Nutrition

Question 1

what dietary components are recommended to achieve a healthy weight before, during and after pregnancy?

Answer 1

meals based on:

• starchy foods
• fibre rich foods
• 5 fruit and veg per day
• low fat diet
• reduced portion size

Question 2

what social factors may make it difficult to maintain a healthy pregnancy?

Answer 2

low socio-economic status

drugs / alcohol / smoking

poor mental or physical health

unsupportive relationship

Question 3

what myth often occurs in pregnant mothers eating more during their pregnancy?

Answer 3

may think they need to eat for two - this is not true

Question 4

how many extra calories do pregnant women need per day in trimester 1 compared to trimester 3?

Answer 4

1 = 70kcals per day

3 = up to 500kcals per day

Question 5

what groups are most at risk of nutritional deficiencies in pregnancy?

Answer 5

exclusion diets - vegetarian, vegan, GF

underweight / overweight before pregnancy

adolescents - improper mobilisation of fat storage

multiple pregnancy - depletion of maternal reserves

previous poor pregnancy outcome

smokers

Question 6

which groups should take a high dose of folic acid preconception and up until 12 weeks?

Answer 6

5mg

• obese women / diabetics
• history of baby with neural tube defects
• if on anti-epileptics

Question 7

how can folates be taken from a diet?

Answer 7

green leafy vegetables
fruits (eg oranges)
cereals

Question 8

what pregnant mothers are most at risk of iron deficiency?

Answer 8

young age at first pregnancy
repeated pregnancies
multiple pregnancies

Question 9

how can iron deficiency in pregnancy be managed / minimised?

Answer 9

optimisation of age of first pregnancy

increase inter-pregnancy intervals

improve dietary intakes through education (fish, veg)

daily or intermittent iron supplements

Question 10

what maternal and foetal complications can result from lack of vitamin D in pregnancy?

Answer 10

maternal risks
- osteomalacia, pre-eclampsia, GDM

foetal risks
- SGA, rickets, neonatal hypoglycaemia, asthma / resp infection

Question 11

what food-derived infections are pregnant women at risk of?

Answer 11

listeria - pate, soft cheeses, cooked sliced meat, smoked salmon

salmonella - raw meat and egg, unpasteurised milk

toxoplasmosis

Question 12

what is the aim of the healthy start scheme in the UK?

Answer 12

available to pregnant women who are on benefits and those <18

vitamin supplements:

• 70mg vitamin C
• 10ug vitamin D
• 400ug folic acid

+ vouchers to buy discounted fruit / veg

Question 13

exclusive breastfeeding is recommended for how long after birth?

Answer 13

6 months

Question 14

what are the risks of having a low BMI during pregnancy?

Answer 14

maternal

• nutritional depletion esp if hyperemesis develops
• beware “normal blood loss” may be lots for small person
• drug adjustments for low weight (eg fragmin)

foetal

• IUGR
• preterm labour
• low birthweight

Question 15

women with a high starting BMI are recommended to put more weight on during pregnancy than those with low BMI - true or false?

Answer 15

false

• lower BMI should put more weight on than women with high BMI

Question 16

what maternal risk factors does obesity cause in pregnancy?

Answer 16

longer time to conception 
miscarriage 
gestational diabetes 
pre-eclampsia 
shoulder dystocia 
c-section 
PPH

Question 17

what foetal risk factors are increased by obesity in pregnancy?

Answer 17

fetal anomalies ↑
miscarriage ↑
macrosomia ↑
still Birth ↑
NICU admission ↑
neonatal Death ↑

later life T2DM

Question 18

how is obesity in pregnancy managed antenatally?

Answer 18

high risk pregnancy (red pathway - consultant led)

• counselling about risks and scan difficulties
• optimum programme

nutritional advice and regular exercise

• weight monitoring
• folic acid 5mg till 12 weeks
• low dose aspirin and fragmin from booking (VTE)
• OGTT 24-28 weeks
• USS growth from 28 weeks
• anaesthetic review

Question 19

how is obesity in pregnancy managed during labour?

Answer 19

MDT plan - inc manual handling

bariatric beds / avoid lithotomy position (bed tips back)

ranitidine regularly (decrease stomach acid)

in 3rd stage - IM syntometrine (must use muscle not covered by fat eg deltoid)

or use IV oxytocin

Question 20

what problems may occur in an operative delivery of a baby in an obese patient?

Answer 20

IV access
difficult spinal 
airway problems 
abdominal entry 
PPH anticipated

Question 21

what advice and management should be given to obese women post-partum?

Answer 21

extra monitoring if sleep apnoea 
thromboprophylaxis (TED stockings often dont fit) 
fragmin dose (weight dependent)
support breastfeeding 
wound problems

Question 22

many women of childbearing age are undergoing bariatric surgery - what advice must be given about conception following this?

Answer 22

delay conception until weight is stable (can take 1-2 years)

if weight is not stable then risk of preterm delivery increases

Question 23

what complications can bariatric surgery cause?

Answer 23

nutritional deficiencies (affect absorption - usually vitamin D, B12 and folate)

high risk of GDM (difficult to diagnose as OGTT may be impossible)

Question 24

what are the basics of managing pregnant patients who have had bariatric surgery?

Answer 24

vitamins
supplements
avoid oral contraception due to lack of absorption

Question 25

what cultural event may cause nutritional difficulties for mother and baby?

Answer 25

muslim - ramadan

• pregnant women should avoid fasting
• however, if chooses to then must be supported in this

Question 26

what vitamins often needed supplemented if a woman with a vegetarian diet is pregnant?

Answer 26

iron
vit B12
vitamin D

Question 27

what vitamins often require supplementation in a vegan diet if a patient is pregnant?

Answer 27

iron
vit B12
calcium
vitamin D

Question 28

how much fruit and veg should be eaten in a pregnancy diet?

Answer 28

5 a day
more veg than fruit (due to sugars)
avoid dried fruit / fruit juices
increase veg consumption and reduce carbs

Question 29

what rules should pregnant women follow with regards to the carbs in their diet?

Answer 29

portion size of 30-50g/meal
avoid 2 sources of carbs
wholemeal options

Question 30

how should pregnant women consume fats and spreads in their diet?

Answer 30

unsaturated fats (healthy heart = olive, sunflower, rapeseed oil) 
in small amounts

Question 31

how much dairy are pregnant women encouraged to have?

Answer 31

use milk alternative if just having milk (normal milk has natural sugars)

limit normal milk to 150ml/day

switch to low fat greek style yoghurt, which has less sugars

Question 32

why is exercise useful in GDM and what types of exercise are recommended for pregnant women?

Answer 32

increases amounts of glucose used by muscles for energy = lowers blood glucose

insulin used efficiently

prevents weight gain and reduces weight

walking (30mins/day) or swimming are recommended forms of exercise in pregnancy