Term
| How does maternal nutrition affect risk of LBW baby and preterm delivery? |
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Definition
| Poor maternal nutrition increases risk of LBW baby, but preterm delivery is usually the consequence of medical or obstetric rather than nutrition-related complications |
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Term
| What is the relationship between maternal weight gain and infant birth weight? |
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Definition
| Maternal weight gain is strongly correlated with infant birth weight |
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Term
| What is the recommended weight gain per week in pregnant women? |
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Definition
- Underweight: 0.51 kg/week (40 lb)
- Normal weight: 0.42 kg/week (35 lb)
- Overweight: 0.28 kg/week (25 lb)
- Obese: 0.22 kg/week (20 lb)
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Term
| Is fetal growth restriction expected in overweight women who gain less weight than expected but are otherwise healthy? |
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Definition
| No. If the mother is overweight and otherwise healthy, weight gain below recommendations is unlikely to be associated with fetal growth restriction |
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Term
| How do energy needs in pregnancy vary by trimester? |
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Definition
- First trimester: negligible increase
- Second trimester: extra 350 kcal/day
- Third trimester: extra 500 kcal/day
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Term
| How should energy needs be measured in pregnant women with hypermetabolic conditions (trauma, sepsis, burns)? |
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Definition
- Indirect calorimetry if available
- If indirect calorimetry is not available, use traditional formulas that estimated needs for hypermetabolic conditions with an additional 200 to 300 kcal/day to support pregnancy
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Term
| How do blood glucose measurements differ for pregnant vs. non-pregnant women? |
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Definition
- Pregnant women have a hyperglycemic response to meals, but have lowered fasting blood glucose as compared with non-pregnant women
- The mean 24-hour blood glucose levels of pregnant and non-pregnant women are comparable
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Term
| What are target blood glucose levels for pregnant women with diabetes? |
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Definition
- Fasting blood glucose: <90
- 2-hour postprandial blood glucose: <120
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Term
| What are the risks of inadequate carbohydrate consumption during pregnancy? |
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Definition
| Inadequate carbohydrate consumption can cause deleterious effects on embryogenesis and behavioral and intellectual development in childhood |
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Term
| Can excessive protein intake be detrimental to fetal growth? |
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Definition
| Historically it was thought that exces protein would not be well-tolerated by the fetus. However, no recent study has shown that high protein intake is detrimental to the fetus. |
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Term
| What is the DRI for protein intake during pregnancy? |
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Definition
| 1.1 g/kg/d during the second and third trimesters, or an additional 25 grams of protein per day |
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Term
| What is the recommended upper limit for protein intake in pregnant women receiving nutrition support? |
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Definition
- Up to 2 g/kg in pregnant women with moderate or severe stress
- Up to 2.5 kg/kg IBW for morbidly obese pregnant women
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Term
| What are the adequate intakes for ALA and linoleic acid in pregnancy? |
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Definition
- ALA: 1.4 g/day
- Linoleic acid: 13 g/day
- Note: these are the same as for non-pregnant people
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Term
| What is the role of DHA in pregnancy? |
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Definition
| There is increasing evidence that DHA is required for optimal fetal growth and cognitive development |
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Term
| What type of EN formula should be used for pregnant EN patients? |
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Definition
| Most enteral products are adequate for pregnant patients |
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Term
| What type of nutrition support should pregnant women with pancreatitis or diabetic gastroparesis receive? |
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Definition
| Enteral nutrition (traditionally they received PN) |
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Term
| What type of nutrition support is favored in pregnancy? |
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Definition
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Term
| Should PPN be used in pregnant women? |
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Definition
| It can be used for 5-7 days in women with a non-functioning GI tract who are not severely catabolic |
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Term
| Can PPN be used as an adjunct source of calories in women unable to tolerate full nutrition support from EN? |
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Definition
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Term
| How do TPN recommendations differ for pregnant patients? |
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Definition
| Standard TPN recommendations are adequate for most pregnant patients |
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Term
| What types of access are used for PN in pregnant patients? |
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Definition
- Short-term access (<30 days): PICC
- Long-term access (>30 days): subcutaneous port or tunneled catheter
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Term
| How do recommendations for PPN access in pregnant women differ from those in the general population? |
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Definition
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Term
| How do lab reference ranges differ between pregnant and non-pregnant women? |
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Definition
| Pregnant women tend to have slightly lower reference ranges for labs than non-pregnant women (the exception is cholesterol/TGs) |
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Term
| How should glycemic control be monitored in pregnant PN patients? |
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Definition
| Serum glucose in pregnant PN patients should initially be checked every 6 hours, and more frequently in cases of glucose intolerance |
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Term
| How should iron status be monitored during pregnancy? |
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Definition
- Iron-binding capacity
- Serum iron
- Hemoglobin
- Hematocrit
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Term
| What is the relevance of glucosuria in pregnancy? |
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Definition
| More than 50% of pregnant women have glucosuria. It is not necessarily related to maternal hyperglycemia. |
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Term
| What are potential causes of ketonuria in pregnant women? |
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Definition
- Inadequate hydration
- Hyperglycemia
- Inadequate calorie intake
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Term
| Should urine ketones be monitored in pregnant nutrition support patients? Why? |
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Definition
| Monitoring urine ketones is recommended for pregnant nutrition support patients so that calorie and fluid intake can be adjusted appropriately |
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Term
| How often should urine ketones be checked in pregnant nutrition support patients? |
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Definition
| Urine ketones should be checked daily initially, then as-needed if there is a change in the mother's status |
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Term
| What type of nitrogen balance is ideal during pregnancy? |
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Definition
| It is ideal to maintain a positive nitrogen balance to ensure adequate protein for the fetus |
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Term
| How does acid-base balance differ in pregnancy? |
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Definition
| In pregnancy, a chronic state of compensated respiratory alkalosis exists, and buffering capacity is decreased. This is mostly due to increase in maternal respiratory rate and increased excretion of bicarbonate by the maternal kidneys. The result is that pH is maintained within normal limits. |
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Term
| What is the increase in maternal energy requirements during lactation? |
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Definition
- +500 kcal/day for the first 6 months
- +400 kcal/day for the second 6 months
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Term
| How is hyperemesis gravidarum defined? |
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Definition
HG is a condition that results in dehydration, electrolyte imbalance, and a loss of >5% of body weight
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Term
| What micronutrient deficiency is particularly likely in patients with HG? |
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Definition
| Thiamine, particularly when dextrose-containing IVF are initiated without prior supplementation |
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Term
| When does HG typically begin and end? |
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Definition
| HG typically begins between the 6th and 12th week of pregnancy and resolves by the 20th week of pregnancy |
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Term
| At which point should nutrition support be considered for patients with HG? |
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Definition
| Failure of attempts to stop vomiting and continued weight loss with a 48-hour trial of IVF and anti-emetics indicate consideration of nutrition support |
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Term
| What is the algorithm for preferred nutrition in HG? |
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Definition
- Oral nutrition (first line)
- NG tube (PEG if long-term)
- NJ tube (G-J if long-term)
- PN (should only be used if EN fails)
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Term
| What criteria are necessary for consideration of PN in pregnant patients with HG? |
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Definition
- Weight loss over >4 weeks
- Failed conservative therapy
- Failed EN
- Persistent laboratory abnormalities
Note: all of these should be present for consideration of PN |
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Term
| Is the endoscopic or fluouroscopic method of feeding tube placement preferred for pregnant patients? |
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Definition
| Fluoroscopic is preferred and endoscopic placement should be reserved for those who fail flouroscopic placement (despite potential risk of fetal radiation exposure in flouroscopic placement). |
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