Nutrition Through the Life Cycle: Chapters 1-4 Test Study Guide

Toxoplasmosis

AKA. T. Gondii A parasitic infection that can impair fetal brain development. The source of the infection is often hands contaminated with soil or the contents of a cat litter box; or raw or partially cooked pork, lamb, or venison.

Preeclampsia and Eclampsia

Can be related to Vitamin D deficiency and hypertension A pregnancy-specific syndrome that usually occurs after 20 weeks gestation (but that may occur earlier) in previously normotensive women. It is determined by increased blood pressure during pregnancy to > or = 140 mm Hg systolic or > or = 90 mm Hg diastolic and is accompanied by proteinuria. In the absence of proteinuria, the disease is highly suspected when increased blood pressure is accompanied by headache, blurred vision, abdominal pain, low platelet count, and abnormal liver enzyme values. ● Proteinuria is defined as the urinary excretion of > or = 0.3 grams of protein in a 24-hour urine specimen. This usually correlates well with readings of > or = 30 mg/dL protein, or > or = 2 on dipstick readings taken in samples from women free of urinary tract infection. In the absence of urinary tract infection, proteinuria is a manifestation of kidney damage. ● Eclampsia is defined as the occurrence of seizures that cannot be attributed to other causes in women with preeclampsia.

Calculations for Converting grams/calories of the Macronutrients

Carbohydrates provide 4cal/gram of energy - to convert a set number of grams of carbs to calories of energy: -Example: 12grams of carbs x 4 cal/gram = 48 kcal of energy - To calculate the percentage of calories from carbs consumed in a day: -Example: 2,000 calorie diet, and 45 grams of carbs consumed: 1st) 45g of Carbs x 4cal/gram = 180 kcal from carbs 2nd) Divide kcal from carbs by 2,000 calorie total intake from the day = (180kcal / 2,000) x 100 = 9% *The daily recommended intake for Carbohydrates per Dietary Guidelines is 45-65%. This analysis would show that this diet is low in carb intake. Fats/Lipids provide 9cal/gram of energy -to convert a set number of grams of carbs to calories of energy: -Example: 54grams of fat x 9cal/gram = 486kcal -to convert 486kcal of energy from fat into a percentage of a daily intake value: (486kcal/2,000) x 100 = 24% *The daily recommended intake for Fats/Lipids per Dietary Guidelines is 20-35%. This analysis would show that this diet is within the recommended values. Proteins can provide 4cal/gram of energy -to convert a set number of grams of protein to calories of energy: -Example: 65grams of protein x 4cal/gram = 260kcal -to convert 260kcal of energy from protein into a percentage of a daily intake value: (260kcal/2,000) x 100 = 13% *The daily recommended intake for Proteins per Dietary Guidelines is 10-35%. This analysis would show that this diet is within the recommended values.

Proteins (Amino Acids)

Containing Amino Acids, they are used by the body to build and maintain protein-based components of the body such as muscle, bone, enzymes, and red blood cells (RBC's). Can also be used as a source of energy at 4 cal/gram. 9 Essential Amino Acids must be provided by the diet. They are: -Histodine -Isoleucine -Leucine -Lysine -Methionine -Phenylalanine -Threonine -Trytophan -Valine RECOMMENDED INTAKE PER THE DIETARY GUIDELINES: 10-35% of total energy from calories

Placenta

Develops from embryonic tissue and is larger than the fetus for most of pregnancy. Functions are: - Hormone and Enzyme production - Nutrient and gas exchange between the mother and fetus - Uses 30-40% of the glucose delivered by the maternal circulation. - 3 primary mechanisms regulate nutrient transfer: *facilitated diffusion-Receptors ("carriers") on cell membranes increase the rate of nutrient transfer ex. - Some glucose, iron, vitamins A and D. *active transport,- Energy (from (ATP) and cell membrane receptors. ex. - Water-soluble vitamins, some minerals (calcium, zinc, iron, potassium) and amino acids *endocytosis (or pinocytosis) - Nutrients and other molecules are engulfed by placenta membrane and released into fetal blood supply ex. - Immunoglobulins, albumin - The fetus receives small amounts of water and other nutrients from ingestion of amniotic fluid. - Removal of waste products from the fetus Its structure acts as a barrier to many harmful compounds (types of bacteria and viruses, maternal red blood cells, and large proteins), and it governs the rate of passage of nutrients and other substances into and out of the fetal circulation.

List 3 Things that affect Dietary Intake in Pregnancy

Effect of Taste and Smell Changes (pica eg.) Cultural considerations

Specify how 5 Factors - Energy and Nutrient - Change in Pregnancy

Energy Energy requirements during pregnancy increase mainly due to protein and fat tissue synthesis, and the energy cost of maintaining an expanding amount of metabolically active tissues. Protein synthesis primarily occurs in fetal, placental, uterine, and breast tissues. Most of the fat synthesized during pregnancy is used to buildup maternal fat stores. Expanded metabolic activity related to the increased work of the mother's cardiovascular, respiratory, and renal systems is responsible for much of the increase in energy needed for basal metabolism. The fetus accounts for about a third of the increased energy needs of pregnancy. - The Need for Carbohydrates As for adults, approximately 45-65 percent of total caloric intake during pregnancy should come from carbohydrates. Women should consume a minimum of 175 grams carbohydrates to meet the fetal brain's need for glucose. The Need or Protein The recommended intake of protein during pregnancy is 71 grams daily. Protein requirements increase during pregnancy primarily due to protein tissue accretion. Of the approximately 925 grams of protein (2 pounds) accumulated in protein tissues during pregnancy, 440 grams are taken up by the fetus, 216 grams are used for increases in maternal blood and extracellular fluid volume, 166 grams are consumed by the uterus, and 100 grams are accumulated by the placenta. Additional protein is also required to maintain the protein tissue developed. The Need for Fat It is recommended that pregnant women consume 13 grams of linoleic acid (an essential fatty acid) daily, and 1.4 grams of the other essential fatty acid, alpha-linolenic acid. Derivatives of linoleic acid and alpha-linolenic acid serve as precursors for eicosanoids that regulate numerous cell and organ functions. Eicosanoid derivatives of EPA reduce inflammation, dilate blood vessels, and reduce blood clotting. DHA is a major structural component of phospholipids in cell membranes in the central nervous system, including retinal photoreceptors. An adequate intake of EPA and DHA during pregnancy is estimated to be 300 mg per day. The Need for Vitamins and Minerals During Pregnancy Requirements for most vitamins and minerals increase during pregnancy due to metabolic demands associated with placental and fetal growth, expansion of maternal tissues and plasma volume, and increased nutrient needs for tissue maintenance. Maternal physiological adaptations involve changes in vitamin and mineral absorption and utilization that respond to the changing needs for these nutrients by time in pregnancy. Folate Inadequate folate during pregnancy has long been associated with anemia in pregnancy and reduced fetal growth.151 Only during the last few decades, however, has the broad spectrum of effects of folate been recognized. Discoveries of the multiple effects of inadequate folate intake on the development of congenital abnormalities and clinical complications of pregnancy represent some of the most important advances in our knowledge about nutrition and pregnancy. Choline Choline is a B-complex vitamin that humans can produce, but not in high enough amounts to meet needs when dietary intake of choline is very limited. The need for choline increases during pregnancy due to its roles as a component of phosopholipids in cell membranes and a precursor of intracellular messengers. Choline can be converted to betaine, which, like folate, serves as a source of methyl groups used to regulate gene function, neural-tube and brain development, and the conversion of homocysteine to methionine.169 Large amounts of choline are transported via the mother's blood to the embryo and fetus during pregnancy. Vitamin A Vitamin A is a key nutrient in pregnancy because it plays important roles in reactions involved in cell differentiation. Deficiency of this vitamin is rare in pregnant women in industrialized countries, but it is a major problem in many developing nations. Vitamin A deficiency that occurs early in pregnancy can produce malformations of the fetal lungs, urinary tract, and heart. Vitamin D Vitamin D supports fetal growth, the addition of calcium to bone, and tooth and enamel formation. Lack of a sufficient supply of vitamin D during pregnancy compromises fetal as well as childhood bone development.179 Lack of maternal vitamin D readily compromises fetal vitamin D status. Calcium Calcium is primarily needed in pregnancy for fetal skeletal mineralization and maintenance of maternal bone health. Approximately 30 grams of calcium (a little over an ounce) is transferred from the mother to the fetus during pregnancy. Fetal demand for calcium peaks in the third trimester when fetal bones are mineralizing at a high rate. Fluoride Teeth begin to develop in utero, so why isn't it recommended that pregnant women consume sufficient fluoride so that the fetus builds cavity-resistant teeth? A limited amount of fluoride is transferred from the mother's blood to the developing enamel of the fetus. Iron Iron status is a leading topic of discussion in prenatal nutrition because the need for iron increases substantially; women require about 1000 mg (1 g) of additional iron for pregnancy: ◗ 300 mg is used by the fetus and placenta. ◗ 250 mg is lost at delivery. ◗ 450 mg is used to increase red blood cell mass. Iodine Iodine is required in pregnancy by the mother and fetus for thyroid function and energy production, and for fetal brain development. Sodium Sodium plays a critical role in maintaining the body's water balance. Requirements for it increase markedly during pregnancy due to plasma volume expansion.

Correlate Critical Periods & Nutrients

Fetal growth and development proceed along genetically determined pathways in which cells are programmed to multiply, differentiate, and establish long-term functional levels during set time intervals. Such time intervals, known as critical periods, are most intense during the first 2 months after conception, when a majority of organs and tissues begin to form. Hyperplasia Critical periods of growth and development are characterized by hyperplasia, or an increase in cell multiplication. Because every human cell has a specific amount of DNA, periods of hyperplasia can be determined by noting times during gestation when the DNA content of specific organs and tissues increases sharply. Deficits or excesses in nutrients supplied to the embryo and fetus during critical periods of cell multiplication can produce lifelong defects in organ and tissue structure and function. The organ or tissue undergoing critical periods of growth at the time of the adverse exposure will be affected most.

Lactation

Hormones involved: - In pregnancy, the luteal and placental hormones - Placental lactose and Chorionic Gonadotropin - allow further preparation for breastfeeding involved in Alveolar development and milk secretion. - Oxytocin is a hormone produced during letdown that causes milk to be ejected into the ducts. -Human Growth Hormone (HGH) responsible for the development of terminal end buds. -Estrogen is involved in ductal growth. -Progesterone is involved in alveolar development. -Prolactin is involved in Alveolar development and milk secretion. It stimulates milk production. Names & Stages of Milk Production: Lactogenesis I - During the first stage of milk production, milk begins to form, and the lactose protein content of milk increase. This stage extends the first few days postpartum. Lactogenesis II - This stage begins 2-5 days postpartum and is marked by increased blood to the mammary gland. Clinically, it is considered the onset of copious milk secretion, or "when milk comes in." Significant changes in both the milk composition and the quantity of milk that can be produced occur over the first 10 days of the baby's life. Delayed lactogenesis II is associated with failure to sustain breastfeeding. Lactogenesis III - This stage of breast milk production begins about 10 days after birth and is the stage in which the milk composition becomes stable. Common Breastfeeding Challenges & How to overcome them: Sore, Flat and/or Inverted Nipples. Letdown Failure - Proper positioning of the baby on the breast can help soreness. Using a breast pump or rolling the nipples between the fingers helps with flat/inverted nipples. Oxytocin nasal spray can be prescribed for letdown failure, or reduce stress. Plugged Ducts, Mastitis, Breast Abscess, & Engorgement. - Continuing to breastfeed is advised, Ibuprofen for pain and inflammation, antibiotics. cold compresses, heat, massage, pumping and in worst case scenario, a physician is needed to drain the abscess. Maternal Medications -Avoid long-acting forms, schedule doses carefully, evaluate the infant, choose the drug that produces the least amount in the milk.

Minerals

Humans require 15 minerals. They consist of single atoms and carry a charge in solution. The charge (resulting from having an unequal number of electrons and protons) carried by minerals allows them to combine with other minerals to form stable complexes in bone, teeth, cartilage, and other tissues. In body fluids, charged minerals serve as a source of electrical power that stimulates muscles to contract (eg. the heart to beat) and nerves to react. They also help the body to maintain an adequate amount of water in tissues and control how acidic or basic body fluids remain. The 15 minerals are: Calcium Phosphorus Magnesium Iron Zinc Fluoride Iodine Selenium Copper Manganese Chromium Molybdenum Sodium Potassium Chloride

List 3 Common Pregnancy Health Problems & their Nutrition Interventions

Nausea & Vomiting - Hyperemesis Gravidarum Between 1 and 2 percent of pregnant women with nausea and vomiting develop hyperemesis gravidarum (more commonly called hyperemesis).278 Hyperemesis is characterized by severe nausea and vomiting that last throughout much of pregnancy. It can be debilitating. Nutrition Intervention: ◗ Continue to gain weight. ◗ Separate liquid and solid food intake. ◗ Avoid odors and foods that trigger nausea. ◗ Select foods that are well tolerated. ◗ Vitamin B6 (pyridoxine) supplements given in a 10-25 mg dose every 8 hours reduce the severity of nausea in many women.The upper limit for vitamin B6 intake during pregnancy is 100 mg per day. ◗ Diclegis (also called Dilectin) is a prescription medication that combines vitamin B6 with doxylamine, effectively reduces nausea and vomiting of pregnancy. ◗ Ginger in doses of 550-1050 mg a day for 4 days, decrease nausea and vomiting in some women. Heartburn Pregnancy is accompanied by relaxation of gastrointestinal tract muscles. This effect is attributed primarily to progesterone. Relaxation of the muscular valve known as the cardiac or lower esophageal sphincter at the top of the stomach is thought to be the principal reason for the 40-80 percent incidence of heartburn in women during pregnancy. The loose upper valve may allow stomach contents to be pushed back into the esophagus. Nutrition Intervention: ◗ Ingest small meals frequently. ◗ Do not go to bed with a full stomach. ◗ Avoid foods that seem to make heartburn worse. ◗ Consume adequate fiber (25-30 g/d). ◗ Elevate your head and upper body during sleep. Constipation Relaxed gastrointestinal muscle tone is thought to be primarily responsible for the increased incidence of constipation and hemorrhoids in pregnancy. Nutrition Intervention: One way to prevent these maladies is to consume approximately 30 grams of dietary fiber daily.

DRI's (Dietary Reference Intakes)

Nutrient intake standards for healthy people. They include: RDAs (Recommended Dietary Allowances) -Are the levels of essential nutrient intake judged to be adequate to meet the known nutrient needs of practically all (98%) of healthy people while decreasing the risk of certain chronic diseases. AIs (Adequate Intakes) -These are "tentative" RDA's. Based on less conclusive scientific information than are the RDAs. EARs (Estimated Average Requirements) -These are nutrient intake values that are estimated to meet the requirements of half the healthy individuals in a group. The EARs are used to assess adequacy of intakes of population groups. ULs (Tolerable Upper Intake Levels) -These are the upper limits of nutrient intake compatible with health that should not be exceeded.

Fats (Lipids)

Solid at room temperature; oils are liquids; suppliers of essential fatty acids required for growth and health. Consist of various triglycerides: *3 fatty acids (fat soluble) + *Glycerol (water soluble - converts to glucose) Fats and oils are a concentrated source of energy Provide 9 cal/gram of energy Needed for cholesterol and sex-hormone synthesis; components of cell membranes, and are vitamin carriers Essential Fatty Acids: Components of fat that are a required part of the diet. Examples of two that contain unsaturated fatty acids are: Linoleic Acid & Alpha-Linoleic Acid. Two derivatives of Alpha-Linoleic Acid are - DHA & EPA - 2 most important Essential Fatty Acids. (Omega-3 Family) DHA stands for Docosahexaenoic Acid. Found in large amounts in the central nervous system, the retina of the eye, and the testes. Estimated need is: 300-500mg daily. EPA stands for Eicosapentaenoic Acid. Found in large amounts in the central nervous system and retina. Biologically active derivatives of essential fatty acids are: -prostaglandins (perform functions such as the constriction and dilation of blood vessels and stimulate of smooth muscles and the uterus) -thromboxanes (produced in platelets that promote blood clotting, constrict blood vessels, and reduce blood pressure) -prostacyclins (produced by blood vessel walls to inhibit blood clotting, dilate blood vessels, and reduce blood pressure) Trans Fats: -Raise blood LDL -cholesterol levels more than saturated fats -While they are naturally occurring in dairy products & meats, most people consume them as hydrogenated fats: -Hydrogenated: when oils are made solid by adding hydrogen. This process makes some fatty acids saturated by adding hydrogen to the unsaturated carbon bonds; enhances storage life. Cholesterol A fat-like clear liquid substance primarily found in lean and fat components of animal products. A precursor of estrogen, testosterone, and vitamin D. A component of all animal cell membranes, the brain, and the nerves. RECOMMENDED INTAKE PER THE DIETARY GUIDELINES: 20-35% of total calories

Vitamins

There are 14 Vitamins classified as either water or fat soluble. They are as follows: Water Soluble Vitamins: B-Complex Vitamins Thiamin (B1) Riboflavin (B2) Niacin (B3) Vitamin B6 Folate Vitamin B12 Biotin Pantothenic Acid Choline Vitamin C (Ascorbic Acid) Fat-Soluble Vitamins: (DEKA) Vitamin A (retinol, beta-carotene) Vitamin D (1,25 dihydroxycholecaliferol) Vitamin E (alpha-tocopherol) Vitamin K Vitamin D & Potassium (Vitamin K) are common deficiencies in the American diet, so they have been added to the new Nutrition Label. *Deficiencies in Vitamin D produces weak, deformed bones (children) and loss of calcium from bones in adults; osteoporosis. There's also an increased risk of inflammation-related diseases and death from all causes. *Deficiencies in Vitamin K leads to bleeding and bruises. Decreased calcium in bones. Long-term use of antibiotics may induce deficiencies.

6 Essential Nutrients

These are Nutrients that the body cannot manufacture or generally produce in sufficient amounts, and must be obtained from the diet: Carbohydrates Essential Amino Acids (Proteins) Essential Fatty Acids (Fats/Lipids) Vitamins Minerals Water

Daily Values for nutrition labeling based on intakes of 2000 calories per day in adults and children aged 4 years and above:

Total Fat 65g Saturated Fat 20g Cholesterol 300mg Sodium 2400mg Total Carbs 300g Dietary Fiber 25g Vitamin A 5000IU Vitamin C 60mg Calcium 1000mg Iron 18mg

Pagophagia

Type of Pica Compulsive consumption of ice or freezer frost.

Amylophagia

Type of Pica Compulsive consumption of laundry starch or cornstarch.

Carbohydrates

Used by the body as a source of readily available energy. Simple Sugars - monosaccharides (most basic) *Glucose *Fructose - disaccharides *Sucrose *Maltose *Lactose Complex Carbs - polysaccharides *Starches *Glycogen *Most types of fiber Most Dietary Sources of Fiber Provide 4cal/gram of energy Alcohol Sugars *Ethanol *Xylitol Provide 7cal/gram of energy RECOMMENDED INTAKE PER THE DIETARY GUIDELINES: 45-65% of calories come from carbs

State Recommendations for Pregnancy Weight Gain

Weight gain during pregnancy is an important consideration because newborn weight and health status tend to increase with adequate weight gain. Birthweights of infants born to women with weight gains of 15 lbs. (7 kg.) for example, average 3100 grams (6 lb 14 oz). This weight is about 500 grams less than the average birthweight of 3600 grams (8 lb) in women gaining 30 pounds (13.6 kg). Rates of low birthweight are higher in women gaining too little weight during pregnancy.84 Weight gain during pregnancy is an indicator of plasma volume expansion and positive calorie balance, and provides a rough index of dietary adequacy. PrePregnancy Weight Status BMI & Recommended Weight Gain: Underweight - 18.5 kg/m2 28-40 lb (12.7-18.2 kg) Normal weight, 18.5-24.9 kg/m2 25-35 lb (11.4-15.9 kg) Overweight, 25-29.9 kg/m2 15-25 lb (6.8-11.4 kg) Obese, 30 kg/m2 or higher 11-20 lb (5.0-9.1 kg) Twin pregnancy 25-54 lb (11.4-24.5 kg)

Gestational Diabetes

is a carbohydrate intolerance that begins or is first recognized during pregnancy. It is closely related to type 2 diabetes. It is diagnosed in 4-9% of pregnancies. Escalating rates of obesity are increasing the rates of gestational diabetes. Risk factors for Gestational Diabetes: ● Obesity, especially high levels of central body fat ● Weight gain between pregnancies ● Age over 35 years ● Native American, Hispanic, Asian ancestry ● Genetic traits (GIP variant) ● Strong family history of type 2 diabetes ● History of delivery of a macrosomic newborn (. 4500 g or. 10 lb) ● Chronic hypertension ● Mother was SGA at birth ● History of gestational diabetes in a previous pregnancy ● Physical inactivity ● Polycystic ovary syndrome ● Multifetal pregnancy ● Consumption of Western-type diet (low fiber intake, low vegetable and fruit intake, regular intake of sugars and high-glycemic index foods, red and processed meats) The mother is usually obese and has insulin resistance. Have a hemoglobin A1c > or = 6.5% Factors associated with reduced risk of developing gestational diabetes are: ● Weight loss (if needed) ● Regular exercise ● Healthy dietary pattern ● High fiber intake ● Intake of low GI carbohydrate sources ● Regular vegetable and fruit consumption

5 Physiological Changes in Pregnancy

1st Half of Pregnancy - maternal anabolic changes because they build the capacity of the mother's body to deliver relatively large quantities of blood, oxygen, and nutrients to the fetus in the second half of pregnancy. 2nd Half of Pregnancy - maternal catabolic changes in which energy and nutrient stores, and the heightened capacity to deliver stored energy and nutrients to the fetus, predominate. Blood Volume Expansion ● Blood volume increases 20% ● Plasma volume increases 50% ● Edema (occurs in 60-75% of women) Hemodilution ● Concentrations of many vitamins and minerals in blood decrease Blood Lipid Levels ● Increased concentrations of cholesterol, LDL cholesterol, triglycerides, HDL cholesterol Blood Glucose Levels ● Increased insulin resistance (increased plasma levels of glucose and insulin) Maternal Organ & Tissue Enlargement ● Heart, thyroid, liver, kidneys, uterus, breasts, adipose tissue Circulatory System ● Increased cardiac output through increased heart rate and stroke volume (30-50%) ● Increased heart rate (16% or 6 beats/min) ● Decreased blood pressure in the first half of pregnancy (29%), followed by a return to nonpregnancy levels in the second half. Respiratory System ● Increased tidal volume, or the amount of air inhaled and exhaled (30-40%) ● Increased oxygen consumption (10%) Food Intake ● Increased appetite and food intake; weight gain ● Taste and odor changes, modification in preference for some foods ● Increased thirst Gastrointestinal Changes ● Relaxed gastrointestinal tract muscle tone ● Increased gastric and intestinal transit time ● Nausea (70%), vomiting (40%) ● Heartburn ● Constipation Kidney Changes ● Increased glomerular filtration rate (50-60%) ● Increased sodium conservation ● Increased nutrient spillage into urine; protein is conserved ● Increased risk of urinary tract infection Immune System ● Suppressed immunity ● Increased risk of urinary, reproductive tract, and other infections Basal Metabolism ● Increased basal metabolic rate in second half of pregnancy ● Increased body temperature Hormones ● Placental secretions of large amounts of hormones needed to support physiological changes of pregnancy

Key Nutrients for Preconception

A growing body of evidence indicates that intake of Antioxidants such as vitamin E, vitamin C, beta-carotene, selenium, and antioxidant-rich pigments in vegetables and fruits play important roles in fertility in women and men. Antioxidants - fight free radicals (production of potentially destructive reactive oxygen molecules); needed to protect cells of the reproductive system, including eggs and sperm, from damage caused by oxidative stress. Oxidative stress can harm egg and follicular development and can interfere with corpus lute function and implantation of the egg in the uterine wall. Oxidative stress decreases sperm motility and reduces the ability of sperm to fuse with an egg; damages DNA. Zinc - plays an important role in the reduction of oxidative stress, sperm maturation, and testosterone synthesis. Deficiency in men has been found to be related to poorer sperm quality and sperm concentrations, and to abnormal sperm shapes. Soy Isoflavones - are chemically similar to estrogen and are known to induce infertility, and reduced sperm count. Iron - poor iron status prior to pregnancy is a fairly common problem in women of childbearing age and is related to reduced fertility and lack of ovulation. Increases risk of early delivery. Negative Energy Balance -Anorexia Nervosa, Bulimia Nervosa affect fertility and are likely to miscarry, experience preterm delivery, and and deliver newborns that are low birthweight. The low levels of body fat are related to reduced estrogen production in fat cells. Suppressed activity of GnRH leads to a decrease in estrogen production by the ovaries. Women & Exercise -Amenorrhea associated with the female athlete triad (chronic energy deficits combined with very high levels of physical activity) appears to be triggered when energy intake is about 30% less than energy requirement. Polycystic Ovary Syndrome(PCOS) -Leading cause of female infertility. Related to absence of ovulation due to insulin resistance, high blood insulin levels, obesity, polycystic ovaries, menstrual dysfunction, amenorrhea, hirsutism (excess body hair), and acne. PKU (Phenylketonuria) -an inherited error in phenylalanine metabolism most commonly caused by a deficiency of phenylalanine hydroxyls, which converts the essential amino acid phenylalanine to the nonessential amino acid tyrosine. When PKU is present during early pregnancy, high levels of phenylalanine accumulate in the embryo and fetus and impair normal central nervous system development, and risk of heart defects. Untreated women with PKU have a 92% chance of delivering a newborn with mental retardation, and a 73% change that the infant will be born with an abnormally small head (microcephaly). Celiac Disease -the effects of celiac disease on reproductive functions in males and females is related to malabsorption-induced deficiencies of nutrients such as zinc, folate, and iron; and direct effects of inflammation on intestinal and other tissues. It is an autoimmune disease characterized by chronic inflammation of the small intestine due to an inherited sensitivity to the gliadin portion of gluten in wheat, rye, and barley. Excessive vitamin A intake (retinol, retinoic acid) increases the risk the fetus will develop facial and heart abnormalities. Folate deficiency is related to the development of approximately 50% of cases of neural tube defects (NTDs). Iodine deficiency early in pregnancy increases risk of children with impaired mental and physical development. Caffeine - Some evidence shows that 300mg of caffeine or more affected the length of time in which women can become pregnant, but most studies are mixed. Alcohol - affects fertility in men and women; for men it increases testosterone levels and reduces sperm concentration, total sperm count, and the % of sperm with normal shape. 1-5 drinks/week decreased fertility in women; over 10 drinks/week decreases by 66%. It also reduces fertility in women with a specific gene variant that reduces the rate of alcohol breakdown in the body. *Undernutrition, Overnutrition, Excess body fat by way of obesity or weight loss fluctuations also affect fertility. *Poorly controlled blood glucose levels early in pregnancy increase the risk of fetal malformations, excessive infant size at birth, and the development of diabetes in the offspring later in life. **Heavy-Metal exposure decreases sperm production, motility and shape. Inhaled or ingested it disrupts hormonal communications with the testes, resulting in lowered testosterone levels,

hemoglobin A1c

A form of hemoglobin used to identify blood glucose levels over the lifetime of a red blood cell (120 days). Glucose molecules in blood will attach to hemoglobin (and stay attached). The amount of glucose that attaches to hemoglobin is proportional to levels of glucose in the blood. The normal range of hemoglobin A1c is 4-5.9 percent. Also called glycosylated hemoglobin and glycated hemoglobin.

Congenital Abnormalities

A structural, functional, or metabolic abnormality present at birth. Also called congenital anomalies. These may be caused by environmental or genetic factors, or by a combination of the two. Structural abnormalities are generally referred to as congenital malformations, and metabolic abnormalities as inborn errors of metabolism.

Listeria

AKA. Monocytogenes A foodborne bacterial infection that can lead to preterm delivery and stillbirth in pregnant women. Listeria infection is commonly associated with the ingestion of soft cheeses, unpasteurized milk, ready-to-eat deli meats, and hot dogs.

Pica

An eating disorder characterized by the compulsion to eat substances that are not food. Affects over 1/2 of pregnant women in some locations of the southern part of the United States.

3 Problems of Pregnancy Outcome

Infant Mortality -Two-thirds of deaths of liveborn infants occur within the first month after birth, the neonatal period. Low Birthweight -Low-birthweight infants make up 8 percent of all births, yet comprise 66 percent of all infant deaths. Preterm Delivery -The 11.4 percent of newborns delivered prior to 37 weeks of pregnancy similarly account for a disproportionately large number of infant deaths.6

Gravida

Number of pregnancies a woman has experienced.

Edema

Swelling (usually of the legs and feet, but can also extend throughout the body) due to an accumulation of extracellular fluid.

Amniotic Fluid

The fluid contained in the amniotic sac that surrounds the fetus in the uterus.

Parity

The number of previous deliveries experienced by a woman; nulliparous = no previous deliveries, primiparous = one previous delivery, multiparous = two or more previous deliveries. Women who have delivered infants are considered to be parous.

Geophagia

Type of Pica Compulsive consumption of clay or dirt.