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What would you recomend to a pregnant woman in terms of macronutrients, vitamins, minerals, other things?
- 1. Omega 3 FAs (carbs/protein not a problem in USA)
- 2. Increased folate, calcium
- 3. Increased iron, Zn
- 4. Increased fiber
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What would you recommend to a vegan/vegetarian pregnant woman? (6)
- 1. Omega 3 FAs (carbs/protein not a problem in USA)
- 2. Increased folate, calcium
- 3. Increased iron, Zn
- 4. Increased fiber
BUT ALSO, vitamin D and more exercise in sun. B12
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What is recommended to prevent and intervene with pre-eclampsia? (5) What should she not be given? (1)
- 1. Adequate vitamin D
- 2. Calcium supplement
- 3. Use of mutlivitamin
- 4. 5 servings of fruits/veggies daily
- 5. Moderate exercise
She should NOT be given high doses of iron, bc that can aggravate inflammation by increasing body's free-radical load
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When would you make the diagnosis of diabetes?
What are the values for a oral glucose tolerance test:
1. Overnight fast?
2. 1 hr after glucose load
3. 2 hr after glucose load
4. 3 hr after glucose load
What should a diabetic woman be closely monitored for?
A diagnosis for gestational diabetes is made when two or more values for venous serum/plasma glucose concentration exceed:
- Overnight fast: 95 mg/dL
- 1 hr: 180 mg/dL
- 2 hr: 155 mg/dL
- 3 hr 140 mg/dL
Pre-eclampsia
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When is management of blood glucose levels in diabetes considered successful? give numbers for OGTT
- When fasting blood glucose levels remain at 95 mg/dL or less. 1 hr = 140 mg/dL or less
- 2 hr = 120 mg/dL or less.
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What is recommended for a woman with gestational diabetes? (5)
- 1. To closely monitor blood glucose levels to make sure diabetes is managed
- 2. Moderate exercise
- 3. Low GI foods or high fiber carb foods
- 4. Limited intake of simple sugars esp in morning
- 5. Small frequent meals
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What are caloric intake recommendations for pregnant woman? Lactating woman?
+350 kcal in 2nd trimester and +450kcal in 3rd trimester.
For lactating woman: +330 kcal first 6 months and +400 kcal 2nd 6 months.
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What is considered a normal birth weight? Too high? Too low?
Another name for too high?
3 other names for too low?
Another name for normal?
Too high: above 90th percentile. Too low: Below 10th percentile
Small for gestational age (SGA), intrauterine growth retardation (IUGR), or intrauterine growth restriction
Too high: Large for gestational age (LGA)
Normal: Appropriate for gsetational age (AGA)
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How much weight should a child be gaining per today? How much length per day?
- 0-3 months: 20-30 g; 1 mm
- 3-6 months: 15-21 g ; 0.68 mm
- 6-12 months: 10-13 g, 0.47/day
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When should an infant be weaned from breast milk/formula to a cup?
Between 12-24 months.
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What supplements are recommended for healthy preterm baby?
Vitamin A, E, and iron due to low storage of these nutrients usually accumulated late in pregnancy.
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What is recommended to relieve colic?
Rocking, swaddling, bathing, positioning baby well for eating, and burping to relieve gas or mother's diet while breastfeeding (i.e. onions).
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What should you do if infant has diarrhea?
Constipation?
Keep feeding normal diet and continuing adequate intake of fluids and perhaps go to doctor.
Constipation - ensure enough fluids and not excessive amounts of fiber.
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What would you recommend an obese woman who wants to get pregnant?
Who is pregnant?
Who is breastfeeding?
Preconception: lose weight (modest weight loss can vastly improve fertility)
Pregnant: Exercise, balanced diet, and to gain 11-20 lbs over pregnancy rather than 25-35 lbs (15-25 lbs for overweight).
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What are negative impacts of an obese pregnant woman on delivery and her baby?
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What would you recommend to anemic woman:
Preconception?
Prenatally?
Breastfeeding?
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What would you recommend to diabetic woman
Preconception?
Prenatally?
Breastfeeding?
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What are negative impacts of gestational diabetes on baby? Anemia?
Gestational diabetes: hyperglycemia, large birthweight. higher Bmi later on
Anemia: preterm delivery and low birth weight.
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What is recommended weight gain for women during pregnancy for normal, overweight, and obese?
- Underweight: 28-40 lbs
- Normal: 25-35 lbs
- Overweight: 15-25 lbs
- Obese: 11-20 lbs
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In what order would you introduce veggies, fruits, iron-fortified foods, sugar/salty foods, juice, cow's milk, eggs, and honey?
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How would you introduce a certain new food?
One new food over several days to track allergies & introduce 21 times if necessary.
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What are vitamins/minerals infant may need? (4)
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What is recommended for infants high risk of atopic disease? (2)
Exclusive BFing for at least four months.
When compared to cowmilk protein formula-fed infants, BF fed infants were less likely to have atopic dermatitis or cow milk allergy in first two yeras of life.
If breastfeeding isn't an option, using partially/extensively hydrolyzed formulas compared to cows milk formula can delay/prevent atopic dermatitis.
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What is recommended to protect against wheezing in early life?
Exclusive breastfeeding for at least 3 months (but if there's genetic predisposition, exclusive breastfeeding is less helpful).
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Is a soy-based infant formula useful for allegy prevention?
no
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Does delaying introduction of complementary foods beyond 6 months (such as eggs, nuts, etc) have significant protective effect on development of atopic disease?
No.
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After what age is dietary intervention not shown to protect against development of atopic disease?
After 4-6 months.
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How should obese pregnant women be managed? (4)
- 1. Offer nutrition consultation
- 2. Encourage exercise program
- 3. Consider screening for gestational diabetes and repeating if first is negative in FIRST TRIMESTER
- 4. Discuss potential pregnancy complications (difficulty estimating fetal weight and obtaining fetal heart rate)
- 5. Suggest consultation with anesthesiologist prior to delivery. bc at high risk of emergency c sections
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How should pregnant women be dealt with in terms of anemia?
1. What's done for everybody no matter what? (2)
2. What should you do for each outcome of the second thing? (2)
What should you keep in mind when treating women with anemia? (2)
- At first prenatal visit:
- 1. Should start them on low dose of iron (30 mg/day)
- 2. Screen for anemia: If Hbg<9.0 refer for further medical evaluation; if Hb > 9.0, but anemic (under 11ish or mid 10s), treat with oral dose of 60-120 mg/day then reduce to 30 mg/day.
Should be given smaller doses (higher absorption), but remember that the more pills, the less compliance.
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What is dietary treatment for pre-eclampsia?
Limit salt
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What is recommended fish intake? Which fish should be avoided? (name 2) Which fish can be eaten? (3)
Eat up to 12 oz of fish/shellfish per week (tuna, salmon, shrimp)
Don't eat shark, swordfish, king mackeral or tilefish.
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What should doctors discuss with patients during pregnancy? (5)
- 1. Prenatal supplements
- 2. Diet nutrient-dense (remember extra calorie limits)
- 3. Discuss target weight gain
- 4. No skipping meals
- 5. Encourage moderate physical activity
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What should a nutritionist do at a counseling session? (5)
- 1. Have patient be aware of target weight gain
- 2. Develop nutritional care plan specific to culture/food prefs/ SES
- 3. Recommend meals/snacks throughout day
- 4. Stress importance of nutrient-dense foods (esp calcium and iron)
- 5. Must be individualized!
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What should a nutritionist do in monitoring a pregnant woman? 6
- 1. Weight gain
- 2. Iron status
- 3. BP
- 4. Fluid accumulation
- 5. Ketones in urine
- 6. Compliance with nutr care plan & multivitamin/mineral supplements
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What is recommended to prevent preterm births? Does adding antioxidants help? (5)
- 1. With pre-eclampsia, calcium supplements for ca-def women.
- 2. Zinc
- 3. Folate
- 4. Vitamin C (low levels can lead to premature rupture of membranes)
- 5. low fat/cholesterol
No
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Which ranges of birth weights are associated with adult chronic diseases later on? What symptoms/diseases? (essentially 6), but 3 are in same group.
Higher BP (systolic), hypertension, T2D (insulin resistance & impaired glucose tolerance) and earlier period onset for girls.
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What does gestational diabetes in mom lead to? (3)
Increased risk for type 2 diabetes & obesity.
Kids after gestational diabetic pregnancy have higher BMIs into childhood/adolescence.
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fWhat are recommendations for buying formula? (4)
- 1. Major formulas/brands are interchangeable
- 2. Get cheapest brand and buy in bulk
- 3. Provide unbiased facts to mom
- 4. Take allergies into consideration.
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