FN 124 LE 1 - Pregnancy Flashcards
Conditions/Factors to consider during preconception care
o Care before pregnancy
o Fertility
o To motivate potential new parents to participate in
advanced planning of pregnancies
o Risks prior to conception include medical, social, psychological, or lifestyle conditions
preconception care
component of preconception care that includes:
o Individual and social conditions o Adverse health behaviors
o Medical conditions
o Psychological conditions
o Environmental conditions
o Barriers to Family Planning, Prenatal Care, and Primary
Health Care
Risk Assessment
component of preconception care that includes:
o Promotion of behaviors
o Counseling about the availability of social and financial
assistance programs
o Advice on family planning, birth spacing
o Counseling on the importance of prenatal care o Identification of barriers to care
Health Promotion
component of preconception care that includes:
o Treatment of medical conditions
o Referral for treatment of adverse health behavior(s) o Rubella and hepatitis immunization (free)
o Counseling to reduce psychosocial risks
o Nutrition counseling
Interventions to Reduce Risks
refers to nutrition during the time of
pregnancy
Perinatal Nutrition
what does Maternal Dietary Practices prior to pregnancy (always start with studying their dietary patterns) determine
(1) fertility, (2) pregnancy, and (3)
course of pregnancy
Stages of menstrual cycle
- Follicular Phase
- Ovulation – release of the egg cell
- Luteal Phase
In this stage of the menstrual cycle, the egg is released from day 20-24
Ovulation
In this stage of the menstrual cycle, it is the optimal time for conception (when egg is most ready)
Ovulation
appetite-suppressing hormone produced by
adipocytes
Leptin
High leptin production result to?
creation of cysts in
the ovaries (PCOS)
what does high amounts of adipocytes result result to?
high leptin prod
Major preventive measure for PCOS
weight loss
Patients with PCOS are prescribed with?
Metformin treatment
an Oral Hypoglycemic Agent/Drug (OHA) that causes weight loss as one of its side effects
Metformin
What does undernutrition do to fertility?
can cause delayed puberty and amenorrhea
Individual experiences puberty, menarche, and ovulation as expected
Normal Nutrition
Besides undernourished mothers, ______ is usually experienced by female athletes
amenorrhea
being overweight/obese can result to
infertility
Overnutrition
Factors acting in fetal life that can affect future fertility of the baby
o Lifestyle, diet, environmental chemicals
Increased leptin production results in:
o Anovulation
o Hirsutism – hair in other parts of the body due to increase in androgen production
Factors acting in pregnant mother that can affect fetal
development
o Hormone changes due to over/undernutrition
Factors affecting future fertility that are already determined at
birth up to 1 year of age
o Health status of infant
* Female vs. male infants are affected by different factors
Factors acting in adulthood that can affect fertility for females
Female adult – diet, season, occupation, lifestyle
Factors acting in adulthood that can affect fertility for males
Male adult – season, occupation, scrotal heating (time
spent seated)
Role in Spermatogenesis: RNA and DNA synthesis
Cobalamin
Role in Spermatogenesis: Promotes healthy sperm
Folate
Role in Spermatogenesis: Spermatogonia differentiation
Vitamin A
Role in Spermatogenesis: Protects sperm from oxidative stress
Vit C
Role in Spermatogenesis: Defends sperm from ROS-related events
Vit E
Role in Spermatogenesis: Initiate sperm motility
Calcium
usually not consumed by pregnant women due to their side effects, primarily diarrhea
antibiotics
Role in Spermatogenesis: formation of the flagella
Selenium
Role in Spermatogenesis: Enhances sperm motility
Zinc
Role in Spermatogenesis: sperm production
Nickel
diarrhea during pregnancy lead to:
dehydration (due to water loss) where Less nutrients are available for the fetus since the GI tract is compromised and is unable to absorb
Expansion in red cell mass is proportionally smaller than that in plasma, resulting in the so-called ________
physiologic anemia of pregnancy
amount of volume of blood pumped
by the heart
Cardiac ouput
volume of blood pumped from
the left ventricle per contraction
Stroke volume
Due to the increase nutrients and the need of
something to transport them
Increased blood volume
usually decreased (1st and
2nd trimesters) under blood volume changes
arterial pressure
Induces changes in blood flow
Increased blood volume
occurs from
10-12wk through 33-35wk
Progressive plasma volume expansion
Weekly increments are maximal during _____
mid-gestation (5-6 months)
Blood pressure tone _____ and peripheral vascular resistance _____
decreases; falls
blood vessels far from the heart
Peripheral vascular system
blood vessels have decreased resistance to improve blood flow
Blood pressure tone
Resistance to blood _____ to induce better blood flow
decreases
Arterial pressure falls during the ______
1st trimester
used as the baseline to evaluate
pregnancy-induced hypertension (PIH) to the 3rd
trimester
Arterial pressure during the 1st trimester
Changes in regional blood flow: uterine blood flow increases from ______ in non-pregnant to ______ near term
15- 20 ml/min; 500-600 ml/min
Adjustments in respiration: results in increased intraabdominal pressure and elevation of the diaphragm
enlarging uterus
Resting ventilation increases by about ____
48%
Changes in Renal Function (4)
(1) urethral dilation, (2) slowed velocity of urine, (3) increased susceptibility to UTIs, and (4) uterine compression of the ureters
Renal blood flow and Glomerulus flow rate (GFR) are ______
increased
increase in ___ presents the tubules with greater quantities of nutrients than they can absorb
GFR
Changes in Gastrointestinal Function
(1) taste changes, (2) heartburn, (3) nausea & vomiting, and (4) constipation
detected by pregnancy tests through urine
HCG
Released after embryogenesis is completed
HCG
Some proteins cause unappetizing
smells/tastes/sensations for pregnant women
Taste changes
o Caused by relaxation of the esophageal sphincter (acids can more easily move through GI tract)
o Becomes normal through the 3rd trimester
Heartburn
Caused by the relaxation of GI muscles, reducing its motility (movement), resulting in difficulty of defecation
Constipation
Changes the progesterone causes:
- Relaxation of the smooth muscles in the uterus for expansion
- Relaxation of the GI muscles, thus reducing motility
- Induces fat deposition
- Reduces alveolar and arterial pressure (CO2)
- Increases renal sodium excretion
____ is lower than progesterone during the 1st few months but rises sharply near term
Estrogen
Functions of estrogen
o Promotes growth and controls the function of
the uterus
o Alters the structure of the mucopolysaccharides
in the connective tissues (for flexibility and
water retention)
Excess fluid is a hallmark of _____
preeclampsia
(hypertension during delivery)
usually rises by the 4th month
BMR
The BMR increased by ____ by term and returns to normal 5-6 days postpartum
15-20%
reflects increased oxygen demands of the uterine placental fetal unit, as well as O2 consumption from increased maternal cardiac work
Elevated BMR
50-70% of the kcal needed by the fetus in the 3rd
trimester is derived from _______
glucose
20% is from _______; and the rest is from _____
amino acids; fats
when maternal blood glucose ____, the rate of glucose transfer to the fetus declines and ____ will be the more dominant fuel source
falls; fatty acids
The net effect of maternal fuel adaptations is to increase the use of ___ as fuel by the mother and conserve ____ to the fetus
fat; glucose
contain fetal blood vessels and extend into the pool of mother’s blood
Fingerlike projections (placental villi)
requires channels and carriers that are potassium and protein-dependent
Active transport
Recite transport mechanism and substance transported
(table for diffusion and transport)
Hormone produced by placenta
Human Chorionic Gonadotropin (HCG)
Produced by Trophoblasts
HCG
Postulated mechanisms responsible for placental and fetal growth retardation as seen with maternal malnutrition
Recite the table
Decreased placental size due to
lack of hPL produced
Reduced nutrient transfer – due to
impaired transfer system
Alters maternal physiology to ensure fetal nutrition in utero (inside the uterus)
ENDOCRINE FUNCTION OF FETAL PLACENTAL TISSUE
Alters maternal pituitary function and mammary development to ensure ongoing fetal nutrition after birth (lactation)
ENDOCRINE FUNCTION OF FETAL PLACENTAL TISSUE
Determines the time of labor and delivery (parturition)
ENDOCRINE FUNCTION OF FETAL PLACENTAL TISSUE
Fetal testosterone production
placenta
Male differentiation of the reproductive system before the fetal
hypothalamus and pituitary develop into a functional axis
placenta
take about 6 days to complete
Events between fertilization and implantation
occurs at about day 22 of the menstrual cycles
Implantation
At this time, ovary is in the midluteal phase and secreting large amounts of progesterone
Implantation
to maintain fetus… (“pampakapit”)
progesterone
Stimulates secretion from the uterine glands, which provide
nutrients to the embryo (Histiotropic nutrition)
progesterone
Inhibits myometrial contraction and prevents release of
paracrine factors
* Example: Cytokines, prostaglandins, chemokines, and
vasoconstrictors for menstruation
progesterone
Induces the “window of receptivity” in the uterine
endometrium (D20-24)
progesterone
optimal time in which oocyte
can receive the sperm
window of receptivity
oocyte is released and no longer waits
for a sperm cell
After Day 24
_____
levels can be used as one measure of fetal health
estriol/ estrogen
Human chorionic somatomammotropin (hCS)
HPL
placenta grows during
gestation, ____ secretion increases
hPL
protein anabolic and lipolytic
hPL
antagonistic action to insulin is the major basis for the diabetogenicity of pregnancy
hPL
Antagonistic to insulin – counteractive action to insulin
(which decreases blood glucose)
hPL
But if blood glucose is excessively high and goes
past the limit, it can induce ____ to the mother
gestational diabetes
Insulin production and insulin sensitivity of cells is affected by ______
hPL and other hormones
____ inhibits maternal glucose uptake and use, thereby _____ serum glucose levels.
hPL; increasing
hPL ____ fetal glucose availability
increases
THE THREE MAIN PLAYERS OF PREGNANCY
The Mother, the Placenta, and the Fetus
did
not reach the uterus, embedded in the lines of the fallopian
tubes or ovaries
Ectopic pregnancy
a stage in the development of the embryo in o which cells are arranged in a single layer to form a hollow
sphere
blastocyst
A newly fertilized ovum is about the size of a period at the end of this sentence
zygote
solid mass of cells representing a mulberry,
formed by cleavage of a fertilized ovum
morula
at less than one week after fertilization is not much bigger and is ready for implantation.
zygote
five weeks after fertilization is about 1⁄4 inch long.
embryo
expected due to release of HCG (normal)
morning sickness
measures close to 20 inches in length. From eight weeks to term, this infant grew 20 times longer and 50 times heavier.
infant
The fertilized egg divides into cells that fold in on one
another
Blastogenesis Stage
after 11 weeks of development is just over an inch long. Notice the umbilical cord and blood vessels connecting the fetus with the placenta.
fetus
An inner cell mass evolves giving rise to the embryo and an
outer coat which becomes the placenta
Blastogenesis Stage
The stage is complete in 2 weeks after fertilization
Blastogenesis Stage
outer layer giving rise to the brain, nervous system, hair, and skin
ectoderm
middle layer that produces all of their voluntary muscles, bones, cardiovascular, and excretory systems
mesoderm
inner layer forms the digestive & respiratory systems, and the glandular organs
endoderm
Period of most rapid growth
Implications to diet – time to increase caloric intake
Begins from the 3rd month until term
Fetal weight increases (from 6g to 3,000-3,500 at birth)
Fetal stage
After __ days of gestation, all major features of the human infant have been achieved
60
(conception to 2 weeks)
o Implantation into uterine wall
zygote
o Rapid cell division (1.25 inches)
o Complete CNS, beating heart, digestive system (immature)
Embryo (2 weeks to 8 weeks)
Each organ has defined growth rate
Birth (38 weeks to 42 weeks)
Fetus (8 weeks to birth)
o After birth, before a baby becomes an infant (months
old)
Neonate
Normal head circumference and skeletal growth but poorly developed muscles and no subcutaneous fat
Type I: Growth retardation primarily affecting weight
weight of < 2500 g, irrespective of gestational age
low birth weight
the first weight of the fetus or newborn obtained after birth; ideally measured within the first hour of life
birth weight
Worse condition because at least Type II retains proportionality (all organs are within proportion of each other)
Type I: Growth retardation primarily affecting weight
o Size of all body parts are reduced proportionally
Type II: Growth reduction in both weight and height
Babyisstillalivebutsurvivalisthequestion
Very low birth weight (< 1500 g)
Extremely low birth weight
< 1000 g
height and pre-pregnancy weight of
the mother
maternal body size
amount of weight gained by the
mother during pregnancy
maternal weight gain
Peak age of reproduction
25-28
Normal weight gain is about ______
11 to 15 kg
the remainder in of maternal weight gain?
maternal
reproductive tissues, fluid, blood, and “stores” (fat)
Less than 1⁄2 of the total weight gain where?
fetus,
placenta, and amniotic fluid
Low birth weight is primarily related to:
o Low pre-pregnancy BMI (kg/m2)
o Low gestational weight gain
determinant for how much you should gain
height
These anthropometric factors reflect inadequate food intake, which may be related to:
o Poverty
o Cultural ideas of thinness
Lessens later in the pregnancy due to less release of HCG
Nausea and vomiting
components of weight gain table
recite the table
Due to enlargement of uterus and stomach linings
Heartburn
Intestines are crowded (“naiipit”), decreasing motility of
the GI Tract
Constipation
Cravings are usually a sign of nutrient deficiency like
_____ and _____
calcium and iron
factors that determine energy requirements
(1) Changes in the mother’s usual physical activity; and
(2) Increase in her metabolism to support the work
required for fetal growth and accessory tissues
Cumulative energy cost of pregnancy
- 40,000 to 70,000 kcal
- Extra 200-300 kcal for the 2nd and 3rd trimesters
About ____ CHON are deposited in a normal weight fetus and in the maternal accessory tissues divided by the ___ days of gestation = ___ of added CHON daily
925 g; 280; 3.3g
can cause other nutrient deficiencies in both, improper bone matrix formation, and infertility
Protein deficiency
in protein, leads to unhealthy and excessive maternal weight gain; impairs normal fetal development, inhibits fetal growth due to possible development of other nutrient deficiencies
excess intake
____ kcal distribution for CHO
50-70%
Required for cell division to proceed
folate
Deficiency affects cells that have a high rate of turnover
(e.g. RBC and the CNS)
folate
recommendation for folate
Recommendation: 300-400 μg/day
important contributor to the process of cell division
B12
concerned with amino acid metabolism and CHON
synthesis; believed to provide relief for nausea and
vomiting during early months of pregnancy
B6
serve as coenzymes for energy production
B1, B2, B3
believed to help alleviate symptoms of preeclampsia
and premature rupture of the cell membranes
C
positive effects on calcium balance and neonatal calcium homeostasis
D
fetal storage of the vitamin
A
believed to prevent spontaneous abortion
E
blood coagulation after giving birth
K
Needed to manufacture hemoglobin for both maternal and
fetal needs
Iron
Fetus acquires most of its ____ in the 3rd trimester when skeletal growth is maximum, and teeth are being formed
Ca
During 3rd trimester, fetus draws ___ mg per hour of Ca from the maternal blood _____ mg/day
13 mg; 250-300 mg/day
Believed to prevent pregnancy-induced hypertension
Calcium
Loss of teeth and hair during
pregnancy
Calcium Deficiency
Loss of calcium stores in mothers lead to early
______
osteoporosis
Excess _____ is detrimental for calcium
absorption (uses the same enzymes for digestion and
absorption)
phosphorus
Primarily important for males (spermatogenesis)
zinc
- Component of insulin
- Part of an enzyme that helps maintain acid-base
balance in tissues - Acts in the synthesis of DNA and RNA
zinc
____ deficiency in rats has led to the development of congenital malformation
zinc
Maternal ____ deficiency has led to cretinism at birth
iodine
inadequate length and/or height
cretinism
________ during conception brings out
children with autism
Hypo or hyperthyroidism
_______ → role in iodine regulation
Thyroid
2nd trimester onwards ONLY
vit A
given in the 1st trimester
Iron and folate
Additional energy intake during last half of gestation
o Additional 200-300 kcal
Critical nutrients during 1st trimester
o Protein
o Folic Acid
o Vitamin B12
o Zinc
Critical nutrients during 2nd and 3rd trimester
o Protein
o Iron
o Calcium
o Magnesium
o B Vitamins
o Omega-3-fatty acid, docosahexaenoic acid (DHA)
Coffee max. amount
2 cups/day
need to provide supplements because diet will never be sufficient
iron
Cups of fluid
9-10
Amount of fiber per day
(20-25 g/day)
- Low nasal bridge, flat midface, indistinct philtrum, thin upper lip, short nose, minor ear abnormalities, microcephally, very low-low IQ
FAS
- Mice – decreased brain and liver weight
- Rats – reduced growth
Caffeine effect
sugarcannotentercells
hyperglycemia
Hyperglycemia in mother results in hyperglycemic child because placenta is immersed in the maternal blood
Causesmacrosomicinfant(excessivefetalgrowth
and fat deposition)
sign to stop exercise: labored or difficulty in breathing
dyspnea
Fetal pancreas is overworked in releasing insulin to lower glucose stores (Hyperglycemia)
Leads to hyperinsulinemia -> Macrosomic Infant
sign to stop exercise: lightheadedness, muscle weakness, blurred vision, feeling faint
presyncopal
