Pregnancy Nutrition Flashcards
(148 cards)
1
Q
Define periconceptional (time)
A
-4 to 4 weeks
2
Q
Define preterm (time)
A
less than 37 weeks
3
Q
Define postterm (time)
A
more than 42 weeks
4
Q
Define very preterm (time)
A
less than 34 weeks
5
Q
Define term (time)
A
38-42 weeks
6
Q
Define embryo (time)
A
weeks 0-8
7
Q
Define fetus (time)
A
weeks 8-40
8
Q
Define neonatal/neonate/newborn (time)
A
month 1
9
Q
Define postneonatal (time)
A
more than 1 month
10
Q
Define miscarriage (time)
A
0-20 weeks
11
Q
Define fetal death/stillbirth (time)
A
20-40 weeks
12
Q
Define perinatal (time)
A
20 weeks to 7 days post delivery
13
Q
Define low birthweight
A
less than 2500g or 5 lb 8 oz
14
Q
Define very low birthweight
A
less than 1500g or 3 lb 4 oz
15
Q
What are natality statistics?
A
summarize info about:
pregnancy complications and harmful behaviors
infant mortality and morbidity
16
Q
What type of events lead to declines in infant mortality?
A
improvements in social circumstances
infectious disease control
availability of safe and nutritious foods
tech advances in medicine (less important)
17
Q
Define liveborn infant
A
completely expelled or extracted fetus breathes or shows other signs of life whether or not the cord has been cut
18
Q
What advantages do newborns weighing 3500-4500 grams have?
A
least likely to die within first year of life or gestation stages, less likely to develop heart disease, diabetes, lung disease, hypertension and others
19
Q
What is the difference between gestational age and menstrual age?
A
gestational age - weeks from conception
menstrual age - weeks from LMP
important difference for calculating nutrition events
20
Q
What is the sequence of tissue development and approximate week of maximal change?
A
- maternal plasma volume - 20
- maternal nutrient stores - 20
- placental weight - 31
- uterine blood flow - 37
- fetal weight - 37
21
Q
What do the physiological changes during the first half of pregnancy do?
A
“maternal anabolic”
build capacity to deliver blood, oxygen and nutrients
10% of fetal growth
22
Q
What do the physiological changes during the second half of pregnancy do?
A
“maternal catabolic”
energy and nutrient stores and capacity to deliver dominate
90% of fetal growth
23
Q
What changes occur during the maternal metabolic phase?
A
expanded blood volume, increased cardiac output
buildup of fat, nutrient and liver glycogen stores
growth of some maternal organs
increased appetite and food intake
decreased exercise tolerance
increased levels of anabolic hormones
24
Q
What changes occur during the maternal catabolic phase?
A
mobilization of fat and nutrient stores increased production and blood levels of glucose, triglycerides, and fatty acids decreased liver glycogen stores accelerated fasting metabolism increased levels of catabolic hormones increased appetite declines near term
25
What are some changes related to energy and nutrient needs?
body water changes, hormonal changes, maternal nutrient metabolism
26
How does the increase in body water impact vitamin status?
dilution effect
| blood levels of fat-soluble vitamins tend to increase and water-soluble vitamins tend to decrease
27
Define placenta
organ of nutrient and gas interchange between mother and fetus
28
How does CHO metabolism change during pregnancy?
first half - increases in insulin prod. and conversation of glucose to glycogen and fat
second half - inhibit conversion of glucose, increase insulin resistance so she relies more on fats for energy
29
Why does CHO metabolism change?
promote maternal insulin resistance so there is a continued supply of glucose for the fetus
30
Why does metabolism change to accelerate fasting?
allows pregnant women to primarily use stored fats for energy so the fetus can use the glucose and amino acids
31
Define ketones
metabolic by-products of the breakdown of fatty acids in energy formation
32
Define glucogenic amino acids
amino acids that can be converted to glucose
33
Why does protein metabolism change?
nitrogen and protein are needed in increasing amounts to synthesis new tissues, this comes from food intake rather than stores
34
How is the increased need for protein met?
reduced levels of nitrogen excretion
| conversion of amino acids
35
Why does fat metabolism change?
promote the accumulation of maternal fat stores in the first half and enhance fat mobilization in the second half
36
How does calcium metabolism change?
increased rate of bone turnover and reformation
increased absorption from food
decreased excretion in urine
37
How does sodium metabolism change?
mother has an increased requirement due to increased body water, needs to accumulate in mother, placenta and fetus
change in kidneys help retain sodium
38
What are the functions of the placenta?
hormone and enzyme production
nutrient and gas exchange b/t mother and fetus
removal of waste products from fetus
39
How does nutrient transfer from the placenta occur?
placenta fulfills its needs before supplying the fetus
depends on concentration of nutrients in maternal and fetal blood, molecule size and charge, and lipid solubility
some substances are more regulated than others
40
What are the mechanisms of nutrient transport across the placenta?
passive diffusion
facilitated diffusion
active transport
endcytosis
41
What is the difference between growth and development?
growth - increase in size through cell multiplication and enlargement of cells
development - progression of physical and mental capabilities through growth and differentiation of organs and tissues and integration of functions
42
Define differentiation
cells acquire one or more characteristics or functions different from the original cells
43
Define critical periods
preprogrammed time periods during embryonic and fetal development when specific things are formed or integrated
44
Define hyperplasia
increase in cell multiplication
45
Which organ develops first in humans and gets priority access to nutrients, oxygen and energy?
the brain
| followed by heart and adrenal glands
46
Define hypertrophy
increased size of cells
| mainly through accumulation of lipids and protein in cells
47
What is the sequence of growth and development?
first just hyperplasia, then rate of hyperplasia slows
hyperplasia-hypertrophy phase
hypertrophy only
*specialized functions occur at the same time
maturation - stabilization of cell number and size
48
What is the general trend of fetal body composition?
progressive increases in fat, protein and mineral content
49
What is IGF-1?
insulin-like growth factor-1
primary growth stimulator of fetus
promotes uptake of nutrients and inhibits fetal tissue breakdown
levels are sensitive to maternal nutrition
50
What is IUGR?
intrauterine growth retardation
51
What can cause reduced fetal growth?
```
prepregnancy underweight and shortness
low weight gain
poor diet
smoking, drug abuse
certain clinical complications
```
52
Define SGA
small for gestational age
| newborns whose weight is less than the 10th percentile for gestational age
53
Define dSGA
disproportionately small for gestational age
| normal length and head circumference
54
Define pSGA
proportionately small for gestational age
| weight, length and head circumference are all less than 10th percentile for gestational age
55
Define LGA
large for gestational age
| newborns with weights greater than 90th percentile for gestational age
56
Why does dSGA usually occur?
malnutrition in the third trimester (maternal weight loss or low weight gain late in pregnancy)
compromised liver glycogen and fat storage
compromised energy, nutrient and oxygen availability
57
What are dSGA infants at risk of?
hypoglycemia, hypocalcemia, hypomagnesiumenia, hypothermia
tend to preform less well in academics
greater risk for heart disease, hypertension, type 2 diabetes
58
Why does pSGA usually occur?
long-term malnutrition in utero (pre pregnancy underweight, consistently low rate of weight gain, inadequate diet, chronic exposure to alcohol)
59
What are pSGA infants at risk of?
reduced number of cells
fewer problems at birth, but catch-up growth is poorer
remain shorter and lighter with smaller heads
60
What might cause LGA?
pre-pregnancy obesity, poorly controlled diabetes, excessive weight gain, other factors
*don't know for sure
61
What are maternal complications from LGA babies?
```
delivery and postpartum
increased rates of operative delivery
shoulder dystocia (blockage of delivery)
postpartum hemorrhage
```
62
What nutritional factors are related to an increased risk of miscarriage?
pre-pregnancy underweight
| elevated cholesterol, triglycerides, inflammation markers
63
What are preterm infants at greater risk of?
death, neurological problems, low IQ, congenital malformations, chronic health problems (ex: cerebral palsy)
problems with growth, digestion and respiration
64
What nutritional factors are related to risk of preterm delivery?
underweight women who gain less than the recommended amount
obese women to a lesser extent
possibly women entering pregnancy with elevated blood lipids, high inflammation markers, and oxidative stress
65
What is the fetal-origins hypothesis?
theory that exposure to adverse nutritional and other conditions during critical periods can permanently affect body structures and functions and predispose people to certain diseases and disorders
66
Define developmental plasticity
the concept that development is not strictly determined by genetics, but also by environmental conditions
67
Define epigenetics
biological mechanisms that change gene function without changing the structure of DNA; they are affected by environmental factors
68
What are the recommended weight gains for the different weight statuses?
underweight - 28-40 lbs
normal - 25-35 lbs
overweight - 15-25 lbs
obese - 11-20 lbs
69
What influences birth weight?
maternal weight gain, gestational duration, smoking, maternal health status, gravida, parity
70
Define gravida
number of pregnancies
71
Define parity
number of previous deliveries
nulliparous - none
primiparous - one
multiparous - 2+
72
What is the general pattern of maternal weight gain?
```
3-5 pounds in the first trimester
gradual and consistent after that
highest rate is mid-pregnancy
rate slows a bit a few weeks prior to delivery
*weight should not be lost
```
73
What is the composition of weight gain?
only about 1/3 goes to the fetus, the rest goes to maternal tissues and fat stores
74
Why do energy requirements increase during pregnancy?
increased maternal body mass and fetal growth
| increased cardiac and respiratory work; added breast and uterine muscle/tissue; placenta; fetus
75
How much does energy requirement increase on average?
300 kcal per day
340 kcal/day in the second trimester
452 kcal/day in the third trimester
76
What are the recommendations for CHO, PRO, and FAT intake?
CHO: 50-60% of kcal, min. 175 g
PRO: 71 g day (25 additional g)
FAT: 13g of linoleic acid; 1.4 g alpha-linolenic acid
77
What are the effects of alcohol intake during pregnancy?
abnormal mental development and growth
| lifelong deficits
78
Which nutrients are of concern in vegetarian diets?
protein (mainly vegans), B12, D, calcium, iron, zinc, omega-3 fatty acids
79
What is linoleic acid?
essential fatty acid: omega-6
long chain polyunsaturated fatty acid
sources: safflower, corn, sunflower, soy oil
structural component of cell membranes
80
What is alpha-linolenic acid?
essential fatty acid: omega-3 (DHA and EPA)
long chain polyunsaturated fatty acid
sources: flaxseed, walnut, soybean, canola, leafy greens
structural component of cell membranes
81
What are eicosanoids?
synthesized from fatty acids
| regulate numerous cell and organ functions
82
What is EPA?
eicosapentaenoic acid
an omega-3 fatty acid
very important in pregnancy
small amount can be derived from food sources of alpha-linolenic acid
83
What is DHA?
docosahexaenoic acid
an omega-3 fatty acid
very important in pregnancy
small amount can be derived from food sources of alpha-linolenic acid
84
What are food sources of EPA and DHA?
fish and seafood - richest sources
egg yolk
fortified eggs and beverages
human milk
85
What role does EPA play?
reduce inflammation
dilute blood vessels
reduce blood clotting
heart, immune systems
86
What role does DHA play?
major structural component of phospholipids in cell membranes in the central nervous system
brain, eyes, CNS
87
How does sufficient intake of EPA and DHA impact birth outcomes?
somewhat higher levels of intelligence
better vision
more mature central nervous system functions
prolong gestation by an average of 4 days
decrease the risk of preterm delivery
88
What is the recommended intake of EPA and DHA?
250 mg or more per day
| don't exceed 3 g per day
89
What is the recommendation on fish consumption?
no more than 12oz per week
no more than 6oz per week of albacore tuna
should be ones that are good sources of EPA and DHA and contain low levels of mercury and other contaminants
90
What types of fish are high in mercury?
swordfish, king mackerel, tilefish, shark
91
What are the functions of folate?
synthesis of DNA, gene expression, gene regulation, conversion of homocysteine to methionine
92
What are the risks of high cellular and plasma levels of homocysteine?
increased risk of placenta rupture, stillbirth, preterm delivery, preeclampsia, structural abnormalities, reduced birth weight
93
Define preeclampsia
increased blood pressure and protein in the urine
results in decreased blood flow to maternal organs and through the placenta
usually occurs after 20 weeks
94
What are the 3 types of neural tube defects?
1. spina bifida - failure of spinal cord to close
2. anencephaly - absence of brain or spinal cord
3. encephalocele - protrusion of brain through the skull
95
What is the crucial period for adequate folate availability?
21-27 days after conception
96
What are food sources of folate?
oranges and orange juice, pineapple juice, papaya juice, dried beans
fortified cereals and grains
97
What is the recommended intake of folate?
600 mcg of dietary folate equivalent per day
400 from fortified foods or supplements
200 from fruits and vegetables
UL is 1000 mcg per day (so it doesn't mask the symptoms of B12 deficiency)
98
What is the role of choline?
component of phospholipids
precursor to intracellular messangers
can be converted to betaine to regulate gene function, neural-tube and brain development, and convert homocysteine to methionine
99
What is the RDA for choline?
450 mg per day
average intake is low
sources: eggs and meat
100
What role does vitamin A play?
reactions involved in cell differentiation
101
What is the impact of vitamin A deficiency early in pregnancy?
malformations of the heart, lungs, and urinary tract
102
What is the impact of excess vitamin A in the retinol or retinoic acid form?
```
fetal abnormalities
small or no ears
abnormal or missing ear canals
brain malformation
heart defects
```
103
What role does vitamin D play?
supports fetal growth, the addition of calcium to bone, and tooth and enamel formation, normal functioning of the immune system and inhibit inflammation
104
What adverse outcomes are possibly linked to vitamin D deficiency?
miscarriage, preeclampsia, preterm birth, maternal infection, childhood development of type 1 diabetes and asthma
105
What are risk factors for vitamin D deficiency?
vegan, obese, dark skin, limited exposure to direct sunlight (without sun block), low dietary intake of milk
106
What is the recommended intake of vitamin D?
5 mcg (200 IU) daily
UL - 50 mcg (2000 IU)
*recommendations are being revised
107
What is the impact of inadequate calcium intake?
increased blood pressure (mom and infant)
decreased subsequent bone remineralization
decreased breast-milk concentration of Ca
108
What is the link between calcium and lead?
lead is contained in bone tissue, demineralization of bone to provide calcium also releases lead into the bloodstream
109
What are the symptoms of iron deficiency?
weakness, fatigue, irritability, short attention span, poor appetite, increased susceptibility to infection
110
What are the additional symptoms of iron deficiency anemia?
paleness, rapid heart beat, exhaustion
111
What is the impact of iron deficiency anemia in pregnancy?
increased risk (2-3x) of preterm delivery and low birth weight
112
What is the impact of iron deficiency in pregnancy?
lower scores on intelligence, language, gross motor, and attention tests
iron deficiency in the infant from inadequate stores at birth
associated with higher maternal mortality
postpartum maternal iron status impacts
113
What are the recommendations for iron supplementation?
30 mg daily after the 12th week
60-180 mg daily in women with iron deficiency anemia
1/2 of women enter pregnancy with inadequate stores
114
What is the recommended intake of iron?
an additional 3.7 mg absorbed
total need is 5.5 mg absorbed daily (27 mg)
UL is 45 mg per day consumed
115
What is the role of iodine?
thyroid function, energy production, fetal brain development
116
What is the result of iodine deficiency in early pregnancy?
hypothyroidism - growth impairment, mental retardation, deafness
higher incidence of infant mortality
117
What is the recommended intake of iodine?
220 mcg daily
UL - 1100 mcg daily
salt in processed foods usually isn't iodized - has been an issue as more processed foods are consumed in developed countries
118
Define bioactive food components
constituents of foods other than those needed to meet basic human health nutritional needs that are responsible for changes in health status
ex) phytochemicals, antioxidants, caffeine
119
Who might benefit from multivitamins and mineral supplements?
```
people with an inadequate diet
multifetal pregnancy
smoke, drink, or use drugs
vegans
iron deficiency anemia
diagnosed nutrient deficiency
```
120
Why are pregnant women more susceptible to food borne illness?
The increased progesterone levels decrease the ability to resist infectious disease
121
Which food borne illnesses are of greatest concern?
listeria
| toxoplasma gondii
122
What are the possible effects of listeriosis?
spontaneous abortion and stillbirth (1/3)
| mild infection in mother
123
What foods are associated with listeria?
raw or smoked fish, oysters, unpasteurized cheese, raw or undercooked meat, unpasteurized milk
processed meats need to be stored correctly and heated throughly
124
What can toxoplasma gondii cause?
mental retardation, blindness, seizures, death
125
What are food sources of T.gondii?
raw and undercooked meats, surface of fruits and vegetables, cat litter
126
What are the impacts of mercury exposure?
mild to severe effects on brain development
mental retardation, hearing loss, numbness, seizures
accumulates in mothers tissues
127
What are common health problems during pregnancy?
nausea and vomiting
heartburn
constipation
128
What is hyperemesis gravidarum?
severe nausea and vomiting lasting through much of the pregnancy, can be debilitating
concerns - weight loss, dehydration, electrolyte imbalance, headache, jaundice
1-2% of pregnancies
may require hospitalization for IV or TPN
129
What dietary interventions can be used to manage nausea and vomiting?
```
continue to gain weight
separate liquid and solid food intake
avoid odors and foods that trigger nausea
select foods that are well tolerated
supplements - B6, multivitamins, ginger
```
130
Why is heartburn common in pregnancy?
progesterone causes the muscles of the gastrointestinal tract to relax so food is more likely to be pushed through the lower esophageal sphincter and into the esophagus
131
What dietary interventions can be used to manage heartburn?
eat small meals frequently
don't go to bed with a full stomach
avoid foods that make it worse
antacid tablets are ok
132
Why is constipation common in pregnancy?
relaxed gastrointestinal muscle tone
133
What dietary interventions can be used to manage constipation?
consume 30 g of fiber daily
| laxatives aren't recommended
134
What are inhibitors of iron bioavailability and absorption?
polyphenols, calcium, chlorogenic acid (coffee), phytates
| taking it as part of a multivitamin
135
What are enhancers of iron bioavailability and absorption?
ascorbic acid, alcohol
136
Why does the US have worse birth outcomes than many other developed countries?
healthcare access
| higher c-section rate (elective, litigation)
137
What are the parts of an APGAR score?
How ready is this child?
| heart rate, respiration, irritability, tone, color
138
What are normal anatomical changes in the first trimester?
pressure on bladdar, lifts later
139
What are normal anatomical changes in the second trimester?
weight starts shifting back - pushing on spine and causing constipation and low back pain
140
What are normal anatomical changes in the third trimester?
weight shifting up - presses on stomach - feel full quickly and heartburn, harder to breath
swelling in feet and legs - blood vessels compressed
141
What is relaxin?
promotes angiogenesis
relaxes ligaments
softens and enlarges the cervix
142
What is hCS?
human chorionic somatotropin
increases maternal insulin resistance
promotes breakdown of fat for energy
143
What is hCG?
human chorionic gonadotropin
stimulates CL to produce E and P
stimulates endometrium
144
What is the distribution of weight gain in a normal pregnancy?
```
breasts - 1-2 pounds
baby - 6-8 pounds
placenta - 1-2 pounds
uterus - 1-2 pounds
amniotic fluid - 2-3 pounds
your blood - 3-4 pounds
your protein and fat storage - 8-10 pounds
your body fluids - 3-4 pounds
```
145
Why do energy needs increase during pregnancy and my how much?
increased body mass and fetal growth
only by about 300 kcal per day
3-5 pounds in first trimester, 1-2 pounds/week after that
146
Why do iron needs increase?
fetal iron requirements
increased RBC mass
compensation for losses at delivery
147
What is the recommended amount of exercise for most pregnant women?
30 minutes of moderate exercise most or all days of the week
148
What are the benefits of exercise during pregnancy?
reduce and prevent lower back pain, lower liquid retention, reduced CVS stress and risk of GDM, prevent thrombosis and varicose veins, control weight gain, improve sleep, improve self-esteem, possibly reduce PPD
