case study 2
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Sheridan College *
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Health Science
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Feb 20, 2024
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FDNM 1008: Case Study 2: Neural tube defect in pregnancy
1.
2 points: What is the role of folic acid in preventing neural tube defects (NTD)?
In the early weeks of pregnancy, folic acid plays a role in ensuring the proper growth of a baby's spine, brain, and skull, which also helps to avoid neural tube defects. (The Spinal Bifida. ,2021)
The methylation of deoxyuridylate to thymidylate, which occurs during the synthesis of DNA, is a folate-dependent event that is necessary for healthy cell division. Dysfunction of this response sets off a chain of events that may result in megaloblastic anemia. Moreover, folate participates in single-carbon transfers during the synthesis of nucleic acids (DNA and RNA) and the metabolism of amino acids as a coenzyme. (NIH Office of Dietary Supplements,2020)
2.
1 point: When should a woman be concerned about obtaining adequate folic acid?
Every woman who has a chance of getting pregnant should take a daily multivitamin that contains folic acid. At least three months before getting pregnant and during the first three months of pregnancy, folic acid should be taken. (The Spinal Bifida. ,2021)
3.
2 points: What is the prevalence of neural tube defects (NTDs) in Canada?
About one in every 1300 pregnancies in Canada is affected by NTD. (The Spinal Bifida. ,2021)
Prenatal folic acid supplementation has been shown to significantly lower the risk of neural tube defects (NTDs) by more than 70%. (The Spinal Bifida. ,2021)
4.
Risk factors:
a.
6 points: Who is at higher risk of having a child with an NTD?
If they already had a child with an NTD or a pregnancy that was impacted by an NTD, either alone or with their male partner. (HealthLinkBC, 2020)
If someone is battling with alcohol or drug addiction. (HealthLinkBC, 2020)
One is consuming anti-epileptic drugs or drugs that prevent your body from utilizing folic acids, such as anticonvulsants, methotrexate, sulfasalazine, triamterene, trimethoprim, etc. (HealthLinkBC, 2020)
If a person has Crohn's or Celiac disease, has had gastric bypass surgery, has
advanced liver disease, or is on kidney dialysis. (HealthLinkBC, 2020)
b.
4 points: What are Rosie’s risk factors for NTD?
After reviewing her medical and family history, it is discovered that during her previous pregnancy, at 28 weeks, her blood glucose levels were in the gestational diabetes range. An established risk factor for NTD is gestational diabetes. (HealthLinkBC, 2020)
Rosie admits that she smokes. Smoking is a type of drug abuse that might be considered a risk factor for NTDs. (HealthLinkBC, 2020)
5.
Foods and folate:
a.
6 points: List food sources high in folate.
Foods that contain folate include:
Pulses like green soybeans (edamame), dry beans, peas, and lentils. (HealthLinkBC, 2020)
Items made from enriched grains, such as enriched cornmeal and pasta. (HealthLinkBC, 2020)
Other seeds and grains like Peanuts, sunflower seeds, and wheat germ. (HealthLinkBC, 2020)
Asparagus, avocado, spinach, broccoli, romaine lettuce, beets, Brussels sprouts, green peas, gai-lan, and Bok choy are examples of dark green vegetables. (HealthLinkBC, 2020)
b.
2 points: Which of these foods (from question 5a) is high in folate should not be consumed during pregnancy and why?
High vitamin- A food, such as liver and liver products (e.g. liverwurst spread and liver sausages), should be avoided during pregnancy. Especially during the first trimester, eating foods high in vitamin A can result in birth abnormalities. (HealthLinkBC, 2020)
No more than 75g (2.5 oz) of liver or liver products should be consumed weekly if you chose to consume them. Limiting these types of foods while pregnant is the safest course of action. (HealthLinkBC, 2020)
6.
6 points: Based on the nutrition assessment of Rosie’s diet history, what dietary modifications would you suggest (identify the foods to change and revise the recall menu to meet Rosie’s nutritional needs. Remember the guidelines for menu planning and food guide)? Is she meeting DRIs for Calcium, iron and folate?
Based on her diet history following things need to be changed.
Breakfast:
o
Instead, 1 large bagel should be replaced with whole grain bread or whole wheat toast as it contains added fiber, folate, and other nutrients to it. (HealthLinkBC, 2020)
o
Consider having a higher calcium option like low-fat yogurt instead of cream cheese.
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o
Consider adding a source of protein such as eggs or Greek yogurt to increase nutrient content.
Lunch:
o
Choose whole grain bread that has added fiber, folate, and nutrients instead of potato bread which is high in fat and carbohydrates. (HealthLinkBC, 2020)
o
Consider lean protein sources like grilled chicken or turkey without the skin instead of turkey breast deli meat. (HealthLinkBC, 2020)
o
Avoid or reduce the amount of mayonnaise, as it is high in fat and calories. Use mustard or hummus as a healthier alternative.
Snack:
o
Instead of pretzels, choose a healthier option like raw vegetables (carrot sticks, celery) with hummus or a handful of nuts for added nutrients and healthy fats.
Dinner:
o
Consider having grilled or baked fish instead of fried flounder to reduce the intake of unhealthy fats. (HealthLinkBC, 2020)
o
Should have steaming or boiling vegetables instead of corn on the cob, as it is high in starch and lower in nutrients.
o
Replace the Diet Coke with water or unsweetened herbal tea.
o
Instead of low-fat frozen yogurt she should have a low-fat Greek yogurt with added fruits as a healthier option for dessert. 7.
2 points: Should a vitamin and mineral supplement be considered for this patient? Why or why not.
Rosie's consumption of vital vitamins and minerals is inadequate compared to the amount actually required, hence it is recommended she should take vitamin and mineral supplements, especially for iron and folic acid. (Nutrients You Need to Help Your Baby Grow, n.d.)
Her DRI indicates that her calcium intake is 608 mg, iron is 10 mg, and folate
is 238 μg. Whereas, according to the DRI references index, her calcium
should be 1000mg/day, iron 27 mg/day, and folate 600 g and 400 g from supplements. (The National Academies, 2010)