FNH 371 REVIEW MIDTERM PACK – QUESTIONS ANSWERED AND EXPLAINED FOR COMPLETE PREPARATION

1. What is consumption advice in making informed choices about fish? - ANSWER - limit consumption of fresh/frozen tuna, shark, swordfish, escolar, marlin, and orange roughly 150 g/month, limit consumption - less limit on white canned tuna to 300 g/week and no limit on canned light tuna 2. Describe alcohol consumption in pregnancy and breastfeeding in general? - ANSWER no known safe amount of alcohol use 3. what is fetal alcohol spectrum disorders? - ANSWER - group conditions caused by prenatal alcohol exposure - can cause lifelong physical, behavioural and learning problems - leading preventable cause of birth defects and developmental disorders 4. Descibe caffeine and herbal teas in pregnancy? - ANSWER - caffeine safe below 300 mg/d, ~2-3 cups of coffee per day - not all herbal teas are safe: - avoid chamomile, stinging nettle and others - citrus, ginger are generally safe 5. what are 4 foods to avoid in pregnant due to increase risk for foodborne illness in infection for fetus? - ANSWER raw fish undercooked meat soft cheese unpasteurized milk 6. How does foodborne illness impact pregnancy? - ANSWER - more likely due to a suppressed immune system - may cause miscarriage or stillbirth - key pathogens: listeria monocytogenes (deli meats, unpasteurized dairy, raw and smoked fish) and toxoplasma gondii (raw and undercooked meats and cat litter) 7. In general what do most pregnancy symptoms reflect? - ANSWER normmal physiological changes in pregnancy 8. Name 5 common concerns in pregnancy? - ANSWER 1) PICA 9. 2) Nausea and vomiting of pregnancy 3) cravings/aversions 4) reflux/heartburn 5) leg cramps 10. Describe how nausea and vomitting of pregnancy and dietary strategies? - ANSWER - morning sickness and worst in first trimester - cause is unclear but likely due to changing hormones - dietary strategies: small frequent meals, dry crackers, ginger, B6 11. What are cravings and aversions? - ANSWER - cause unknown Cravings: - defieincies - altered hormones and taste receptors combines with non restricted food intake Aversions: - often to meat/fish - may be protective against food borne illness 12. what is reflux/heartburn in pregnancy in pregnant and potential treatment? - ANSWER Caused by: relaxation of lower espangeal sphinctor pressure from growing uterus 13. Treatment: small infrequent meals, fluids between meals, remain upright after eating, avoid late night snacks 14. What is pica and what is the concern and treatment? - ANSWER - craving to eat non-food substances (dirty, clay, laundry starch) - concern: may displace nutritious foods, or lead to toxin ingestion - treatment: suggest alternatives; ensure nutrients needs are met 15. What are leg cramps in pregnancy, cause and remedies? - ANSWER - common in 2nd and 3rd trimester - cause unclear - remedies: supplements of magnesium or calcium, stretching, activity, hydration 16. What is fluid retention caused by and treatment? - ANSWER - cause: pressure from uterus on lower limbs - treatment: water and resting with legs elevated - swelling associated with headache, fever or high blood prpessure may be a sign of pre-eclampsia (fatal disorder) 17. What is the best resources for pregnant women? - ANSWER the society of obstetricians and gynaecologists of canada 18. In early to mid pregancy how is blood pressure impacted? - ANSWER lower than non-pregnant, due to vessels relaxing and then it creeps up slowly reaching the end of pregnancy 19. What are 3 hypertensive disorders of pregnancy? - ANSWER 1) gestational hypertension 2) pre-eclampsia 3) eclampsia 20. what is gestational hypertension? - ANSWER high blood pressure, 140/90 mmHg that develops in pregnancy 21. what is pre-eclampsia? what could help? - ANSWER - hypertension + edema + proteinuria - most common serious complication of pregnancy and can lead to eclampsia - potentially life-threatening siezures - occurs 5-8 10,000 pregnancies and the cure is delivery - calcium 22. what is gestational diabetes mellitus? - ANSWER - in pregnancy we go through insulin resistence to ensure adequate glucose for fetus - all pregnant people are screened for this at about 24 weeks - high blood sugar first diagnosed during pregnancy.. 23. what are the two tests for GDM? - ANSWER one step approach: - single, 2 hour fasting with 75 gram oral glucose tolerance test - tested at 0 and 2 hour 24. two step approach: - nonfasting, two step: - 50g at 1 hour glucose test followed by 75 g at 0,1,2 hours 25. what is the reatment for GDM? - ANSWER counselling on diet and exercise - could involve insulin or other meds (rare) 26. what are the effects of GDM in infants? - ANSWER - macrosomia (4000g) or large for gestational age (above 90% tile) - infant may develop severe hypoglycemia after birth - increased risk of perinatal mortality (still birth) 27. what are the top 5 overall advice for pregnancy? - ANSWER 1) appriopriate weight gain and rate of weight gain 2) healthy diet 3) avoid known risks 4) moderation in all things 5) adequate social supports and care 28. what is the recommendations from health canada for breastfeeding? - ANSWER - exclusive breastfeedign for first 6 months, may continue up to 2 years and beyond - optimal for grwoth 29. What are the benefits for breastfeeding for the infant? - ANSWER 1) optimal nutrition, breastmilk is designed for babies with quanitity and quality (fats and proteins) 2) change and adapt for the baby 3) immunological beneftis, protection from acute or chornic diseases 4) bonding 5) may improve cognitive development 30. What is known about breastfeeding and IQ? - ANSWER - observational studies suggest breastfeeding is associated with reduced risk for low IQ - mechanism not known but could be: - nutritional content of human milk (omega 3 fatty acids, other lipids) - parent-child interactions - confounding effects 31. what are potential benefits for breastfeeding for mother and parent? - ANSWER - bonding & emotional benefits - promotoes involution of uterus, oxytocin - suppress ovulation for natural spacing between babies - decreased risk for chornic disease (breast cancer) - convieneint once established - less expensive - potentially reduces postparttum depression 32. what is postpartum depression? - ANSWER - mood disorder within 1 year after childbirth - unknown etiology (potentially genetics, changing hormones, stress) - postpartum depression is relatively common in women 23% reported feelings 33. what could increase risk for post partum depression increased with? - ANSWER - history of depression - higher stress during pregnancy/ high risk pregnancy - lack of support after birth - lifestyle- poor diet, lack of sleep, lack of exercise 34. How is pospartum diagnosed? - ANSWER - symptoms must be present everyday for atleast 2 weeks - used edinburgth postnatal depression score of 13 or higher indicates probable major depression 35. What is the prevelance of breastfeeding in canada? - ANSWER 9 in 10 mothers initiated breastfeeding in canada 36. what influences breast feeding initiation and continuation before six months? - ANSWER - not enough milk - difficulty breast feeding - child weaned themself - medical condition parent/baby 37. What can be a major reduction in the likelihood of successful breastfeeding? - ANSWER infrequent breastfeeding, breastfeeding is supply and demand - increase breastfeeding and pumping 38. what is the breastfeeding paradox? - ANSWER those who stand to gain most from the health benefits of breastfeeding are least likely to breastfeed 39. When might a baby and parent actually need to stop breastfeeding... contraindications? - ANSWER - infant is galactosemia (can not process lactose) - nursing parent: - currently undergoing radioactive therapy or chemi HIV or some other virus, substance abuse (opiods), some medications and illnesses are temporarly incompatible with breastfeeding 40. Name 4 categories that can impact breastfeeding and what can each do in examples? - ANSWER Support or hinder breastfeeding 1) health care systems: educate with trained professionals to promote early initiation 2) workplace: provide safe spaces for feeding/pumping, job security and supported leaves 3) community: provide safe spaces for feeding/pumping, de-stigmatize, educate, support groups 4) family: support and pass along knowledge, be there for parent 41. What is anticipatory guidance and early initiation? - ANSWER - early, effective, exclusive - guidance on breastfeeding provided before birth to increase likelihood of breastfeeding after birth - early initiation & skin to skin after birth increases the likelihood of successful breastfeeding 42. what was baby friendly hospital initiative? - ANSWER - launched by WHO to promote and support breastfeeding in hospitals - provided 10 steps to successful breastfeeding and if hospitals meet standards are certified as "Baby-Friendly." 43. what are the international code on marketing of breastmilk substitues? - ANSWER 1) no advertising of breastmilk substitiues 2) no free samples to mothers 3) no promotion of products through health care facilities 44. what are health canadas regulations on modernization of foods for special use and infant foods? (code on marketing of breastmilk substitiues?) - ANSWER - proposed ot prohibit the following on all infant formula labels: 1) pictures of infatns, idealizing formula 2) no use of humanized, maternalized, human milk ect. 3) statements comparing infant formula to human milk 45. when are female breasts considered to be fully developed? - ANSWER after pregnancy 46. Describe breast development in puberty, adult, pregnancy, lactation and involution? - ANSWER Puberty: fat desposition to breast tissue Adult: well developed size and milk ducts are present Pregnancy: causes synthesizing and secretion of milk Lactaion: breasts reach full potential before glands INVOLUTE and go back to adults breast 47. What are the key elements to the breast? (4) - ANSWER 1) nipple 2) adipose tissue 3) milk-producing mammary gland 4) milk duct 48. what is the role of the nipple? - ANSWER - where milk comes out - visual cue to the baby, slightly darker than rest - hardens to give baby something to grip - secretes substance to prevent chafing/rubbing during lactation 49. What is the endocrinology of breastfeeding during pregnancy, after delivery and during breastfeeding? - ANSWER - Pregnancy: estrogen, progesterone and placental lactogen prepare breast and prolactin - Delivery: pregnancy hormones drop, prolactin and oxytocin increase - Breastfeeding: prolactin promotes milk synthesis and oxytocin promotes let down (ejection of milk from milk ducts to nipple 50. what is the let down reflex? (4 steps) - ANSWER 1) suckling stimulates nerves in nipple 2) nerves send message to hypothalamus 3) hypothalamus sends message to pituritary gland 4) pituritary gland, which stimulates milk production and oxytocin which stimulates milk release 51. How is breastfeeding supply and demand? - ANSWER Increased suckling, removal of milk from breast, stimulates increased milk production - feeding or pumping promotes milk supply - early feeding and frequent 52. Do you need to pregnant to product milk/lactate, who could this be an option for? - ANSWER no, you can have induced lactation - adoptive parents 53. What is the general mineral concentraion in mature human milk? - ANSWER minerals: lower concentrations to reduce solute load forms so they are well absorbed 54. Describe breastmilk in terms of istonic, contains and changes? - ANSWER - isotonic with plasma, breastfed infants do not require additional water - contains: macro, micronutrients, nucleotides, WBC, enzymes, hormones, immunoglobins - changes with infant and stage of feed to meet needs 55. How does diet effect milk composition in terms of: - protein & carbohydrates - fat - vitamins - minterals - flavours - ANSWER - minimal/no effect - diet infleuces fatty acid composition of milk, but minimal/no effect on total fat content - influced by maternal diet + stores, if mom is low the breastmilk will be low - minimal/no effect - can influece taste (garlic, mint, onions) 56. What is colostrum? what are the beneftis? - ANSWER - Yellowly, viscous fluid secreted in small amounts at start of lactation with more protein and less lactose than mature milk - made yellow by carratin, vitamin A - benefits: - establishing bacterial flora - passage of meconium (first poo) - high antibody content (pass on some passive immunity to baby) 57. How is breastmilk in terms of providing vitamins? - ANSWER adequate amounts of all vitamins except D and K 58. What are common external factors to influece the composition of breastmilk? that makes it vary person to person? - ANSWER - maternal: diet, genetics, microbiome, alcohol, drugs, medication, substances - age of infant and stage of lactation - length of feed - infection 59. What is human milk microbiome? is milk sterile? - ANSWER milk is not sterile. community of beneficial microorganisms natrually present in breastmilk that feed gut microbiome of baby, impacting immune function and long term health of infant 60. What are the sources of bacteria in milk? - ANSWER 1) retrograde flow during suckling, mothers skin and infants mouth 2) from mothers gut, enetro-mammary pathway, bacteria travels through immune cells to mammary gland 61. how does human milk microbiome impact the infant? - ANSWER - helps colonize infants gut with beneficial microbes - supports immune development and reduces risk of infections/allergi 62. How does iron differ in breastmilk and formula? - ANSWER - breastmilk contains much less iron than formula - iron in breastmilk is better absorbed than formula 63. What carbohyrates are present in human milk? (2) - ANSWER 1) lactose 2) human milk oligosaccahrdies 64. what are human milk olgosaccahrides? what is their role? - ANSWER - carbohyrates in human milk - promote growth of beneficial gut bacteria and protect gut health 65. Describe fats in human milk? - ANSWER - fatty acid composition reflects matneral diet and fat stores - medium chain fatty acids that improve absorption and are important in gut health - fats are more easily digested in milk 66. What is the protein composition in human milk? - ANSWER Casein: 20-30% - promotes calcium abosprtion, aggregates to form milks white appearance - Whey: 70-80% - soluble and easier to digest - most abundant - include enzymea and antibodies to support baby immune system (immunoglobulins, lysozyme antibacterial and lactoferrrin that carries iron and promotes iron absorption) 67. What is non protein nitrogen? - ANSWER 25% of nitrogen in mature milk includes: - peptides - free amino acids creatine, carnitine, choline - nucleotides - polyamines 68. what is the EER in lactation? what is it for 0-6 months post partum and 6-12 months - ANSWER EER= non-pregnant EER + energy for milk production-energy mobilized from fat stores: 0-6 months postpartum EER= non pregnant EER + 400kcal 6-12 months postpartum EER= non-pregnant EER + 380kcal 69. What are the general energy and weight recommendations for lactation and post partum? - ANSWER - lactatign persons should consume 300-400 kcal/day above pre-pregnancy needs - do not restrict energy, can decrease volume of milk produced - nutrient-dense food choices - weight loss should be gradual 70. How does breastfeeding relate to postpartum weight loss? - ANSWER - breastfeeding has shown slightly more weight loss in postpartum - should not emphasize weight loss as a benefit of breastfeeding 71. Review macronutrinet needs in lacataion from lecture 8 - ANSWER 72. which micronutrient needs in lactaion go up? - ANSWER - Vitamin A,E,C - choline - iodine 73. which micronutrient needs go down in lactation? - ANSWER - folate - iron 74. How does water recommendations change during lactation and pregnancy? - ANSWER - highest in lactation, accounts for extra water secreted in milk, making in milk is loss of fluid - increases in pregnanacy, highest for lactation 75. Which macromolecules increase in lacatation compared to preganacy? - ANSWER carbohyrate, protein 76. Should prenatal multivitamin be continued in lactation? - ANSWER no. prenatal is expensive and high in iron and folate, and needs decrease in pregnancy 77. Who should consider supplements during lactation? - ANSWER - those who dont consume dairy, calcium and vitamin D - dont eat animal products B12, zinc, iron - at higher risk for nutrient deficiences, poor diet, medications or chronic conditions - continued use of folic acid if pregnancy is possible 78. How can alcohol impact breastfeeding? - ANSWER Alcohol is lipid soluble and diffuses into milk - can reduce milk production and interfere with infant sleep and cognitive development - no alcohols is safe while breastfeeding - if consuming alcohol wait until reduced blood ocncentration before feeding/pumping to elimiate alchohol from blood - your blood alchol is the same as milk alcohol 79. How can drugs contaminant human milk? - ANSWER - transfer through to breastmilk and to infant, with varying metabolism - most perscription and over the counter medications are safe with recommneded soes - illicit drugs can have severe impacts on baby 80. How does cannabis impact breastfed babty? - ANSWER - impact synpasing for brain development of baby - goes to breastmilk via passive diffusion 81. How does caffeine contaminate breastmilk? - ANSWER - 300 mg of caffeine per day is considered safe - energy drinks are discouraged due to large amounts of caffeine and herbal ingredients and vitamins - infants may react to caffeine: irritable, fussy, difficulty sleeping or staying asleep 82. What are potential enviornmental risks that could contaminant human milk? - ANSWER metals and persistent organic pollutants 83. in general what is the recommendations in terms of contaminants and breastfeeding? - ANSWER beneftis of breastfeeding outweights potential risks of containminants 84. How often should healthy newborns be fed? - ANSWER - on demand, every 2-3 hours - as often as baby wants to feed - 10+ times per day 85. Why is ondemand feeding recommended in terms of milk supply? - ANSWER breastmilk is supply and demand and feeding on demand allows for contiued production of breastmilk 86. What are common hunger cues; early, mid and late? 87. How is this different from a not hungry baby? - ANSWER Early: stirring, mouth opening, turning head, seeking, rooting mid cues: stretching, physical movement, hand to mouth late cues: crying, agitated body, colour turning red Not hungry baby: content 88. What are the breastfeeding positions revolve around? - ANSWER - tummy to mummy - parent is comfortable and supported - babys head is supported but free to move - bottom is supported for baby to feel secure 89. What is a good latch? - ANSWER - baby latches with wide open mouth, chin first and then mouth - lips flange - ~2-3cm of breast tissue in mouth - listen and look for signs of swallowing 90. how do you tell if baby is getting enough breastmilk? - ANSWER - overall feed frequency, wet and soiled dipaers and appriopriate weight gain 91. What are the typical wet diapers and bowel movements for a baby getting enough milk? - ANSWER - Wet diapers increase with days after birth by day 6, 6+ dipaers a day - 1-3 bowel movements a day, increasing to 3-5 + per day - transition from meconium (thick, black) to yellow and soft 92. How can weight gain and alertness be used as signs for infant getting enough milk? - ANSWER - weight gain: loss up to 7% in first 5 days and growth after 5 days. initial loss due to fluids before gaining - aler and responsive: sleeping too much and when awake they are not alert could be sign of lack of nutrients 93. What are four ways to identifying if new born is getting enough milk? - ANSWER 1) wet diapers 2) bowel movements 3) weight gain 4) alert and responsive 94. What is a solution to nipple pain when breastfeeding? - ANSWER correct the latch or use nipple shield 95. what is a blocked duct when breasfeeding and what is the solution? - ANSWER - due to inadequate emptyinf of breast or pressure on breast from tight clothing or bra - solution: massage, warmth, hand expressing, - could be due to infection - If accompanied by fever it could be mastitis and need antibiotics/antifungals - could be caused by incorrect latch and nipple damage so bacteria enters and causes infection 96. How could milk supply issue be resolved? - ANSWER - increase feeding, pumping or use hand expressing to make more - stimulate milk production with galactagogues (not authorized in canada to promote lactation) or natrual remedies 97. Should a parent breastfeed when they or infant is sick? - ANSWER yes, milk has immonoligcal benefits 98. How long is recommended breastfeeding duration? - ANSWER - exclusive breastfeeding 0-6 months, contiuted for 2 years and beyond 99. Describe infancy? how does weight and length change? - ANSWER 0-1 year old - triple weight and lenght by 50% - per unit size, nutrient needs greater than any other stage of life 100. What are the goals of nutrition during infancy? - ANSWER provide energy adn nutrients to support rapid growht - lay basis for good eating habits - start transition from feeding to eating 101. How does newborn weight change right after birth? - ANSWER goes down in first 5 days due to first poo adn surplus fluid loss - should regain birth weight by day 10-14 102. What can under nutrition during infancy lead too? - ANSWER stunting 103. what is stunting? - ANSWER child is too short for age - may impair ability to reach both physical and cognitive potential, and increase risk of chronic disease later in life 104. How are the proportions of a new borns body? - ANSWER head is 25% of body 105. Why is monitoring growth important for infants? - ANSWER - appriopriate growth is sign of good health, delayed or rapid growth could be due to malnutrition or other health issue 106. How can we monitor growth? - ANSWER WHO growth charts, international standard to represent physiological growth of children 107. What are the healthy growth patterns for infants according to WHO growth charts? - ANSWER between 3-97 percentile - similar percentiles for weight and length - tracking with consistent percentiles over time, but crossing can occur in the first 2-3 years - over time is important, can be used for monitoring 108. How are preterm infants measured on WHO growth charts? - ANSWER - growth catchup does not occur immediatley - corrected postnatal age until 24-36 months Corrected age: - postnantal age in weeks: 40 weeks-gestational age in weeks 109. What is the corrected postnatal age for baby 12 weeks postnatal age an infant is 30 weeks gestational age? - ANSWER 12-[40-30] or 2 weeks corrected postnatal age 110. What does a normal growth pattern look like over time? - ANSWER normal growth pattern tends to follow the same percentile growth curve over time 111. what else can you use to diagnosis with WHO growth charts? - ANSWER - head circumfrance - medical history - atlerness - feeding 112. What are the 4 development relevant reflexes to feeding? - ANSWER - rooting - suck swallow - tongue thrust - gag 113. based on oral reflexes disappear when would you introduce solid foods? - ANSWER 6 months 114. what are the two distinct stages of infancy and how should feeding change in short? - ANSWER 0-6 months: exclusive breastmilk 7-12 months: intro of solid foods 115. Describe the neuromuscular developmental milestones at: 4-6 months 6-9 months 9-12 months 116. 1+year - ANSWER 4-6 months: biting and chewing added to sucking, sits with support 6-9 months: sits w/o support, grasps and finger feeds 9-12 months: tongue lateralization, rotaory motion of jaw, finger thumb motions 1+year: proficient self-feeding 117. What is rooting? stimulation and action for feeding? - ANSWER touching of cheek or side of mouth - baby turns to source and opens mouth, able to seek breast 118. What is suck swallow? stimulation and action for feeding? - ANSWER touching of mouth - baby sucks rhythmically on object, finger, nipple or treat - sucking is coordinated with swallow and enables infant to feed safely in reclined position 119. What is tongue-thurst? stimulation and action for feeding? - ANSWER touching of lips - tongue moves forward out of mouth -assisist with feeding feeding from breast but not solid foods, protects against choking 120. What is gag? stimulation and action for feeding? - ANSWER placing object towards back of mouth - object is expelled by tongue - protects from choking 121. How do we monitor cognitive, social and motor development? - ANSWER milestones 122. Describe developments of baby for gross, fine motor, langauge, social and cognitive? - ANSWER gross: sitting, standing, crawling, waling fine motor: grabbing, holding, eating laguage: speaking, understanding social: connectign, cooperating, responding to others feelings cognitive: learning, understanding, problem solving 123. List 6 poop colour options of baby and associations? - ANSWER yellow: normal breastfed brown/orange: normal formula white: medical attention, liver issues black: first poo, medical attention if continutes, internal bleeding red: medical attention, blood in stool green: not concern 124. what are two adaptions to fat content of human milk that improve fat absorption? - ANSWER 1) lingual lipase 2) easier to digest 125. what is hte main source of carbohydrates in breastmilk? - ANSWER lactose 126. How does teh large intestine develope and mouth in infnacy? - ANSWER mouth: Lingual lipase helps babies digest MCT fats early on, improving fat absorption and energy supply. large intenstine: development of gut microbiota 127. How does teh small intestine adn pancreatic enzymes work in infancy? in terms of macromoleules - ANSWER protein: digestion well developed fat: low levels of lipase and bile slats 85-90% of human milk fat is abosrbed (adults can abosrb more) carbohydrates: low pancreatic amylase, startch is poorly digested 128. Describe the need for essential fatty acids in infancy? - ANSWER - Adequate intake for omega 3 and 6 - human milk does provide some we would only be concerned for defiiency if it drops too low 129. How does protein needs vary for newborns compared to other lifestages? - ANSWER infants need the amount of protein per kg basis of body weight compared to adults 130. DO I NEED TO KNOW THE AI AND EAR RDA * lecutre 10 - ANSWER 131. what are water recommendations for infants? - ANSWER young infants should not consume water, breastmilk is isotonic with plasma so they do not need water 132. Describe calcium needs for infants? - ANSWER - proprotionality more calcium added to bone in first year than any other time of life - infant abosrbs 55-60% of calcium in breastmilk (calcium content in breaskmilk is lower but bioavalibiliy is higher from breast milk than formula) 133. Why are infants born with low levels of vitamin K? - ANSWER - low transfer in pregnancy - low amounts in breastmilk - immature gut microbiome (immature gut microbiome is not gaining vitamin k from bacterial syntehsis) 134. Why is vitamin K important for newborns? - ANSWER - they are born with low levels and can lead to vitamin k deficiency bleeding - bc blood can not clot without vitamin k and internal bleeds may be fatal if not clotted 135. what is the solution for vitamin k deficiency bleeding? - ANSWER recommended routine intramuscular administration of single dose of vitamin K at 1mg to all newborns 136. What two vitamins are recoomeded to newborns? - ANSWER vitamin D & K 137. Describe vitamin D for infants? - ANSWER - supplement is recommded for breastfed infants - limited sun exposure and low amoutns of vitamin D in breastmilk can cause low vitamin D in infants - can increase risk for ricekts, bowlegs 138. What diet of infants should receive vitamin D? - ANSWER - breastfed - formula & breastfed - NOT: striclty formula fed 139. Describe iron and infants? sources and need? - ANSWER - breastmilk contains very little iron but is well absorbed (compared to formula) - infants have adequate iron stores for 0-6 months but will need iron rich foods following 6 months as breastmilk does not provide iron for brain development 140. Why do infants not require iron until 6 months? - ANSWER - recycyling of hemoglobin + iron stores + iron in breastmilk 141. What is bilirubin for infants and what is the risk? - ANSWER - byproduct of fetal hemoglobin breakdow, the imature liver can not metabolize all excreted bilirubin and so the newborn is predisposed to hyperbilirubinemia which causes neonatal jandice 142. what is neonatal jaundice? - ANSWER - build up of bilirubin - presents as yellow colouring of skin - elevated bilirubin can cause permanent neurological damage if not resolved 143. What are the treatments for neonatal jaundice? and how do both types present and symptoms? - ANSWER physiological jaundice: frequent breastfeeding to aid in excretion of bilirubin. flush out bilirubin - shown as jaundice in face and trunk patholocial jaundice: phototherapy, - jaundice spread to arms, legs and weigth loss, baby is tired and cant eat 144. what is the division of responsibility first six months? - ANSWER parent: what is offered (breastmilk/formula), provide positive and supportive enviornment 145. infants responsibility: when to eat and how much to eat 146. what are the nutrion requirements for infants? - ANSWER exclusive breastfeeding - vitamin D 147. what are the general recommendations from birth to six months? - ANSWER - breastfeeding exclsuively (not breastmilk subsititues) - routine growth monitorying - vitamin D - first foods should be iron rich 148. 3 most common benefits of breastfeeding to the baby? - ANSWER 1) sufficient energy and nutrients for first 6 months 149. 2) ntrients in correct quantity and quality to promote absorption 150. 3) bioactive factors that offer protection against gastroenteritis diarrhea, respiratory infection adn allergy in early life 151. 3 Alternatives to breastfeeding? - ANSWER 1) expressed mothers own milk (from pumping and bottle feed) 152. 2) donor milk 153. 3) human milk subsititues (formula) 154. in what four instances is breastfeeding contradicted? - ANSWER 1) galactosemia 155. 2) radioactive/chemotherapy therapies 156. 3) HIV 157. 4) abuse of unregualted substances (e.g opiods) 158. Describe how donor milk can be used with the milk bank? - ANSWER pasteurized from milk bank: - pasteruzied: destroys potential pathogens but decreases some immune factors and vitamins in milk - high demand and for babys in NICU or premature babies 159. what is informal milk sharing? - ANSWER not endorsed bc it is unpasteruized - carries risk of infection with hepatitis B and C HIV and transfer of drugs, tobacoo or alcohol in milk 160. What type of formula is recommended and when is it not used? - ANSWER cows mil formula is recommneded - soy milk formula is used when infant cannot consume animal products or metabolize lactose 161. Why can't regular whole cows milk be used instead of cows milk? - ANSWER fatty acid composition of human milk differes from cows milk 162. how is cows milk atlerted to make infant formula? - ANSWER - decrease protein - decrease solute loads and dilute for minerals - add iron - add lactose for carbohydrtaes - modify fat composition 163. How is infant fomrula desgined? what are the 3 forms? - ANSWER - based on animal milk or plant sources to mimic human milk - strictly regulated by health canada 1) powder: mixed with water, cost effective, mess and must be diluted accuratley 2) ready to feed: quick and easy, pour into bottle, expensive 3) liquid concentrate: mixed with water, less messy than poweder, expensive 164. what are teh 3 types of infant fomrula and abotu each? - ANSWER 1) cows milk: most recommneded 165. 2) soy milk based: lactose free and vegan 166. 3) therapeutic formulas: - hydrolyzed : protein broken down - elemental • first two for babies with allergies - preterm: higher calories, protein 167. Key recommendations 6-24 months? - ANSWER - breastfeeding continutes with complemnerary feeding for added nutrients and iron rich foods - supplmental vitamin D 168. Why is introduction of complementary foods important? - ANSWER - provide additional energy and nutrients - transition to independant eating and allows infant to explore new textures and flavours 169. what nutrient should you be most concerned about for infant solely breastfed at 1 years old? - ANSWER iron, breastmilk does not supply iron 170. what are the roles of the caregiver for infant 6-12 months? - ANSWER - provide foods for childs developmental age - boudnaries for meal structure - balance automy and dependency - competence based approach 171. what are 5 signs a baby is ready for complemnetary foods and solids? - ANSWER 1) tracking spoon 172. 2) shows interest 173. 3) sits by self with good head control 174. 4) close lips over spoon 175. 5) indicate they dont want something (turn head away) 176. Describe textures in complementary foods? and commerical baby foods? - ANSWER important to include textures and variety of textures beyond puree - babies dont need commerical baby foods, except iron fortified baby cerreals 177. Define how infatns regulate and accept food? - ANSWER they possess ability and capacity to - food regulate: knowing how much to eat - food accept: enough exposures (up to 20 times) to come around and accept new food on their own timing based on competence stance 178. what are teh divisions of responisbility for the second six months? - ANSWER parent: what is offered, when, where 179. baby: how much and what is eaten 180. What is baby led weaning? what is teh recommedations? - ANSWER - belives baby natrually learn how to eat different food at their own pace - better health with least amount of intereference from parents or caregivers - no utensils - there is limited supportive evidence 181. How should food be modiefyed for babies and baby weaning? - ANSWER - prevent chokign hazards until age 4, modify teh textures to be softer, pureed, 182. how should common allergens be introduced? for babies at high risk and not increased risk? - ANSWER - babies at increased risk: priotize potential food allergens at the start of complementary foods - not increased risk: introduce potential food allergens as part of their complemnetary food 183. what should be done for parents selecting plant-based beverages for child? - ANSWER - calcium, vitamin D should be equivelant to cows milk so look for fortification 184. when should vitamin D supplements stop? - ANSWER continued until baby is having 2 serving of dairy products and eating a wide variety of vitamin D rich foods, conitnute with vitamin D drops 185. What food safety percautions should be taken for babies in terms of specific foods? - ANSWER - honey: risk of infantile botulism under q year 186. Guidelines on the following food up to 5 years: - unpasterurized dairy products - unpasteurized juices - not fully cooked/raw meat, eggs, fish, sprouts 187. how much of an allergen can cause the reaction? - ANSWER test out allergern with even small amount (amount does not matter) for allergy only intolerence 188. how to tesst for food allergy in baby? - ANSWER test for allergy at around 6 months (not before 4) - if there is not reaction keep feeding throughout the week to prevent development of food allergery 189. WHat is choking and concerns? - ANSWER choking is medical emergency that requires inteventiojn. ti si different from gaging which is a naturla leanring step and relfex. choking can be prevented by avoiding specific choking hazard foods 190. what is the goal of nutrition during pregnancy? - ANSWER provide nutrients needed to support fetal growth and development while supporting pregnant person with nutrients they need to maintain their own health 191. Explain preganacy and dietary advice? - ANSWER - Potentially an ideal time for advice and change - time of change - dedicated health care provider and regular vists (consider diet and nutrition) - motivate changes for mother and child 192. why is nutrition important during pregnancy? - ANSWER Nutrition in pregnancy sets stage for health baby and parent - inadequate/excess nutrients or exposure to toxins can impact development of embryo/fetus and short and long term health - fetus depends on pregnant person, pregnant person must nourish themselves - risk of maternal mortality, infant mortality and low birth weight 193. when did the birth rate drastically drop and why? - ANSWER - prior to the 60s no birth control - now people have control 194. what is maternal mortality and ratio? - ANSWER Maternal deaths: deaths related to pregnanacy up to 42 days postpartum 195. MMR=#maternal deaths/100 000 live births 196. What is the MMR and what does it indicate? - ANSWER Maternal mortality ratio - key performance indicator of the stength and quality of health care 197. What is the trend in maternal mortality in canada? why? - ANSWER Maternal mortality has increased - older births - medical co-morbidities - growing refugee and immigrant population with different risks and resiliencies 198. How does Canadas maternal mortality ratio compare the the rest of the world? - ANSWER it is rare - high compared to developed countries - low compared to undeveloped countries 199. What is infant mortality? ratio? what plays role? - ANSWER Death of child before 1 200. infant deaths/1000 live births 201. what plays role in infant mortality rates? - ANSWER - poverty, unemployment, food insecurity, lack of access to healthcare, inadequate housing, unemployment - overall socioeconomic factors and community 202. Describe the inequalities in infant mortality in canada? - ANSWER - improved over the past few decades - improvement is not equally distributed - rate is strongly associated with socioeconomic status (1.6x higher in materially deprvied areas) 203. Describe low birth weight? - ANSWER low birthweight-- high risk fo health complications - pregnant person likley wasn't getting proper nutrition 204. Describe the trends for low birth weight in canada? - ANSWER - more underweight babies being born in canada trend - 2022, 7% of babies were low birthweight 205. when is nutrition most important? - ANSWER - fetal development and infancy than any other time in life 206. With regards to chronic disease when is the most vunerable time in pregnancy and which group birthed has highest risk? - ANSWER - early pregnancy - babies born small for gestational age (did not receive adequate nutrition) 207. what is the developmental origins of adult disease hypothesis? (3 main points) - ANSWER 1) risk for chronic conditions may depend on enviornment fetus experiences in utero 208. 2) maternal nutrition is key determinant of fetal enviornment and therfore affects likelihood offspring will experience health challenges decades later 209. 3) low birth weight babies appear to be at higher risk 210. Describe the impacts of the dutch faminine in terms of birth weight and nutrition? - ANSWER - pregnancy rates droppped by 50% during famine - average birth weight dropped by 372 g 211. SEE CRITICAL PERIODS IN DEVELOPMENT (and slides beyond until future grandchild, ask prof) - ANSWER 212. Describe how generations can be impacted by nutrition? - ANSWER when pregnant you are also pregnant with your grandchild, - the eggs that become granndchild are inside the duaghter while she is in mothers womb and nourished by mothers diet and enviornment 213. What are the two types of age methods for pregnancy? - ANSWER 1) fetal 214. 2) gestational 215. describe fetal age? notes? - ANSWER - period of intrauterine development from CONCEPTION to BIRTH (~38 weeks) - difficult to pinpoint exact conception date 216. describe gestational age? notes? - ANSWER - period of interuterine development from FIRST DAY OF THE LAST MENSTURAL CYCLE to BIRTH (~40 weeks) - find fetal by subtracting 2 weeeks 217. which is longer fetal or gestational? - ANSWER gestational 40! 218. Fetal 38! 219. Formula to find estimated due date given last menstural period? - ANSWER Naegoeles rule: 220. EDD (estimated due date)= (last menstural period)-3 months +7 days 221. what is a full-term birth, preterm and posterm? - ANSWER full term: 37-42 weeks gestational age 222. preterm: less than 37 weeks 223. post-term: greater than 42 weeks 224. What are the two birthweight definitions? - ANSWER small for gestational age (SGA)= low birth weight - 10th percentile for age & sex - for males, 10th percentile at 37 weeks (~2500g, 5.5 pounds), anything under 2500 225. large for gestational age: - 90th percentile for age & sex - for males, 90th percentile at 40 weeks ~ 4200 g (9.3 pounds) 226. what are the consequences of low birth weight? (5) - ANSWER 1) increased risk of mortality 227. 2) increased risk of infection 228. 3) feeding issues 229. 4) developmental delays 230. 5) long term increased risk of chronic disease 231. what are the risk factors for low birth weight? (7) - ANSWER 1) premature birth 232. 2) multipel births 233. 3) low weight gain in pregnancy 234. 4) low pre-pregnancy weight status 235. 5) health conditions during pregnancy 236. 6) stress, poverty, lack of social support 237. 7) smoke or drug exposure 238. what is a caviet in large babies? - ANSWER larger people tend to have larger babies 239. what are the risk factors of large for gestational age? (4) - ANSWER 1) history for previous LGA births 240. 2) poorly controlled diabetes 241. 3) maternal obesity 242. 4) excessive weight gain during pregnancy 243. Describe nutrition and newborn maturity? - ANSWER nutrition is one of the most modifiable variables leading to birth of mature (term) infant with appropriate weight 244. what are the stages of development? - ANSWER 1) conception 245. 2) germinal stage 246. 3) embryonic stage 247. 4) fetal stage 248. what does the placenta form from? - ANSWER trophoblast 249. what is the first stage of development? - ANSWER conception - joining of sperm +ovum and genetic material combine to form zygote at ovulation (day 14 of menustral cycle) =day 0 fetal stage 250. what is the second stage of development? - ANSWER Germinal stage: - zygote divides and differentiates into a blastocyst - implants into uterus and placenta begins to form - conception-~2 weeks 251. what is the third stage of development? - ANSWER embryonic stage: - embryo day 15-until end of 8th week - formation of all major body systems 252. what are the 3 layers the embryo differentiates into? - ANSWER Ectoderm: (outer) nervous system and skin, hair, nails 253. Meso (middle): bone, muscles, heart, kidneys, gonads 254. Endo: (inner) digestive system adn respiratory system 255. what is the fourth stage of development? - ANSWER fetal stage: fetus - 9th week-birth - growth and development of baby and preperation for life outside of womb 256. what 2 things does the fetus do in utero? - ANSWER - urinate (in fluid they drink) - circulate blood through the heart 257. What is the fetal adaption for hemoglobin? - ANSWER Fetal hemoglobin have higher affinity for oxygen promoting transfer from placenta to fetus 258. Describe the location of the placenta? - ANSWER attaches to upper uterun wall, ideally up high to not black any passage ways and connects to baby via umbilical cord 259. What is the placenta and when is formed adn functional? - ANSWER - organ body makes and delivers for pregnancy - begins developing 2 weeks after fertilization and functional by 10 weeks 260. what are the funcitons of the placenta? Characteristic and what happens if dysfunction? - ANSWER - functions: exchange between maternal and fetal circulation, endocrine secretions (HCG, estrogen, progesterone) - high metabolism: placenta uses 30-40% of glucose delivered by maternal circulation - placental dysfunction can cause complicaitons for both baby and pregnant person 261. SEE SLIDE MATERNAL FETAL CIRCULATION AND THE PLACENTA (lecture 2) up until physiological changes in pregnancy - ANSWER 262. what are the physiological changes in pregnancy? (15) see lecture - ANSWER see the chart in lecture 2 slides 263. what 3 key nutrients will be needed to support the expansion of blood volume in pregnancy? how will this impact the blood concentration of vitamins? - ANSWER 1) iron 264. 2) folate 265. 3) b12 266. water - vitamin and mineral concentrations will apepar lower 267. how are hormones impacted by pergnancy? - ANSWER hormones in the mother are going wild - Human chorionic gonadotropin (secreted right after conception), tells the corpus luteum to keep going. after 12 weeks, HCG goes down 268. what is the timeline for each trimester? - ANSWER 1) 1st trimester: first day of the last menstrual period to end of week 13 269. 2) 2nd trimester: weeks 14-27 270. 3) 3rd trimester: weeks 28-birth 271. Full term birth occurs between 38-42 weeks 272. What is the maternal anabolic phase? - ANSWER 1st & 2nd trimester - building, growing organs, creating stores - increased blood volume and body fluid - building fat, liver glycogen, and micronutrient stores - growth of maternal organs - increased appetite, food intake (positive caloric balance) 273. what is the maternal catabolic phase? - ANSWER 3rd trimester - mobilzation of fat and nutrient stores - increased production and blood levels of glucose, triglycerides, fatty acids - decreased liver glycogen - increased catabolic hormones 274. what trimester are the key stages/majority of stages for growth and development? what does this invole/mean? - ANSWER the first trimester; fertilization-embryonic stage - most differentiation of tissues occurs during critical periods in this time - development of placenta - most vulnerbale to toxins and nutrient inadequacy during this time 275. what is a critical period? when are they mostly and why are they imporant? - ANSWER - specific time period during which the cells of a tissue (or organ) are genetically programmed to multiply - mostly occur in early pregnancy - if proper growth and development does not take place during this period, it can not be made up for later 276. what is preconception? - ANSWER period around conception - from a few months before conceiving and including first few months of pregnancy 277. why is preconceptional nutrition important? - ANSWER - nutrition before coneption and during begining of pregnancy - important to start body with adequate nutrient status and body weight/composition can imporve pregnancy outcomes - key events occur in early pregnancy, often before prenatal care begins 278. what are 3 recommended areas of focus for preconception in reproducing individuals? - ANSWER - folic acid - iron - BMI 279. why is neural tube defects? - ANSWER birth defects of the brain or spinal cord caused by improper closure of neural tube in early development - inadequate folic acid is related to 50% of cases 280. why is folic acid important in preconception? - ANSWER - decreases neural tube defects (defects of spine and brain) - pregnant women, those who could become pregnant, breastfeeding should be supplementing 281. why is preconceptional iron important? - ANSWER - most common nutritional deficiency worldwide - easier to improve iron status prior to conception - iron deficiency prior to pregnancy: 1) increases risk of iron deficiency in pregnancy 2) increases risk of low iron stores in infants 3) increases rates of preterm devlivery 282. why is prepregnancy BMI important? - ANSWER BMI before/ going into pregnancy cna effect the baby 283. what impacts human energy requirements? - ANSWER age, physical activity, sex, body size, pregnancy 284. what are the three components for energy expenditure? define each? - ANSWER 1) physical activity - energy for muscular work 285. 2) diet induced thermogensis - energy to digest and absorb food 286. 3) basal metabolism (resting energy expenditure) - energy to maintain normal body functions while at rest 287. describe what determines the compoennts of energy expenditure and the amount of each? - ANSWER 1) physical activity determined by intensity, duration, body weight genetics - most variable amount - usually second 288. 2) diet induced thermogensis determined by amount of fodo & composition and hormones/SNS - smallest amount of energy 289. 3) Basal metabolism: determined by body weight, height, fat free mass, fat mass, age, gender, hormones, SNS - largest energy expenditure 290. describe how energy needs change during pregnnacy? - ANSWER - physical activity (up or down) - diet induced thermogensis (same) - basal metabolism (increased) - energy for depositing both fetal and maternal tissues (more energy to grow the baby for metabolism) 291. describe energy costs for depositing tissue, how and when? - ANSWER - mainly in 2nd and 3rd trimester, no energy is needed in first - ~200kcal/day - tissue growth for pregnant person and the baby 292. what is eer? - ANSWER - equations to predict energy ependiture/requirement based on a person's sex, age, height, weight and activity level - based on analysis of doubly-labeled water studies 293. name two ways to monitor fetal growth? - ANSWER 1) fundal height - measuring distance from pubic bone to top of uterus - track gradual steady growth - @ the week should length be number of weeks +/- cm 294. 2) ultrasound - more accuarate - measurements of fetus and amnionic fluid - less ultrasounds the better 295. Describe weight gain in the first trimester? - ANSWER - majority weight gain is in 2 & 3rd trimester - 1st trimester is 0.5-2kg 296. What is appropriate weight gain in pregnancy based off and why is the weight gain important? what are they based on? - ANSWER - depends on pre pregnancy BMI - for ensuring adequate energy for both pregnant peson adn fetus - based on observational data from pregnancies with good outcomes 297. what are the recommendations for weight gain rates amounts during pregnnacy based off of pre pregnancy BMI category? - ANSWER - underweight: 0.5 kg gain/week - normal weight: 0.4 kg gain/week - overweight: 0.3 kg gain/week - obese: 0.2 kg gain/week 298. Describe how weight is distributed in pregnancy? - ANSWER - blood volume - extra body fluids - energy stores - breasts - placenta - baby - amniotic fluid - uterus 299. what happens when too much weight is gained during pregnancy? - ANSWER large baby: challenges with delivery, challenges with subsequent weight manangement for pregnant person 300. what is the problem with insufficient weight gain? - ANSWER baby may be low birthweight, nutrient reserves may be depleted, higher risk of immediate and long-term health complications 301. what are 3 pros to measuring pregnancy weight gain regularly? - ANSWER - babys growth + health outcome - easy to do and noninvasive - early interventions 302. what could be the cons in regularly measuring weight in pregnancy? - ANSWER - added stress for changing body - inaccurate energy intake/growth - too much foucs on weihgt/kcal 303. How can practitioners help pregnant people in terms of weight gain? - ANSWER - create healthy attitudes about chanigng bodies - encourage healthy eating and activity patterns - focus on nutrient dense foods and following hunger cues 304. how are current protein requirements (EAR) determined for pregnancy? - ANSWER using factorial method- adding all nitrogen lost per day and accounting for extra needed for growth 305. what is the additional protein needs for growth in pregnancy? - ANSWER 12.6 g/day, including fetal/placental growth in 2nd and 3rd trimesters 306. Calculating requirements for protein??/all the and including way to carbohydrates in pregnnacy lecture 3 - ANSWER 307. How and why can omega 3 and 6 be comsumed during pregnancy? - ANSWER - important for brain and retina development and function - higher intake of omega-2 may also reduce risk of pre-term brith (could increase post-term birth) 308. How do fat recommedations change for pregnancy? - ANSWER - fat recommendations do not change - needs for fats accommodated by increase energy intake and altered metabolism - blood lipids increase (cholesterol for steroid syntheiss and fetus for nerve and cell membrane formation) 309. What are the 3 macronutrients focused on in pregnancy lecture? how is each impacted by pregnancy? - ANSWER 1) protein - RDa goes up by 1.1 g/kg/day in 2nd and 3rd trimester - 1 extra serving of protein-rich sources 310. 2) carbohydrate: - increase slightly, high fibre choices prevent constipation 311. 3) fat - choose rich sources of omega-3 fats - % kcal does not chage 312. what are the three highest focused vitamins and minerals for pregnancy increase? how are they signifigant? - ANSWER 1) foale 313. 2) iodine 314. 3) iron - 50% increase 315. describe how calcium is important in pregnancy? how can we ensure adequate calcium intake? - ANSWER - for fetal skeleton - recommednations do not change but calcium absoprtion increases - intakes of milk or calcium fortified foods 316. Describe iron deficiency in pregnant women? - ANSWER - most common nutreitn deficiency among pregnant women 317. why is iron needed in pregnant women? - ANSWER - fetal needs - increased maternal hemoglobin production associated with higher blood volume 318. what are the potential consequences of inadequate iron intake during pregnancy? - ANSWER - low birth weight, preterm birth, still birth and infant death - pallor and exhaustion during pregnancy - could be life-threatening during/after birth 319. what does health canada recommend with iron in pregnancy? - ANSWER multivitamin wiht 16-20mg iron - some are percriped a 30mg 320. why is fluid intake important in pregnancy? - ANSWER - essential for increasing mothers blood volume, lubricant, regulation of body temp, amniotic fluid and prevents fluid retention constipation urinary tract infections 321. what is the AI for fluid intake in pregnancy? - ANSWER - 3 liters/day 322. GUEST LECTURE 4 DOHAD theory all the way to folate recommendations in pregnancy - ANSWER 323. why are folate requirements in pregnancy due to? - ANSWER - increase cell division and metabolism - placental and fetal development - uterine englargement - maternal blood volume expansion 324. what are the RDA for folate? - ANSWER 600 micrograms of dietary folate equivelant 325. What are folate recommendations for pregnancy independent of? - ANSWER - womens age (14,-18, 19-30, 31-50 years) - gestational age (no distinction between trimesters) 326. what can low folate status during pregnancy be associated with? - ANSWER - Neural tube defects - preterm birth - low birth weight - placental abruption - preeclampsia - maternal megalonlastic anemia 327. describe folate and folic acid sources? - ANSWER - natrual food: dark green vegetables, legumes, oranges - folic acid fortified foods - prenatal viamin supplementation 328. how much folate should a woman consume of childbearing age? - ANSWER 0.4 mg folic acid 329. what can B12 deficiencies cause? - ANSWER - low birth weight - preterm birth - NTD - small for gestational age 330. who is at risk for low B12 intake? - ANSWER - women following vegan diet - women following an ovo-lacto-vegetarian diet 331. How is B12 status during pregnancy impacting child? - ANSWER - strong determinants of neonatal and infant B12 status 332. How does B12 recommendations change among women? - ANSWER womens recommednations increase with pregnancy and increase again with lactation 333. what is low conceptional vitamin B6 status associated with? (3) - ANSWER - increased risk of preterm birth - increased risk of pregnancy loss - reduced probability of conception 334. do we need to know recommendations for B6, B12, folate, ect in mg/d? - ANSWER 335. Describe how choline is being researched? - ANSWER - potentially boost infant brain function - methyl nutrient metabolism 336. Do pregnant women need supplements what should be top priotity? 337. What could be a vitamin comobination? - ANSWER - iron and folic acid - folic acid: 0.4mg 2-3 prior to conception - daily multivitamin with folic acid (0.4mg) and (16-20 mg iron) and prevatal vitamin with 2.6 micro grams B12. 338. what is the protein, carbohydrate, fat recommendations for pregnancy? what can be done for each? - ANSWER protein: increase in 2nd and 3rd trimester, ~1 extra serving of protein-rich sources 339. carbohydrate: slight increase, high-fibre choice help prevent constipation 340. fat: not %kcal change, choose rich sources omega 3 fats 341. what are the 3 major increases in vitamins and minerals? - ANSWER - folate, iodine, iron 342. Describe vitamin A in pregnancy? - ANSWER - too little: poor fetal growth - too much: birth defects - important to stay in range - increases slightly in pregnancy to account for fetal accretion 343. what is the recommendations for water soluble vitamins in pregnancy? - ANSWER - slight increase in all water-soluble vitamins to account for increased metabolism and energy needs in pregnancy 344. Describe iodine in pregnancy? - ANSWER - goes up 50% in pregnancy and needs for thyrode and very important in fetal development - required for thyroid function, and fetal brain development - defieicecy can lead to hypothyrodism in offspring adn development delays - consumption of iodine-fortified salt usually meets recommendations 345. Describe sodium in pregnancy? - ANSWER sodium is essential for fluid balance, and beyond normal healthy eating guidelines thought ot reduce swelling in pregnancy so they could reduce in pregnancy 346. What can omega 3 fatty acids supplements do in pregnancy from evidence? - ANSWER - reduced preterm birth - reduced risk of low birth weight 347. How can omega 3 fatty acids be reached in pregnancy with fish? - ANSWER - atleast 150 grams (~5 ounces) cooked fish once a week - fish contains omega 3 fats and other important nutrients for a healthy pergnancy 348. what could cause a pregnant person to reach EPA+DHA? - ANSWER only salmon, herring and mackeral 349. what are the pros and cons of fish oil (EPA + DHA) supplement? - ANSWER Pros: lower PTB, LWB, easier to obtain adequate amounts natrually, possibly decrease allergies and post partum depression and increase cognitive development 350. cons: expensive, high calories, thin blood, increased risk for post term birth,