Term
| Morning Sickness Facts and Treatment (14) |
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Definition
Affects 60 to 70% of pregnant women
Culprits: rapid elevations in pregnancy hormones
Protective effect – fewer miscarriages, preterm births, stillbirths
Common pattern - starts ~5 weeks and subsides ~12 weeks
No single recommendation works for all:
– Dry, bland foods
– Eat saltines or other dry carbohydrates ASAP in the morning
– Avoid highly seasoned foods
– Separate liquid from solid foods
– Drink fluids between meals only
– Sour and tart liquids often better tolerated – add lemon to water
– Avoid cooking smells – eat food cold
– Small, frequent meals
– Vitamin B6: 25 mg three times per day
– Acupressure (bands)
– Ginger: 250 mg 4x/day found to be as effective as B6 (Obstet Gynecol 2004;103(4) |
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Term
| Hyperemesis gravidum (10) |
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Definition
Excessive N & V during pregnancy (with >5% wt loss)
Affects 1 in 200 pregnant women
Culprits: may be related to H. Pylori infection, elevated levels of hCG and progesterone
Concerns:
o Dehydration – may require IV fluids or TPN in severe cases
o Electrolyte imbalances
o Inadequate weight gain (mother and fetus)
o Increased pre-eclampia risk
o Tooth decay and gum disease
o Esophagitis |
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Term
| Pregnancy Reflux/Heartburn (13) |
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Definition
Culprits: lack of internal space with enlarging uterus and fetus + slowed peristalsis d/t progesterone
Recommendations:
o Small, frequent meals
o Eat slowly and chew thoroughly
o Eat in a relaxed environment
o Avoid spicy and fatty foods
o Reduce intake of chocolate and mint
o Walk after meals
o Sit up after meals / do not eat late at night then recline
o Calcium carbonate tablets (chewable)
o Digestive bitters to help promote peristalsis
o Homeopathics – no side effect |
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Term
| Pregnancy Constipation/Hemorrhoids (8) |
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Definition
Culprit: progesterone, which relaxes GI muscles and slows the digestive process to enhance nutrient absorption
Pressure of an enlarging uterus on the lower portion of the intestine during the 3rd trimester can make elimination difficult.
Recommendations:
o Increase fluid, fiber, and physical activity
o Natural laxatives - whole grains, legumes, dried fruit, bran, apple juice
o Alter quantity or quality of Fe supplements
o Fruits & vegetables (flavenoids) support vascular integrity
AVOID stimulant laxatives – can cause uterine contractions |
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Term
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Definition
Culprits: muscle fatigue, restricted blood flow to the extremities due to the pressure of the uterus, or a deficiency in Mg or K+
Ensure adequate potassium and magnesium
Supplement Mg in addition to MVI
Stay well hydrated |
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Term
| Post Partum Depression (6) |
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Definition
Affects 10 to 15% of women
Culprits: low levels of RBCs and omega 3 fatty acids
o Higher DHA in breast milk is associated with less PPD
o Lower DHA post-delivery was associated with more PPD
Case Study: 4 grams EPA and 2 g DHA from 25 weeks pregnancy had a significant improvement in depressive symptoms by week 29
Recommendation: >300 mg DHA and >220 mg EPA |
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Term
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Definition
Gravida – state of pregnancy
Para – number of live births |
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Term
Gestational Age
vs
Menstrual Age |
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Definition
Gestational age
assessed from date of conception
average pregnancy is 38 weeks
Menstrual age
assessed from onset of last menstrual period (LMP)
average pregnancy is 40 weeks |
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Term
| Maternal anabolic changes (3) |
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Definition
Weeks 1 - 20
~10% of fetal growth occurs
Build mother’s capacity to deliver nutrients to fetus |
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Term
| Maternal catabolic Changes (3) |
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Definition
Weeks 20 ~ 40 (delivery)
~90% of fetal growth occurs
Nutrients delivered to fetus |
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Term
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Definition
Increased by ~7-10 L (2-21/2 gal.)
Plasma & extracellular volume
Amniotic fluid
Edema
Swelling due to accumulation of extra-cellular fluid – OK as long as no HBP |
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Term
| Carbohydrate Metabolic Changes (6) |
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Definition
Glucose is preferred fuel source for fetus
Early pregnancy:
Higher insulin
Increases the amount of glucose stored as glycogen & fat
Late pregnancy:
Lower insulin
Less conversion of glucose to glycogen & fat
“Diabetogenic effect of pregnancy”
Glucose stays in circulation for the fetus instead of going into maternal cells (insulin resistance) |
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Term
| Change in protein metabolism |
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Definition
| About 925 g of protein accumulate during pregnancy (fetus & placenta) |
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Term
| Changes in lipid metabolism (4) |
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Definition
1st half of pregnancy
Maternal fat storage
2nd half of pregnancy
Maternal fat mobilization (utilization)
Dramatic increase in blood lipids, no matter what the diet!
Cholesterol
Triglycerides |
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Term
| Changes in mineral Metabolism (4) |
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Definition
Calcium
increased bone turnover & reformation
Sodium
accumulates in mother, placenta, fetus
restriction of sodium potentially harmful (functional & growth impairments)
HBP should not be treated by reducing sodium intake! |
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Term
| Placenta Structure and Function (5) |
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Definition
Structure:
Double lining of cells separating maternal & fetal blood
Functions:
Produces hormones & enzymes
Exchanges nutrients & gas
Removes waste from fetus
Barrier to SOME harmful substances |
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Term
| Factors in variations in fetal growth (5) |
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Definition
Availability of energy, nutrients, O2
Genetic programming
Insulin-like growth factor (IGF-1):
main fetal growth stimulator
is decreased in undernourished mother |
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Term
| Fetal Origins of Disease Hypothesis |
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Definition
| Pregnancy can affect future propensity for disease in baby |
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Term
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Definition
300 additional calories/day
+0 kcal/day - 1st trimester
+340 kcal/day - 2nd trimester
+452 kcal/day - 3rd trimester |
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Term
| Carbohydrate needs during pregnancy (3) |
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Definition
Glucose is primary source of fuel for the fetus - placenta uses ~30% of glucose intake by 3rd trimester
Recommended carbohydrate intake
AMDR: 50-65% of calories
RDA: 175 g/day (up from 130)
Glycemic index (GI)
High GI foods increase fetal fat |
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Term
| Pregnancy Protein Needs (5) |
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Definition
RDA: 1.1 g/kg/day (up from 0.8)
+25 g/day, or from 46 g to ~71 g
2 ways to calculate protein needs:
1.1 g/kg/day
0.8 g/kg/day + 25 g
Average intake of typical female ~78 g/day
Limited protein usually coincides with limited calories |
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Term
| Vegetarian Diet Needs during pregnancy (3) |
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Definition
Protein needs ~30% higher in vegetarians vs. non-vegetarians = 90-95 g PRO/day
Calculation: 1.1 g/kg/day + (1.1 g/kg/day x 0.30)
Diet may be low in vit B12, vit D, riboflavin, calcium, zinc, omega-3’s
DHA from algal supplements |
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Term
| Omega 3 Pregnancy Facts (3) |
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Definition
Benefits of EPA & DHA:
Infant - brain development, learning ability, healthy vision, longer gestation
Mother - reduced risk of pre-eclampsia and postpartum depression
ALA conversion to DHA only 1-4%
Intake recommendations for EPA & DHA |
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Term
| Amount of Water Recommended |
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Definition
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Term
| Purpose Of Folate (not NTD prevention) |
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Definition
| DNA synthesis, gene expression and regulation. |
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Term
| Threat of not enough calcium |
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Definition
| Inadequate calcium > bone breakdown > release of lead from bones |
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Term
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Definition
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Term
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Definition
Additional iron needs for pregnancy due to:
Fetus & placenta
Increased RBC
Blood loss during delivery
27 mg/day pregnancy (up from 18)
Iron-deficiency anemia in pregnancy:
~18% of pregnant women in developed countries
Results in lower IQ, language, motor skills, etc. |
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Term
| Cons of iron supplementation (4) |
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Definition
Oxidizing effect in gut
Inflammation & mitochondrial damage
Decreased zinc absorption
Constipation |
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Term
| 5 Recommended supplements during pregnancy |
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Definition
MVI
Iron
Calcium
DHA/EPA
Probiotics |
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Term
| Three Major Toxicity Concerns of Pregnancy |
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Definition
Mercury Intake
Listeria
Toxoplasma |
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Term
| Most commonly used herb that can promote milk production |
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Definition
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Term
| Reasons why exclusively breast feeding is important (7) |
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Definition
Supplements fill up the baby, making him less interested in breastfeeding.
Water supplements contribute to newborn jaundice.
Formula supplements in the newborn period can sensitize some babies to milk allergy or intolerance.
When given with an artificial nipple, supplements have been associated with
breastfeeding problems.
Supplements contribute to engorgement of mother’s breasts.
Supplements interfere with the establishment of a mother’s milk supply.
Early supplementation is strongly correlated with a shorter duration of breastfeeding. |
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Term
| 11 benefits of breastfeeding |
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Definition
Complete nutrition for the first 6 months.
Uniquely matches the needs of the infant – dynamic.
Minerals absorbed more easily (Fe, Zn, Ca, Mg).
Provides long chain PUFA’s (DHA) for brain & retinal development and cognition.
Lower incidence of SIDS
Better oral-facial development
Better visual acuity
Higher IQ
Warmth and closeness with mom
Best quality protein
Provides immune cells |
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Term
| 7 Breastfeeding Benefits for Mother |
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Definition
Low cost – mom just needs extra calories
Reduced risk of postpartum hemorrhage
Reduced risk of postpartum depression
Quicker return to pre-pregnancy weight – uterine contractions & calories!!
Reduced risk of breast, endometrial and ovarian cancers.
Contributes to spacing of pregnancies (prolactin delays fertility).
Increased “maternal response” – oxytocin. |
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Term
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Definition
TEE = REE x Activity Factor + Calories for Lactation
+ 330 kcals first 6 months
+ 400 kcals / after 6 month |
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