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Flashcards in this deck (65)

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  • What fetal and maternal complications are associated with preexisting diabetes in pregnancy?

    • Fetal growth problems
    • Preeclampsia
    diabetes pregnancy complications

  • How does chronic hypertension relate to preexisting diabetes in pregnancy?

    Chronic hypertension can be worsened by poor glycemic control in pregnancy

    hypertension diabetes pregnancy

  • What metabolic state describes diabetic ketoacidosis in pregnancy?

    Reliance on ketone bodies from fatty acid breakdown for energy instead of glucose

    dka metabolism diabetes

  • What fetal risk is increased by diabetic ketoacidosis during pregnancy?

    Increased risk of fetal death

    dka fetal risk

  • When is organogenesis and the period of highest risk for congenital malformations in pregnancy?

    Organogenesis occurs during the first 8 weeks of pregnancy

    congenital organogenesis pregnancy

  • What preconception Hgb A1C level is associated with the lowest risk of congenital abnormalities?

    Hgb A1C levels <6.5% are associated with the lowest risk of congenital abnormalities

    a1c preconception diabetes

  • What general Hgb A1C goal does the American Diabetes Association recommend?

    General ADA Hgb A1C goal: <7%

    a1c guidelines diabetes

  • What blood glucose target is described for very tight control during pregnancy?

    Very tight blood glucose control: <100 mg/dL

    glucose pregnancy targets

  • When is gestational diabetes typically diagnosed?

    Typically diagnosed at 24–28 weeks' gestation

    gdm diagnosis pregnancy

  • Why does insulin resistance increase in the second and third trimesters?

    Insulin resistance increases due to fluctuations in hormone levels

    insulin gdm pregnancy

  • What causes gestational diabetes when insulin resistance rises?

    An inadequate maternal insulin response to overcome high insulin resistance

    gdm pathophysiology pregnancy

  • Name fetal and infant adverse outcomes associated with gestational diabetes.

    • Fetal macrosomia
    • Perinatal injury
    • Shoulder dystocia
    • Neonatal morbidity
    • Hypoglycemia
    • Increased risk for obesity and diabetes
    gdm fetal outcomes

  • Name maternal adverse outcomes associated with gestational diabetes.

    • Progression of GDM to type 2 diabetes
    • Increased Cesarean delivery
    gdm maternal outcomes

  • What are key components of medical nutritional therapy for gestational diabetes?

    • Carbohydrate timing
    • Carbohydrate quantity and quality
    • Physical activity
    • Emotional support
    • Medications
    gdm treatment nutrition

  • When does hyperemesis gravidarum usually begin in pregnancy?

    Usual onset during weeks 4–10 of gestation

    hyperemesis pregnancy onset

  • What is the most common indication for hospital admission during the first trimester?

    Hyperemesis gravidarum is the most common indication for admission in the first trimester

    hyperemesis hospital pregnancy

  • What are frequent hallmarks or complications of hyperemesis gravidarum?

    • Dehydration
    • Electrolyte abnormalities
    hyperemesis complications pregnancy

  • What possible cause of hyperemesis gravidarum is mentioned?

    May be caused by a rise in select hormones and GI sensitivity to hormonal changes

    hyperemesis etiology pregnancy

  • What weight change defines severe weight loss in hyperemesis gravidarum?

    • Weight loss >5% of pre-pregnancy weight
    hyperemesis obstetrics

  • Name three maternal complications of hyperemesis gravidarum.

    • Micronutrient deficiency
    • Protein calorie malnutrition
    • Diaphragmatic tears
    hyperemesis maternal

  • Name three fetal complications associated with hyperemesis gravidarum.

    • Premature birth
    • Low birth weight
    • Increased length of stay in hospital after birth
    hyperemesis fetal

  • What are basic treatments recommended for hyperemesis gravidarum?

    • Hydration
    • Small frequent meals
    • Avoid GI irritants or high fat foods
    hyperemesis treatment

  • How do fraternal (dizygotic) twins form?

    • More than one mature egg is released, each fertilized and implanted separately
    twins fraternal

  • List key features of fraternal twins.

    • Separate placenta and amniotic sac
    • Share ~50% of DNA
    • Can be boys, girls, or both
    twins fraternal

  • How do identical (monozygotic) twins form?

    • One egg is fertilized by sperm, then splits into two or more embryos
    twins identical

  • List key features of identical twins given in the notes.

    • Most share a placenta but have separate amniotic sacs
    • Identical DNA/genetics
    • All boys or all girls
    twins identical

  • What factors increase the likelihood of a multiparity (multiple pregnancy)?

    • Heredity
    • Older age
    • High parity
    • Black women (race)
    • Ovulation-stimulating medication
    • IVF
    multiparity risk-factors

  • List maternal complications associated with multiple gestation or high-risk pregnancy in the notes.

    • Preeclampsia
    • Iron deficiency anemia
    • Hyperemesis gravidarum
    • Placenta previa
    • Cesarean section delivery
    • Gestational diabetes mellitus
    pregnancy maternal

  • List fetal complications associated with multiple gestation or high-risk pregnancy in the notes.

    • Preterm birth
    • Low birthweight
    • Congenital anomalies
    • Fetal loss
    pregnancy fetal

  • What nutritional therapy recommendation is given for pregnancy-related nutritional needs?

    • Eat more macro and micronutrients
    nutrition pregnancy

  • What is Lactogenesis I and its typical duration?

    Lactogenesis I: Milk formation begins; occurs from the last trimester to 2–5 days after birth.

    lactation lactogenesis

  • What characterizes Lactogenesis II and when does it occur?

    Lactogenesis II: Increased blood flow to the breast and onset of copious milk secretion; ~2–5 days after birth to ~10 days postpartum.

    lactation lactogenesis

  • What is Lactogenesis III and when does it begin?

    Lactogenesis III: Milk composition is stable; begins at ~10 days after birth.

    lactation lactogenesis

  • What is the role of prolactin in breastfeeding?

    Prolactin stimulates milk production and its secretion is stimulated by suckling.

    lactation hormones

  • What is the role of oxytocin in breastfeeding?

    Oxytocin causes ejection of milk from the mammary gland (letdown) and its secretion is stimulated by suckling.

    lactation hormones

  • Name three factors that affect breast milk synthesis.

    • How vigorously an infant nurses
    • How much time the infant is at the breast
    • How many times per day the infant nurses
    lactation supply

  • What is the major component of human breast milk?

    Water is the major component of breast milk.

    milk composition

  • How much of human milk calories come from lipids and how do foremilk and hindmilk differ?

    Lipids provide 1/2 of calories in human milk; fat is lower in foremilk and higher in hindmilk.

    milk lipids

  • Which fatty acid in human milk is noted as essential for brain and retinal development?

    DHA is noted as essential for brain and retinal development.

    milk dha

  • How does human milk cholesterol compare to human milk substitute (HMS)?

    Cholesterol is higher in human milk than in HMS.

    milk cholesterol

  • How does protein content in human milk compare to whole cow's milk, and what properties does it have?

    Human milk has lower protein content than whole cow's milk and has antiviral and antimicrobial effects.

    milk protein

  • What percentage of human milk protein is whey and what are its roles?

    Whey is 60% of total protein in human milk; it is part of several mineral, vitamin, and hormone-binding proteins and has antimicrobial activity.

    milk protein

  • What is casein's role and proportion in mature human milk?

    Casein is the major protein in mature human milk, ~40% of total protein, and it facilitates calcium absorption.

    milk casein

  • What is the main carbohydrate in human milk and one of its functions?

    Lactose is the major carbohydrate and it enhances calcium absorption.

    milk lactose

  • Which vitamin is doubled in colostrum and contributes to its yellow color?

    Vitamin A is doubled in colostrum; beta-carotene gives colostrum a yellow color.

    milk vitamins

  • Which vitamin in breast milk may be insufficient for preterm infants?

    Vitamin E may not be enough for preterm infants.

    milk vitamins

  • What intervention is required at birth to prevent vitamin K deficiency?

    A vitamin K injection at birth is required to prevent deficiency.

    newborn vitamink

  • How does the bioavailability of water-soluble vitamins in human milk compare?

    Bioavailability of water-soluble vitamins is greater in human milk.

    milk bioavailability

  • Name a trace mineral explicitly mentioned in the lactation notes.

    • Zinc
    nutrition minerals

  • What is one hormonal benefit of breastfeeding mentioned?

    • Increased oxytocin stimulates the uterus to return to pre-pregnancy status
    breastfeeding hormonal

  • What physical reproductive benefit of breastfeeding is listed?

    • Delay in monthly ovulation resulting in longer intervals between pregnancies
    breastfeeding physical

  • What psychological benefits of breastfeeding are mentioned?

    • Self-confidence & bonding with infant
    breastfeeding psychological

  • How does human milk compare to human milk substitutions (HMS) according to the notes?

    • HMS use human milk as a standard
    breastfeeding nutrition

  • What type of curd does human milk contain and why is it beneficial?

    • Soft, easily digestible curd (whey protein)
    breastfeeding nutrition

  • How does human milk meet infants' protein needs?

    • Meets infants' protein needs without overloading kidneys
    breastfeeding nutrition

  • Name two nutritional qualities of human milk listed.

    • Provides generous amounts of beneficial lipids
    • Minerals more bioavailable
    breastfeeding nutrition

  • List three immunological benefits of breastfeeding mentioned.

    • Decreased infant mortality in developing countries
    • Fewer acute illnesses
    • Reductions in chronic illness
    breastfeeding immunology

  • What childhood outcome related to weight is associated with breastfeeding?

    • Better childhood weight status
    breastfeeding outcomes

  • Name two additional benefits of breastfeeding noted besides immunological and nutritional.

    • Cognitive benefits
    • Analgesia effects (decreases infant pain)
    breastfeeding benefits

  • What general recommendation about exclusive breastfeeding duration is given?

    • Exclusively breastfeed for first 6 months
    breastfeeding recommendation

  • How is infant colic defined in the notes?

    • Infant colic: crying for more than 3 hours/day – no medical cause
    colic definitions

  • Which maternal dietary components are noted as more likely associated with infant colic?

    • Cow's milk, onions, cabbage, broccoli & chocolate
    colic diet

  • What advice is given to mothers whose foods seem to cause infant colic?

    • Exclude foods that seem to cause problems & replace nutrients lost with the exclusion
    colic diet

  • What is stated about food intolerance and allergenic elimination in relation to colic?

    • Low allergen maternal diet associated with decreased colic; allergenic foods eliminated: cow's milk, eggs, peanuts, tree nuts, wheat, soy, fish, shellfish
    colic allergy

  • What two maternal lifestyle aspects are listed under maternal diet recommendations?

    • Energy requirements
    • Exercise
    maternal diet
Notes de cours

Pregnancy: Diabetes and Glycemic Control

Preexisting diabetes (type 1 or 2)

  • Main risks: fetal growth abnormalities, preeclampsia, worsened chronic hypertension with poor glycemic control.
  • Diabetic ketoacidosis (DKA): maternal reliance on ketones increases fetal death risk.
  • Congenital malformations: occur during organogenesis (first 8 weeks); risk rises with higher maternal HbA1c.
  • Preconception goal: optimize glycemia; aim for HbA1c \(<6.5\%\) to minimize congenital risk (ADA general goal \(<7\%\)).
  • During pregnancy: maintain very tight blood glucose control; target fasting/glucose values often cited as \(<100\ \text{mg/dL}\) (individualize per clinician).

Gestational diabetes mellitus (GDM)

  • Timing/diagnosis: usually screened and diagnosed at 24–28 weeks gestation.
  • Pathophysiology: rising insulin resistance in 2nd–3rd trimesters; GDM results when maternal insulin response is inadequate.
  • Fetal complications: fetal macrosomia, shoulder dystocia, perinatal injury, neonatal hypoglycemia, increased long‑term risk of obesity and diabetes.
  • Maternal complications: increased cesarean delivery rates and higher future risk of type 2 diabetes.
  • Treatment principles: medical nutritional therapy (carbohydrate timing and quality, portion control), physical activity, glucose monitoring, and medications (insulin or approved oral agents when needed).

Hyperemesis gravidarum (HG)

  • Definition: severe, persistent nausea and vomiting of pregnancy beyond typical morning sickness.
  • Typical onset: between 4–10 weeks gestation; common first‑trimester cause of hospitalization.
  • Key features: dehydration, electrolyte disturbances, and often >5\% weight loss from pre-pregnancy weight.
  • Maternal complications: micronutrient deficiencies, protein–calorie malnutrition, rarely severe complications (e.g., organ strain).
  • Fetal complications: prematurity, low birth weight, longer neonatal hospital stays.
  • Management: rehydration, correct electrolytes, small frequent meals, avoid GI irritants and high‑fat foods, antiemetics and nutritional support as needed.

Multiple pregnancy (multiparity)

Types

  • Fraternal (dizygotic): two separate eggs fertilized; separate placentas and sacs; siblings share ~50% DNA; can be mixed sexes.
  • Identical (monozygotic): single fertilized egg splits; embryos usually share a placenta but have separate sacs; identical genetics → same sex.

Risk factors for multiples

  • heredity, advanced maternal age, high parity, Black race, ovulation‑stimulating medications, and IVF.

Maternal complications

  • higher rates of preeclampsia, iron‑deficiency anemia, hyperemesis gravidarum, placenta previa, cesarean delivery, and GDM.

Fetal complications

  • preterm birth, low birthweight, congenital anomalies, increased perinatal loss.

Care points

  • increased prenatal monitoring, tailored nutritional support (higher macro/micronutrient needs), and planning for delivery complications.

Lactation and Breastfeeding

Phases of lactogenesis

  • Lactogenesis I: begins in last trimester until ~2–5 days postpartum; initial milk production starts.
  • Lactogenesis II: ~2–5 days to ~10 days postpartum; onset of copious milk (milk "coming in") and increased breast blood flow.
  • Lactogenesis III (galactopoiesis): from ~10 days onward; milk composition stabilizes.

Hormonal control

  • Prolactin: stimulates milk synthesis; increased by infant suckling.
  • Oxytocin: causes milk ejection (let‑down); released with suckling and other stimuli.

Factors affecting milk supply

  • infant nursing vigor, duration at breast, and feed frequency (supply follows demand).

Milk composition (high‑value points)

  • Water: major component.
  • Lipids: provide ~50% of calories; foremilk lower and hindmilk higher in fat; includes DHA (critical for brain/retinal development) and cholesterol (higher than in formula).
  • Protein: lower total protein than cow's milk; mainly whey (~60% of protein) and casein (~40%), promoting easier digestion and calcium absorption.
  • Carbohydrate: lactose is the primary carbohydrate and enhances calcium absorption.
  • Vitamins/minerals: Vitamin A is high in colostrum; Vitamin E may be insufficient for preterm infants; Vitamin K prophylaxis at birth is required; water‑soluble vitamins and trace minerals have higher bioavailability than in formulas.

Benefits of breastfeeding

  • Hormonal/physical: oxytocin aids uterine involution and lactational amenorrhea delays ovulation.
  • Nutritional: milk composition matches infant needs; proteins and lipids are optimally balanced and minerals are more bioavailable.
  • Immunological: fewer acute and chronic illnesses, lower infant mortality in resource‑limited settings.
  • Psychological/socioeconomic: bonding, maternal confidence, cost savings.
  • Other: analgesic effect for infant pain, cognitive benefits, improved childhood weight outcomes.

Recommendations and practical guidance

  • Exclusive breastfeeding for the first 6 months when possible.
  • Maternal nutrition: increased energy and nutrient needs during lactation; maintain healthy exercise.

Infant colic and maternal diet

  • Colic: inconsolable crying >3 hours/day without identifiable medical cause.
  • Certain maternal foods (cow's milk, onions, cabbage, broccoli, chocolate) may worsen colic; trial elimination for ~2 weeks if suspected and replace nutrients lost.
  • A low‑allergen maternal diet can reduce colic in some infants; common allergens to consider eliminating: cow's milk, eggs, peanuts, tree nuts, wheat, soy, fish, shellfish.

Quick clinical takeaways

  • Preconception glycemic control (HbA1c \(<6.5\%\)) reduces congenital risk in diabetic women.
  • Screen for GDM at 24–28 weeks and treat with diet, activity, monitoring, and medications when indicated.
  • Treat hyperemesis with fluids, electrolytes, nutritional support and symptom control to prevent maternal and fetal harm.
  • Multiples require closer surveillance and enhanced nutritional/obstetric planning.
  • Encourage exclusive breastfeeding for 6 months; understand milk composition, hormonal regulation, and common lactation issues.