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ntrs 413 midterm

Menstrual cycles
Follicular phase(first half): (Estrogen) stimulates hypothalamus and secrets (GnRH) causing the pituitary to release (FSH). LH lvld increase follicles secreting progesterone. ovulation occurs

Luteal Phase: lower estrogen and progesterone, menstrual flow

Know which Dietary factors related to infertility in women
?oral contraceptive
?Anorexia and bulimia
?Vegan diet
?Age >35
?Metabolic Syndrome?
?Pelvic inflammatory disease?
?Endometriosis?
?Polycystic ovary syndrome
?Poor iron stores
Know which Nutrition factors related to infertility in men
Zinc deficiency
Heavy Metals
Halogens and glysol
Estrogen
Sperm defect
excessive Heat testes
Steroids abuse
high intake of Soy
Fertility is affected in women with a BMI
BMI < 20 and > 30.
An underweight woman with amenorrhea should
should increase her weight in order to increase her hormones.
Recommended daily intake of folate for all women who may become pregnant is
400mcg from fortified grains products vegetables fruits or supplements
Exposures to these nutrients would disrupt fetal growth and development
Insufficient folate
High maternity blood levels of lead
Excessive vitamin A ( facial and heart abnormalities)
Iodine deficiency
Iron deficiency (impaired mental and physical development)
What is the primary effect (s) of chronic undernutrition on reproduction in women?
Birth of small and frail infants with a higher likelihood of death in the 1st year of life
From the article know how chronic diseases influence conception and some possible interventions:
– Most chronic conditions increase in frequency with age.
– The longer a woman has had a chronic condition the greater her health has been affected.
-Treatments may be teratogenic and/or hazardous to the mother in pregnancy and need to be modified for women who are pregnant or at risk for conception.
-Nutrition, exercise, and reduce smoking and stress are recommended.
What are teratogens?
Teratogens: exposures that produce malformations in embryos or fetuses (alcohol, high blood glucose levels during first 2 months)
Know what comprises the diets developed for people with type 2 diabetes.
Total of kcalories= 15-20% protein,
<30% fat, 50% carbohydrates, saturated fat <7%, Trans fats as low as possible, <200 mg cholesterol, 14g fiber/100kcal, grain intake = 50% whole grains, low glycemic index foods.
Know the clinical signs associated with polycystic ovary syndrome (PCOS).
Menstrual irregularities
polycystic ovaries
excessive abdominal fat
Insulin resistance,
high blood insulin and testosterone levels, obesity/ overweight
infertility
amenorrhea
low HDL cholesterol lvl
Dietary recommendations for women with PCOS emphasize which foods?
-Omega-3 fatty acids such as EPA DHA or fish oil
-whole grains
-fruits, and vegetables high in antioxidants and fibers
-Eat regular meals, non-fat dairy, low-glycenic foods.
Be able to identify the three components of the female athlete triad.
Amenorrhea: Intake is 30% less than required
Disordered eating: anorexia and bulimia
Osteoporosis. Vitamin D, and Calcium are needed
Which conditions would be seen in higher rates in obese women?
They have higher rates of metabolic syndrome, polycystic ovary syndrome, gestational diabetes and hypertension, fetal overgrowth cesarean delivery and still birth.
Know signs and symptoms of celiac disease.
male: delayed sexual maturation hypogonadism
female: amenorrhea, increase miscarriage, fetal growth restriction, LBW, short duration of lactation, other: anemia, weight loss, lactose intolerant, osteoporosis, irritable bowel disease.
What are the changes in lipid blood levels that occurs during pregnancy and why do
they occur?
During pregnancy, increased concentrations of cholesterol, blood lvls of LDL and HDL , plasma triglycerides, phospholips and fatty acids.
These changes promote the accumulation of maternal fat stores in the first half of pregnancy and enhance fat mobilization in the second half.
What is the preferred source of fuel for the fetus?
Glucose
The recommended daily protein intake for pregnant women is
+25g or 71g daily and 1.1g/kg body weight for females aged 14 and older. The average intake for females is ~78g.
What is Pica?
Pica: Eating disorder characterized by craving non-food substances. 75% of pregnant women in southern parts of USA and most common in African Americans. Pregnant women crave and consumed nonfood items.
likely to be iron deficient.
What are some changes a pregnant woman in the anabolic phase of pregnancy can expect?
Maternal anabolic phase 0-20wks
-Blood volume expansion, increased cardiac output
-Buildup of fat, nutrient, and liver glycogen stores
-Growth of some maternal organs
-Increased appetite, food intake
-Decrease exercise tolerance
-Increase levels of anabolic hormones
What are some changes a pregnant woman can expect in the catabolic phase?
Maternal catabolic phase 20+ wks
-Mobilization of fat and nutrient stores
-Increased production and blood levels of glucose triglycerides, and fatty acids, decreased liver glycogen stores
-Accelerated fasting metabolism
-Increased appetite and food intake decline somewhat near term
-Increase levels of carbolic hormones
Explain why the hemodilution of nutrients occurs during pregnancy.
Concentration of most vitamins and minerals in blood decrease becase the volume of blood increases during pregnancy (hemodilution), a moderate decrease in the concentration of red blood cells and hemoglobin is normal
Explain the difference between small for gestational age (SGA) and low birth weight.
SGA: Newborn weight is <10th percentile for gestational age Low birth weight: Newborn weights <2500g (5lb 8oz)
Know the probable outcome for a severe food shortage at different times during a pregnancy .
The baby will be low birth weight and most likely to be small for gestational age (SGA)
What are the major functions of the placenta
-hormone and enzyme production
-nutrient and gas exchange between mother and fetus
-removal of waste products from the fetus
What are factors related to infants who are large for gestational age (LGA)?
>90% weight for gestational age.
-Related to pregnancy obesity
-poorly controlled diabetes in pregnancy
-excessive weight gain in pregnancy (44lbs) possible other factors.
What are the recommended weight gains for women during pregnancy.
Underweight 28-40lb
Normal 25-30lb
overweight 15-25lb
obese 11-20lb
twins 25-54lb
The recommended dietary allowance for folate, iron, calcium, DHA and vitamin
D during pregnancy are …
Folate: 600 IU/day
-400mcg folic acid from foods or supplements
-200mcg from vegetables and fruits
Iron: 27/mg/day,
DHA: 250 mg/day,
Calcium: 1000 mg/day,
Vitamin D: 770 IU/day
What is the role of edema in pregnancy?
Edema: the swelling due to accumulation of extracellular fluid usually of legs and feet.
gains in body water vary a good deal among women during normal pregnancy because high gains are associated with increasing degree of edema.
It reflects a healthy expansion of plasma volume. birth weight is strongly related to plasma volume. greater the expansion the bigger the newborn
What advice can we give to a woman suffering peristent nausea and vomiting?
-continue to gain weight
-Separate liquid and food intake
-Avoid odors and food that trigger
– select foods that are well tolerated
-Vitamin B6, multivitamins, and ginger
Know common pregnancy health problems (i.e. heartburn) and advice to treat them.
Heartburn:
-Ingest small meals frequently.
-Don’t go to bed with a full stomach
-Avoid foods that make heartburn worst
Constipation:
-Consume 30g dietary fiber daily
-Drink water along w fiber
-Laxative pills are not recommended
Hypertension is defined as having a blood pressure of >
> or = 140mm Hg systolic or > or = 90mm Hg diastolic
Women with which characteristics are at risk of developing preeclampsia?
-Insulin resistance
-Obesity
->age 35
-High blood triglycerides
-First pregnancy
-chronic hypertension and proteinuria
Which nutrients appear to reduce or prevent preeclampsia?
-multivitamin and mineral supplements.
-1000-2000 mg or more of supplemental calcium
-adequate vitamin D
-colorful vegetables and fruits
-moderate exercise
-NO high iron supplements
Of the hypertensive disorders during pregnancy know which are less serious and which are more serious.
Gestational hypertension appears to be less serious, because blood pressure should return to normal by 12 weeks postpartum. Preeclampsia-exclampsia is the most serious hypertensive disorder during pregnancy because it could affect the mom and the baby
chronic is the least its before pregnancy
Women with preeclampsia are at an increased risk of developing what other types of conditions during pregnancy?
risk of Gestational diabetes- type 2 diabetes, hypertension, heart disease and stroke later on
Glucose screens are not recommended for women at low risk of developing gestational diabetes during pregnancy. Who are low-risk women?
-Age <25, -not Hispanic, African Americans, south or east Asians, Pacific Islanders -no diabetes in first degree relatives -normal weight -no history of glucose intolerance -no prior poor obstetrical outcomes
For a majority of women with gestational diabetes, what is the primary way to achieve healthy infant outcomes? (is it medications or lifestyle changes or something else?)
well controlled blood glucose lvls and through healthy diet and exercise.
What are the primary goals for women with gestational diabetes?
-assessing dietary habits and exercise habits
-developing an individualized diet and exercise plan for blood glucose control
-monitoring weight gain, dietary intake
-interpreting blood glucose and urinary ketone results
-ensuring follow-up during pregnancy and postpartum
The Institute of Medicine recommends women gain _____. (know for all BMIs)
Underweight 28-40lb
Normal 25-30lb
overweight 15-25lb
obese 11-20lb
twins 25-54lb
know about eating disorders during pregnancy
anorexia nervosa, bulimia nervosa, binge eating disorder
Know how we define fetal alcohol spectrum disorders and recommendations for alcohol intake during pregnancy.
Fetal alcohol spectrum: describes range of effects that fetal alcohol exposure has on mental development and physical growth.
-It is recommended that women do not drink alcohol while pregnant.
Know what causes gestational diabetes.
Insulin resistance, obesity, weight gain, underweight, >35 age, family history
Know components of appropriate dietary advice for women with gestational diabetes.
-carbohydrates =40-50%–should be obtained from complex carbohydrate foods that are high in fiber
-protein = 20%
-fat = 30-40%– fat calories should be obtained primarily from food sources of unsaturated fats.

-whole grain breads and cereal vegetables fruits and high fiber foods
-limited intake of simple sugars
-low gi-foods
3 regular meals and snacks daily

Know components of appropriate dietary advice for women with preeclampsia.
1000-2000 mg per day of dietary or supplemental calcium
-adequate vitamin D status
-use of a multivitamin-mineral supplement
-five or more serving of colorful vegetables and fruits daily
What are nutrition goals for women with HIV?
-Maintenance of positive nitrogen balance & preservation of lean muscle & bone mass
-Adequate intake of energy & nutrients to support maternal physiological changes & fetal growth & development
-Correction of elements of poor nutritional status identified by nutritional assessment
-Adoption of safe food-handling practices
Delivery of a healthy newborn
What nutritional and other information should be given to pregnant teens?
-They need more kcalories -nutrient dence diet for proper weight gain
-higher calcium DRI (1300mg)
-psychological support.
Know the different hormones and what they are responsible for
Estrogen: Ductal growth.
Progesterone: Alveolar development.
Human growth hormone: Development of terminal end buds.
Prolactin: Stimulates milk production and Released in response to suckling, stress, sleep
Human placental lactogen: Alveolar development.
Oxytocin: Stimulates letdown, Tingling of the breast may occur corresponding to contractions in milk duct, and Causes uterus to contract, seal blood vessels, & shrink in size.
Know the maternal benefits of breastfeeding.
•Immunological benefits
– Lower infant mortality in developing countries
– Fewer acute illnesses
• Reductions in chronic illnesses
– Reduce risk of celiac disease, IBS
– Reduce risk of allergies and asthmatic disease
• Breastfeeding & childhood overweight
– Typically breastfed infants are leaner at 1 year of age
• Cognitive benefits
– Studies show an increase even after adjusting for family environment as
assessed by IQ
• Socioeconomic benefits
– Decrease need for medical care
• Analgesic effects
– Reduction of infant pain
Know the different stages of lactogenesis and when milk “comes in”
Lactogenesis I (birth to 2-5 days) milk formation begins
• Lactogenesis II—(begins 2-5 days after birth) increased blood flow to breast; milk
“comes in”
• Lactogenesis III—(begins at ~10 day after birth) milk composition is stable
On the second feeding after birth, a first-time mom was concerned that her infant was not getting enough milk. What would the lactation consultant want the new mom to know?
Milk does not come right after birth
Know common barriers to breastfeeding initiation.
•Embarrassment
• Time & social constraints
• Lack of support from family & friends
• Lack of confidence
• Concerns about diet & health
• Fear of pain
How does changing the diet change the fat, carbohydrate and protein
composition of breast milk
– Fatty acid profile reflects dietary intake of mother
– Very low fat diet with adequate CHO & protein, milk is high in medium-chain fatty acid
Know what nutrients are missing among women following a strict vegetarian
diet and how they can be obtained.
Low vitamin B12, Iron, Protein, and Zinc
Know the effectiveness of breastfeeding as a form of birth control.
There is a delay in monthly ovulation resulting in longer intervals between
pregnancies. not an effective birth control
Know the composition of milk
composition includes: secretory IgA, lactoferrin, casein, calcium, sodium, vitamin A, b1 ,B2 ,C.
Colostrum has higher concentration of sodium potassium and chloride than mature milk.
dominant carbohydrate in human milk is lactose.
Know the common barriers to breastfeeding initiation
-Embarrassment
-Time & social constraints
-Lack of support from family & friends
-Lack of confidence
-Concerns about diet & health
-Fear of pain
How does changing the diet change the fat carbohydrate and protein composition of breast milk?
Fatty acid profile reflects dietary intake of mother
Very low fat diet with adequate CHO & protein, milk is increase in medium-chain fatty acids
Know what nutrients are missing among women following a strict vegetarian diet and how they can be obtained.
low in vitamin B12,calcium, Iron, zinc, and omega 3 fatty acids eicosapentaenoic and doxosahexaenoic acid.
obtained by supplements veggy meat, and fortified foods (pg111)
know the effectiveness of breastbeeding as a form of birth control.
There is a delay in monthly ovulation resulting in longer intervals between
pregnancies. Not recommended
Know common conditions that may be experienced by a woman who is breastfeeding and how they can be treated (i.e. sore nipples).
?1. Sore nipples- proper latching of infant
?2. flat or inverted nipples-
?3. letdown failure- oxytoxin
?4. hyperactive letdown- express (let a little of the milk out before feeding)
?5. hyper lactation- pump milk out and store it
?6. Engorgement – express
?7. plugged ducts – continue to breast feed (move baby’s chin to clogged area)
?8. Mastitis (infection)
?9. Low milk supply – lower stress levels, eat more calories
Know symptoms of an infant suffering from an excess of caffeine.
Wakeful, hyperactive, fussy
What nutrition interventions are recommended for management of early jaundice?
Breastfeeding
Know what foods a nursing mom should avoid because they have the potential to cause gas in her baby.
None
Know about medicinal herbs during lactation.
Chicory, orange spice, peppermint, raspberry, red bush tea, rose hips. are safe alternative drugs
Know influence of alcohol on milk production.
Low oxytocin and letdown, affect milk’s odor. Low volume and interfere with sleeping patterns.
Know recommendations for alcohol and smoking while breastfeeding.
?-If a mother chooses to drink alcohol while she is breastfeed she should wait for the alcohol to clear her system, express milk prior to drinking, if engorged pump milk with contaminates and discard. Mothers who are intoxicated should not breastfeed until sober.
?-Stop smoking* if not reduce smoking, consider low-nicotine cigarettes, and delay feeding for as long as possible after smoking, half-life of nicotine is 95 mins.

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