lecture 5 - Physiological Changes During Pregnancy

Question 1

how much growth occurs during maternal anabolic phase

Answer 1

10%

Question 2

how much growth occurs during maternal catabolic phase

Answer 2

90%

Question 3

what is the maternal anabolic phase

Question 4

what is the maternal catabolic phase

Question 5

adaptations during pregnancy (3) to achieve positive energy balance

Answer 5

• increased intake
• decreased energy expenditure
• metabolic adaptations

Question 6

what is the BMR of healthy weight, underweight women and why

Answer 6

healthy: BMR increases (eating more therefore trying to maintain their weight)

underweight: decreased BMR (to allow the continuation of pregnancy)

Question 7

why do women with higher body weight have greateer increase in BMR during pregnancy

Answer 7

increased BMR to offset further fat accumulation

Question 8

how much extra energy is recommended during 2nd and 3rd trimester

Answer 8

2nd: 340 kcal/day
3rd: 452 kcal/day
additional 2-3 servings per day

Question 9

hCG (human chorionic gonadotrophin)

Answer 9

maintain the corpus luteum -> so it doesn’t degrade and prevents menstruation

Question 10

hPL (human placental lactogen)

Answer 10

changes maternal carbohydrate and fat metabolism by causing insulin resistance - this keeps more glucose in moms blood so its available for fetus

Question 11

estrogen during pregnancy

Answer 11

• increases binding hormones
• influences macronutrient and bone metabolism

Question 12

progesterone during pregnancy

Answer 12

relaxes smooth muscle in GI and urinary tract

Question 13

carbohydrate metabolism in pregnancy

Answer 13

In early pregnancy, estrogen and progesterone increase insulin secretion, which promotes storing glucose as glycogen and fat so the mother builds energy reserves for later fetal growth.

Question 14

how is hpL involved in carbohydrate metabolism

Answer 14

↑ insulin secretion
◼ ↓ insulin sensitivity
◼ ↑ hepatic glucose production

hPL makes the mother’s tissues less sensitive to insulin, so glucose is not stored as easily; the body produces more insulin to compensate, but blood glucose remains higher to provide energy for the fetus.

Question 15

during late pregnancy where there is maternal insulin resistance, what does the mother use as fuel, explain

Answer 15

because the mothers tissues are not responding to insulin and there is decreased glucose uptake, there will be more glucose in the blood stream for the baby. The mother will switch to fats as fuel for herself (lipolysis). When the fats are breaking down it will also make glucose from glycerol for the baby

Question 16

what does it mean that pregnant women get to a fasted state more rapidly

Answer 16

pregnant women use up glucose stores faster, so after only a short time without eating, their body shifts into a “fasting” state—burning fat and producing ketones sooner than usual.

Question 17

what is the RDA of carbohydrates of pregnant and non pregnant women

Answer 17

pregnant - 175g/d
non-pregnant - 130g/d

Question 18

What do estrogen, progesterone, and insulin do to fat metabolism in early pregnancy?

Answer 18

They promote fat storage (fat deposition) and inhibit lipolysis.

Question 19

Why do lipid levels (triglycerides, cholesterol) increase in early pregnancy?

Answer 19

provide energy stores for the mother and supply cholesterol for placental steroid hormone production and fetal nerve/cell membrane development.

Question 20

What effect does human placental lactogen have on maternal fat metabolism in late pregnancy?

Answer 20

It stimulates lipolysis and mobilization of fat stores.

Question 21

Why does the mother use more fat oxidation in late pregnancy?

Answer 21

• conserve glucose for baby
• increase fatty acid for baby

Question 22

Adequate intake for linoleic and linolenic acid

Answer 22

linoleic: 12 - 13g/day
linolenic: 1.1 -1.4g/day

Question 23

Why are AA and DHA important in pregnancy

Answer 23

support fetal neural and vision development

Question 24

issue with DHA, explain

Answer 24

conversion of linolenic to DHA is low, women need to get ~200mg, so they need it from fish (concern about fish)

Question 25

what is the recommendation for fish consumption

Answer 25

2-4 servings of fish/shellfish with low methyl mercury

Question 26

how is nitrogen retention affected in late pregnancy, why

Answer 26

increased so there is less protein being broken down and is available for baby

Question 27

how is urea synthesis and excretion affected in late pregnancy, explain

Answer 27

less urea synthesis and excretion because less nitrogen waste is produced/ nitrogen retention

Question 28

are amino acids being oxidized less or more in late pregnancy, why

Answer 28

less because the mother is breaking down fewer amino acids for energy -> spared for fetal tissue rather than energy

Question 29

does the mother transfer more or less amino acids to fetus in late pregnancy, explain

Answer 29

more, she is breaking down less proteins and these amino acids are being transferred to the fetus to support development

Question 30

how are other nitrogen wastes affected

Answer 30

other nitrogen waste will be more excreted

Question 31

protein RDA for non pregnant and pregnant, when is this for

Answer 31

non pregnant: 0.8g/kg/day pregnancy: 1.1g/kg/day second and third trimester

Question 32

RQ

Question 33

folate recommendations for pregnant and non pregnant

Answer 33

pregnant: 600 mcg/day non pregnant: 400 mcg/day

Question 34

what is the upper limit of folic acid (synthetic)

Answer 34

synthetic: 1000 mcg/day

Question 35

how much folic acid should come from food and synthetically for pregnancy

Answer 35

600 mcg total: 400 mcg synthetic 200 mcg from food

Question 36

what are the values of hemoglobin during 1st, 2nd, and 3rd trimester

Answer 36

1st and 3rd: >110g/l (greater than 110) 2nd: >105g/l (greater than 105) shortness of breath *

Question 37

what are the maternal risks of iron deficiency during pregnancy (4)

Answer 37

- fatigue - decreased work performance - impaired resistance to infections - poor tolerance to blood loss

Question 38

what are the fetal risks of iron deficiency during pregnancy (3)

Answer 38

- preterm delivery/ low birth weight - lower intelligence, language, gross motor, attention tests - low iron stores to fetus. risk of iron deficiency anemia

Question 39

what is the relationship between iron dose and absorption

Answer 39

the larger the does, the less the absorption

Question 40

how does food affect iron supplementation

Answer 40

There is less absorption when taken with food or other supplements

Question 41

how does iron absorption change in pregnancy

Answer 41

iron absorption increases as pregnancy progresses

Question 42

what is the EAR and RDA for iron during pregnancy

Answer 42

EAR: 22mg/d RDA: 27 mg/d

Question 43

what is health canada's recommendation for iron supplements during pregnancy

Answer 43

supplementation of 16-20mg iron throughout pregnancy - higher if maternal iron deficiency.

Question 44

what micronutrients are involved in maintenance of maternal bones and skeletal development of fetus

Answer 44

calcium and vitamin D

Question 45

RDA for calcium and vit D in pregnancy

Answer 45

calcium: 1000mg/d vit D: 600 IU/d same as in non-pregnant

Question 46

what is the RDA for vit A in pregnancy, what is a safer source of vit A

Answer 46

770 mcg RAE/day - beta carotene

Question 47

can caffeine be consumed during pregnancy

Answer 47

maximum: 300mg/d - 250ml coffee comeback

Question 48

what artificial sweeteners are considered safe and not safe in pregnancy

Answer 48

safe: aspartame, acesulfame-potassium, sucralose, saccharin, stevia not safe/ not recommended: cyclamates

Question 49

can herbal products be consumed during pregnancy

Answer 49

the safety of many herbal products is unknown but they are generally considered safe in moderation

Question 50

vegetarianism

Question 51

why is weight loss not recommended during pregnancy (3)

Answer 51

- limits nutrients available - promotes ketone formation - reduced fetal growth and impaired cognitive function

Question 52

what occurs more quickly due to accelerated fasting metabolism (entering fasting state more) (2)

Answer 52

- ketone formation - low blood glucose occurs more quickly

Question 53

what are common cravings and common aversions (don't like)

Answer 53

cravings: dairy and sweets (better to choose foods from healthy food group rather than others/no nutrition value aversions: caffeine, meats, alcohol - if its meats, consume other protein rich foods

Question 54

what foods should be avoided during pregnancy

Answer 54

- raw and undercooked foods - foods with increase risk of foodborne illness (listeriosis, toxoplasmosis, salmonella)

Question 55

benefits of physical activity during pregnancy, list 3

Answer 55

- prevent gestational diabetes and induced hypertension - provide strength for labour, promotion of appropriate weight gain

Question 56

what are limitations of physical activity during pregnancy

Answer 56

type of activity shouldn't be over exerting and high risk

Question 57

what is PAR-med-X, what guideline does it use

Answer 57

a screening tool used to determine if pregnant women can safely exercise - FITT: frequency, intensity, type, time