Pregnancy Ch 4-5 Flashcards Preview

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Flashcards in Pregnancy Ch 4-5 Deck (37)
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1

What are the factors that increase infant mortality risk?

general health
socioeconomic status of a population
↓ in mortality related to improvements in...
-social circumstances, safe & nutritious food availability, & infectious disease control

2

What is the difference between gestational age and menstrual age?

GESTATIONAL AGE: Assessed fm date of conception; avg pregnancy = 38 wks
MENSTRUAL AGE: Assessed fm onset of last menstrual period; avg pregnancy = 40 wks

3

What are the physiological changes that normally occur during pregnancy?

2 phases of changes:
1. Maternal anabolic changes
-in 1st half of pregnancy
-Builds the capacity of the mother’s body to deliver
2. Maternal catabolic changes
-in the 2nd half of pregnancy
-Fetal growth (90%)

4

What are maternal anabolic and catabolic phases?

ANABOLIC:
-blood volume explansion
-↑ cardiac output
buildup of fat, nutrient, & liver glycogen stores
-growth of some maternal organs
-↑appetite & food intake (+ caloric balance)
-↓ exercise tolerance
-↑ levels of anabolic hormones

5

What is the catabolic phase?

CATABOLIC (20+ wks)
-mobilization of fat & nutrient stores
-↑inc production & blood levels of glucose, triglycerides, & fatty acids
-↓ liver stores
-accelerated fasting metabolism
-↑ appetite & food intake ↓ somewhat near term
-↑ levels of catabolic hormones

6

How pregnancy affects the carbohydrate metabolism?

Glucose is preferred fuel for fetus
Diabetogenic effect of pregnancy” results from maternal IR
EARLY PREGO
-High estrogen & progesterone stimulates insulin
production
-↑ conversion of glucose -> glycogen & fat
LATE PREGO
-Human chorionic somatotropin (hCS) & prolactin inhibit conversion of glucose -> glycogen & fat

7

How pregnancy affects blood lipid levels?

Fat stores:
-Accumulate in first half of pregnancy
-Enhanced fat mobilization in last half

Blood lipid levels ↑
-↑ cholesterol: substrate for steroid hormone synthesis & nerve and cell-membrane formation (fetus)

8

What are the placenta functions? (3)

1. Hormone & enzyme production
2. Nutrient & gas exchange
-Nutrient Transfer: fetus is not a parasite
3. Remove waste from fetus

9

!what is the placenta?

Double lining of cells separating maternal & fetal blood

10

preterm babies are @ risk for... (4)

-death
-neurological problems
-congenital malformations
-chronic health problems

11

What is the recommended weight gain ranges for women who enter pregnancy underweight, normal weight, overweight, and obese?

UNDERWT: 28-40 lb
NORMAL: 18.5-24.9 => 25-35 lb
OVERWT: 25-29.9 => 15-25 lb
OBESE: ≥30 => 11-20 lb
TWINS: 25-54 lb

12

What is the relationship between nutrition and preterm delivery / what increases & decreases the risks?

↓ risk:
-multivita supps or folate intake
- 1-3 fish meals / wk

↑ risk:
-underwt & obesity
-elevated blood lipids

13

Describe nutrition related developmental programming of later disease risk

Fetal exposure to certain levels of energy & nutrients modify function of genes in ways that affect metabolism & development of diseases in later life

14

What is the energy requirement during pregnancy? (1st/2nd/3rd trimesters)

1st: same
2nd trimester: +340 kcal/d
3rd trimester: +452 kcal/d

15

Describe the relationship between folate and pregnancy outcomes (2). Functions (2)

-folate is asso w/ anemia and reduced fetal growth
-Folate requirements ↑ - extensive organ and tissue growth
FUNCTIONS of FOLATE
1. Metabolic reactions
2. Deficiencies lead to abnormal cell division and tissue formation

16

! relationship w/ folate & abnormalities?

NTDs = Neural Tube Defects
Malformations of the spinal cord and brain
3 major types
1. Spina bifida 2. Anencephaly 3. Encephalocele

17

What are food sources of folate? (3)
how has folate status in W improved?
Recommended intake of folate?

Fruits, vegetables, whole grains

improved w/ fortified cereals and supplements

600 mcg DFE (dietary folate equivalents)

18

Discuss the importance of iron during pregnancy.

Iron-deficiency anemia in pregnancy:
-Early pregnancy: risk of preterm delivery, LBW
-Late pregnancy: lower scores on intelligence, language, gross motor and attention tests

19

What are the pros (2) and cons (3) of iron supplementation?

PROS:
-Iron is absorbed better fm supps containing IRON
ONLY than when mixed with other minerals
-Amount absorbed depends on the need and the amount of iron in the supplement
CONS:
-Side effects (nausea, cramps, gas & constipation
- >free radicals in GI tract (cause inflammation & mitochondrial damage to cells)
-May interfere with zinc absorption

20

What are the main food safety issues during pregnancy?

1. FOOD BORNE ILLNESS
-Listeria monocytogenes
-Toxoplasma gondii

2. MERCURY CONTAMINATION
-High levels in large, long-lived predatory fish
-Lower content in boqom feeders
-Avoid shark, swordfish, king mackerel, tile fish, albacore tuna, walleye, pickerel, bass

21

How do you assess nutritional status during pregnancy?

DIETARY ASSESSMENT: usual intake, supplement use, wt gain progress

NUTRITION BIOMARKER ASSESSMENT – iron and other vitamins and minerals, triglycerides

22

Describe the common health problems during pregnancy? (hyperemesis gravidarium, heartburn, constipation)
What are the dietary interventions for their treatment or amelioration?

NAUSEA & VOMITTING:
-hyperemesis gravidarium: severe N/V during most of pregnancy
- Management of n/v
Separate liquid & food intake
Avoid odors and foods that trigger N/V
-Dietary supplements for the treatment of n/v
Vitamin B6, multivitas, & ginger
HEARTBURN
- Management of heartburn
Ingest small meals frequently
Do not go to bed with a full stomach
Avoid foods that make heartburn worse
CONSTIPATION
- prevention
Consume dietary fiber (30 grams/day)
Drink water along with the fiber
Laxative pills are NOT recommended

23

Describe the relationship between pre-pregnancy obesity and infant outcomes (4)

Obesity associated with higher rates of:
-stillbirth
-LGA newborns
-Cesarean-section delivery
-May ↑ risk of child becoming overwt or having Type 2 diabetes later in life

24

What are the nutrition-related recommendations intended for women who enter pregnancy obese? (5)

-Meet nutrient needs
-Consume a variety of basic foods
-Participate in physical activity
-Maintain appropriate rates of wt gain
-Weight loss is NOT recommended

25

Diagnosis of gestational diabetes

Gestational diabetes: carb-intolerance w/ 1st onset during pregnancy

All prego should be screened @ 1st prenatal visit for undiagnosed diabetes:
1 confirmed + result is diagnosis of diabetes:
-Hemoglobin A1c (A1c) >6.5%
-Fasting plasma glucose >126 mg/dL (7.0 mmol/L)
-2-hour glucose >200 mg/dL aier 75 g oral load
-Random plasma glucose >200 mg/dL
-------
All prego W w/o diabetes should be tested for GDM by a 75-gm oral glucose tolerance test at 24-28 weeks.
Diagnosis cutpoints: W w/ 1 elevated plasma glucose levels are diagnosed with GDM:
-Fasting plasma glucose >92 mg/dL
-1-hr plasma glucose >180 mg/dL
-2-hr plasma glucose >153 mg/dL

26

consequences of gestational diabetes

1. Elevated glucose from mother -> risk of adverse outcomes:
-Spontaneous abortion, stillbirth, neonatal death
-Congenital anomalies
-↑ insulin -> ↑ glucose uptake & triglyceride formation in fetus
2. fetal changes ↑ likelihood later in life:
-Insulin resistance and/or Type 2 diabetes
-High blood pressure
-Obesity

27

management of gestational diabetes

First approach is medical nutrition therapy to normalize blood glucose levels w/ diet & exercise
-Blood glucose levels can be brought ↓ w/ low calorie intake ( avoid elevated ketones )
-Oral medication meuormin (glyburide) used to↓ insulin resistance

28

!what is the main reason for big babies (macrosomia) in W w/ GDM?

↑ blood glucose levels is the main factor for macrosomia

29

Describe the characteristics of preeclampsia

-Oxidative stress, inflammation, & endothelial dysfunction
-Increased blood pressure
-Insulin resistance
-Adverse maternal immune system responses to the placenta
-Elevated blood levels of triglycerides, free fatty acids & cholesterol

-Signs, symptoms, &health consequences of preeclampsia range from mild to severe
-Cause is unknown, but appears to originate from:
- Abnormal implantation & vascularization of placenta w/ poor blood flow.

30

what is preeclampsia-eclampsia

pregnancy-specific syndrome occurring >20 weeks gestation accompanied by proteinuria
-Proteinuria:urinary excretion of ≥0.3 gram protein in 24- hour urine sample
-Eclampsia—occurrence of seizures not attributed to other causes, but just bc one is prego