CHAPTER 4-5 FSHN 322
55. What are the differences between preterm (< 37 wks), term (38-42 wks), and post-term (>42 wks)? Name three pregnancy outcomes concerns.
o Preterm: before 37 weeks
o Term: around or on the 40 weeks
o Post term after 42 weeks
o Pregnancy concerns
Low birthweight
Preterm delivery
• Increasing risk
o Underweight and gain less than recommended
o Pre-pregnancy obesity
o Increased cholesterol, TG, FFA, markers of inflammation and oxidative stress
• Decreasing risk
o Use of multivitamin supplements and adequate folate intake
o 1-3 fish meals per week
o exercise
Infant mortality
56. Define nutritional genomics. How might epigenetic modifications occurring during pregnancy affect adulthood diseases?
o
57. What is the fetal/developmental origins of disease hypothesis?
o Dutch famine studies
Men and women born in Amsterdam Nov 1943- Feb 1947 during severe famine
Famine exposure during late/mid gestation
• Decreased glucose tolerance
Famine exposure during early gestation
• Atherogenic lipid profile
• Increased BMI and CHD risk
58. Describe what is happening during the maternal anabolic phase vs. the catabolic phase.
o Anabolic phase (0-20 weeks):
Blood volume expansion
increased cardiac output
buildup of fat, nutritent, and liver glycogen stores
growth of some maternal organs
increased appetite & food intake
decreased exercise tolerance
increased levels of anabolic hormones
o Catabolic phase (20+ weeks)
Mobilization of fat and nutrient stores
Increased production and blood levels of glucose, triglycerides, and fatty acids
Decreased liver glycogen stores
Accelerated fasting metabolism
Increased appetite and food intake declines near term
Increased levels of catabolic hormones
59. What are the functions of the placenta? What hormones does it produce?
o Hormone and enzyme synthesis
Human Chorionic Gonadotropin (hCG):
• Maintains early pregnancy by stimulation estrogen and progesterone production by 2nd month
Progesterone
• Maintains implant
• Induces changes in uterine and gastrointestinal structure
• Stimulates Brest duct development
• Promotes Brest and uterine development
Estrogen
• Increases fat synthesis and deposition
• Protein synthesis
• Promotes breast and uterine development
Human Chorionic Somatotropin (hCS)
• Increases maternal insulin resistance
• Promotes protein synthesis
• Breakdown of maternal energy source
Leptin
• Regulates appetite and fat metabolism
• Weight gain
• Utilization of fat as maternal energy source
o Nutrient and gas exchange
o Removal of waste products from fetus
o Prevents passage of maternal red blood cells, bacteria, and large proteins
60. How does glucose metabolism change during pregnancy?
o In the 3rd trimester, insulin insensitivity occurs to increase glucose availability to fetus
61. What changes occur in maternal protein and fat metabolism?
o 2 pounds of protein are accumulated in pregnancy
Small decrease in nitrogen exretion
Small increase in conservation of amino acid for tissue synthesis instead of energy
Diet
o Fat metabolism
First half: fat storage
Second half: fat breakdown
62. What is happening with calcium and sodium during pregnancy?
o Increased water volume and tissue synthesis requires increased sodium and other electrolytes
63. What is Pica?
o Increased cravings for non food items
Related to deficiencies in some minerals like iron
64. Describe the classifications for fetal growth: AGA, LGA, IUGR, SGA-dSGA vs. pSGA
o AGA: appropriate for gestational age
10-90th percentile for gestational age
o LGA: large for gestational age
>90th percentile for gestational age
Related to pre-pregnancy obesity, uncontrolled diabetes, excessive pregnancy weight gain
Few health concerns for infant (except if mother had poorly controlled diabetes), but increased delivery complications for mother
o IUGR: Intrauterine growth restriction/retardation
General term for infants who are small for gestational age
o SGA: Small for gestational age
<10th percentile for gestational age
o dSGA: disproportionally SGA
<10th percentile for gestational age
with normal length and head circumference
Skinny, wasted appearance, small abdomens, little body fat
Due to low maternal weight gain or poor nutrition in 3rd trimester
o pSGA: proportionally SGA
<10th percentile for weight, length,and head circumference
Small but normally proportioned
Likely due to long-term malnutrition in utero
65. Know pregnancy wt gain guidelines (Table 4.17) and how to apply them.
o
66. What is happening with postpartum weight retention?
o Women are gaining more weight during pregnancy and loosing less after delivery
o Prevent by:
Pregnancy weight gain management programs
Weight loss of 1 to 2 pounds per month
Breastfeeding may facilitate weight loss but should not be promoted as an effective weight loss method
67. What are the calorie recs for the 2nd & 3rd trimester? Carbs? Protein? Fat? EPA + DHA
o During pregnancy: calorie intake > energy expended (for resting metabolism and physical activity)
o By trimester
+0 kcal/day for first trimester
+340 kcal/day for second trimester
+452 kcal/day for 3rd trimester
o Carbs:
45-65% of daily calories should come from carbs
At least 175g
From:
• Whole grain products
• Fruits and vegetables
• Other foods that contain no added sugars
o Protein:
Needs to increase
71 g/day
Used for tissue synthesis (for baby)
o Fatty Acid
Linoleic acid (omega-6)
• 13g/day
• From plany oils
Alpha linolenic acid (omega-3)
• 1.4g/day
• Eicosapentaenoic acid (EPA) & Docosahexaenoic acid (DHA) are crucial for fetal neural development, and can be made from dietary ALA, but in low amounts (only 9% conversion of ALA to EPA/DHA)
o Must be obtained from diet
o 300 mg/day
o From:
Cod liver oil
Fish oil (salmon, sardines, herring)
o Alcohol (how much is safe)
Less is better
Passes through placenta to the fetus
o Folate (folic acid vs. dietary folate)-how much of both, name food sources
600 mcg dietary folate
• 400 cg from fortified foods or supplements
• 200 mcg from fruits and veg
From:
• Orange
• Pineapple juice
• Papaya juice
• Dried beans
• Cereal
• Bread
• Pasta
• Rice
o Choline (what is it, why important, and food sources)
Function:
• Phospholipids, cell membranes, and intracellular messengers
• Choline to betaine conversion provides methyl doners (like folate)
450 mg/day
From:
• Eggs
• Beef
• Pork chops
• Lamb
• Ham
• Turkey
• Salmon
• Bread
• Pasta
• Rice
o Vitamin A
Function:
• Cell differentiation
No more than 5000 IU from supplements
Too much will increase fetal abnormalities
• Retinol/retinoic acid intake >10,000 IU/day
• Accutate/retin-A for acne and wrinkles
o D (IU)
Function:
• Fetal growth
• Addition of calcium to fetal bone
• Maternal immunity
15 mcg (600 IU)/ day from food
From:
• 3 cups vitamin D milk
• Sunlight (2x15 mins = 1250 IU)
o Calcium (mg)
Function:
• Fetal skeletal mineralization
• Maintenance of maternal bone
Low calcium associated with
• Increased blood pressure in mom and infant
• Decreased bone remineralization in mother
• Decreased milk calcium content
• Increased release of lead from bone
From:
• 3 cups milk/day
• 2 cups calcium fortified OJ + milk
o Iron (mg)
27 mg/day after 12th week
60-180 mg daily for women with anemia
Take on itself, better absorption
• Has side effects: nausea, cramps, gas, constipation
Diet:
• Best from heme iron & consumed with vitamin C
o Iodine
Function:
• Thyroid function
• Energy production
• Fetal brain development
From
• Iodized salt
• Half of all prenatal vitamins also contain iodine, but amount is not always accurate
o Sodium
Function
• Water balance and plasma volume expansion
From
• Should be consumed to taste
o Caffeine
Limit or stop consumption
<4 cups a day
300mg/dayis ok
o Fluids
At least 3 liters of water
68. What is the MTHFR C6777 variant? Should pregnant women be screened for it? Does folate type matter for women with this variant? How much folate do they need to prevent birth defects?
o MTHFR C6777 is a gene variant that affects production of the major circulating form of folate used in the body
o Women w gene variant are at higher risk of having an NTD affected newborn
NTD -> neural tube defect: affects formation of brain and spinal cord
69. What food safety considerations are there during pregnancy?
o Pregnant women are more susceptible to foodborne infections
Listeria monocytogenes (spontaneous abortions and stillbirth)
o Avoid:
Raw fish
Oysters
Uncooked meat
Unpasteurized milk
Correctly store lunch meats and hotdogs
Raw meats
• Can be passed on from cats
Large, long lived fish
• Sharks
• Swordfish
• Tilefish
• Albacore tuna
• Bass
o Risks
Toxoplasma gondii (mental retardation, blindness, death)
Mercury (fetal neurotoxin)
70. How much should pregnant women exercise?
o At least 150 mins a week
20-30 mins
3-5 times a week
o Walking cycling swimming jogging
71. What is hyperemesis gravidarum?
o Severe form of nausea and vomiting
72. How should we treat heartburn & constipation in pregnancy?
o Heartburn
Eat small meals frequently
Do not go to bed with a full stomach
Avoid acidic foods
o Constipation
Consume dietary fiber
Drink water
Laxative is not recommended
73. How does nutrition affect miscarriage and preterm delivery rates?
o Preterm delivery
Underweight and gain less than recommended
Pre-pregnancy obesity
Increased cholesterol, TG, FFA, markers of inflammation and oxidative stress
o Decreasing risk
Use of multivitamin supplements and adequate folate intake
1-3 fish meals per week
exercise
o
74. How do we treat obesity during pregnancy?
o Low calorie diets
o Prescribed with diuretics and amphetamines
o Use saccharin to limit weight gain
75. Describe the four types of hypertensive disorders during pregnancy. What are the differences between them?
o Chronic hypertension
Diagnosed before pregnancy
Increased risk of preeclampsia, preterm, growth, retardation
Recommendations
• Follow hypertension related diet prescribed before pregnancy
• Salt restriction is NOT recommended but can be decreased if previously treated
o Gestational hypertension
First occurs during pregnancy
Increased risk of later hypertension and stroke
Associated with maternal obesity and central adiposity
Recommendations
• Similar dietary recommendations to chronic hypertension
o Preeclampsia & eclampsia
Oxidative stress
Platelet aggression, increased coagulation
Restricted blood flow
Hypertension
Insulin resistance
Increased FA TG cholesterol
Proteinuria
Pre-pregnancy and pregnancy diets high in plant foods and fiber tend do decrease while diets high in processed meats, drinks and salty snacks tend to increase the risk
Additional antioxidants
• No individual supplement has shown to be effective
Salt
• No restriction has shown to make change
76. What are the three main types of diabetes during pregnancy? How are they treated?
o Gestational diabetes
In 2-12% of pregnancy, increases with maternal obesity
Outcomes in mother
• Early C section
• Shoulder dystocia
• Maternal death
• Increased risk of preeclampsia
• Increased risk of gestational diabetes, hypertensino, T2DM
Outcomes in newborn
• Stillbirth, spontaneous abortion, macrosomia (>10lbs)
• Congenital anomalies
• Increased risk of obesity, hypertension, T2DM, Hypoglycemia, Hypocalcemia
Treated through diet and exercise
• Assess diet and exercise habits
• Develop individualized diet and exercise plan
• Monitor weight gain and dietary intake
• Interpret blood glucose and urinary ketone results
• Follow up during pregnancy and postpartum
• Diet plan
o Whole grains
o Fruits
o Vegetables
o Unsat fat
o Decrease foods and beverages with simple sugars
o Monitor carb intake
o 3 meals and snacks with distributed calories
o Type 2
Occurs in women who enter pregnancy with T2DM will need medical nutrition therapy and close monitoring
Management
• Good glucose control before pregnancy
• Time meals with glucose levels and insulin
• Minimize hyper OR hypo glycamia
• Monitor and adjust weight gain
• Manage carbs and include appropriate fiber, fruits, veg, unsat fats
o Type 1
Blood glucose should be monitored closely
Management
• Dietary intake
• Exercise
• Insulin dose
• Ketones should be monitored
77. What are the risks associated with GDM? How do you diagnose it?
Outcomes in mother
• Early C section
• Shoulder dystocia
• Maternal death
• Increased risk of preeclampsia
• Increased risk of gestational diabetes, hypertensino, T2DM
Outcomes in newborn
• Stillbirth, spontaneous abortion, macrosomia (>10lbs)
• Congenital anomalies
• Increased risk of obesity, hypertension, T2DM, Hypoglycemia, Hypocalcemia
o Diagnosed through blood test
78. Name some risk factors for multifetal pregnancies for mom and newborn.
o Mom
Hypertension and preelampsia
Anemia
GDM
Placenta previa
Kidney disease
Preterm delivery
C section
Fetal loss
o Newborn
Death
Congenital abnormalities
Respiratory distress
Cardiac dysfunction
Cerebral palsy
LBW
79. What is the mean gestational age for twins and triplets? How does their birthweight compare to singletons?
o Twins
37 weeks
5.4 lbs
o Triplets
33-34 weeks
4.0 lbs
80. What are the weight gain guidelines for multifetal pregnancies? What are the general nutrition recommendations for these pregnancies?
o Gain 37-54 lbs
o Nutritional recommendations
Balanced diet
Increase caloric needs (+450 cal a day)
Vitamin and minerals similar to when having one
81. What are some risks of ED during pregnancy? What is the most common ED during pregnancy? What are the nutrition recs?
o Risks
Low fertility
Preterm labor
Spontaneous abortion
IUGR
Hypertension
Anemia
UTI
Poor weight gain
o Most common: binge eating
o Behavioral changes
o Ketosticks to help understand when they are not consuming enough food for healthy pregnancy
82. What are the nutrition recommendations for pregnant teens?
o Similar weight gain and protein as adults
o Increased caloric needs
o Increased calcium (+300 mg) and vitamin D needs
o Referral to food and nutrition programs
Short Answer/Case Study Question Tips for Exam 1, Spring 2025
1. Know how to calculate BMI (no equation will be provided) given a specific case study.
a. Weight (kg) / height (m) 2
2. Know how to interpret BMI for adults-what is classified as underweight, healthy, overweight, obese.
a. Underweight
i. <18.5
b. Normal
i. 18.5 – 24.9
c. Overweight
i. 25 – 29.9
d. Obese
i. 30
e. Severely obese
i. 40
3. Know how to use the Miflon-St. Jeor Equation (No equation will be provided) to calculate total energy needs by multiplying it by activity factors. Know activity factors for different levels of exercise.
a. •Males = (10 x wt) + (6.25 x ht) – (5 x age) + 5
b. •Females = (10 x wt) + (6.25 x ht) – (5 x age) -161
c. •1.2 Sedentary, 1.5 Moderately Active, 1.7 Very Active
- Height in CM and weight in KG
4. Know how to adjust energy needs for weight loss or weight gain.
a. Loss
i. Less food more exercise
b. Gain
i. More food less exercise
5. Be able to discuss the below conditions & preconception:
a. Underweight & Hypothalamic amenorrhea
b. Obesity
c. PCOs,
d. PKU,
e. Celiac Disease,
f. PMS
i. What nutrients, vitamins, and minerals of are of concern with these conditions?
ii. Name three foods that provide these nutrients, vitamins, minerals.
iii. What nutrition/lifestyle/physical activity recommendations do you have for these conditions?
iv. Are there any dietary supplement recommendations for these conditions?
6. Memorize the energy, carbs, pro, fat needs for pregnancy. How do energy needs increase during the pregnancy?
7. Memorize the weight gain guidelines for level of BMI and rate of weight gain for pregnancy.
8. Be able to discuss the below conditions & pregnancy:
a. Nausea & Vomiting
b. Heartburn
c. Constipation
d. Vegetarian & Vegan
e. Obesity
f. 4 Hypertensive Disorders for Pregnancy-how are they different?
g. Type 1, 2 and Gestational Diabetes-know how to apply CHO counting meal plan
h. Multifetal
i. Eating Disorders
j. Adolescents
i. What nutrients, vitamins, and minerals of are of concern with these conditions?
ii. Name three foods that provide these nutrients, vitamins, minerals.
iii. What nutrition/lifestyle/physical activity recommendations do you have for these conditions?
iv. Are there any dietary supplement recommendations for these conditions?