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Questions and Answers
What is the total cost of full term pregnancy in terms of energy?
80,000 kcals
How many additional calories are recommended per day during the third trimester?
Iron deficiency and iron-deficiency anemia are related to reduced iron stores in ___________.
newborns
Iodine deficiency in the mother can lead to cretinism in the fetus.
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During which stage of pregnancy does the conceptus become an embryo?
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Maternal insulin resistance increases during the second half of pregnancy.
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What causes the 'mask of pregnancy' also known as chloasma or melasma?
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During pregnancy, the maternal body composition undergoes _______ changes.
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Match the following physiological changes with their effects during pregnancy:
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What factors influence the transportation of molecules across the placenta?
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What are some examples of small molecules that can pass easily through the placenta?
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The placenta is a nutrient sensor and can modify its own transport function according to maternal nutrient supply and fetal needs. Fetus receives small amounts of water and other nutrients from ingestion of ________ fluid.
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The fetus is considered a parasite that can take whatever nutrients it needs from the mother's body at her expense.
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What describes critical periods during embryonic and fetal development?
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Which vitamins are mentioned to reduce risk of asthma and lung inflammation?
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What is generally concluded to be a safe intake of coffee per day during pregnancy?
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During pregnancy, except for iron, nutrient needs should be met by a well-balanced diet.
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Healthy diets for pregnancy should be consumed when individuals have iron deficiency anemia, diagnosed nutrient deficiency, smoke, drink, use drugs, are vegans, or have a(n) ____________.
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Match the following herbal remedies with the issues they can cause during pregnancy:
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What are the benefits of exercising for the mother and fetus?
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What is the recommended frequency and duration of exercise during pregnancy?
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Which of the following are examples of exercises to avoid during pregnancy?
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What issues can Listeria monocytogenes cause?
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"Match the following food safety issues with their consequences:
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Study Notes
Nutrition During Pregnancy
Physiology of Pregnancy
- Pregnancy is a period of intense growth and development, and nutritional status is crucial.
- Physiological changes occur in two phases:
- Anabolic phase (1st 20 weeks): mother's metabolism is anabolic, and nutrients are stored.
- Catabolic phase (21-40 weeks): fetal growth accelerates, and maternal insulin resistance increases.
Maternal-Fetal Metabolism
- Maternal metabolism changes during pregnancy:
- Insulin resistance increases.
- Glucose and insulin levels in blood increase.
- Lipids, cholesterol, and triglycerides increase.
- Fetal metabolism:
- Fetus receives glucose from maternal blood.
- Fetus uses ketone bodies for energy during fasting.
Physiological Changes During Pregnancy
- Body water changes:
- Increased plasma volume and extracellular fluid.
- Fatigue associated with plasma volume increase.
- Blood volume changes:
- Increased blood volume (20%) and plasma volume (50%).
- Edema and hemodilution occur.
- Blood lipid levels:
- Increased cholesterol, LDL, and triglycerides.
- HDL levels also increase.
- Blood glucose levels:
- Increased insulin resistance and glucose levels.
Organ and Tissue Enlargement
- Heart, thyroid, liver, kidneys, uterus, and breast tissue enlarge.
- Adipose tissue increases.
Circulatory System
- Cardiac output increases (30-50%).
- Heart rate increases up to 90/min.
- Blood pressure drops, and peripheral resistance decreases.
Respiratory System
- Tidal volume increases (30-40%).
- Oxygen consumption increases (10%).
- Diaphragm is displaced, and respiratory capacity increases.
Gastrointestinal Changes
- Relaxed gastrointestinal tract muscle tone.
- Gastric and intestinal transit time increases.
- Gastrointestinal motility slows, and food moves more slowly through the intestinal tract.
- Nausea, vomiting, and heartburn occur.
Kidney Changes
- Kidneys grow and filter more blood.
- GFR increases (50-60%).
- Urinary urgency and incontinence occur.
Immune System
- Suppressed immunity.
- Increased risk of UTI and reproductive tract infection.
Basal Metabolism
- Increased BMR in the second half of pregnancy.
- Increased body temperature.
Hormonal Changes
- Placental secretions of large amounts of hormones:
- Progesterone and estrogen.
- Hormonal changes affect maternal metabolism and physiology.
Maternal Nutrient Metabolism
Carbohydrate Metabolism
- Glucose is the preferred fuel for energy for the fetus.
- Maternal insulin resistance: Diabetogenic effect of pregnancy.
Protein Metabolism
- Increased protein synthesis for maternal and fetal tissues.
- Decreased N2 excretion and conservation of amino acids for protein tissue synthesis.
Fat Metabolism
- First half: Accumulation of maternal fat stores.
- Second half: Increased fat mobilization.
Mineral Metabolism
- Calcium metabolism: Increased rate of bone turnover and reformation.
- Sodium metabolism: Increased aldosterone secretion and retention of sodium.
Placenta
Functions
- Hormone and enzyme production.
- Nutrient and gas exchange between mother and fetus.
- Removal of waste products from the fetus.
- Barrier to some harmful compounds.
Nutrient Transfer
- Placenta uses 30-40% glucose delivered by maternal circulation.
- Lipid solubility of particles affects transport.
- Concentration of nutrients in maternal and fetal blood affects transport.
Embryonic and Fetal Growth and Development
Critical Periods
- Set time interval during which fetal growth and development proceed along genetically determined pathways.
- No reverse or correction of errors during critical periods.
Fetal Body Composition
- Fetal growth and development dependent on nutrient availability and oxygen supply.
- Insulin-like growth factor-1 (IGF-1) promotes fetal growth.
Fetal-Origins Hypothesis of Later Disease Risk
- Risk of disease begins in utero.
- Fetal programming: alterations in fetal growth and development in response to the prenatal environment.
- Barker's hypothesis: "fetal origins of adult disease".
- Environmental exposures modify development through epigenetic mechanisms.
- Epigenetic mechanisms influence growth and development by silencing certain genes and activating others.### In Utero Critical Periods of Growth
- Early gestation: Hypothalamic centers are susceptible to exposure to over or undernutrition, affecting regulation of appetite and growth, and increasing the predisposition to later obesity.
- Late gestation: Differentiation and hyperplasia of adipocytes occur, and overnutrition causes adipocyte hyperplasia, leading to increased fetal accumulation of fat and later obesity.
Short-Term and Long-Term Effects of Nutrients
- Short-term effects:
- Fetal nutrition affects neurosensory development, growth, and muscle/bone body composition.
- Other epigenetic factors influence metabolic programming, cholesterol, lipids, proteins, hormones, and cell receptors.
- Long-term effects:
- Cognitive capacity and education
- Immunity and work capacity
- Diabetes, cardiovascular disease, stroke, hypertension, cancer, and early aging
Diseases Associated with Underweight at Birth
- Low birth weight is associated with:
- Increased infant death and low birth weight
- Poorer offspring growth and development
- Down-regulation of fetal growth
- Reduced birth weight and thinness
- Increased risk of heart disease, type 2 diabetes, hypertension, and other chronic diseases later in life
Pregnancy Weight Gain
- Recommendations:
- 3500-4500g (7 lbs 13 oz to 10 lbs) birth weight
- Higher weight gain needed for underweight women
- Duration of gestation, smoking, maternal health status, gravida, and parity influence birth weight
- Composition of weight gain:
- Fetus: 5 kg
- Mother: 6 kg
- Body fat changes:
- Storage of body fat during pregnancy, especially between 10-20 weeks
- Decrease before the end of pregnancy
Maternal Obesity Risks
- Risks:
- Preclampasia
- Gestational diabetes
- Cesarian section
- Low Apgar scores
- Macrosomia
- NTD (neural tube defects)
- Fetal overgrowth
- Importance of optimum nutrition to avoid under and overnutrition
Postpartum Weight Reduction
- Factors influencing weight gain:
- High weight gain in pregnancy
- Weight gain after delivery
- Low activity levels
- Importance of exercise and healthy-eating programs
Nutrition in Pregnancy
- Pregnancy: a 3-compartment model (mother, placenta, and fetus)
- Maternal diet:
- Major environmental factor
- Modifies the expression of the genome
- Influences endocrine, immunological, and epigenetic programming
- Increased need for nutrients, especially:
- Energy
- Carbohydrates
- Protein
- Fat
- Vitamins and minerals (e.g., folate, iron, calcium, vitamin D)
Energy and Macronutrient Needs
- Energy:
- 80,000 kcals for full-term pregnancy
- Increased energy needs averaged to +350 kcals/day
- Active women: high need
- Carbohydrates:
- 50-60% of total daily calories
- Main source of extra calories during pregnancy
- Minimum of 175 gms/day
- Protein:
- +25 grams/day or 71 grams/day
- 1.1 gram/kg body weight
- Fat:
- 33% of total daily calories
- Energy source for fetal growth and development
- Source of fat-soluble vitamins
Specific Nutrient Needs
- Folate:
- Prevents anemia and reduced fetal growth
- Essential for DNA synthesis, gene expression, and gene regulation
- High homocysteine levels: genetic abnormalities, rupture of the placenta, stillbirth, preterm delivery, and preeclampsia
- Vitamin A:
- Cell differentiation and growth
- Excessive intakes: malformations of the fetal lungs, urinary tract infection, and heart disease
- Vitamin D:
- Fetal growth, bone mineralization, and immune system function
- Deficiency: smaller than average birth weight, low blood calcium levels, and poorly calcified bones
- Calcium:
- Fetal skeletal mineralization and maternal bone health
- Deficiency: increased blood pressure during pregnancy, decreased bone remineralization, and increased blood pressure of infants
- Iron:
- Fetal growth and development
- Deficiency: increased risk of preterm delivery, low-birth-weight infants, and impaired central nervous system development
- Iodine:
- Fetal brain development and thyroid function
- Deficiency: stillbirth, cretinism, and mental retardation
- Sodium:
- Maintaining body water balance
- Deficiency: exhaustion of sodium conservation mechanisms and excessive sodium loss
Bioactive Components
- Antioxidant pigments:
- Protect fetal DNA from damage
- Reduce risk of asthma and lung inflammation
- Caffeine:
- Increases heart rate, acts as a diuretic, and stimulates CNS
- Limit intake to 4 cups of coffee per day
Herbal Remedies and Supplements
- Use with caution:
- One-third of herbs are unsafe for pregnant women
- Some herbs can produce malformations in animal studies
- Safe options:
- Peppermint tea and ginger root for nausea
Exercise and Pregnancy
- Benefits:
- Improved cardiovascular function
- Limited pregnancy weight gain
- Decreased musculoskeletal discomfort
- Mood stability
- Recommendations:
- 3-5 times a week for 20-30 minutes at 60-70% VO2 max
- Beginners: walking, cycling, swimming, and aerobics
- Exercisers: running, strength training
- Exercises to avoid:
- Contact sports
- Scuba diving
- Gymnastics
- Horseback riding
- Standing for long periods
Food Safety Issues
- Listeria monocytogenes:
- Spontaneous abortion, stillbirth, and mild infection in mothers
- Avoid raw or smoked fish, oysters, unpasteurized cheese, and hot dogs
- Toxoplasma gondii:
- Mental retardation, blindness, seizures, and death
- Avoid raw and undercooked meats, and contaminated fruits and vegetables
- Mercury contamination:
- Fetal brain development, mental retardation, hearing loss, numbness, and seizures
- Avoid eating fish high in mercury
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Description
This quiz covers the factors that influence the transport of nutrients and molecules across the placenta, including molecular size and charge, lipid solubility, concentration gradients, and blood flow. It also touches on the regulation of nutrient transport and the placenta's role as a nutrient sensor.
