Maternal and Infant Final

Why might low fertility be experienced among the !kung and Turkana of Kenya? Summarize your answer in 2-3 sentences.

!Kung people were hunters and gather and there was a scarcity of food when living this way. It was thought that this decreased their fertility because they could become undernourished. It was also thought that their fitness level was maximized by limiting fertility. The fertility and conception rate of Kenya women shows a high correlation with the early dry season. This is when the food supply has been at its best for a time and women are peaking at their nutritional status. This allows the Kenya people to follow a highly seasonal distribution with most births occurring between March and June.

Sensible weight loss for nursing mothers who are trying to lose the weight gained during pregnancy is ___ pounds per week after the 4th week postpartum.

0.5-1

Describe: 1) five risk factors for preeclampsia, 2) five potential outcomes of preeclampsia, and 3) how diet might have an influence on the development and treatment of preeclampsia.

1. Five risk factors of preeclampsia are hypertension, increased maternal age, diabetes mellitus, elevated body mass index, and preeclampsia in a prior pregnancy. 2. Five potential outcomes of preeclampsia are separation of the placenta from the uterus, preterm births, pregnancy loss or stillbirth, low birth weights, and increased risk of developing hypertension and metabolic diseases later in life. 3. Eating a high carbohydrate or fat diet can increase your risk of developing hypertension which can increase the chance of developing preeclampsia. Therefore, it is important to eat a diet rich in vegetables, fruits, and fish to decrease the chance of developing hypertension while pregnant. Decreasing the work your heart is having to do to push blood through the body is going to make it easier for the proper development of the placenta and decrease the chance of preeclampsia.

Visit this website and choose two objectives related to preconception nutrition to summarize in your own words. Then describe their importance to public health or individual health in 1-2 sentences each. Please copy and paste this into a new window so that it does not navigate the page away from your quiz.

1. Goal 1 is reducing the rate of fetal deaths at 20 or more weeks of gestation. Currently, fetal deaths are 5.9 per 1,000 live births. Individual health is incredibly important as the only nutrients the fetus is getting to grow and develop is through the mother. If her health is not adequate or she is deficient in nutrients then the fetus's health can be greatly affected. 2. Goal 2 is to increase the proportion of pregnant women who receive early and adequate prenatal care. The percent of pregnant women currently receiving care is 80.5%, which has shown an increase from the baseline value. This goal is very important to public health as this can be handled in large groups similar to the WIC program. The overall decrease in this problem would decrease fetal deaths, preterm births, and an increase in the healthy weight of women before pregnancy.

For the following list of microorganisms, list the complications they may cause for the mother and/or infant, and the foods they can be found in. Listeria monocytogenes Toxoplasma gondii Salmonella typhi Campylobacter jejuni Clostridium perfringens Escherichia coli O157:H7 Norovirus Vibrio vulnificus

1. Severe cases can lead to meningitis, abortion, or septicemia. Women can obtain flu-like symptoms. Listeria monocytogenes can be found in hotdogs, deli meats, or poultry that were cooked or reheated improperly 2. Toxoplasma gondii is more infectious to the fetus. It can cause spontaneous abortion, seizures, and mental retardation. It can be found in cat feces, raw or undercooked meats. 3. Salmonella typhi can cause infants to have a fever or diarrhea at birth. Babies born to mothers who obtained salmonella can develop sepsis or development meningitis. It can be obtained from chicken, turkey, beef, and even vegetables. Foods have to be eaten that contain animal feces. 4. Campylobacter jejuni can be obtained from undercooked poultry, beef, pork or lamb. If a mother obtains this she can get an intrauterine infection of the fetus and cause stillbirth, early neonatal death, or abortion. 5. Clostridium perfringens come from foods cooked in large batches and held at unsafe temperatures. Pregnant women would develop flu-like symptoms including vomiting and stomach cramps. 6. Escherichia coli comes from beef, sprouts, spinach, and ready-to-eat salads. It can cause dehydration via excessive diarrhea. To the fetus, it can cause a preterm rupture of membranes. 7. Norovirus comes from leafy greens, fresh fruits, and shellfish. Mothers need to keep up their fluid intake by drinking plenty of water to prevent dehydration. 8. Vibrio vulnificus can be found in oysters and shellfish from warm coastal waters. It is not known if vibrio can harm a developing baby. An expecting mother can develop diarrhea and vomiting.

In the United States, a study using the National Hospital Discharge Survey reported a _____% increase in the prevalence of GDM from 1989-1990 to 2003-2004.

122

Amari's BMI is 29. How much weight should she gain during her pregnancy?

15-25 lbs

Fill in the blank: Fetuses do not produce thyroid hormone until _____ weeks gestation.

20

Neural tube defects develops within _____ days of conception

21

In the U.S., pregnant women are screened for gestational diabetes between ___ and ___ weeks gestation.

24, 28

Choose the iodine assessment method that is best described by this sentence: For reliable assessment of iodine status, multiple runs are suggested. This method is also expensive and cumbersome.

24-h urine iodine excretion

Autumn's BMI is 22. How much weight should she gain during her pregnancy?

25-35 pounds

Madison's BMI is 19. How much weight should Madison gain during pregnancy?

25-35 pounds

A baby is 2 months old and weighs 5 kg. How many ounces of milk does the baby need to consume each day? (Note: assume that the milk provides 20 calories per ounce).

26 ounces per day

During gestation, approximately how much iron does a fetus accumulate?

300

If a family does not want to supplement their fully or partially breastfed child with vitamin D, research shows that a maternal intake of at least _____ IU/d of Vitamin D could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status and is not too excessive.

4000

In which of the following scenarios would fluoride supplementation be needed?

A 6+ months of life if the water in the mother's diet is not fluoridated

Which of the following statements is/are true regarding adequate nutrition during the first 1,000 days of life?

A. Impacts national development B. Impacts a child's ability to grow, learn, and thrive C. Provides the essential building blocks for proper brain development, healthy growth and a strong immune system.

Match the terms with the correct definitions: A. the lack of conception after 1 year of unprotected intercourse B. Interval in which hormones direct buildup of blood and nutrients stores within uterus, ovum matures and is released C. Loss of baby within 1st 20 weeks of pregnancy D. Characterized by an unusually long time for conception; reduced level of fertility E. Eggs females produce & store within the ovaires F. Period in which humans become biologically capable of reproduction

A. Infertile B. Menstrual Cycle C. Miscarriage D. Sub-fertility E. Ova F. Puberty

Which of the following statements is/are true regarding oxidative stress, antioxidant status, and fertility?

A. antioxidants include vitamin E, vitamin C, beta-carotene, and selenium B. Oxidative stress reduces the ability of the sperm to fuse with an egg C. Oxidative stress interferes with the implantation of an egg D. Oxidative stress reduces sperm motility E. Oxidative stress harms egg

Answer the question (describe your answer): Should formula fed babies be supplemented with vitamin D? (this takes some critical thinking) To answer this question, you need to know 1) how much vitamin D is in formula?, and 2) how much formula do babies consume?

According to the websites, babies should not drink more than 32 ounces of formula in 24 hours. Infant formulas are fortified with vitamin D and provide your baby with an adequate amount. Depending on the age of the baby, the amount at each feeding changes. If your baby is receiving an adequate amount of formula for their nutrients then the baby does not need a supplement of Vitamin D.

established when there is not enough evidence to develop an RDA and is set at a level assumed to ensure nutritional adequacy

Adequate Intake

Which of the following are holistic approaches to treatment for restless leg syndrome?

Adequate sleep Compression socks Massage

As gestation progresses, secretion of ____ decreases, which leads to decreased insulin sensitivity.

Adiponectin

Which organization's screening method is best for testing for Gestational Diabetes?

American College of Obstetrics and Gynecology

•Step 1: 50g, 1 hour OGTT (> 135-140 mg/dL) AND •Step 2: 100g, 3 hour OGTT (2 cut-offs)

American College of Obstetrics and Gynecology

Select the answer that correctly describes the organization's gestational diabetes screening guidelines.

American College of Obstetrics and Gynecology - Step 1: 50g, 1 hour OGTT (> 135-140 mg/dL) AND Step 2: 100g, 3 hour OGTT (2 cut-offs)

75 g, 2 hour OGTT •Fasting Values > 92 mg/dL OR •1-hour Values > 180 mg/dL OR •2-hour Values > 153 mg/dL

American Diabetes Association

When ________ are adequate, the mTOR pathway stimulates blastocyst growth and invasion, increasing chances of conception.

Amino Acids

Which of the following is/are correct regarding the definition of anemia?

Anemia occurs when there are not enough red blood cells present. There are various types of anemia. Anemia is diagnosed when hemoglobin values are less than a certain number, which may vary depending on age, sex, and trimester of pregnancy. Anemia occurs when the red blood cells do not function properly.

At which age should complementary foods be introduced?

Apprx. 6 months

Describe why infant need to receive a shot of vitamin K at birth.

Babies are born with a minimal amount of vitamin K in their bodies which can lead to severe bleeding problems. A single vitamin K shot at birth protects the baby from dangerous bleeds that can lead to brain damage or death.

Select all of the disorders that are associated with adequate intake of calcium.

Binge Eating disorder Bulimia Nervosa

A ____ is a mass of cells that forms the embryo and an outer layer of cells known as a _____, which nourishes the embryo and later forms the placenta.

Blastocyst, trophoblast

Danielle is a professor and she loves her job of teaching. She is 5 months pregnant and finds that when she is standing up in front of a large class, she has a difficult time catching her breath while teaching. Which of the following would explain why she has a hard time catching her breath?

Blood flow to the uterus increased. She is experiencing an increase in her heart rate. She is experiencing an increase in end-diastolic volume. She is experiencing increased blood volume and cardiac output

Select the following eating disorders that are associated with small for gestational age (SGA) and low birth weight (LBW) infants.

Bulimia Nervosa Anorexia Nervosa

Select all of the following that should be washed prior to use.

Canned goods Vegetables Fruits

Which of the following is a cure for Preeclampsia/Eclampsia?

Childbirth

Place the following food safety principles in order from first step to last step.

Clean, separate, cook, chill

Adequate health and nutrition status can aid in the prevention of which of the following outcomes?

Congenital anomalies Fetal Growth Restriction Maternal mortality Low Birth Weight Small for gestational age Fetal Mortality Neonatal illness Pregnancy complications

Which of the following are possible adverse effects of routine iron supplementation?

Constipation Diarrhea Nausea Vomiting

How can pregnant women alleviate constipation during pregnancy?

Consume high fiber foods Increase consumption of liquids above the recommendation of 6-8 glasses per day. Exercise regularly

A mother comes to you for nutrition counseling because she has been nauseated during her first trimester of pregnancy. What is some advice you could give her to manage her nausea?

Consume small, frequent meals and beverages Get out of bed slowly Consume high carbohyrdate foods Avoid fried, spicy, and high fat foods

Which of the following are ways in which vegetarian mothers can gain weight during pregnancy?

Consuming small, frequent meals throughout the day Using refined foods if fiber intake is too high

List three nutrients that have an increased requirement during lactation. Describe this increase and the types of foods these nutrients can be found in.

Copper: Copper needs to be increased due to it being a component of enzymes in iron metabolism. An increase should be from roughly 900 - 1300 mcg. Women can eat nuts, seeds, lobster, leafy greens, or dark chocolate to increase their copper intake. Zinc: Zinc needs to be increased due to its function in multiple enzymes and proteins as well as being involved in the regulation of gene expression. Zinc concentration needs to be increased from 8/9 -12/13 mg while lactating. Foods to eat while trying to increase zinc concentrations are avocados, blackberries, peaches, kiwifruit, and blueberries. Oysters are a great option for zinc, however, you could also incorporate more red meat or chicken into your diet. Iodine: Iodine needs to be increased since it is a component of thyroid hormone, and prevents goiter and cretinism. Iodine requirements increase from 150-290 micrograms. The best way to increase iodine is through shellfish, fish, salts, eggs, or dairy.

Describe the critical dimensions of responsive feeding.

Critical dimensions of responsive feeding include providing a child with options based on clear feeding cues such as hunger and satiety. The caregiver responds in an appropriate way to develop a proper relationship in feeding the child when they seem hungry and full. Allowing the child to communicate what they need and giving them food.

What is the main source of iodine in the american diet?

Dairy

Which of the following describes an infant that is exclusively breastfeeding?

David is 2 months old. He has never had any liquids or solids besides breast milk. Elizabeth is 3 months old. She has never had any liquids or solids besides breast milk and vitamin D drops.

Match the hypertensive disorders with the correct definitions.

Diagnosed for the first time after 20 weeks of pregnancy: Gestational hypertension Hypertension usually occurring after 20 weeks gestation, impacting all organ systems: Preeclampsia/Eclampsia HTN present before pregnancy, diagnosed <20 weeks, or 12 weeks postpartum without resolution: Chronic Hypertension

Select all the sources for Vitamin D3 (cholecalciferol).

Dietary supplementation Animal Sources Sunlight

What are the recommended dietary modifications for gestational diabetes?

Distribute glucose throughout the day with small frequent meals Emphasis on complex carbohydrates over simple carbohydrates

Discuss the role of the Registered Dietitian (RD) and healthcare team in establishing a diagnosis and appropriate nutritional goals for a pregnant woman with an eating disorder.

Each type of eating disorder affects the body differently and involves a different relationship with food. Providers need to determine the correct ED a patient has to properly provide the care needed for the health of the mother and the baby. For example, if someone has anorexia then they need to gradually increase energy consumption while a binge eater needs to reduce the frequency of eating binges. The registered dietician working with this patient is going to be specialized in eating disorders for this reason. The team will be working with the patient during and after pregnancy to assist in nutritional education and monitoring to make sure treatment is successful and maintained. Pregnancy gives mothers a reason to work to diminish their ED but postpartum ED are common to reappear. Providers act as a support system to provide appropriate goals for nutrition.

Which of the following is correct about hypertensive disorders of pregnancy?

Eclampsia is the occurrences of seizures that cannot be attributed to other causes. Preeclampsia - eclampsia is accompanied by proteinuria, headaches, blurred vision, abdominal pain, and abnormal liver enzymes levels. Gestational hypertension is diagnosed after 20 weeks of pregnancy Chronic hypertension is present before pregnancy or diagnosed before 20 weeks of pregnancy

Maria is 25 weeks pregnant and has HIV. What can a dietitian do to help ensure the health of Maria and her baby?

Educate on safe food-handling practices Conduct a nutrition assessment to identify and correct elements of poor nutritional status Encourage adequate calorie, protein, and micronutrient intake.

Compare and contrast equity and equality.

Equality means that each individual or group is given has the same availability of the same resources or opportunities. While equity understands that people have different circumstances and works to provide the exact resources and opportunities needed to reach a similar outcome.

is the amount of a nutrient estimated to meet the requirement of half of all healthy individuals in the population

Estimated Average Requirement (EAR)

Match the hormone below with the corresponding function related to pregnancy.

Estrogen: Increases uterine blood flow; Helps to supply nutrition to the fetus; prepares breast for lactation hCS/HPL: Increases insulin resistance and reduces maternal glucose uptake to facilitate transfer to the baby Progesterone: Maintains the implanted embryo; stimulates the growth of the endometrium and its secretion of nutrients hCG: Rescues the corpus luteum from demise and maintains progesterone and relaxin production until the luteal-placental shift in progesterone production at 9 weeks gestation Leptin: Metabolic indicator that may be involved in fetal intrauterine growth adaption and long-term health Adiponectin: A hormone that facilitates insulin sensitivity

Cloth towels are the preferred method for cleaning cooking surfaces.

False

Human milk is naturally high in vitamin D.

False

Iodine supplementation is not recommended because of the risk of Wolff-Chaikoff effect

False

Some research shows that increased alcohol consumption may decrease the time to conception

False

Standard weight gain recommendations are not used for vegetarian mothers. There is a separate standard used for pregnant women following a vegetarian diet.

False

The AAP recommends giving infants whole cows milk at 11 months of age.

False

The outcomes of maternal metabolic syndrome on newborns are definitively known.

False

Vitamin D levels are sustained during lactation for the 6 months and then start to deplete

False

When lactating people drink alcohol, before nursing their baby, they need to "pump and dump" their milk to remove alcohol.

False

Women with binge-eating disorder consume food that are readily absorbed to meet their energy needs.

False

_______ cross(es) the placenta and ensures adequate supply for brain and retinal development

Fatty Acids

What is complementary feeding?

Feeding an infant foods and liquids, along with human milk, when an infant's nutrition needs can no longer be met by human milk alone

Women with Celiac Disease should adhere to a gluten free diet always, especially during reproductive years, to reduce the risk of which of the following conditions/events?

Fetal growth restriction Miscarriage Short Duration of lactation Amennorhea Low-birth weight deliveries

Choose the top three components of maternal weight gain during pregnancy.

Fetus Maternal Fat Stores Extracellular Fluid

Modifiable factors of gestational diabetes include all of the following EXCEPT:

Genetics

What is the role of hepcidin during iron absorption? There may be multiple correct answers.

Hepcidin prevents iron from entering the bloodstream when iron stores are sufficient or excess Hepcidin plays a role in regulation of iron absorption

Amber was in her first trimester when there was a famine in her country. The famine did not last through her entire pregnancy. By the time she was in her late second trimester, she was able to consume adequate nutrition. Which of the following are the most likely consequences to her baby?

Her baby may have an increased risk of heart disease later in life. Her baby will most likely be of normal size at birth

Anika is a single mother with two children and is pregnant with her third. She works a stressful job and she often does not know how she will be able to purchase food for her and her children. It is rare that her and her family are able to eat a nutritious meal. How might her unborn baby be affected by the current situation?

Her unborn baby may experience growth restriction

What steps should a caregiver follow when paced bottle-feeding an infant?

Hold the bottle horizontally Allow the baby to draw the bottle nipple into the mouth Hold the baby upright Allow the baby to take pauses

Kate is in her first trimester and is suffering from severe nausea and vomiting. What health complications is she at risk of?

Hospitalization for dehydration and electrolyte imbalance Extreme weight loss Renal failure

Reflect on your own sleep quality. How many hours of sleep do you get each night? Scan this article which reviews many factors that can impact sleep, and discuss 3 of them that might interfere with your sleep, or three things you do well in your lifestyle that help you sleep

I tend to get 7-8 hours of sleep at night. However, it takes me close to an hour to fall asleep. Three factors that are affecting my sleep could be caffeine consumption, electronic use before bed doing school work, and I also tend to work out late at night. These three things are meant to wake your body up instead of help relax and put you to sleep.

Develop a treatment plan for a pregnant mother who has trouble sleeping. Use at least three strategies mentioned in the notes/lecture/reading.

If a woman has restless leg syndrome and that is causing her to lie awake at night then there are three main options she can turn to. A woman could work her way down the list as her "plan" to start with little help and work her way up if need be. First is the holistic approach of reassurances, stretching/massage, adequate sleep, and the use of compression socks to give the left weight and support. The second is through diet and exercise. Women need to avoid caffeine, maintain moderate exercise, and be aware of their iron levels in case they are in need of supplementation. Third, is the pharmacologic approach. Typically women turn here when other methods are not successful. Some medications that can help are clonazepam, carbidopa-levodopa, and oxycodone.

Match the intervention in infants and children with the most likely results Multiple micronutrients supplementation in children

Improved height and weight gain, increase in reasoning abilities, improved hemoglobin concentration, reduced IDA and retinol deficiency

Which of the following statements regarding the history of weight gain recommendations during pregnancy is CORRECT?

In the past, weight gain during pregnancy was limited or restricted in order to preserve a woman's figure Recommended weight gains during pregnancy have approximately doubled from the 1930's until the present In the past, women were told to gain less than or equal to 15 pounds during pregnancy

Match the intervention in infants and children with the most likely results Kangaroo Care

Increase in breastfeeding at 1-4 months of age and increase duration of breastfeeding, reduction in the risk or mortality, reduction in nosocomial infection or sepsis, reduction in prevalence of hypothermia

Match the intervention in infants and children with the most likely results Delayed cord clamping

Increase in newborn hemoglobin and higher serum ferritin concentration at 6 months of age, reduction in need for blood transfusion, lower risk of complication after birth

What changes to the mother's cardiovascular system occur during pregnancy?

Increase in ventricular wall muscle mass Increase in end-diastolic volume

Match the intervention in infants and children with the most likely results Massage for premature infants

Increased insulin and IGF-1, increase weight gain, reduce hospital stay, improves bone density

Which of the following are benefits to vegetarian diets during pregnancy?

Increased magnesium and folate intake Lower gestational weight gain Higher fiber intake=less constipation

Which of the following are health consequences associated with gestational diabetes?

Increased risk of the mother developing type 2 diabetes Increased risk of the mother getting gestational diabetes in subsequent pregnancies Increased risk of the newborn baby having hypoglycemia and hyperbilirubinemia

The likelihood of developing iron deficiency _____ as gestation _____.

Increases, increases

The guidelines for gestational weight gain that we discuss in this class are published by:

Institute of Medicine (IOM)

These (this) compound(s) made by the placenta are decreased by maternal under-nutrition or increased by maternal blood glucose levels.

Insulin growth factors 1 and 2

Which of the following statements is correct about insulin sensitivity during pregnancy?

Insulin sensitivity decreases because adiponectin decreases with increasing gestation.

The most important nutrient to focus on when introducing complementary foods to infants is ________.

Iron

Discuss whether or not iron supplementation should be routinely recommended to all women of child bearing age. Including in your answer a discussion of at least two vulnerable population groups that could be benefitted or harmed by routine iron supplementation.

Iron supplementation should not be routinely recommended to all women of childbearing age because women with adequate iron stores can be harmed from this. One vulnerable group is mothers who are carrying multiples during pregnancy. This is not something that can be prevented or known until you become pregnant. Monitoring your iron levels before becoming pregnant would ensure that your iron is at a safe level for a safe pregnancy and if multiples were to occur then the doctor can do an early small supplement to aid in maintaining your iron stores and the multiple's requirements as they grow. Iron takes months to build up and reverse the health effects. Therefore, if you are not monitoring your iron before and become pregnant with multiples, your iron could drop below the desired amount for you and your babies and potentially cause health problems for everyone. Another group that could be of concern for iron supplementation is women who are iron-replete. Excess iron can impair immunity and cause preterm births resulting in an LBW child. Women who already know their iron levels can take quicker action on symptoms similar to iron deficiency knowing there is another possible cause. Some physicians may automatically recommend iron supplementation for women who become pregnant and if your iron stores are sufficient then you are able to deny the supplementation for proper health reasons. By denying the excess iron, you are taking the same precautions to keep your child safe just as a woman who is taking supplements when iron deficient.

Which of the following description correctly describes the term "stunting"

It is caused by malnutrition The inability for a child to reach their genetic potential for height

Which of the following descriptions correctly describes the term "wasting"

It is caused by malnutrition The loss of fat and muscle mass

Which of the following are reasons why choline is important in the diet of a pregnant person?

It is used to make acetylcholine It may protect against preeclampsia It lowers cortisol concentration in cord blood

For the following conditions: obesity, metabolic syndrome, PCOS, and hypertension, discuss how a person could eat and live a healthy lifestyle in order to reduce the risk of complications for oneself and their offspring. You do not need to have a separate answer for each condition, but you may discuss them all together. Please discuss both diet and lifestyle characteristics.

Lifestyle: A healthy lifestyle decreasing the chances of all of these conditions would be proper sleep, regular not extreme exercise, decrease to little alcohol and caffeine consumption. A lifestyle including the previous things is typically going to lead to an increase in weight gain typically resulting in confounding factors leading to metabolic syndrome and PCOS. Diet: A proper diet including a colorful array of foods will be beneficial in decreasing the chance of obesity, hypertension, PCOS, and metabolic syndrome. A diet should include vegetables, fruits, low fat dairy, water, whole grains, fish, poultry, beans, nuts, and vegetable oils. Careful consideration should be taken into account of folic acid and iron concentration in the diet for women and zinc concentration for men. There are a variety of options to assist in maintaining proper vitamin and mineral levels to decrease the chance of becoming deficient such as certain foods and supplementation. Proper lifestyle changes will help to incorporate a better diet helping to maintain weight, blood pressure, blood sugar, and HDL levels.

Summarize 3 of the "10 steps," and for each one, describe why it is important.

Listed below are three of the "10 steps" of successful breast feeding. 3. Physicians and nurses must discuss the importance and management of breastfeeding with the pregnant mother so the mother's wants are known prior to birth. This is important so the mother's wants are known and can be followed while receiving help from hospital staff. 4. Once the baby is born there needs to be an uninterrupted skin-skin time for the mother and baby to initiate breastfeeding as soon as possible after birth. This is important so the natural relationship can develop to allow the baby to know this is where I am supposed to go to receive life or food. 5. Physicians and nurses must support mothers to initiate and maintain breastfeeding through common difficulties. This is important because breastfeeding is not quickly done by everyone. Some have more trouble than others initially which is normal. It is important for the hospital staff to assist the mother so she does not give up and the baby can receive the proper nutrients from breast milk.

Which of the following is true about listeriosis?

Listeria monocytogenes can multiply in refrigerated foods Pregnant women are particularly susceptible to listeriosis To avoid listeriosis, pregnant women should avoid deli meats, soft cheeses, and unpasteurized milk, eggs, and juice Consequences of listeriosis in pregnancy may include miscarriage or stillbirth

Match the parenting style with the corresponding characteristics.

Low/no expectation, low nurturance:Uninvolved Clear expectations, high nurturance: Responsive Strict expectations, low nurturance: Controlling Low/no expectations, high nurturance: Indulgent

Iodine deficiency during pregnancy may increase the risk of the following outcomes?

Lower IQ in children Preterm birth and low birth weight in offspring Miscarriage, prematurity, and stillbirth Maternal and fetal goiter

Gestational weight gain __________ the recommendations showed lower incidences of large for gestational age among infants.

Lower than

How are placental growth factors affected by maternal nutrition and what affect would they have on the fetus?

Maternal undernutrition lowers IGF-1, leading to fetal growth restriction.

Explain what medical lore is and its impacts on vitamin D supplementation.

Medical lore is when medical students are taught something based on outdated information or data that has been carried through to the present by professors. It is has impacted the supplementation of vitamin D through the false concern children will develop SAS syndrome. Since the researchers believed then it caused SAS syndrome, professors have carried this through even though there have been studies to invalidate this topic. Therefore, supplementation has not been recommended to mothers when it actually is very important to the mother and her baby. What actually happened was the researchers were testing a child with William's syndrome.

Which of the following factors drive milk production?

Milk removal from the breast Breast stimulation

Describe three ways in which people who are pregnant and with an obese BMI can be supported.

Mothers who are expecting and obese need to be supported by their nutritionist, physician, and/or specialty provider (ex: physical therapist) to; 1. Maintain proper nutrient intake through dietary recommendations of macronutrients, micronutrients, and protein. This can also include determining socioeconomic and economic factors contributing to weight and finding ways to eliminate or decrease them. 2. Gain within the recommended limits of weight gain for their pre-pregnancy BMI to avoid any complications or metabolic changes that could occur. 3. Provide a proper exercise regimen that equals 30 minutes or more of exercise each day. The goal of the exercise is not to help lose weight but to maintain function, flexibility, and relaxation.

In 1998, in an effort to prevent ______, the FDA mandated that refined grain products be fortified with _______.

Neural Tube Defects, folic acid

Why is it important for women of childbearing age to consume adequate amounts of folate, either from food or a supplement?

Neural tube defects in the baby may result from a lack of folate in the maternal diet

What are the primary functions of the placenta?

Nutrient and gas exchange, Produce metabolic hormones and enzymes, Accumulate glycogen when glucose is in surplus, Remove waste from the fetus

Risk factors for developing gestational diabetes include (check all that apply):

Obesity Race Family history of diabetes

When fish oil is given during pregnancy, it significantly increases which of the following components in the milk?

Omega 3- fatty acids Immunoglobulin A and other immune proteins

Which of the following diagnostic tools for diabetes is used to diagnose gestational diabetes?

Oral Glucose Tolerance Test (OGTT)

Briefly describe the process of paced bottle-feeding.

Paced bottle feeding is a bottle feeding method that allows the infant to be more in control of the feeding pace. This method slows down the milk flow into the nipple and the mouth, allowing the baby to eat more slowly and take breaks. This process consists of recognizing feeding cues like allowing your baby to move their head toward the mother or start sucking on their own fingers. The bottle needs to be kept horizontal while slightly tipped, which prevents milk from flowing too fast. While the baby is eating, watch for cues that they are done and remove the bottle to stop milk flow.

Select all of the following that are responsible for food borne illness:

Parasites Chemical contaminants Viruses Bacteria

What symptoms might indicate that a pregnant woman has preeclampsia?

Persistent and severe headaches Hypertension Abdominal Pain

Which of the following factors may put a nursing mother at nutritional risk?

Pica Being underweight before pregnancy Lactose Intolerance Alcohol, tabacco, and/or recreational drug use Eating disorders

Trophoblast cells of the ____ attempt to compensate for protein restriction by enhancing villous development.

Placenta

Select all the sources for Vitamin D2 (ergocalciferol).

Plants Dietary Supplements

A diet rich in ____ will increase its percentage in breast milk without affecting the total ____ content.

Polyunsaturated fatty acids (PUFAs): fat

Describe the positive and negative impacts of COVID-19 on health inequities.

Positive: COVID-19 leveled the field as to available health care. There was no difference in the amount of money or resources due to lock-down, hospital capacity, and health care worker availability. There was also no cure or treatment at the beginning. Health care and testing available were offered to everyone free of charge once the option became available. Negative: COVID-19 made those resources that children and families were getting to support themselves, like free school lunches, impossible to get. For a while, there were no options to help those in need who depended on outside resources to feed their family.

Which of the following are symptoms of anemia?

Pounding in ears Pale skin Dizziness Shortness of breath Cold hands or feet Weakness Chest pain Headache Fast heartbeat

_______________ is the best indicator of gestational weight gain.

Pre-pregnancy BMI

Vitamin D supplementation during pregnancy seems to have a positive effect on which of the following conditions?

Preeclampsia Infections Gestational Diabetes C-sections

Describe the importance of hand washing in terms of safe food handling practices. Additionally, outline the components of proper hand hygiene.

Pregnant women are at a higher risk of obtaining foodborne illnesses compared to non-pregnant women. The easiest way to decrease the chance of foodborne illnesses is by cleaning the utensils, hands, and food before cooking. This decreases the spread of germs and therefore, results in a decreased risk of disease contamination of the baby. Proper hand hygiene goes through 12 steps. You must first rinse your hands with water, then use soap or hand sanitizer, wash your palms, scrub each finger, rub the back of your hands and between fingers, rub the base of your thumbs, scrub nails on palms, and wash your wrist. After going through steps 1 - 8, one must rinse off the soap with water, dry hands with a towel or dryer, and turn off the faucet with a paper towel. Finally, you can consider your hands clean!

Describe the process of safely preparing infant formula. Include in your answer why it is important to use boiling water.

Preparing infant formula: 1. First you must wash your hands with warm water and soap. You also need to make that the workspace is clean as well. 2. Prepare bottle (This can entail getting the parts together, and making sure they are clean with warm water and soap.) 3. Measure the formula and water ratio because too much water can cause the nutrients to be diluted. It is important to use boiling water when making formulas because the water and formula are not sterile. 4. Add water to the powdered formula and mix together. You must let the bottle cool to a temperature no cooler than 70 degrees Celsius before feeding it to the baby.

How does prematurity impact iron stores in babies? Select all that apply.

Preterm babies are at risk for low birth weight, which is associated with low iron stores When born too early, babies do not have enough time for iron stores to accumulate in utero

Match the interventions in women of reproductive age and during pregnancy with the most likely result. Folic acid supplementation by fortification of the food supply

Prevents neural tube defects, improves birth weight, and decreases megaloblastic anemia

Which condition is characterized by excessive secretion of saliva?

Ptyalism

Research from a(n) _____ study found that Vitamin D supplementation ____ childhood asthma rates.

Randomized controlled Trial, decrease

average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people

Recommended Dietary Allowance

Match the interventions in women of reproductive age and during pregnancy with the most likely result. Intermittent iron supplementation

Reduce risk of anemia, reduce low birth weight

Match the intervention in infants and children with the most likely results Vitamin A in neonates

Reduced mortality and oxygen requirement at 1 month of age

Match the interventions in women of reproductive age and during pregnancy with the most likely result. Calcium supplementation

Reduces gestational hypertensive disorders

Match the interventions in women of reproductive age and during pregnancy with the most likely result. Daily iron or iron and folic acid supplementation

Reduction in anemia at term, reduction in iron deficiency anemia (IDA), reduction in the incidence of low birth weight

Match the interventions in women of reproductive age and during pregnancy with the most likely result. Iodine supplementation

Reduction in cretinism, increase in development scores in children

Which of the following are thought to be the cause of obstructive sleep apnea in pregnancy? Select all that apply.

Reduction in pharyngeal patency Decrease in nasal patency

Match the interventions in women of reproductive age and during pregnancy with the most likely result. Zinc Supplementation

Reduction in preterm birth

Match the intervention in infants and children with the most likely results Vitamin K

Reduction in risk of bleeding

Match the intervention in infants and children with the most likely results Vitamin A in children

Reduction of all-cause mortality, reduced diarrhea and measles

Select all of the health professionals involved in treating maternal obesity.

Registered dietitian Physical and Occupational therapists Social Workers Medical Doctor

Match the definitions with the appropriate terms.

Repeatedly offer healthy foods such as vegetables to young children: Familiarization Children may also establish food preferences by observing what their caregivers eat: Observational learning Food preferences develop based on the context and psycho-emothional atmosphere in which its offered: Associative learning

Match the hormones of maternal metabolism with their function:

Rescues the corpus luteum from demise and maintain progesterone and relaxin production until the luteal-placental shift in progesterone production at 9 weeks gestation: Human chronic gonadotropin (hCG) Modulates satiety and energy homeostasis: Leptin Modifies the metabolic state of the mother: Human Placental Lactogen (HPL) Increases insulin resistance: Tumor necrosis factor-alpha (TNF-alpha) Increases uterine blood flow; helps to supply nutrition to the fetus: Estrogen

Summarize the characteristics of responsive feeding practices and include in your answer long term benefits.

Responsive feeding includes being attentive to the feeding cues of young children and infants. Caregivers watch for feeding cues and respond by either offering them food or ending the meal when the child seems satisfied. The long-term benefits of responsive feeding are the awareness of eating when you are hungry by listening to your body and stopping when you seem full. This decreases the chance of obesity in children as they can be more aware of what their body needs and when but also when to stop eating. This also allows the baby from an early age to pick up on signs of care, love, and support that support emotional health development and a dependent relationship with the caregiver.

Describe the following types of parenting: responsive, controlling, indulgent, uninvolved.

Responsive: Families who interact in a way that parents are aware of their child's emotions and physical needs and respond consistently with actions based on what the child needs. Controlling: Controlling parenting is when a parent uses authorization or a helicopter method to manage a child's every move. Indulgent: Parenting style where the parents are highly responsive to the child with low actions of demanding. Uninvolved: Parents who are uninvolved typically seem as neglectful because they lack responsiveness to the child's needs.

_______ has iodine added to it to aid in the declination of global iodine deficiency.

Salt

Which of the following correctly describes the function of the synctiotrophoblasts?

Secretes progesterone, hCG, and HPL Covers the villi of the placenta Directs maternal metabolism and fetal growth and development

A mother goes out for caffeinated beverages with her friends. She consumes 100 mg of caffeine. Which of the following scenarios should the mother follow to make sure her breastfed baby is not irritated by the caffeine? Choose the BEST answer.

She might need to experiment with the best thing to do, because caffeine bothers some babies but does not bother others

What signs indicate that an infant is ready for solids?

Sits up and holds head up Drools when hungry Wants to eat more frequently Is no longer satisfied with breast milk or formula

What lifestyle modifications are recommended for the management of gestational diabetes?

Spread carbohydrates intake throughout the day Insulin and/or medication if other lifestyle modifications aren't effective Blood glucose monitoring four times per day

Match the following acronyms to the correct definitions.

Stimulates production of T3 and T4: TSH Converted to T3: T4 Active form of thyroid hormone: T3

Which of the following methods assess long term iodine status, but the data can be affected by smoking and environmental factors?

Tg levels

Anitra has been trying to get pregnant with her first baby, but it is taking a long time. She has been trying for over two years and has not yet conceived. Her BMI is 18 and she is 29 years old. Which of the following are steps that her health care provider (HCP) should take to best help Anitra and her future baby?

The HCP should work with Anitra on strategies to safely gain weight. The HCP should consider a referral to a psychologist if Antira is unwilling to gain weight.

Search the internet to learn what organizations recommend regarding alcohol during pregnancy (such as ACOG, WHO, etc). Summarize your findings in 1-2 sentences here.

The WHO recommends that pregnant women need to discuss alcohol consumption as early as possible when trying to conceive or while pregnant. WHO continues to state that there is no safe level of alcohol use during pregnancy. The ACOD had similar comments and that even moderate drinking can cause lifelong problems for the baby. Therefore, it should be avoided all together

Explain why the iron requirement is higher for vegetarians.

The best source of iron comes from red meat. This source is heme iron and is most easily absorbed into the body. Vegetarians are either not eating meat at all or rarely eating meat. This significantly decreases their supply of heme iron. Iron supplementation can make up for this, as well as other foods but the chance for inadequate intake is a greater risk. Therefore, their requirement for iron is greater to compensate for the lack of natural heme iron in their diet.

Discuss the components of nutrition care for a pregnant person with an eating disorder.

The components of nutrition care for a pregnant person with an eating disorder can vary based on the case. However, in general, the first step of nutritional care is to identify that the woman has an eating disorder and what type. Once a diagnosis has been made medical nutrition therapy is initiated which involves a complete assessment of the patient. This assessment includes anthropometric, biochemical, dietary, clinical, and intake analysis. Registered dietitians will work closely with the patients to determine the exact intervention that is necessary. The goal of the intervention is to ultimately reduce the risk of the eating disorder and improve/promote the health of the mother and growing fetus. Nutrition education and monitoring of the patient are crucial for care to be successful during and after pregnancy.

Describe one theory of the pathogenesis of preeclampsia/eclampsia.

The development of preeclampsia is caused by the poor formation, structure, and/or arrangement of the placenta. This results in the poor transfer of nutrients, respiratory gases, and water from the maternal tissue to a growing embryo. This lack of placental development causes oxidative stress and mediates an inflammatory response, endothelial dysfunction, and lack of modulation of angiogenic and antiangiogenic factor production/activity.

Describe how the ecological model can foster an environment of nurturing care.

The ecological model provides multiple levels of influence on health behaviors and how they tie together. By following the model, a parent or provider can know to use one, more, or all of the interrelation options to develop a relationship and find what works with a child to make sure they feel loved and cared for.

Which of the following is true about glucocorticoid exposure in utero?

The enzyme 11-BHSD is down-regulated during periods of maternal undernutrition, which leads fetal exposure to glucocorticoids Repeat exposure to maternal glucocorticoids leads to growth restriction

Design an intervention for a population that is deficient in multiple nutrients discussed in this unit. Describe your intervention in 2-3 sentences. Utilize at least two strategies discussed within the unit.

The intervention I would focus on would be the health of mothers in prenatal care to make sure their body is healthy as possible. I would increase or advise fortified foods as well as supplementation of iron, folic acid, and a multiple micronutrients supplement. I would advise starting to include fortified foods in their everyday diet while alternating the supplementations of iron or micronutrients every other day. This would decrease the chance of anemia, low birth weight babies, and neural tube defects. By taking supplements every other day we could avoid oversupplying the body with nutrients not needed.

Which of the following are differences between the 1990 and 2009 IOM weight gain guidelines?

They use different BMI categories The 2009 guidelines include a closed recommendation for the obese BMI category

Describe three reasons why pregnancy increases iodine requirements.

Three reasons we covered in the lecture for an increase in iodine requirements are: 1. Increased excretion in iodine through urine since pregnant mothers are urinating more. 2. Increase in blood volume. 3. Increase deactivation of the TH by the placenta.

maximum daily intake unlikely to cause adverse health effects

Tolerable upper intake level

What is the impact of higher than normal triglyceride levels during pregnancy?

Triglycerides are used efficiently by the mother, which spares glucose for the fetus Triglycerides contribute to newborn development via increased milk synthesis Triglycerides represent a floating energy depot

A pregnant woman usually has serum triglycerides that are higher during pregnancy than when she is not pregnant. What is the advantage to having higher than normal triglyceride levels during pregnancy?

Triglycerides contribute to newborn development via increased milk synthesis. Triglycerides represent a floating energy depot Triglycerides are used efficiently by the mother, which spares glucose for the fetus

All eating disorders are associated with suboptimal intake of most nutrients.

True

Bone loss may occur when a mother is nursing her baby/child, but reversal of bone density losses occur within 3-6 months of weaning.

True

Conversion from 25(OH)D to 1,25(OH)2D heavily increases by 12 weeks gestation.

True

Conversion from vitamin D to 25(OH)D is unchanged during pregnancy.

True

Every country in the world is affected by malnutrition.

True

Excessive intake of one-carbon nutrients may increase the risk of developing colitis and allergic diseases in the offspring.

True

Folate found naturally in foods are polyglutamated and require hydrolysis to monoglutamates for absorption.

True

Gestational diabetes can have both long-term and short-term consequences for a pregnant woman and her baby.

True

Gestational diabetes is impaired glucose metabolism associated with pregnancy and usually goes away in the postpartum period.

True

In order to avoid adverse neonatal outcomes in women with gestational diabetes, blood glucose levels must be monitored throughout pregnancy.

True

Iodine is essential for neurodevelopment among infants

True

It is difficult to get enough zinc in our diets, regardless of whether a person is a vegetarian or not.

True

It is normal/common to gain more than the recommended amount of weight during pregnancy.

True

Maternal obesity should be addressed before, during, and after pregnancy.

True

More research is required in order to truly understand the clinical outcomes of iron deficiency in mothers and infants.

True

Pregnancy can serve as an incentive to treat and gain control over an eating disorder.

True

Pregnant people are more inclined to practice safe food handling principles compared to non-pregnant people.

True

Some research shows that increased caffeine consumption may increase the time to conception

True

Sperm production can cease when a man looses greater than 25% of his body weight (if he is at a normal BMI to begin with)

True

Synthetic folate in the form of folic acid is more bioavailable than the folate found naturally in foods.

True

The World Health Organization recommends continued breastfeeding, along with complementary foods for 2 or more years.

True

The literature suggests that short sleep duration can lead to weight gain and obesity

True

Vegetarian diets have been proven to be safe during pregnancy.

True

Women should be able to produce milk of sufficient quantity and quality to support growth and promote the health of infants, even when the mother's supply of nutrients is limited.

True

Women who enter pregnancy with their disorders in remission are more likely to have positive birth outcomes.

True

Women with PKU should adhere to a phenylalanine restricted diet always, especially during reproductive years, to reduce the risk of delivering infants with congenital anomalies.

True

Match the uncooked foods to their appropriate internal cooking temperature.

Turkey, chicken, duck: 165 Ground beef, pork, veal, lamb: 160 Fish: 145

Match the type of diabetes with the correct definition.

Type 1: Results from destruction of insulin-producing cells of pancreas Type 2: Due to body's inability to use insulin normally, or produce enough insulin Gestational Diabetes: Carbohydrates intolerance with first onset during pregnancy

Which of the following nutrients are dependent on maternal nutrient intake and nutrient stores?

Vitamin A Vitamin D Vitamin B12

Which of the following nutrients must be supplemented for vegetarians?

Vitamin B12

When a person is deficient in ________, the following side effects are often seen: skin lesions, convulsions, and growth retardation.

Vitamin B6

Which of the following are ways in which Vitamin D influences iron metabolism?

Vitamin D increases cellular sensitivity to erythropoietin Vitamin D supplementation decreases serum hepcidin concentrations Vitamin D improves hemoglobin concentrations Vitamin D increases cellular erythropoietin receptors

Describe why weight gain during pregnancy is normal and important. Include in your answer a description of four components of weight gain.

Weight gain in pregnancy is normal due to the fact a woman is growing a fetus and sustaining its life based on her intake of nutrients. There are variable growth rates of maternal, placental, and fetal components for each woman that can cause different weight gain. As the fetus grows, the amount of amniotic fluid is rising as well. The mother is developing a uterus and breast tissue to hold the baby and produce milk. In addition, weight gain is normal due to the fact extracellular fluid, blood, and adipose tissue volumes increase as gestation takes place.

75 g, 2 hour OGTT (1 or more indicate GDM) •Fasting Values > 92 - 125 mg/dL OR •1-hour Values > 180 mg/dL OR •2-hour Values > 153 - 199 mg/dL

World Health Organization

Alexandria had a baby named Noah. Noah is 4 days old and Alexandria is worried that he is not getting enough of her breast milk. Noah has several yellow, seedy stools each day, he is having about five wet diapers each day, and he is gaining about 0.75 ounces per day. Is Noah receiving the nourishment he needs?

Yes

Which of the following interventions directly resulted in an improvement in height in children?

Zinc supplementation. Multiple micronutrient supplementation Promotion if dietary diversity and complementary feeding

Julia is in her third trimester and she has been experiencing heartburn. What lifestyle recommendations can you make to help her manage her heartburn?

avoid chocolate and seasoned foods Consume small, frequent meals

An infant born to a mother with gestational diabetes is at increased risk for _____________ in the days immediately following birth.

hyperbilirubinemia

An infant born to a mother with gestational diabetes is at increased risk for _____________ in the days immediately following birth.

hypoglycemia