fetus - breaksdown fetal heme - iron release storage good for the first 6 months
42
Critical Periods
A specific time period during which the cells of a tissue (or organ) are genetically programmed to multiply
- proper growth and development does not take place during this period, it can not be made up later
- most ciritcal periods occur early in pregnancy
43
What key nutrient is needed for proper closure of the neural tube?
Folate/Folic acid
44
Maternal-Placental Fetal Triad
interconnected physiological relationship between the mother, placenta, and fetus during pregnancy
45
The Placenta
Begins to develop after implantation (~2 weeks after fertilization). Fully functional ~2nd trimester
46
What are the functions of the placenta?
Nutrient and gas exchange
Removal of waste from fetus
Endocrine secretions (HCG, estrogen, progesterone)
High metabolism: Placenta uses 30-40% of the glucose delivered by materal circulation
Placental dysfunction can cause complications for both baby and pregnant person
47
Maternal - Fetal Circulation and the Placenta
1. Uterine arteries - O2/nutrient rich blood
2. Umbilical vein - takes in the blood
3. Umbilical arteries - O2 poor/nutrient waste
4. Uterine veins
48
Placental Transport
Maternal and fetal blood DO NOT MIX
Most substances cross the placenta
Nutrient transfer depends on:
- Size and charge of molecules
- Lipid solubility of particles
- Concentration of nutrients in maternal and fetal blood
Placenta fulfills own needs before nutrients are available to fetus
49
If a pregnant person’s blood alcohol was 0.07, what would
be the approximate blood alcohol of the fetus?
A. ~0.07
B. Much less than 0.07
C. Much more than 0.07
A. ~0.07
50
What key nutrient(s) will be needed to support the expansion
of blood volume?
Iron
Water
Folate/B12
51
Body water increases from 7 to ~10 liters with plasma volume
increasing by 50%.
The expansion of body water in pregnancy is likely to make
water soluble vitamin and mineral concentrations:
A. Appear lower
B. Appear higher
C. Unchanged
A. Appear Lower
52
What is the purpose of insulin resistance in pregnancy?
What might be an unintended consequence of this?
Gestational diabete
- inc. blood glucose
- supply of glucose for fetus
53
Maternal Anabolic Phase
1st and 2nd Trimester
- Increased blood volume and body fluid
- building fat, liver glycogen and micronutrient stores
- growth of maternal organs
- increased appetite, food intake (positive caloric balance)
54
Maternal Catabolic Phase
- Mobilization of fat and nutrient stores
- increased production and blood levels of glucose, triglycerides, fatty acids
- decreased liver glycogen
- increased catabolic hormones (glucagen, cortisol, epinephrine
55
First Trimester
- Most differentiation of tissues occurs during critical periods in this time
- development of the placenta
- most vulnerable to toxins and nutrients inadequacy durng this time
56
In Canada and the United States, the proportion of
“unplanned” pregnancies is estimated to be:
A. <10%
B. 10-25%
C. 25-50%
D. 50-75%
E. >75%
C. 25-50%
57
Periconception
period around conception (generally from a few months before conceiving and including the first few months of pregnancy)
58
Why is periconceptional nutrition important?
1. Starting with adequate nutrient status and body composition can imrpove pregnancy outcomes
2. Key events occur in early pregnancy - often before prenatal care begins
59
Neural Tube Defects (NTDs)
Adequate folate is related to ~50 percent of cases of neural tube defects
- birth defects of the brain or spinal cord caused by improper closure of the neural tube in early development
60
Are you getting enough folic acid?
If you are:
- a women who could become pregnant
- planning a pregnancy
- pregnant or breastfeeding
**Take a multivitamin with 0.4 mg of folic acid every day**
Fortification of grains such as white flour, enriched pasta and corn meal manadatory
61
Periconceptional Iron
* Iron deficiency is the most common nutritional deficiency
worldwide
* Iron deficiency prior to pregnancy
- Increases risk of iron deficiency in pregnancy
- Increases risk of low iron stores in infants
- Increases rates of preterm delivery
* Much easier to improve iron status prior to conception than
during pregnancy
62
Which of the following impact human energy requirements:
[Select all that apply]
A. Age
B. Physical activity
C. Sex
D. Body size
E. Pregnancy
All of the above
63
What are the components of energy expenditure?
1. Physical activity
2. Diet induced thermogenesis
3. Basal metabolism (Resting energy expenditure, REE)
64
Physical Activity
Energy for muscular work
- Variable
Determinants
- intensity
- duration
- body weight
- genetics
65
Diet induced thermogenesis
Energy to digest and absorb food
~10% of energy intake
Determinants
- amount of food & composition
- hormones/SNS
66
Basal metabolism (resting energy expenditure)
Energy to maintain normal body functions while at rest
- breathing, heart beat
Determinants
- body weight
- height
- fat free mass
- fat mass
- age
- gender
- hormones (thyroid, leptin, insulin, etc.)
- SNS
67
How are energy needs affected during pregnancy?
1. Physical activity - dec.
2. Diet induced thermogenesis - same, no change
3. Basal metabolism (Resting energy expenditure, REE) - inc.
4. Energy for deposting both fetal and maternal tissue - *extra fat stores, grow placenta
68
What are the energy cost of deposting tissue?
~38,000-42,000 kcal to deposit 925 g protein and 3.8 kg fat
- Mainly deposited in the 2nd and 3rd trimester
- averages ~200 kcal/d
69
Approximately how many more calories are needed in the
first trimester of pregnancy?
A. Negligible/none
B. ~200 kcal per day
C. ~450 kcal per day
D. ~2000 kcal more per day
E. >2000 kcal more per day
A. Negligible/none
70
What would be the best way to determine whether a pregnant person
is meeting their increased energy needs?
A. Conduct periodic 24-hour recalls to determine if, compared to pre-pregnancy dietary intake, they are consuming at least 200 kcal more during the 2nd and 3rd trimester
B. Monitor weight gain throughout the pregnancy
C. Monitor growth of the fetus throughout the pregnancy
D. Monitor weight gain and growth of the fetus throughout pregnancy
D. Monitor weight gain and growth of the fetus throughout pregnancy
71
What techniques used to monitor fetal growth?
**Fundal height**: determined by measuring the distance from the pubic symphysis to the highest part of the uterus
- ex. 33 week bay should measure 33 (+/-2) cm
**Ultrasound **
- varibility w/ appearance
- certain ranges
72
How should gestational weight gain?
Weight gain in 1st trimester is ~0.5-2 kg
Most weight gained in 2nd and 3rd trimesters and total amount and rate of weight gain should be steady rate
Appropriate weight gain is important for ensuring adequate energy for both pregnant person and fetus
- depends on pre-pregnancy weight
Recommendations for weight gain are based on observational data from pregnancies with good outcomes
73
Typically, where does the largest proportion of the
gained mass go (other than to the fetus itself)?
A. Breast tissue
B. Maternal blood
C. Placenta
D. Maternal fat stores
D. Maternal fat stores
74
The distribution of weight gain in pregnancy
Blood volume + Extra body fliuds = 7-8 lbs
Placenta = 1-2 lbs
Baby = 7-8 lbs
Amniotic fliud = 2 lbs
Energy stores = 6-8lbs
75
Why is it important to manage weight gain in pregnancy?
**Insufficient weight gain:**
Baby may be low birthweight, nutrient reserves may be
depleted, higher risk of immediate and long-term health
complications
**Too much weight gain:**
Large baby = challenges with delivery, challenges with
subsequent weight management for pregnant person
76
What is the practitioners role?
To help pregnant women create healthy attitudes and beliefs about their changing bodies, while encouraging them to maintain healthy eating and activity patterns
77
How are current protein requirements (EAR) determined for
adults?
A. Using the factorial method – adding all nitrogen lost per
day and accounting for extra needed for growth
B. Nitrogen balance
C. Estimating mean intakes of healthy people
D. Using a protein indicator method
B. Nitrogen balance
78
What is the additional protein needs in pregnancy?
RDA: 0.8 g/kg/d
RDA: 1.1 g/kg/d pregnant
Growth:
- Average of 925 g protein deposited for fetal/placental/pregnant growth in the 2nd and 3rd trimesters
- Accounting for absorption, additonal protein needs for growth = 12.6 g/d
Maintenance
- Additonal needs to maintain new maternal tissue growth
79
Jane weighed 57 kg pre-pregnancy.
Now starting her third trimester, Jane weighs 64 kg. How
much have her protein requirements increased from pre-
pregnancy?
Pre-pregnancy:
57kg x 0.88 g/kg/d = 45 g
Pregnancy:
64 kg X 1.1 g/kg/d = 70 g
Difference: 70g - 45 g = 25 g
80
What is the protein recommendations for pregnancy?
Pre-pregnancy:
ADMR: 10-35%
RDA: 0.8 g/kg/d
Pregnancy
ADMR: 10-35%
RDA 1.1 g/kg/d + ~25 g
High quality or complementary proteins to ensure needs for all essential amino acids are met
81
Do you think the AMDR and RDA for carbohydrates change
during pregnancy?
A. Yes, both increase
B. RDA increases, AMDR stays the same
C. AMDR increases, RDA stays the same
D. Neither increase
B. RDA increases, AMDR stays the same
82
What are carbohydrates recommendation in pregnancy?
Dietary requirements: do not change signifcantly
Carbohydrayes metabolism does
Pre-pregnancy:
ADMR: 45-65%
RDA: 130 g/d
AI Fibre: 14 g/1000 kcal
Pregnancy
ADMR: 10-35%
RDA 175 g/d
AI Fibre: 14 g/1000 kcal
Nutrient dense sources to provide adequate nutrients
Fibre to reduce constipation
83
What are the adaptations in pregnancy to ensure supply of glucose for fetus?
* **Early pregnancy**: ↑ estrogen and progesterone stimulate
insulin ⇒ promotes storage of glucose as glycogen and fat
* **Late pregnancy:** maternal insulin resistance ⇒
diabetogenic effect of pregnancy
84
What is fats in pregnancy?
Do not chnage in pregnancy
Needs for fats accommodated by ↑ energy intake and altered metabolism
Blood lipids increase - ↑ Cholesterol ↑ TG
- Cholesterol is used for steriod hormone synthesis (estrogen prgesterone) and by the fetus for nerve and cell membrane formation
85
What are fat recommendations in preganancy?
AMDR = 20-35%
Pre-Pregnancy:
- AI for omega-6 & 3 = 12 & 1.1 g/d
Pregnancy:
- 13 & 1.4 g/d
Encourage pregnant people to choose rich sources of omega-3 fatty acids (increase slightly) such as fatty fish
86
What are calcium needs in pregnancy?
Needed for fetal skeleton
* About 25-30 g of calcium in fetus
Recommendations do not change as **calcium absorption increases**
RDA for calcium **does not** change from non-pregnant state:
* 1000 mg/d (19+)
* 1300 mg (14-18)
Ensure adequate intakes of milk or calcium fortified foods to maintain maternal bone density
87
Sukhdeep is a 28-year-old woman who is 10 weeks pregnant.
She has kept food intake records for a long time, and her
usual calcium intake is ~850 mg/day. Her calcium intake
thus far in her pregnancy has not changed and it continues
to be ~850 mg/day.
Considering this information and the RDA for calcium for
pregnant females of her age, we can conclude that
Sukhdeep does not meet her calcium requirement.
A. TRUE
B. FALSE
B. False
88
What are vitamin A needs during pregnancy?
Too little: poor fetal growth
Too much: malformations
RDA increases slightly in pregnancy to account for fetal accretion (700 RAE → 770 RAE)
Excess retinol (preformed vitamin A) may be teratogenic (birth defects)
UL = 3000 mcg RAE (as retinol)
At intakes above this level, ~1/57 infants had congenital
malformations
89
What are water soluble vitamins needs during pregnancy?
Slightly increase in all water-soluble vitmains to account for increased metabolism and energy needs in pregnancy
90
What is iodine needs during pregnancy?
Required for thyroid function, energy production, and fetal
brain development
Deficiency in pregnancy can lead to hypothyroidism in offspring
and development delays
Consumption of iodine-fortified salt usually meets
recommendations
91
Should sodium be restricted in pregnancy?
A. Yes, because it can cause high blood pressure
B. Yes, because it can be dangerous for the fetus
C. No, because sodium is essential for fluid balance
D. No, because sodium is necessary for adequate energy
C. No, because sodium is essential for fluid balance
92
What are water needs during pregnancy?
Adequate water intake is essential for:
* Increase in blood volume
* Amniotic fluid
* Regulation of body temperature
* Metabolism
* Excretion of wastes (urine and feces)
AI for fluid intake:
* Pregnancy: 3.0 L/d
* Non-pregnant: 2.7 L/d
93
Adequate water intake prevents
Fluid retention
Constipation
Urinary tract infections
94
What are the canadian prenatal nutrition advice?
* Eat a variety of healthy foods each day
* Choose foods with healthy fats instead of saturated fat
* Choose fish low in mercury
* Eat a little more food each day than you normally would
* Make water your drink of choice
* Be mindful of your caffeine intake
* Healthy eating is more than the foods you eat
**Eating well can give you the nutrients you need to feel good, have energy and support a healthy pregnancy**
95
From Canada's Food Guide, Why healthy eating matters?
Healthy eating habits
Food safety during pregnancy
Weight gain during pregnancy
What you eat and drink during your pregnancy can support a healthy pregnancy
- your baby's healthy growth and development
- you get the vitamins, minerals and nutrient you need
96
From Canada's Food Guide, What are healthy eating habits?
You need just a little more food each day when pregnant
Choose foods that have little to no added:
* sodium
* sugars
* saturated fat
Choose fish low in mercury
Choose foods with healthy fats instead of saturated fat
Make healthy drink choices such as water, milks
Be mindful
97
What nutrients would you recommend be supplemented?
[Select all that apply]
A. Iron
B. Folic acid
C. B12
D. Omega-3 fatty acids (DHA + EPA)
E. Iodine
A. Iron
B. Folic acid
98
What is omega 6 & 3 important during pregnancy?
High amounts of ω-6 ARA & ω-3 DHA in membranes of the retina
and brain
DHA important for brain development & brain function
Omega-3 fats are also less inflammatory and may counteract
more inflammatory effects of omega-6 fats
99
For which of the following does evidence support the use of
omega-3 fatty acid supplements in pregnancy? [Select all
that apply]
A. Improved brain development/cognition in offsrping
B. Reduced pre-term birth
C. Reduced risk of low birth weight
D. Reduced incidence of allergies in offspring
E. Postpartum depression
B. Reduced pre-term birth
C. Reduced risk of low birth weight
100
Canadian Food Guide for fish recommendations
Have at least 150 grams (5 ounces) of cooked fish each week, as
recommended in Canada’s Food Guide
Fish contains omega-3 fats and other important nutrients for a healthy pregnancy.
Before and during pregnancy:
- Limit consumption of fresh/frozen tuna, shark, swordfish,
escolar, marlin, and orange roughy to 150 g/month
- Limit is 150g/week for general population
- Limit canned white (albacore) tuna to 300 g/week
- No limit for canned light tuna
101
What are pros and cons of fish oil supplements?
Pro of fish oil (EPA + DHA) supplement:
- dec. risk of preterm birth
- dec. risk of LBW
- Possibily dec. post partum depression
- dec. allergies
- inc. cognitive
Cons of fish oil (EPA + DHA) supplement:
- Expensive
- miss nutrient in fish
- fishy burps
- blood thinning
*Post dates
- naturally go over birth date
- stop by 37 weeks
102
What are navigating risks in pregnancy?
Alcohol
Caffeine & herbal teas
Food safety
103
Alcohol in pregnancy:
A. Should be avoided completely
B. Is fine in small quantities
C. Is fine in “moderation”
D. Is safe
A. Should be avoided completely
104
What are the Canada's Guidance on Alcohol and Health?
- When pregnant or trying to get pregnant, there is **no known safe amount of alcohol use**
- When breastbreeding, not drinking alcohol is safest
- No matter where you are on the continuum, for your health, less alcohol is better
105
What are fetal alcohol spectrum disorders?
- Group of conditions caused by prenatal alcohol exposure
- Can cause lifelong physical, behavorial, and learning problems
- Leading, preventable cause of birth defects and developmental disorders
106
Caffeine & Herbal Teas
Health Canada: Caffeine safe below **300 mg/d**
* ~2-3 cups of coffee per day
Not all herbal teas are “safe”
* Avoid chamomile, stinging nettle, and others
* Citrus, ginger are generally safe
107
Pregnant people are 10 times more likely to get listeriosis. This
foodborne illness can infect the fetus even if the pregnant
person doesn’t feel sick. To avoid this illness, all of the
following should be avoided in pregnancy EXCEPT:
A. Raw fish
B. Undercooked meat
C. Soft cheese
D. Unpasteurized milk
E. Shellfish
E. Shellfish
108
Food Safety during Pregnancy
Foodborne illness
* More likely due to suppressed immune system
* May cause miscarriage or stillbirth
Key pathogens:
**Listeria monocytogenes**
* Deli meats, unpasteurized dairy, raw and smoked fish
**Toxoplasma gondii**
* Found in raw and undercooked meats and cat litter
Food Safety Tips
* Follow food safety rules: **clean, separate, cook, chill**
* Avoid:
* Raw or undercooked meat, fish, or eggs
* Unpasteurized dairy or juices
* Soft cheeses
* Raw sprouts
* Uncooked deli meats (turkey, bologna) and hotdogs
* Refrigerated pate (canned is fine)
109
What are common concerns in pregnancy?
* Nausea and vomiting of pregnancy
* Heartburn
* Cravings/aversions
* Constipation, bloating, and gas
* PICA
* Leg cramps
* Fluid retention (edema)
* Altered smell/taste
* Fatigue
* Frequent urination (urgent need)
* Breast tenderness, back, pelvic, and hip pain
* Skin changes
110
What are recommended treatments for nausea and vomiting of pregnancy using the Health. Canada Guidelines, SOGC (Society of Obstetrics & Gynecology Canada), PEN (Practice Based Evidence in Nutrition?
Treatments:
- Dry crackers before rising
- Small frequent meals, avoid hungry
- Avoid caffenine, highly seasoned foods
- Vitamin B6
- Ginger
111
Cravings
- Deficiency?
- Altered hormones and taste receptors combined with non-restricted food intake
112
Aversions
- Often to meat/fish
- May be protective against food borne illness
113
Refluc Heartburn
- Caused by relaxation of the lower esphosugus sphincter (leaky) + pressure uterus
Treatment:
- Small freguent meals, fluids between meals
- Remain upright 1-2 hrd after esting elevate head of bed
- Avoid late night snacks
114
PICA
Craving to eat non-food substances (dirt, clay, laundry starch)
Concern: may displace nutirtious foods, or lead to toxin ingestion
115
Leg Cramps
Common in 2nd and 3rd trimester
Cause unclear
Suggested remedies: supplements of magnesium or calcum stretching, activity and hydration
116
Fluid Retention
Caused by pressure from the unterus on lower limbs (compressing veins)
Treatment: water (flush it out) and resting with legs elevated
Swelling associated with headache, fever, or high blood pressure may be sign of **pre-eclampsia**
117
In early to mid pregnancy, blood pressure is typically:
A. Higher than non-pregnant
B. Same as non-pregnant
C. Lower than non-pregnant
C. Lower than non-pregnant
118
What is gestationsal hypertension?
High blood pressure >140/>90
mmHg that develops in pregnancy
119
What is pre-eclampsia?
Hypertension + edema, proteinuria, [also visual
disturbances, headache] (usually arise ~32+ weeks)
Most common serious complication of pregnancy (~3% of
pregnancies in Canada)
Can lead to **eclampsia**
* Potentially life-threatening seizures
* Occurs in ~5 to 8 of 10,000 pregnancies
* Cure is delivery
120
What are recommendation of gestational diabetes mellitus (GDM)?
Recommendation: Screening at 24—28 weeks gestation with
50-g glucose challenge screening test (GCT)
Treatment: counselling on diet & exercise,
* Insulin or other meds (rare)
Effects of GDM in infants:
* macrosomia - (large for gestational age)
* may develop severe hypoglycemia after birth
* increased risk of perinatal mortality (stillbirth)
121
What are the nutrient needs during pregnancy?
Increase in energy needs (kcal):
- ~340 kcal/day in 2nd trimester
- ~450 kcal/day in 3rd trimester
Pregnant people need up to 50% more of various nutrients than non-pregnant women
This means pregnant women should increase consumption nutrient-dense foods
122
# Iro
Required Iron needs during among pregnant women
Requirements are higher during pregnancy because of:
- Fetal needs
- Increased maternal hemoglobin production associated with higher blood volume
123
RDA for Iron for pregnant women
27 mg/d (compared to 18mg/d for non-pregnant women)
1.8X higher for iron (and 1.5X higher for zinc) for people comsuming plant-based diets
124
Why are the RDAs higher for iron for people consuming plant-based diets?
A. Plant-based diets have lower iron content.
B. Iron from animal sourced foods is more bioavailable.
C. Iron from plant-based foods is faster excreted due to
fibercontent.
D. Iron from animal source foods is higher in vitamin C,
which enhances iron absorption
B. Iron from animal sourced foods is more bioavailable
125
What are potential consequences of inadequate iron intake during pregnancy?
* Low birth weight, preterm birth, stillbirth,
death of infant
* Pallor and exhaustion during pregnancy
* Iron deficiency anemia
* Could be life‐threatening during/after birth
126
What is health Canada's recommendation of iron to pregant women?
multivitamin-multimineral supplement with **16-20 mg** iron during pregnancy
some women may be prescribed 30 mg of supplemental iron during 2nd and 3rd trimester
127
What are requiements of folate during pregnancy?
Higher folate requirements in pregnancy due to:
* increased cell division and metabolism
* placental and fetal development
* uterine enlargement
* maternal blood volume expansion
128
RDA for Folate
600 ug DFE
1 ug DFE = 1 ug food folate
= 0.5 ug folic acid (empty stomach)
= 0.6 ug folic acid with meal
129
Why do we use dietary folate equivalents?
A. Our body can form folate endogenously with dietary precursors.
B. To factor in different bioavailability of folate forms.
C. To account for supplemental folate.
D. Food folate is more readily absorbed compared to synthetic
folate
B. To factor in different bioavailability of folate forms.
130
What are impact of folate inadequacy?
Low folate status during pregnancy is associated with
* Maternal megaloblastic anemia
* Neural tube defects (e.g., spina bifida)
* Preeclampsia
* Placental abruption
* Low birth weight
* Preterm birth
131
What are folate recommendation for pregnant women?
Independent of women's age
Independent of gestational age (no distinction between trimesters)
132
What are souces of folate and folic acid?
Natural food folate
* Green leafy vegetables
* Dark green vegetables
* Legumes
* Oranges
Folic acid fortified foods
* White wheat flour, pasta
* Breakfast cereals
Prenatal vitamin supplementation
* Canada/US: 1,000μg of folic acid in vast majority of prenatal supplements
133
What are strategies to increase folate intake in childbearing-aged women?
Increased consumptionof folate-rich foods
Avoid folate loss during food processing (e.g., raw instead of boiled spinach)
Consumption of folci acid and fortified foods
Use a detiary supplements
134
What are defects formed from inadequate folate?
Neural tube defects include spina bifida, anencephaly, and cleft lip
135
What is health Canada's recommendation of folate to pregant women?
In addition to a healthy diet, women of childbearing age should consume daily a **0.4 mg folic acid supplement**
High risk: personal or family history of NTD‐affected pregnancy; epilepsy, obesity or poorly‐controlled diabetes; may need more
Doses >1.0 mg only under care of a physician
136
What are birth outcomes of vitamin B12?
Low birth weight
Intra-uterine growth restriction
Small for gestational age
Congenital Anormalites
Neural tube defects
Perterm birth
Spontaneous abortion
137
How is early adequacy of B12 cruicial for child development
Development of fetal B12 stores
Newborn with sufficient B12 stores
B12 status in 12 mth old infant associated with maternal serum b12 not breastmilk B12
B12 status/B12 intake during pregnancy = strong determinants of neonatal and infants B12 status
138
Dietary recommendations of B12 for pregnant women
2.6ug/d
Prenatal Supplements: 2.6-12.5 ug B12
139
Who is at risk of low B12 intake?
A. Pregnant women >35years
B. Women following ovo‐lacto‐vegetarian diet
C. Women following vegan diet
D. A and C
E. B and C
C. Women following vegan diet?
140
What are consequences of low periconceptional vitamin B5 status associated with?
Increased risk of preterm birth
increased risk of pregnancy loss
reduced probability of conception
Preconceptional adequacy crucial -> 40% unplanned pregnancies
141
Dietary recommendations of B6
Pregnant women 1.9 mg/d
lactating women 2.0 mg/d
Prenatal supplements contain 1.9-10 mg pyridoxine
142
Function of choline
Functions:
* Methyl nutrient metabolism
* Acetylcholine – neurotransmitter
* Phosphocholine in cell membranes
143
Do pregnant women need supplements?
* YES, need iron and folic acid supplements
* Women should take daily 0.4 mg folic acid
starting 2‐3 months prior to conception
* Specific recommendation: daily multivitamin
with 0.4 mg folic acid and 16–20 mg iron;
prenatal should provide daily 2.6μg vitamin
B12
* NOTE: supplements must be considered an
addition to, not a substitute for, a healthy diet
