Nutrition

Question 1

What 2 supplements are pregnant women recommended to take ?

Answer 1

1. 400 micrograms Folic acid pre-conception & first 12wks (5mg if either obese, diabetics, history of baby with NTD or FH, on anti-epileptics)
2. 10 micrograms Vitamin D through pregnancy & continuation if breast feeding

Question 2

What foods are folates (==> folic acid) found in ?

Answer 2

Found in green leafy vegetables, fruits (such as oranges), cereals and offal.

Question 3

What foods is iron found in ?

Answer 3

Meat and fish, but also legumes and green leafy vegetables

Question 4

Is iron supplementation recommended in pregnant women ?

Answer 4

No - should not be offered routinely to all pregnant women.

Question 5

What foods is calcium found in ?

Answer 5

Bioavailability of calcium highest in milk and derivatives and in mineral water

Question 6

What is the major polyunsaturated fat found in the human brain and retinal rods and ==> what is recommended to women to achieve adequate intake of this fat during pregnancy ?

Answer 6

• Docosahexaenoic Acid (DHA: is the major polyunsaturated fatty acid contained in the human brain and retinal rods)
• 2 to 3 servings of fish per week during pregnancy recommended for optimal fetal development

Question 7

What is the function of vitamin D in relation to pregnancy?

Answer 7

Involved in the regulation of cytokine metabolism and in the modulation of the immune system, thereby contributing to the embryo implantation and regulating the secretion of several hormones

Question 8

What are the maternal and fetal risks of inadequate vitamin D intake ?

Answer 8

Maternal Risks:

• Osteomalacia, Pre-eclampsia, Gestational diabetes, Caesarean section, Bacteria vaginosis

Fetal Risks:

• SGA, Neonatal Hypocalcaemia ,Asthma/Respiratory Infection, Rickets

Question 9

What foods should a women avoid during pregnancy ?

Answer 9

• Soft cheese
• Undercooked meat, cured meats, game
• Tuna
• Raw/partially cooked eggs
• Pate
• Liver
• Vitamin & Fish Oil Supplements

Question 10

What pregnant women are eligable for the UK healthy start scheme and what vitamins are given ?

Answer 10

• Available to pregnant women who are either; on benefits or <18 yrs old
• Vitamin supplements given = vit C, vit D & folic acid

Question 11

Define low BMI/underweight

Answer 11

BMI ≤ 18.5

Question 12

What are the risks associated with being underweight with respect to pregnancy?

Answer 12

• Fertility reduced- >2X more likely to take more tan 1 year to become pregnant ( hormonal imbalances)
• Maternal- nutritional depletion esp if hyperemesis develops
• Fetal- Intrauterine growth restriction, Low Birthweight, Preterm Labour

Question 13

What is the management of low BMI/underweight during pregnancy?

Answer 13

• Exclude eating disorders- manage appropriately
• USS for growth 28, 32, 36 weeks

Question 14

Define obesity

Answer 14

BMI ≥30

Question 15

What are the maternal risks of obesity during pregnancy ?

Answer 15

• Fertility (ovulatory dysfunction) – longer time to conception
• Risk of miscarriage
• Risk of gestational diabetes
• Risk of pre-eclampsia
• Risk of thromboembolic disease ↑
• Risk of infection ↑
• Risk of labour dystocia ↑
• Risk of shoulder dystocia ↑
• Risk of C/S/operative delivery increased ↑
• Risk of PPH ↑
• Risk of infection↑
• Risk for depression/MH issues ( social isolation, loss of confidence, unemployment) ↑
• Reduced breastfeeding rates↑

Question 16

What are the fetal risks of obesity during pregnancy ?

Answer 16

• Fetal anomalies ↑
• Miscarriage ↑
• Macrosomia ↑
• Still Birth ↑
• Neonatal Death ↑
• Less likely to be breastfed
• ↑Later life risks- Type 2 diabetes, Cardiovascular disease

Question 17

What is the management of obesity during pregnancy?

Answer 17

• Antenatal red pathway
• Folic Acid 5mg till 12 weeks
• Vitamin D 10mg ( healthy start vitamins – Vit C, Vit D, Folic acid 400ug)
• Low Dose Aspirin ( 150 mg daily from 12/40 until delivery)
• VTE score- (fragmin from booking/28 weeks – beware BMI>50)
• OGTT 24-28 weeks
• USS growth from 28 weeks

Question 19

What percentage of bariatric surgery is done in women of child bearing age ?

Answer 19

70%

Question 20

What are the main types of bariatric surgery ?

Answer 20

gastric bypass, sleeve gastrectomy, gastric banding

Question 21

What supplements should be given to a pregnant women who has had bariatric surgery ?

Answer 21

• A-Z supplents- use beta carotene
• Adcal D3 1Tablet BD
• Vit D 25mcg
• Ferrous gluconate 300mg/ IV Fe
• Thiamine B12 50-100mg
• Folic acid 5mg
• Vit B12 1mg IM 3 monthly

Question 22

What type of contraception should be avoided in women with bariatric surgery ?

Answer 22

Oral contraceptives