FSHN 459- Unit 1
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| trickle down theory of preconception health | health prior to pregnancy-> healthy pregnant women -> healthy newborns -> health prior to pregnancy
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| preconception intervention too late- why? | critical periods start immediately after missed period
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| reproductive physiology of women | 7 million ova, 400-500 used in life, egg quality decline as age increases
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| reproductive physiology of men | sperm production begins at puberty; decreases after 35
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| estrogen functions (3) | stimulates GnRH, stimulates storage of glycogen/vascularity, inhibits luteal phase
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| GnRH function | stimulates releaseof FSH and LH
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| FSH functions (2) | stimulates maturation of follicles, estrogen production
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| LH function | stimulates progesterone secretion
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| progesterone functions (3) | prepares uterus, vascularity of endometrium, cell division of fertilized ova
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| male reproductive system | ongoing; sperm mature in 70-80 days; stored in epididymis
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| nutrition related disruptions in fertility (5) | undernutrition, weight loss, obesity, high exercise, specific foods
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| body fat and fertility | BMI <20 or >30; adipocytes produce estrogen, testosterone, leptin
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| zinc and male fertility | zinc helps to decrease oxidative stress, help maturation, help testosterone synthesis (low concentration/abnormal shapes if deficient)
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| folate status and fertility | increased fertility in both sexes
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| iron status and fertility | (women- if deficient) lack of ovulation, low iron stores in infant, preterm delivery
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| vitamin D and fertility | low sperm count in males
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| alcohol and fertility (women) | decreased estrogen levels/disrupted menstrual cycles
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| alcohol and fertility (men) | decreased testosterone levels/toxic effects on the testes
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| halogens/glycols and fertility | pesticides, antifreeze, solvents all reduce sperm count
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| other reproductive hazards for males and females (6) | drugs, smoking, medicines, radiation, chemicals, animal feces
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| supplement use and preconception | any contraindicated in pregnancy=contraindicated in preconception
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| pms cause | enhanced responsiveness to changes in hormones; alteration in availability of serotonin
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| pm dysphoric disorder | >5 pms symptoms
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| pms treatment | calcium, b6, chasteberry; vitamin d, magnesium
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| obesity in males | high estradiol (inhibits FSH and LH)
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| obesity in females | testosterone production
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| SHBG | steroid hormone binding globulin (estrogen/testosterone)
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| chronic inflammation associations (2) | high body fat, low vitamin D
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| polycystic ovary syndrome | hardening, ovum isn't released, insulin resistance
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| polycystic ovary syndrome causes (3) | intra-abdominal fat, environment gene interactions, vitamin D deficiency
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| hypothalamic amenorrhea | decreased secretion of GnRH-> decreased FSH and LH
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| female athlete infertility triad | low energy availability, menstrual dysfunction, altered bone mineral density
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| female athlete triad risk factors (4) | restricted kcal, excessive exercise, vegetarian, social
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| PKU | cannot convert phenylalanine to tyrosine
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| PKU risk factors | (fetus) CNS development, heart defects
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| management of PKU | less meat and wheat
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| celiac and infertility | may be correlated, may not be (US yes UK no)
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| status of pregnancy outcomes | better in better socioeconomic areas
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| infant birth weight outcomes | 3000-4000g (decreases chances of heart disease, lung disease, HTN, DM)
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| blood volume during pregnancy | starts to increase at 10 weeks, plasma 50% developed by 34 weeks
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| hemodilution | RBC mass ^ 30% vs plasma ^ 50%
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| blood lipid/glucose levels during pregnancy | higher for all (TG 3x), insulin resistance
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| circulatory system pregnancy | increased HR, SV-> decreased BP (1st half)
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| respiratory system pregnancy | increased breathing rate, tidal volume, oxygen consumption
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| GI changes pregnancy | decreased muscle tone
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| immune system pregnancy | suppressed immunity (especially urinary and reproductive tract)
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| hCG pregnancy | increases early in pregnancy, stimulates estrogen, progesterone, and endometrium growth
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| progesterone pregnancy (3) | lipid deposition, breasts, endometrium
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| estrogen pregnancy | lipid synthesis and storage, protein synthesis, ligament flexibility
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| leptin pregnancy | decreased in late pregnancy
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| carbohydrates pregnancy | (1st half): increased insulin production
(2nd half): inhibition of glucose-> fat/glycogen (for fetus)
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| fats pregnancy | 1st half: promote accumulation
2nd half: mobilization
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| protein pregnancy | increased protein needed, decreased excretion
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| placenta function (3) | hormone/enzyme production, nutrient/gas exchange, waste removal
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| placenta structure | double lining of cells
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| immunological protection by placenta | barrier to RBCs, bacteria, large proteins
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| maternal/fetal circulation | separate (maternal and umbilical)
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| transfer across placenta depends on (3) | size/charge, solubility, concentration
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| what (nutrient-wise) does not cross placenta? | insulin
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| placenta produces what? | hCS, hCG
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| nutrient utilization order | mom first, fetus second
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| catabolic/anabolic phases of pregnancy | an= 0-20 weeks; cat= >20 weeks
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| miscarriage common causes (4) | chromosome, thyroid, hormone, infections
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| highest risk for miscarriage (3) | underweight, obese, elevated blood lipids
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| variation in fetal growth (3) | energy/nutrient/O2 availability, genetics, IGF-1
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| fetal origins hypothesis | risk of adult disorders influenced by prenatal exposures (epigenetics)
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| fetal programming | certain levels of energy/nutrients affect metabolism/diseases later in life
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| epigenetics in pregnancy | fetus adapts by modifying function of certain genes
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| epigenetics glucose example | high BG and insulin later in life if low during pregnancy
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| diseases associated with FoAD hypothesis | immune dysfunction, bone mass, Alzheimer's
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| parity | # of previous deliveries
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| factors influencing birth weight | gestation duration, smoking, maternal health, gravida, parity
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| gravida | # of pregnancies
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| dramatic changes in US population having babies (4) | ethnic diversity, twin/triplet, age, percentage obese
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| low weight gain in pregnancy (3) | LBW, decreased development, DM, HTN, CVD
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| excessive weight gain in pregnancy | LBW, insulin resistance, macrosomia
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| how many kcal's per day 1st trimester | 0
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| how many kcal's per day 2nd trimester | 340
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| how many kcal's per day 3rd trimester | 452
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| vegetarian diets/ protein during pregnancy | may need up to 30% higher
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| vegetarian deficiencies pregnancy | B12, D, Ca, Zn, N3 FAs, riboflavin
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| alpha linolenic acid conversion | 9% in women (essential in diet)
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| DHA and fetal development | signal transduction, neurotransmission, neurogenesis (cell membranes)
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| DHA/EPA pregnancy | EPA needed for DHA transport, highest accretion into fetal brain during 3rd trimester
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| seafood and mercury pregnancy | passes through placenta (carnivorous fish)
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| EPA DHA pregnancy research findings | intelligence, vision, CNS function, less preterm delivery
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| folate function | homocysteine to methionine (CH3 donor)
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| folate deficiency pregnancy | abnormal tissue formation (placental rupture, stillbirth, preterm, defects, LBW)
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| neural tube defects | first 3 weeks, 70% prevented consumption of adequate folate
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| vitamin a function | cell differentiation
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| vitamin A deficiency pregnancy | preventable blindness, malformation of lungs/urinary tract/heart
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| vitamin D deficiency pregnancy (5) | preeclampsia, IR, GDM, small for gestational age, hypocalcemia
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| calcium | 250 mg/day transferred to fetus
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| calcium requirements pregnancy | last 1/4 (300 mg/day increase)
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| calcium and lead | if bones demineralize, lead is released (CNS development, CNS development)
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| maternal iron depletion | iron deficiency anemia in infants, postpartum depression
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| iron deficiency anemia during pregnancy (6) | decreased oxygen to fetus, infection, CNS function, preterm delivery, LBW, stillbirth
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| iron absorption | depends on woman's need (higher if need more)
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| iodine pregnancy | thyroid/energy; affects brain development
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| sodium pregnancy | do not restrict during pregnancy
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| caffeine pregnancy | mom: slower metabolism
fetus: unable to metabolize
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| caffeine pregnancy recommendations | <200 mg per day (modulation of synaptic efficacy and plasticity)
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| nutrition and depression during pregnancy | folate, B12, Ca, Fe, Se, Zn, N3 FAs
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| phytochemicals pregnancy | need more antioxidants (protect from damage)
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| maternal weight gain | promotoe IOM rate and total weight gain (based on weight); if inappropriate, assess possible cause
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| effect of taste and smell on diet (pregnancy) | meats, gas, cleaning products-> hormonal changes?
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| pica | compulsion to eat non-food substances
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| geophagia | compulsion to eat clay or dirt
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| pagophasia | compulsion to eat ice or freezer frost
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| amylophagia | compulsion to eat cornstarch or laundry starch
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| nausea and vomiting pregnancy | (nausea 7/10, vomiting 4/10) high levels of hormones, iron supplements
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| hyperemesis gravidarum | extreme nausea during pregnancy
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| heartburn pregnancy | progesterone relaxes GI muscles, LES allows contents from stomach into esophagus
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| heartburn pregnancy management | small meals, don't eat before bed
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| herbal remedies and pregnancy | have side effects and rarely tested (do not need to prove they are safe)
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| artificial sweeteners pregnancy | limited research; probably shouldn't eat during pregnancy
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| food safety issues pregnancy | suppressed immunity from progesterone
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| primary concern pathogens pregnancy (3) | Listeria monocytogenes, Salmonella, Taxoplasma gondii
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| Listeria monocytogenes pregnancy | trophoblastic cells trap bacteria; may induce severe fetal infection (stillborn/abortion); grow at refrigerated temperatures
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| Listeria monocytogenes foods pregnancy | deli meats/cold meats, soft cheese, raw milk
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| salmonella sources pregnancy | baby poultry (Easter), raw eggs
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| taxoplasma gondii pregnancy | protozoan that can cause disability, blindness, seizures, death
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| taxoplasma gondii sources pregnancy | cats, raw meats, unclean produce
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| pregnancy and exercise | continue regimens (if safe), start exercising gradually if don't
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| benefits of exercise pregnancy | decreased risk of preeclampsia, GDM, preterm
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| exercise, pregnancy, and brain function | lab animals have demonstrated enhanced cognition, and decreased anxiety like behavior
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| exercise patterns during pregnancy | few pregnant women are meeting exercise guidelines
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| bariatric surgery pregnancy | should wait 2 years after; fat malabsorption; D/B12/Fe/Ca/folate deficiencies possible
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| components of all hypertensive disorders (3) | inflammation, oxidative stress, damage to endothelium of blood vessels
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| factors that increase oxidative stress (6) | high fat/processed meats, trans fats, smoking, visceral fat, inactivity, sugary beverages
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| factors that decrease oxidative stress (4) | colorful fruits, EPA/DHA, vit D, activity
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| chronic hypertension | (before pregnancy/early pregnancy diagnosis), >140 systolic or >90 diastolic
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| hypertension risk factors pregnancy | black, obese, >35, high BP in previous pregnancy
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| risks of HTN pregnancy (4) | preterm, growth retardation, placenta abruption, c section
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| gestational HTN diagnosis | no proteinuria, normal 12 weeks postpartum
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| preeclampsia diagnosis | after 20 weeks, >140 or >90, proteinuria (4% pregnancies, 2% subsequent)
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| preeclampia characterized by | immune system responses to the placenta
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| risk factors for preeclampsia | mother was SGA, deficient in vit D and/or Ca
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| preeclampsia outcomes | maternal acute renal dysfunction, infant growth restriction
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| gestational diabetes | higher incidence with obesity, 50% develop type 2 diabetes later in life
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| risk factors for gestational diabetes (4) | underweight, overweight, obesity, poor diet
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| potential adverse fetal outcomes: GDM | increased insulin production (glucose/FA in cells), risk of DM later, LGA
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| potential adverse maternal outcomes: GDM (3) | preeclampsia, DM later, c-section
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| nutritional management of GDM | exercise, BG control, urinary ketone results (some spillage normal in pregnancy)
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| normal glycemia in pregnancy | spread out kcals, high fiber foods
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| TIDM pregnancy | fetal growth determined 1st half (if not managed preconception)
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| risks to mother multifetal pregnancy (5) | preeclampsia, iron deficiency, GDM, c-section, preterm
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| risks to fetus multifetal pregnancy | death, abnormalities, intraventricular hemorrhage, cerebral palsy
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| HIV pregnancy complications | fat malapsorption, infections
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| HIV pregnancy when transmitted | pregnancy, delivery, breastfeeding
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| eating disorders pregnancy | often diminish during, return after
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| alcohol pregnancy | no safe dose during pregnancy
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| effects of alcohol pregnancy | organ and tissue formation, intellectual development
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| adolescent pregnancies | one of highest in US of all developed countries, risk for inadequate calories/nutrients
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| obesity and adolescent pregnancy | increased rates of overweight/obesity
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| US stats for BF of any duration | 1900: >90%, 1950s-1960s: <30%, steadily increasing now
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| healthy people 2020 targets BF | 80% postpartum, 60% 6 months, 35% 1 year
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| exclusive breastfeeding goals WHO/LLL | 6 months both
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| any breastfeeding goals WHO/LLL | >2 years, >1 year
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| _% of women capable of breastfeeding | 98%
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| _% exclusively breastfed after 6 months | 18%
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| lactogenesis I | milk production, not secreting b/c of prolactin inhibitor
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| lactogenesis II | 2-5 days postpartum, milk comes in
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| Lactogenesis I and II are ___ driven | hormonally; occur whether breastfeeding or not
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| lactogenesis III | 10 days after birth; maintenance of production (removal is control mechanism for supply) *autocrine
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| prolactin | stimulates milk production (suckling, stress, sleep, and sex), inhibits ovulation
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| oxytocin | stimulated by sexual arousal, thinking about nursing, suckling (uterus contractions too)
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| prolactin released from | anterior pituitary
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| oxytocin released from | posterior pituitary
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| Variation in composition breastmilk | during feeding, gestation length, infant age, infection, menses, nutritional status
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| Colostrum vs mature milk | higher protein, lower fat, lower CHO, mononuclear cells, higher Na, K, Cl, vit A
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| Water and breast milk | isotonic with maternal plasma; suspension of water soluble vitamins and proteins
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| Quantity of protein in BM | affected by age of intant, antibiotic effects, anti-inflammation
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| Quality of protein in BM | casein holds in Ca, whey contains enzymes/immunoglobulins
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| Carbohydrates milk | lactose= dominant, poly/oligo, protein-bound CHOs
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| Oligosaccharides in breastmilk | free or bound, stimulate bifidus bacteria
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| Lipid content foremilk vs hindmilk | more fat in hindmilk
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| Lipid composition in BM | types of FA varies with diet, but content doesn’t
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| Trans fatty acids and breastmilk | higher insulin resistance later in life for infant
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| BM consumption and cholesterol | high BM consumption related to low blood cholesterol later in life
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| Fat soluble vitamins BM | vit A high in colostrum, vitamin E adequate for full-term infants but not preterm, vit D may be inadequate
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| B12 and folic acid BM | malapsorption disorders/vegans low in B12, folate adequate in BM
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| Minerals in BM | low concentration, but high bioavailability
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| Flavor exposures in utero | volatile compounds passed through amniotic fluid
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| Flavor exposures in vivo | exposure to different flavors, profound effects on appetite regulation/food preference/food intake
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| Milk production and breast size | does not determine production tissue, but does limit storage
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| Feeding frequency | not related to milk production; responds to degree of emptying
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| Feedback inhibitor of lactation | whey protein that inhibits milk secretion
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| Maternal benefits of breastfeeding | oxytocin, lower breast/ovarian cancer, psychological benefits, economical
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| BF and CVD | (maternal) >13 months highest correlation
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| Nutritional benefits BF | balance of nutrients
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| Breastfeeding microbiota | enteromammary pathway transfers microorganisms from maternal gut via BM
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| Secretory immunoglobulins BM | decreased binding of microorganisms w/ enterocytes, limiting antigens that cross mucosal barrier
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| Bifidus factor | supports Lactobacillus bifidus (enhances phagocytosis of antigens)
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| Additional immunological components BM | antimicrobial, maturation of GI tract
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| Acute illness and BF | diarrhea, GI, ear infections, coughing, vomiting, meningitis
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| Chronic illness and BF | allergies, DM, obesity, many more
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| Childhood overweight and BF | lowers risk of overweight and obesity (metabolic programming, self-regulation)
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| Cognitive benefits BF | higher IQ with duration of BF (emotional behaviors, PUFAs, or IGF-1)
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| Weight loss during lactation | prolactin promotes use of FAs from stores and diet
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| Vitamins and minerals BF | well nourished women don’t need supplement (monitor D, C, E, A, Ca, folate, Fe, thiamin, Zinc)
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| Iron needs BF | less than NPNL because lactating women aren’t menstruating
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| Vegetarian diet BF | multivitamin/mineral supplement (B12 may be low in milk even w/out deficiency symptoms)
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| Caffeine BF | may accumulate and interfere with sleep (monitor reaction)
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| Infant feeding frequency | 1.5-3 hours, should consume foremilk and hindmilk
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| Oral contraceptives and lactation | may reduce milk volume (estrogen), alternative contraception recommended
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| Herbal supplements and BF | not regulated, but some affect milk flow or other symptoms
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| Alcohol BF | wait 2-3 hours, decreases milk yield and ejection
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| Smoking and BF | BM 1.5-3.0x nicotine in BM
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| Environmental exposures and BF | accumulates and may harm infant (benefits of BM still outweigh this)
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| Neonatal jaundice | bilirubin (too much can cause neurological damage)
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| Infant allergies | do not avoid food allergens
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| When should solid foods be introduced? | 6 months
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| Infant colic | garlic, onions, other produce; avoid only if causes problems
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