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FSHN 459- Unit 1

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