Exam 2 Flashcards
Preterm birth
less than 37 weeks
Low birth weight
less than 2500 grams, primary factor associated with neonatal death
Neonatal
First 28 days of life
Full term size
3500 g and 20in long
Average GA
bt 10th and 90th percentile
Large GA
greater than 90th percentile
Small GA
wt less than 10th percentile
dSGA
disproportionately- thin but height and head normal (2/3 of SGA) (Diminished nutrition in last trimester, can catch up
pSGA
proportionately- stunted (adapted to diminished nutrition, cant catch up)
Leading causes of infant mortality
1) congential anomalies (birth defects)
2) Preterm/LBW
3) Maternal complication
4) Sudden infant death syndrome
The bigger the mom
the bigger the baby
Obese moms have big babies regardless of
how much they weigh/gain
More weight gain equals
bigger baby
Line is steepest for underweight mom, this means
the weight they gain goes to the baby the most
Dutch Famine Birth Cohort
people exposed to famine at diff parts of pregnancy vs those not
Exposed early had most effects- defects, cancer, diabetes
Hyperplasia
cells dividing
Hypertrophy
cells growing in size
Brain keeps doing _____ (hyperplasia/hypertrophy) after birth
hyperplasia (Increase in DNA bc of cells dividing)
Pregnancy is detected by
gonadotropin hormone in blood
The medical world counts 2 weeks post conception as
4 weeks
Insults during embryogenesis (60 days after conception) may result in
permanent defects
Study: mental development of stunted babies, given social or milk supplement or both Results?
Social helped more, best was both and the babies almost caught up
Most congenital anomalies have an unknown cause the other 35% are caused by
- genetics
- twinning
- environmental (alc)
- genetics+environment
Iodine deficiency results in
hypothyroidism= profound mental and physical retardation in baby, most preventable cause
Closure of neural tube happens at day
19-28
Anencephaly is characterized by
the brain not forming– lethal
Spina bifida is characterized by
an open spine, results in varying degrees of paralysis
Most neural tube defects are caused by
folate deficiency
Obese women have greatest chance of NTDs Why?
we dont know, maybe genetic polymorphism that increases folate requirement
RDA for folate in preg
600 ug lactation:500
RDA vita A
preg: 770 Lactation:1300
High vita A intake has similar effects to the baby as
alcohol
baby and moms blood never directly mixes instead
things are transported by mechanisms
Placenta uses ___ % of glucose baby receives
30-40
Placenta uses ___ % of the CO
10
Glucose is received based on
conc gradient, simple and facilitated diffusion
How are vitas and mineral transported across placenta
ADEK-passive
Water soluble- active
hCG is responsible for
implantation
progesterone is responsible for
relaxation of GI muscles (heartburn, constipation), mediates fat disposition
Estradiol is responsible for
relaxes ligaments in pelvic area
hPL is responsible for
insulin resistance
Insulin resistance is
decreased ability of insulin to stimulate glucose uptake, results in increased glucose and insulin/glucose ratio
T/F: In preg women glucose and insulin shoot up way more than normal women
T
Accelerated starvation
baby takes up lots of glucose in the morning after fasting
Gestational diabetes is characterized by
body cant make extra 30% of insulin required bc they already have insulin resistance and high amounts
Total body water increases ___ and blood volume increases ____
7-10 Liters, 1.5 Liters
Edema occurs in
60-75%
Increased Na retention via
increased aldosterone
Hemodilution
Plasma vol increases 50% and RBC mass increases 25% which decreases Hb conc.
CO increases by
30-50%
Blood pressure decreases in
first half of preg, returns to normal 2nd half
Recommended weight gain
underweight: 28-40 lbs
normal: 25-25 lbs
overweight: 15-25 lbs
Obese: 11-20 lbs
Twins: 25-54 lbs
Rate of weight gain
3-5 lbs in 1st tri
gradual and consistent gains thereafter
How many more calories a day
300 kcal/day average (no change in 1st tri, +340 in 2nd tri, +452 in 3rd tri)
Protein requirement
+25g/day = 70-75g pro/day or 1.1 g pro/day (twins=+50 g)
Minimum amount of carbs
175 grams
Dietary fiber requirement
28 grams
Linolenic requirement
13g/day
alpha linolenic requirement
9.4 g/day
DHA and EPA
300mg/day
Total Iron need in preg and RDA
1000mg, 18-27mg/day
what is suppressed in the 2nd/3rd tris to make Fe more bioavailable
hepcidin
Diagnosis of anemia in preg
1st and 3rd: Hb under 110 g/L 2nd tri: Hb under 105 g/L Serum Ferritin ug/L normal: >35 depleted: <20 deficiency: 12-15
Why is there no increase in Calcium requirement
absorption increases, so RDA stays at 1000mg (under this may result in release of lead)
Vita D RDA
No increase for preg- 15 ug or 600 IU
Choline RDA
450 mg - eggs and meats (avg intake=270mg)
Pica
eating things not normally considered food
Nutrients of concern in teen pregnancy
Ca, Fe, Zn, folate, D
RDA for Ca in teen preg
1300 mg
Leading cause of maternal mortality
Hypertensive disorders
Systolic BP
when left ventricle contracts
Diastolic BP
when ventricles are filling
Normal BP
120/80
Hypertensive BP
> 140 systolic or >90 diastolic
Gestational hypertension detected for first time
at 20 wks, no proteinurea
Preeclampsia
occurs after 20 wks in previously normotensive women (increased BP or HT and proteinuria (>.3g protein in 24hr in urine)
Eclampsia
seizures in women with preeclampsia
Preeclampsia superimposed on chronic
women w chronic who develop proteinuria
Preeclampsia etiology
abnormal implantation of placenta, decreased placenta blood flow biomarker
Associated with immune dysregulation = increased maternal inflammatory state
Preg is pro-oxidative state, things that increase oxidative stress?
fe supplement >30 Increased fat intake Increased blood glucose Excess body fat Physical inactivity
Antioxidants
vita C and E, selenium, plant phytochem-anthocyanins, carotenoids
Normal blood glucose
60-100
Diabetes mellitus is characterized
increased blood glucose to defects in insulin secretion/action
hyperglycemia and glucose intolerance
babies of mothers with diabetes are more at risk for _____ at birth
hypoglycemia bc BS drops and insulin increases but no glc source
Screening for undiagnosed type 2 diabetes
Hb (Alc): >6.5 %
fasting glc: >126 mg/dL
2 hr: >200 after 75g oral
random glucose: >200
Glycosylated hemoglobin
amount of glu bound to Hb
reflects conc. glc in blood over 2-3 months
Nondiabetic=4-6%
Diabetes= HbAlc >6.5
Diagnosis of diabetes- all preg tested at 24-48 wks gestation
Made by any one value exceeded
fasting: >92
1 hr: >180
2 hr: >152
2 hypothesis of enhanced fetal growth
Pederson hypothesis: mom ^ BS, baby ^ B
S=fetal ^ insulin =growth
Fuel mediated teratogenesis: ^glc, decreased insulin, placenta responds differently(make more fat and RBCs bc of high insulin)
Exercise benefits for GDM
aerobic decreases insulin resistance and blood glc
- bike 45 min, 3x wk
- Lift w arms 20 mins, 3x a wk
- brisk walking 30 mins a day
