Nutr 304 Exam 1
First half of pregnancy "maternal anabolic"
Build capacity of mothers body to deliver blood, nutrients, and oxygen to fetus in second half
What is Premenstrual Syndrome
Cluster of physical, emotional and psychological symptoms that some women experience prior to their menstrual cycle
injection
Depot medroxyprogesterone acetate,given every 3 months - Suppresses ovulation - Highly effective, however, high discontinuation rate
ripple effect
Dietary changes introduced to improve intake of one nutrient affect intake level of other nutrients
Dietary reference intakes
+340 kcal/day for 2nd trimester +452 kcal/day for 3rd trimester
Hyperemesis Gravidarum
- 1-2% of women affected - Characterized by severe nausea and vomiting throughout most of pregnancy - Can lead to weight loss, electrolyte imbalance, and dehydration - May require hospitalization, nutrition support, anti-emetic medications, rehydration and correction of electrolyte imbalances.
Maternal Respiratory Changes
- Acceleration in metabolic rate and the need to add to the tissue mass in the uterus and breasts. - For fetus to eliminate carbon dioxide. - With advancing pregnancy, thoracic breathing replaces abdominal breathing, and the descent of the diaphragm with respiration becomes less possible.
Anorexia Nervosa and fertility
- Amenorrhea, classic symptom - Low levels of body fat, low dietary fat intake, excessive exercise - Low GnRH, low LH, low estrogen
Fluctuations in calcium homeostasis and parathyroid hormone dysregulation
- Calcium supplementation (1,000-1,300 mg/day) alleviate majority of symptoms including irritability and cramping. - Low intake of vitamin D and calcium may increase risk of developing PMS
implant side effects
- Erratic bleeding - Weight gain (9lb average after 1 year of use) - Headaches
Nutritional Management
- Folate from fortified grain products, vegetables, fruits, or supplements -Supplement 400 μg folic acid a day 1DFE= 1mcg food folate = 0.6 mcg folic acid OR 1 mcg folic acid = 1.7 DFE -Important to take prior to conception -B12- Vegans and other strict vegetarians need to supplement
Male infertility nutritional issues
- Low Zinc Status - Antioxidant Nutrients - Vitamin D - Alcohol Intake
low nutrient levels
- Low folate intake = ↑ risk of embryonic development of neural tube effects - Low iodine level = ↑ risk of mental retardation and physical development - Iron deficiency = ↑ risk of early delivery and low fetal iron stores -Poor controlled blood glucose = ↑ risk of fetal malformation, ↑ infant size at birth, development of diabetes later in life
Obesity and fertility in men
- Low sperm production - Higher than average erectile dysfunction - Oxidative damage to sperm
Obesity and fertility in women
- Menstrual cycle irregularity - Ovulatory Failure - Amenorrhea - Oxidative damage to eggs - Lack of pre-natal care
iron
- Menstrual losses and low iron intake result in many women entering pregnancy with depleted iron stores. -Difficult to replete iron stores if a woman has iron-deficiency anemia before she becomes pregnant. -Iron deficiency anemia can result in pre-term delivery, low birth weight, and fetal growth restriction.
Managing fluctuations in intake
- Nutrient storage Iron, calcium, Vit A, Vit B12 surpluses stored - Regulation of absorption and elimination Iron and Calcium absorption Vitamin C and water eliminated - Regulation of appetite Energy intake
male infertility
- Poor sperm quality and movement - Low sperm concentration - Abnormal sperm shapes
Placental Hormones: Human Chorionic Gonadotrophin (hCG)
- Produced by chorionic villi of the placenta - Stimulates corpus luteum to produce estrogen and progesterone - Stimulates growth of endometrium
Prostaglandins
- Produced by the uterus during the secretory phase - Secretory phase - the endometrium begins to disintegrate without fertilization - Cause uterus to contract and release blood and nutrients stored in the uterine wall - Cause cramps and other side effects of menstruation - Derived from essential fatty acids
folic acid
- Required for DNA synthesis and cell division - Reduce risk of neural tube defects and other birth defects - Reduce risk of preterm delivery, low birth weight, and fetal growth restriction - Develop within 21 days of conception or before many women know they are pregnant- before the pre- natal care starts
Placental Hormones: Human Placental Lactogen (hPL)
- Stimulate metabolism increasing availability of glucose and amino acid - Stimulates mammary gland growth
For PMS symptoms and premenstrual depression
- Vitamin B-6 (produce serotonin, dopamine) : 100 mg/day - Magnesium: 200 mg/day - Exercise and stress reduction - Caffeine intake: reducing intake can alleviate symptoms
Maternal water 7-10 liters
- ↑ Blood volume 20% - ↑Plasma volume 50% - Edema
injection side effects
- ↑ Body weight (average 12 pounds during 1-3 yr) - ↑ LDL cholesterol and insulin - ↓ HDL cholesterol (good cholesterol) - ↓ Bone density - Fatigue, headache, abdominal pain
Placental Hormones: Estradiol
- ↑ Lipid formation, protein synthesis, uterine blood flow - ↑ Uterine and breast duct development - ↑ Ligament flexibility
reasons for miscarriage
-Defects in fetus - Maternal infection - Structural abnormalities of uterus - Endocrine or immunological disturbances
high nutrient levels
-High Vitamin A (retinol and retinoic acid >5000 IU) intake = ↑ risk of facial and heart abnormality in fetus - High blood levels of lead = ↑ risk of mental retardation - High alcohol intake = ↑ risk for fetal alcohol syndrome and low mental and physical development
oral contraceptives
-↑ HDL cholesterol (good cholesterol) -↑ LDL and TG and total cholesterol - ↑ risk of venous thromboembolism (blood clots), cervical cancer, cardiovascular disease - ↓ blood levels of vitamin B6 and vitamin B12 - ↑ blood levels of copper - Other - glucose intolerance, weight gain, and nutrient deficiency
three stages of lactation
1. production 2. secretion 3. ejection
protein recommended intake
10-35% of calories
Nutrition During Pregnancy - Iron
1000 mg of additional iron required during pregnancy -300 mg is used by fetus and placenta -250 mg is lost at delivery -450 mg is used to ↑ red blood cell mass
fat recommended intake
20-35% of calories
Nutrient Intake during Pregnancy- Fat
33%
kcal in carb
4 kcal
kcal in protein
4 kcal
carb recommended intake
45-65% of calories
Nutrient Intake during Pregnancy- Carbohydrate
45-65% of kcal
RDA of folate for pregnancy
600 mcg DFE/day: 400 mcg folic acid from fortified foods/supplements + 200 mcg DFE from veg/fruits
kcal in alcohol
7 kcal
kcal in fat
9 kcal
patch
A general software security update intended to cover vulnerabilities that have been discovered. - Placed on skin for 3 weeks, then removed for one week.
Fat soluble vitamins
A, D, E, K
over exercise and fertility
Amenorrhea - Triggered when calorie intake <30% of energy requirement. - ↓ Luteinizing hormone (LH) - ↓ Estrogen production - ↓ Bone density - ↑ Susceptibility to stress fracture
Second half of pregnancy "maternal catabolic"
Energy and nutrient stores and the increased capacity to deliver stored nutrients and energy to the fetus
EAR
Estimated Average Requirements
Breastfeeding recommendations
Exclusive breastfeeding for 6 months, continue for 12 months
cancer
High alcohol and processed meat intake; low vegetable and fruit intake
Heart Disease
High saturated fat, trans fat intake; low vegetable, fruit, whole grain intake
Hypertension
High sodium, alcohol intake; low potassium, vegetable, and fruit intake
contraception
Interception in the birth process at any stage from ovulation to ovum implantation
inadequate intake examples
Iron= Anemia Iodine = Goiter Thiamine = Beriberi Protein= growth failure Vit A= Irreversible blindness
mammary gland units
Lactiferous sinuses - Located in the Lactiferous Duct - Maintains a small reserve of milk that will be immediately available to the infant - Pressure is placed directly onto these to manually express milk from the breast, not on the nipple Lactiferous ducts - Gathers the milk from the lobules and delivers it to the nipple
Bulemia and fertility
Little bleeding (oligomenorrhea) or amenorrhea - Low FSH and LH levels - Menstrual disturbances - Increased rate of PCOS - Infertility
Undernutrition and Fertility
Low FSH, LH and estrogen results in anovulatory cycles, amenorrhea, and short or absent luteal phases
PCOS clinical signs
Menstrual irregularities q Excess abdominal fat - Insulin resistance - High testosterone levels - Obesity - Polycystic ovaries - Amenorrhea - Infertility - Hirsutism - Acne - High TG, LDL, TC - Low HDL
dysmenorrhea
Monthly bouts of lower abdominal cramps, bloating, back pain, headaches, food cravings, irritability - does not qualify as PMS - related to prostaglandin release near to and during menses
implant
Norplant;prevents ovulation, thickening of mucus cervix, thinning of uterus lining
Dietary Reference Intake
Nutrient intake standards for healthy people
Mammary gland development
Pregnancy - Luteal and placental hormone -further preparation for breastfeeding - Estrogen stimulates development of milk glands - Progesterone - elongation of tubules, duplication of cells lining the tubules -During the first trimester, small ducts duplicate and proliferate. -In the second trimester, the reduplicated small ducts group together to form large lobules. Their central cavities begin to dilate -In the last trimester, the existent clumps of milk-producing cells progressively dilate in the final preparation for lactation.
Menstrual Cycle
Prepare ovum and uterus 28 Day Cycle +/- few days Day 1 - actual bloodflow begins 1-14 - follicular phase 14/15 - ovulation phase (egg breaks out of capsule) 15-28 - luteal phase
Mammary gland development
Puberty -Increased release of estrogen and -progesterone -Responsible for pubertal breast development -Lobes(AKAalveoli)develop-complete12-18monthsaftermenarche Maturation of ductal system -Fatty tissue and fibrous tissue develop and grow -Cells that secrete milk develop -Nipple grows -Pigment changes
Nutrition During Pregnancy - Calcium
RDA: 1000 mg/day (same as non-pregnant) +300 mg/day in last quarter
Nutrition During Pregnancy - zinc
RDA: 11 mg/day (8 mg/day for non-pregnant) - Required for DNA and RNA synthesis
Nutrition During Pregnancy - Vitamin D
RDA: 15 mcg/day or 600 IU - supports fetal growth, addition of calcium to bone and tooth and enamel formation
Nutrition During Pregnancy - Iodine
RDA: 220 mcg/day
Nutrition During Pregnancy - fluoride
RDA: 3 mg (same as non-pregnant)
Nutrition During Pregnancy - Vitamin A
RDA: 770 mcg/day of preformed vitamin - cell differentiation
RDA
Recommended Dietary Allowance
Gonadotropin-releasing hormone (GnRH)
Stimulates pituitary to release FSH and LH
diabetes mellitus and fertility
Uncontrolled blood sugar ↑ risk of maternal and fetal complications. - Malformations of the pelvis, central nervous system, and heart. -Higher rates of miscarriage - ↑ BG in first trimester are teratogenic - meaning they are associated with a 2-3 fold increase in congenital abnormalities in the infant.
fertility
actual production of children
fortified
addition of any other nutrient
what impacts nutrient needs?
age, body size, gender, growth, illness, genetic factors, lifestyle factors, medication, pregnancy, lactation
protein provides
amino acids to build and maintain tissue
fecundity
biological ability to bear children
essential nutrients
body can't manufacture in sufficient amounts but are required
15 essential minerals
calcium, phosphorus, magnesium, iron, zinc, fluoride, iodine, selenium, copper, manganese, chromium, molybdenum, sodium, potassium, chloride
nonessential nutrients
cholesterol, creatine, glucose
Myoepithelial cell
contract and cause milk to eject in the ducts, under influence of oxytocin
primary malnutrition
dietary in origin
colostrum
first milk, high in immune proteins IgA and IgG, laxative properties, bifidus factor
type 2 diabetes
high saturated fat and calorie intake; low vegetable, fruit intake
maternal obesity
hypertension prolonged labor cesarean deliveries gestational diabetes macrosomia in infants risk of postpartum weight retention childhood obesity
If fertilization occurs
implants in the uterus lining within 8-10 days - Ovum secretes hormones that tell the corpus luteum to increase in size and to continue to produce estrogen and progesterone to maintain nutrient and blood vessel supply in the endometrium.
infertility
lack of conception after 1 yr of unprotected intercourse
miscarriage
loss of a conceptus in the first 20 weeks of pregnancy
underweight mother
low Apgar scores compromised fertility premature delivery intrauterine growth retardation
sequence of physiological changes for fetus
maternal plasma volume maternal nutrient stores placental weight uterine blood flow fetal weight
what is a calorie
measure of the amount of energy transferred from food to the body
Omega-3 (alpha-linolenic acid) DRI
men- 1.6g/day women- 1.1g/day
Omega 6 (linoleic acid) DRI
men- 17g/day women- 12g/day
birth spacing
minimum of 27 month span between births to rebuild nutrition stores in mom
Types of contraceptives
nutru side effects: oral pills, injections, patch, implant nutru effects not know: vaginal ring, IUD
PCOS
polycystic ovarian syndrome - leading cause of female infertility
secondary malnutrition
precipitated by a disease state, surgical procedure, or medication
lifecycle stages
pregnancy lactation infancy: 0-1 yr toddler: 1-5 yr childhood: 5-12 yr adolescence: 13-20 yr young adulthood: 21-44 middle adulthood: 45-64 yr older adults: 65+
carbs are a source of
readily available energy
B12
reduces birth defects
enrichment
refined grain products only added thiamin, niacin, riboflavin and iron
What is nutrition
science of food, nutrients in food, and how body uses those nutrients
Follicle-stimulating hormone (FSH)
stimulates growth of ova
Luteinizing hormone (LH)
stimulates secretion of progesterone
Nutrigenomics
study of nutrient-gene interactions and effects of these interactions on health
water soluble vitamins
thiamin, riboflavin, niacin, vitamin B6, pantothenic acid, folate, biotin, vitamin B12, and vitamin C, choline
Metabolic adjustment Protein
↑ Need for nitrogen and protein for synthesis of new maternal and fetal tissues
Patch side effects
↑ cholesterol and TG (more so than oral) - ↑ HDL - Breast soreness, headaches, abdominal pain, application site reactions - Less effective for women >198 pounds - Do not use if have heart disease, stroke, blood clots, ovarian or cervical cancer