Unit 1 Flashcards

Question

Term

Answer 1

37-43 weeks

Answer 2

- Temporary organ grown during pregnancy and feeds the baby and carries O2, antibodies and nutrients (also removing waste from fetus to mother e.g. CO2) - Starts implantation of the blastocytes - Placenta (trophoblast) are outer cells of the fetus (embryoblast) - Fully formed by 18-20 weeks - Takes over hormonal role of ovary - Connected to the fetus(embryo) by umbilical cord

Answer 3

- pregnancy hormone (recognizes if pregnancy is viable) - Prevents release of more eggs for fertalisation - Combination of controlling other hormone in body (increased estrogen etc) - peaks at early stages of pregnancy and maintains pregnancy

Answer 4

carry deoxygenated blood from fetal circulation to placenta

Answer 5

carry newly oxygenated blood and nutrient rich blood to fetus

Answer 6

- Distubing development of an embryo or fetus. Can cause birth defects in the child or - halt pregnancy e.g. Radiation, maternal infections, chemicals, drugs

Answer 7

- Weight gain: 12-15kg - Hormonal: increase - Metabolic and renal: increase in fluid - Cardiovascular: increase in HR & BP - Respiratory: difficulty breathing due to pressure on lungs - Hematological: Increase in plasma volume and decrease in hemoglobin (RBC), iron deficiency - Gastrointestinal: Decreased GI motility from elevated progesterone relaxing smooth muscle and pressure on colon and rectum causing constipation (also due to iron supplements).

Answer 8

- Continually Increased progesterone and estrogen (via placenta), suppressing hypothalamic axis thus menstrual cycle and promoting prolactin = milk hormone - Increased parathyroid hormone for calcium uptake (gut) and reabsorption (kidney) - Increased cortisol and aldosterone (adrenal) - Placenta produces HLP (only present when pregnant)

Answer 9

Hormone produced by plancenta when pregnant. - Decreases insulin sensitivity and glucose utilizations = raises blood glucose level for adequate fetal nutrition. - Increases gluconeogenesis to increase glucose for availability for fetus - Chronic hypoglycemia leads to rise in HPL. - HPL includes lipolysis, release of FFA to fuel mother. Ketones formed by FFA can be used for fetus as well as glucose. *these functions help to support fetal nutrition even in the case of malnutrition

Answer 10

- Increase in BV proportionally to CO (40/5%) - BV increases in early pregnancy (faster than RBC) :. *More plasma volume than RBC in early pregnancy - increased plasma volume DECREASES RBC (dilutional anemia)

Answer 11

Constipation: - enlarged uterus puts pressure on rectum and lower colon - Decreased gi motility from increase in progesterone relaxing smooth muscle - Iron supplements - Heart burn and belching from delayed gastric emptying - Gastroesphegal reflux due to lower esophegeal spincter relaxing Lower HCI :. Ulcer uncommon

Answer 12

Extreme form of NVP / Sever morning sickness - weight loss, electrolyte imbalance and dehydration requiring hospitalisation. - Poor outcomes - Impacts neuro development and increased risk in respiratory and cardiac disorders - Hormone growth differentiation factor 15 (GDF15) and NVP link - Sensitivity to GDF15 influences severity - Higher maternal levels = increased vomiting

Answer 13

Pelvic girdle pain (126% greater odds) high blood pressure (40% greater odds), proteinuria (50% greater odds), preeclampsia (13% greater odds), 18% more likely to be a girl baby

Answer 14

Gestational length, c-section delivery, mortality, growth of infant

Answer 15

1. reduce sympotoms via diet/environment 2. correct/prevent consequenses or complications of NVP 3. minimise fetal effects of maternal NVP and their treatments

Answer 16

Scientific methods for fertility e.g. In vitro fertilization-embryo transfer (IVF-ET), Gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), Frozen Embryo transfer (FET)

Answer 17

- <35 BMI and drop to <32, <40y/o (F) and <55y/o (M) - unsuccessful with pregnancy after 12 months of intercourse - non-smoker for 3 months - can not have 2+ children - nz citizen Single/lesbian/gay: Anovulation or very irregular periods (<20 or <42 days), Known tubal infertility, Severe endometriosis

Answer 18

· Nausea and vomiting · Heartburn · Fatigue · Constipation/Hemorrhoids Food aversions

Answer 19

- improve symptoms of nausea and is more effective than vitamin B6. - Dose and frequency: ~ 1 g/d (550 – 1050 mg per day) divide twice to 4 times per day (to manage symptoms) via food or beverages Ginger can have positive effects in early pregnancy - NOT be taken in third trimester or close to labour (contra-indication). · Communicate that some ginger supplements contain agents with questionable safety in pregnancy.

Answer 20

calcium absorption/uptake important during pregnancy or could specify support fetal bone health

Answer 21

Iron: + 1 g of for pregnancy (specifically for the fetus and placenta, during delivery, and to increase red blood cell mass Vitamin C: iron absorbtion Folate: 800 mg (neural tubal) Vitamin B6: fortified cereal Vitamin B12: dairy Zinc: deficiency can increase risk of fetal loss, congenital malformations, low birth weight Iodine: (brain development) 150mg

Answer 22

a food-borne infection that results from eating food contaminated with Listeria a common bacterium that can be harmful to the fetus - sealed packs; eat cold or cooked within two days of opening pack - reheat leftovers to piping hot >70degrees - fresh/washed vegetables vs deli) · was the rocket washed *for pregnant, hummus and sprouts is advised not to eat – sesame seeds raw, including in tahini, are a risk) and avoid fresh juice that is unpasteurised

Answer 23

Listeriosis and Toxoplasmosis

Answer 24

12-15kg and 0.42kg per week in trimester 2&3 *higher for twins (17-25kg)

Answer 25

- Water (62%) - Fat Mass (30%) - Fat-free mass (8%) 1/4 from fetus as 90% fetal growth occurs later in pregnancy

Answer 26

1st trimester: low 2nd trimester: reflects deposition and expansions of maternal tissue (1/3) 3rd trimester: fetal, placental and accumulation of amniotic fluid (2/3)

Answer 27

-30 mins moderate intensity PA 5 or more times a week - Healthy eating - Awareness of weight gain guidelines Monitor weight - target weight gains are strongly associated with actual gains

Answer 28

75% under (23%) over (50%)

Answer 29

- caecereans - gestational diabetes - macrosomia (<4kg birth weigth) - small gestational age (SGA) and large gestational age (LGA), preterm birth

Answer 30

1. Emotion and weight: empathy v judge, sensitive subject, midwives frustration 2. Ability to influence: roles & responsibilities, midwives body image 3. Practical challenges and strategies for success: knowledge, time/priorities, personal strategies, interventions

Answer 31

increases BMI, visceral fat and fat mass Metabolic consequences: increased risk of GDM, preeclampsia, hypertension, diabetes (type 2), cardiovascular disease, metabolic syndrome

Answer 32

- Miscarriage and still birth - Pregnancy-induced hypertension (PIH): High blood pressure and protein in urine - High BP - Venous thromboembolism (blood clot which can be fatal if travel to right side of heart and into lungs (pulmonary embolism) - Delivery complications: induction and Caesarean (1.3 more likely) - Gestational diabetes mellitus (GDM)

Answer 33

- Increased risk of congenital (present from birth) abnormalities e.g. CNS, heart, cardiovascular defects, orofacial clefts, hydrocephalus (fluid under brain) and limb reductions Every increase in BMI, increases the risk of birth defects by 7% (high)

Answer 34

- Temp diabetic during pregnancy (3-10%) High blood glucose levels during pregnancy; few symptoms - diagnosed via screening Pathophysiology (cause): unknown, however, hormonal changes (developing insulin resistance - like type 2 diabetes) reversable from help with dietitian to control blood glucose

Answer 35

- Being overweight/obese increases risk by a factor 2.1, 3.6, 8.6 - Previous diagnosis of gestational diabetes or prediabetes, impaired glucose tilerance or impaired fasting glycemia - Family history of T2DM - Maternal age (>35) Prev child with high birth weight (>90 centile or >4kg/macrosomia

Answer 36

- High maternal blood glucose exposes the fetus to higher glucose (placental diffusion facilitated by GLUT3 carriers) -> Increased fetal levels of insulin (insulin can not cross the placenta) - excessive growth of the baby (macrosomia >4kg) or fetal overgrowth high risk of getting type 2 diabetes later in life due to genetics (T2DM)

Answer 37

- Greater risk of developing gestational diabetes during future pregnancy and developing type 2 diabetes - Caesarean birth Induction of labor

Answer 38

if fasting blood glucose is greater than 5.5mmol/L and/or greater than 9 mmol/L 2 hours post load

Answer 39

- below 10th percentile, for age - 18% inscedence of SGA from obese women - Obese mother stillborn infant is smaller than normal body weight mother (biological mechanism is unknown)

Answer 40

"fetal overgrowth" - above 90th percentile for agr macrosomia (>4kg) - delivery of infanct >4kg = increased risk of cecearan delivery, fetal hypoglycemia and shoulder dystocia

Answer 41

4 times greater risk when mother is obese preterm (47%) than healthy weight mothers (9%)

Answer 42

attributed to maintinece Increases over the non-pregnant state due to added metabolism of uterus and fetus and increasing work of maternal heart and lungs

Answer 43

1st trimester: not required 2nd trimester: 1,400kj (340kcal/day) 3rd trimester: 1,900kj (452kcal/day)

Answer 44

iron stores

Answer 45

- Infection when exposed to parasite called toxoplasma gondi - eye and brain damage to unborn baby

Answer 46

- unwashed vege - under cooked meat or ready to eat e.g. salami and ham - unpasturised/raw milk - cross -contamination of food after gardening in areas where cat faeces or direct contact with cats

Answer 47

- growth deficiency of prenatal onset/retardation - CNS disfunction, developmental delays (not picked up until school) - facial features e.g. Short palpebran fissures (eye opening), thin upper lip, smooth or long philtrum (top lip)

Answer 48

Difficulties with math, memory or attention, poor school performance, poor impulse control and judgment

Answer 49

Heart, kidney, bone, hearing problems

Answer 50

-Exposure of fetus to regular heavy alcohol intake or very high concentrations at critical developmental period -Alcohol related neurodevelopment disorder (ARND) -Alcohol related birth defects (ARBD)

Answer 51

- GI diabetes - oxidative stress - preeclampsia (high BP, fluid retention)

Answer 52

is between 17-25 kg

Answer 53

265 calories more per day during twin pregnancy vs singleton (1 mark) OR theoretically increase 150 calories per day to theoretically achieve ~ 18.2 kg weight gain or 4.5 kg more than in singleton pregnancy.

Answer 54

- Tissue growth and maintenance and development of fetus - Increased levels of maternal blood, extracellular fluid and placental and foetal growth

Answer 55

- Neural and visual functions - Development of cell membranes

Answer 56

10g / day essential fatty acid (body cannot produce) must obtain them from the diet. used to make long-chain polyunsaturated fatty acids (LCPUFAs)

Answer 57

1g/day essential fatty acid (body cannot produce) must obtain them from the diet. used to make long-chain polyunsaturated fatty acids (LCPUFAs)

Answer 58

115mg/day 200-300 mg/day

Answer 59

- mothers bone maintence - fetus bone development and formation - 1000mg/day

Answer 60

- fetal erythropoiesis and creation of the blood system - maternal blood volume - ensure healthy red blood cells

Answer 61

Critical examination of a large body of research on a specific topic according to pre-determines search and inclusion criteria - More reliable of information than reading randomly selected individual studies - As a synthesis of a large range of studies on the topic - If 1-2 years old they are mostly likely the most up to date - More than one processor/researchers

Answer 62

Mammary gland 15-20 lobes, 20-40 lobules, 40-100 alveoli, 1 alveolus

Answer 63

Causes myoepithelial / secretory cells to contract for ejection of milk into the ducts via sucking 'let down': tingling, tightening, shooting pain (contractions) -uterus contractions after delivery to pre pregnancy size *Duct secrets milk to longer ducts which release milk ('tree like')

Answer 64

so oxytocin can access the myoepithelial cells to control, squeezing milk out from lactocytes

Answer 65

Progesterone and estrogen Occours 12-18 months after first menstruation/period (menarche)

Answer 66

Human chorionic gonadotropin (HcG) and placental lactogen (HPL) allow further preparation Estrogen: develops glands which produce milk Progesterone: elongating tubuals and duplicating lining epithelial cells

Answer 67

stimulates milk production via suckling and secretion Hypothalamus (3rd trimester)

Answer 68

Colostrum Immunity (white blood cells) Vtamin A , high protein, low fat

Answer 69

Transitional milk onset of milk secretion 1 - 10 days stimulated by hormones marks the transition from the production of colostrum to the production of mature milk.

Answer 70

Mature milk 10 days post partum ~780ml consumed by infant during exclusive breast feeding (0-6m)

Answer 71

- Within the FIRST HOUR of birth Born with reflexes to feed e.g. gag to prevent fluid into lungs Suck and swallow: in coordinated pattern Ora search reflex: open mouth and thrusting tonge when near breast Rooting reflex: turning of head to side when stimulated on side of lip

Answer 72

- Skin to skin contact - Staying hydrated - Responsive feeding - Emptying breast - removal signals production

Answer 73

1st month: 600ml 4-5month: 750-800ml

Answer 74

- Water (88.1%), carbs/lactose (7%), fats (3.8%), protien (0.9%) - other (0.2%) vitamins&minerals, human milk oligosaccharides, antibodies, immune cells, hormones - - - and ~800 strains of bacteria

Answer 75

0.65-0.7 kcal/ml

Answer 76

Produced at the START of feed LOW fat High nutrients

Answer 77

Produced at the END of feed HIGH fat

Answer 78

Comp of fat is related to mothers diet (inc trans fatty acids) Contains cholesterol which is essential for cell membrane

Answer 79

Low in mature milk Whey, Casein, non-protien nitrogen (necleotides)

Answer 80

The lactose ENHANCES calcium absorbtion

Answer 81

Are Indigestible CHO, complex - naturally produced in human milk - medium-length with lactose on one end - Prebiotioc for healthy gutmicrobiome (not energy)

Answer 82

- Stimulates growth of bifidus bacteria - - Inhibits escherichia coli - Prevents infection - Part of immune protection

Answer 83

- Low concentration (0.35mg/L) - Highly bioavailable - 50% is absorbed - 10% absorbed from cows milk based formulas

Answer 84

Protein with anti-tumor effect, has been found to significantly inhibit growth of cancerous cells *found in human milk

Answer 85

Thiamin Riboflavin Vit B6,12 Vit A Iodine Selenium *if mum is deficient then milk also is

Answer 86

0-6months: 2000 kilojules (~500cal) 6+ months: 1680 kilojules (400cal)

Answer 87

No other food or drink, (not water) except breast milk for 6 months of life. But allows the infant to receive ORS, drops and syrups (vit, mins and medicines). Global Prevalance: 48% (target = 70%)

Answer 88

Reductions in - morbidity e.g. diseases and illnesses which reduce mortality/death - Protects from gi infections which cause diarrhea and dehydration AND Protection of respiratory illnesses :. Reduced - Reduces Bacteria causing infection like otitis media - Reduces sudden death by 62% - Reducing ear infections from sucking - Reduces chronic diseases e.g. Allergies, type 2 diabetes, obesity in child Increases cognitive function

Answer 89

- Protected health - Reduced risk of uterine bleeding and shrinks to normal size - Reduces post partum depression and cancer (breast and ovarian) - more for upto2 years - Delays new pregnancy (lactational amenorrhea) "contraception" - not very reliable Helps mother return to pre-pregnancy weight more rapidly

Answer 90

1. Policy communicated to all staff 2. Train in skills to implement this policy 3. Inform about benefits 4. Helping mothers to initiate within first hour 5. Showing mothers how to maintain lactation even when separated from infant 6. Don’t feed water or food 7. Allow to be together 24h day 8. Encourage breast feed on demand 9. No teats or pacifiers Refer to support groups upon discharge from hospital 10. Refer mothers to support groups on hospital discharge

Answer 91

yes - can remain in milk for several hours (Depends on weight and metabolism)

Answer 92

Limits oxytocin causing a delay in 'let down' of milk and decreasing milk production. Alcohol may remain in breast milk for several hours Effects baby's sleep patterns and behavior causing irritability and not feed properly.

Answer 93

40:60 breast milk is whey dominant (easier to digest) *same as whey dominant formula

Answer 94

- Soy protien isolate - High digestible protein - Supplemented with EAA Recommended for older than 6months

Answer 95

greater protein content (increases overweight and obesity) *may be long term effects formula: 2.2g / 100 cal breast milk: 1.5g / cal proposed to keep protien to a min of 0.45g /100kj

Answer 96

Lactose - lactose intollerance is rare in infants - primary lactase enzyme deficiency (uncommon before 2) - Secondary lactase enzyme deficiency is more common but ST. Small bowel injury from non-IgE-mediated cows milk allergy or viral gastroenteritis - Lactose free formula e.g. soy - contain corn-syrup as a sub - Lactose and glucose polymers = preffered cho in formula *Sucrose and fructose are not recommended

Answer 97

-40-50% energy - Ratio of polyunsaturated fat in milk affects digestibility and facilitates absorption of calcium and fat and fat soluble vitamins e.g. A,D,K,E from the gut - Main sources are vege oils (corn, soy, coconut) - Required ratio of PUFA (omega 3 and 6 / linoleic and alpha linolenic acid)

Answer 98

eczema respiratory problems gut infections

Answer 99

iron deficiency feeding difficulties growth issues

Answer 100

400-800 cal/day 1,600kj -3,000 kj/day over 6 months

Answer 101

Early: glucose metabolism and obesity, lipid profile, cornary heart disease, breast cancer, cognition, stress responsiveness, depression Mid: glucose metabolism, lung-disease, renal function Late: glucose metabolism

Answer 102

More susceptible to - Diabetes - Obesity - Cardiovascular disease - Protein in urine disease (Microalbuminuria) also epigenetic changes - them and their offspring were SMALLER

Answer 103

The fetal origins hypothesis states that: Fetal under nutrition mid-late gestation which leads to disproportionate fetal growth, programmes later coronary heart disease. - lower birth weight - more likely to have Coronary heart disease and impaired glucose tollerance -> diabetes (T2DM)

Answer 104

Health: weight loss struggles Health care: "white space" in clinic. Cultural: blessings / permission from village and family Spiritual: repent to god. "meat to me" Socio-economic: cost of fertility treatment (ARTS)

Answer 105

Family: open discussions with eachother Community: more suppourtive e.g. social media groups School: educated in curriculum (pacific females and PCOS Service providers: need to be culturally appropriate when addressing and understanding pacific issues with infertility as is "white space" dominant Research: need more around pacific by pacific for pacific

Answer 106

birth defects from excess mounts of Retinol or retinoic acid (vitamin A) in maternal diet (>10,000IU/day or 3,000RE/day) - small, missing ears and ear canals - cv, craniofacial, small head (microcephaly) , thymus dysfunction

Answer 107

Maternal: gestational dibetes and pre-eclamsia (High bp and protein in urine) Infant: 3 times more likely to have tooth decay by 6 years old, low birth weight, dental decay, acute respiratory infections supplement when no sun exposure food with sun exposure e.g. oily fish, including salmon, mackerel, and sardines. Other sources include egg yolks, red meat, and liver

Unit 1 Flashcards

Preconception, Pregnancy and Lactation (141 cards)