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FN 2241 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

What is fecundity ?

A

Biological ability to bear children

-able to do it

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2
Q

What is fertility?

A

Actual production of children

-you are doing it, you are fertile

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3
Q

What is infecundity?

A

Biological inability o bear children after 1 year of unprotected intercourse

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4
Q

What is infertility?

A

Involuntary absence of production of children

-no timeline

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5
Q

What is sub fertility?

A

Decreased level of fertility

  • > 12 months to conception or repeated early losses
  • applies to people who have had multiple miscarriages
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6
Q

what us a miscarriage?

A

Spontaneous abortion

-up to 20 wks, anything after is a still birth

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7
Q

How many couples experience infecundity in canid?

A

1 in 6 fail to conceive within 1 year of attempting pregnancy
-doubled since 80’s

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8
Q

Do couples who can conceive in one year use fertility treatments?

A

44% of couples who qualify as infertility will go on to conceive without fertility treatment
healthy couples have 20-25% chance go pregnancy within given menstrual cycle

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9
Q

What are the reasons for infertility?

A

Males and females separately but if there is a couple and both have problems then there is an issue

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10
Q

What is the fertility rate equation?

A 
#births/per 1000 females of childbearing age
-age 15-44
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11
Q

What is the trend in fertility rates over the years in canada?

A

High when the men came back from the war (Boomers) and slowly decreasing since then

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12
Q

Why are we seeing fewer children and older moms?

A
  • Women going to school
  • Divorce in previous generation makes current generation more cautious
  • Desire to be financially stable before having a child
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13
Q

What are the symptoms of miscarriage?

A
  • Vaginal bleeding
  • Passing clots and tissue
  • Abdominal pain
  • Pregnancy symptoms disappear
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14
Q

Who do you go to if you have a miscarriage before and after 20wks?

A

Before: Emergency room

After: OBGYN

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15
Q

What can arise as a side affect of a miscarriage?

A

Infertility

Emotional and physical strain

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16
Q

If you have a miscarriage when should you wait to become pregnant?

A

3-6 months to become pregnant again

-because you lost a lot of blood and Fe stores

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17
Q

What are some of the causes of miscarriages?

A
  • Severe defect in fetus (most frequent, eggs or sperm of low quality)
  • Maternal infection (UTI, influenza)
  • Structural abnormality of uterus (tilted)
  • Endocrine or immunological disturbances (progesterone surge doesn’t happen/Thyroid too high/low)
  • Other unknown random events (dehydration/flying)
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18
Q

What is a stilbrith?

A

Death before complete expulsion from the mother >20 weeks gestation

  • fetus doesn’t breath or have a heartbeat
  • baby passes away inside of mom or during birth
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19
Q

What do we tell women to limit to decrease their chances of miscarriage?

A

Bath

Activities that raise the core temperature

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20
Q

What is an abortion?

A

Termination of pregnancy <500g or <20weeks pregnancy

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21
Q

What is the abortion rate equation?

A

abortion/1000females of childbearing age

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22
Q

What is the reproduction physiology at birth for male and female?

A

Female: Immature ova (primordial follicle) eggs produced and stored in ovaries

Male: Sperm producing capabilities but not actually starts until puberty

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23
Q

What happens at puberty interns of reproduction physiology?

A

Capacity of reproduction established

-hormonal changes lead to maturation of reproductive system

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24
Q

What is the purpose of the menstrual cycle?

A

Prepare ovum for fertilization

Uterus for implantation

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25
Q

What are the 2 phases of the menstrual cycle?

A

Phase 1: follicular cycle

Phase 2: Luteal

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26
Q

In the follicular phase what happens to estrogen?

A

Stimulates hypothalamus to secrete GnRH

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27
Q

What does GnRH do?

A

Causes pituitary gland to release:

  • FSH: increases estrogen production by follicle and stimulates maturation
  • LH: Stimulates release of ovum and progesterone by follicle
  • -estrogen and progesterone stimulate preparation of uterus
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28
Q

In the luteal phase, what happens after ovulation?

A

Follicle left a corpus lute which secretes progesterone and estrogen to decrease GnRH, thus FSH and LH; increase endometrium development

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29
Q

What happens if the ovum is or is not fertilized?

A

Not: There is a decrease in corpus lute secretions which leads to menstruation

Yes: Egg signals corpus lute to increase estrogen and progesterone secretions

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30
Q

What is the reproductive system like in males?

A

Hypothalamus secretes GnRH which releases FSH and LH by pituitary

  • LH triggers secretion of testosterone by testes
  • Testostreone and FSH stimulate maturation of spem
  • Sperm stored in epididymis
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31
Q

Is sperm more important at the time you are trying to get pregnant or 3 months prior?

A

3 months prior

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32
Q

What are sources of disruption in fertility?

A
  • Hormones regulating fertility (GnRH, FSH, LH)
  • Presence/length of luteal phase (miss the window)
  • Sperm production
  • Implantation
  • Tubular passageways for ova/sperm to travel are blocked
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33
Q

What does the government fund in terms of fertility?

A

drugs that stimulate ovaries to stimulate more follicles

IVF covers 1 live birth

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34
Q

What are the factors related to impaired fertility?

A
  • Endocrine abnormality (Mostly female- hypothyroidism)
  • Unknown causes (1/2 of cases)
  • Adverse nutritional/environmental exposures
  • Contrceptive use
  • Severe stree
  • Infection
  • Structural problems: tubal damage
  • Chromosomal Abnormalities
  • Underweight
  • Sexually transmitted infections
  • Endometreosis
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35
Q

What are nutrition related disruptions in fertility?

A

Decrease fertility is related to nutritional status:

  • undernutrition
  • Wt loss (too fast or genetic predeposition)
  • High activity levels
  • Intake of dietary components modifying hormone levels
  • Obesity

Generally, temporary decrease in fertility

Amenorrhea

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36
Q

What is amenorrhea?

A

Absences of >3or more consecutive menstrual cycles

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37
Q

What is the different between acute and chronic undernutrition?

A

Acute

  • clearly decrease fertility
  • Famine period associated decrease birth rate
  • decrease hormones regulating fertility

Chronic

  • Primary effect= small/frail infants increase likelihood of death
  • Small decrease fertility
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38
Q

In terms of body Wt, fertility is lower in…?

A

UnderWt: BMI <18.5
Obese: BMI >30

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39
Q

What in terms of body Wt may result in fertility decline?

A

Decrease body fat content may play a role in fertility decline because:

  • Fat produces estrogen
  • Estrogen stimulates hypothalamus to secrete GnRH
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40
Q

What happens to infertility in women when there is a Wt loss of 10-15% of usual Wt?

A

Decrease estrogen concentrations in normal wt women

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41
Q

What are the consequences of rapid wt loss?

A

Hypothalamic amenorrhea
Anovulatory cycles
Short/Absent luteal phase

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42
Q

What are 30% of infertility cases related to?

A

Simple wt loss

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43
Q

How do you treat wt loss?

A

Increase wt within 95% of previous wt
-hormonal concentration return to normal

Hormonal therapy
-increases risk of small for gestational age infant compared to underweigtht women who gain wt

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44
Q

what kind of physical activity has an adverse effect on fertility?

A

Intense physical activity

45
Q

Why are competitive female athletes more infertile?

A

Menarch delayed 2-4 years

40% have abnormal cycles

46
Q

What is the likely cause of hormone and metabolic changes?

A

Overal calorie deficit

47
Q

What is the female athlete triad?

A

Disordered eating

  • low BW
  • inadequate caloric intake and high PA

Mentrual irregulatieis
-low estrogen levels causes decrease GnRH

Low bone mass

  • low estrogen levels cause decrease in bone Ca retention
  • increase risk of stunting/osteoperosis
48
Q

What is the triad?

A

Amenorrhea
Eating disorder
Osteoperosis

49
Q

Do you need to have an eating disorder to have the triad?

A

No, just non regular eating that is unbalanced qualifies

50
Q

What should you do interns of your diet to prepare for pregnancy?

A

Requires establishing healthy habits
Maintain healthy body weight
Healthy eating habits prior to pregnancy support health pregnancy

51
Q

What does pre pregnancy body weight influence?

A

Maternal health

Fetal development

52
Q

What problems do over and under weight moms and newborns face?

A

Greater risk of health problems

Underweight

  • low BW
  • Premature birth

Overweight

  • Large BW
  • Pregnancy complications
53
Q

What are maternal complication of having a high BMI?

A 
Reduced fertility
Impaired glucose tolerance and gestational diabetes
Thromboembolism
Hypertensive disorders of pregnancy
Increased risk of miscarriage
54
Q

What are fetal complications of high BMI?

A

Fetal congenital abnormalities
Fetal growth restricftion
Stillbirth
Increased risk of morbidity in later life

55
Q

Can you exercise during pregnancy ?

A

Can continue exercising like you used to do but do not begin strenuous activity or anything new or that can hurt the baby
-make sure getting extra extra calories

56
Q

What can physical activity do for your pregnancy?

A

Ensure appropriate weight gain
Improve muscle tone and strength
Build stamina for labour and delivery
Speed recovery

57
Q

What do doctors say about smoking while pregnant?

A

Baby could have wuthfral symptoms if you stop so maybe not to quite complete but greatly reduce the amount

58
Q

What dietary components indirectly impair fertility?

A 
Soy isoflavanoids (hormone levels) 
Menstrual cycle irregularities
Increase time it takes to conceive
Probably interrelated effect
Lack of antioxidants
Alcohol, caffeine, heavy metals
59
Q

Does soy effect everyone?

A

Can effect hormones in men and women and can either be beneficial or negative impacts
-also depends on the life stage as well

60
Q

What things do women have to be mindful when eating?

A

Vegetarian diets

  • decrease estrogen levels in N, under and overweight
  • lengthens menstrual cycles

Low fat intake (less than 20% cals)
-lengthens menstrucal cycle

Caffeine
-300mg/day or 2 cups

Fe
-Poor Fe status may be associated with infertility

Alcohol

  • May decrease estrogen by disrupting cycle
  • age and genetics play a role
61
Q

What are nutrients that affect fertility in males?

A 
Zn
Antioxidants
Alcohol Intake
Smoking
Heat
Steroid abuse
Lead
Mercury
Cadmium
Maganese
Boron
Colbalt
Copper
Nickle
Silver
Tin
62
Q

Why is Zn status important in men?

A

Decreases semen volume and abnormal sperm shape
Decrease testosterone levels
Hypogonadism: decrease growth penis and development of testes
*not proven if supplements helps in absence of deficiency

63
Q

Why are antioxidants important for males?

A

Helps protect sperm DNA from oxidative damage

64
Q

Why is lead bad for men?

A

It can be inhale for ingested

  • Affects pituitary gland
  • decrease testosterone as well as sperm production and motility
65
Q

What does mercury do for men fertility?

A

Decrease sperm count

66
Q

How does heat affect fertility in men?

A

Increased temperature of scrotum and testes can decrease sperm count

67
Q

How do steroids affect fertility in meant?

A

Multiple adverse effects of high doses

  • testicle atrophy
  • absence of sperm
  • decreased libido
68
Q

Does wt loss in males affect fertility?

A

Wt loss of 10-15% below normal weight will decrease sperm viability and motility

Wt loss >25% below normal weight, sperm production will ceases

and overall decrease in sex drive

69
Q

What happens to male fertility if the lost weight is regained?

A

Sperm production and libiddo returns to normal

70
Q

What can obesity in men lead to in terms of fertility?

A
  • Increase erectile disfunction and scrotal temp
  • Increase sleep apnea
  • increase estrogen, insulin and leptin
  • Decrease testosterone
  • OOgliozoospermia
  • Increase DFI (DNA fragmentation index)
71
Q

What are the nutrition related side effects of oral contraceptives?

A

Increase:

  • cholesterol, HDL, TG
  • Risk of venous thromboembolism
  • Blood copper
  • Risk of cervical cancer
  • CVD

Decrease:
-Blood concentrations of copper, folate, Vit B6/12

72
Q

What are the nutrition related side effects of injection contraceptives?

A

Wt Gain (water)
Irregular period
Fatigue, Headache and and pain

Increase:
Blood LDL and insulin

Decrease:
Blood HD:
Bone density

73
Q

What are the nutrition related side effects of contraceptive implants??

A

Erratic bleeding
Wt gain
Headache
*depends on place in body

74
Q

What are the nutrition related side effects of contraceptive patches?

A

Increase:

  • blood cholesterol and TGs
  • Risk of blood clot formation
  • HDL concentrations

Headache
Abdominal pain

75
Q

what is the importance of optimal health and nutritional status before conception?

A

Within the first months of pregnancy:

  • embryos basic organ structures form
  • female do not know they are pregnant
  • if mom is exposed baby is too
76
Q

What % of pregnancies are unplanned?

A

50%

77
Q

What are critical periods?

A

When there is an increase in cell size and number at the same time
-exposure to non-beneficial things at this time can have negative side effects

78
Q

If you are underweight female what are your additional risks?

A

Increased:

  • risk of complicated pregnancy
  • risk of small and early born
79
Q

If you are overweight female what are your additional risks?

A

Increased:

  • risk of complicated pregnancy
  • risk neural tube defects, excessive body fat

Babies can get used to a high glucose environment

80
Q

what happens when you have too much vitamin a?

A

Too much intake of retinol and increase risk of facial and heart abnormalities
-teratogenic

81
Q

What can high blood lead lead to in baby?

A

Increased risk of mental retardation

82
Q

What can iodine deficiency result in?

A

hypothyroidism: reduced metabolic rate, fatigue, wt gain

Deficiency in pregnancy and result in cretinism in offspring
-developmental delay, deafness and growth failure

83
Q

What can Fe deficiency lead to?

A
  • Increased risk of really delivery and Fe deficiency in mom and baby
  • Preterm labour
  • Morning sickness
84
Q

What happens when there is insufficiency folate intake?

A

Increased risk of neural tube defects (spina bifida and anencephaly)
-Defects develop very early, first 0-21 days (tube closes 21-28days)

85
Q

If you take folate before pregnancy, how much does it reduce neural tube defects?

A

By 46%

-government mandatory fortification in 1998

86
Q

What are the folic acid intake recommendations?

A

400micrograms before pregnancy
600 during
400-1000 during the remainder

87
Q

What is fetal alcohol syndrome?

A

Alcohol related birth defects
Malformations (physical)
Mental and behavioural abnormalities

88
Q

What is fetal alcohol effects?

A

Alcohol related neurodevelopment disorders

Mental and behavioural abnormalities abnormalities but no malformations

89
Q

What increases your risk of diabetes?

A

High blood glucose levels early in pregnancy

90
Q

How can diabetes affect pregnancy?!

A

Fetal malformations
Excessive size (macrosomia)
Offspring can have diabetes late in life
Decrease fertility is uncontrolled

91
Q

What is the best preconception diet?

A

Diet adequate in nutrients
-Folate and Fe
Follow food guide
No access Vitamin A

92
Q

What is the Ca RDA for women when pregnant, not pregnant and lactation?

A

1000mg/day

93
Q

What is the RDA for folate?

A

19-50 400microgram
Pregnancy 600
Lactation 500

94
Q

How much folate do we get from fortified foods?

A

200micrograms

95
Q

What is the RDA for Fe?

A

19-50 18miligrams
Pregnant 27
Lactation 9
-assuming normal levels

96
Q

Why is lactation Fe requirements lower than pregnancy?

A

While breastfeeding you arent menstruating, so no blood loss so our recommendations are similar to men
○ When bresfteeeding bodys hormones fluctuatee a lot and tell the body not to ovulate (when baby is feeding often
○ When introducing solid foods, baby starts to breastfeed less and the body thinks it can then support another babay and then ovulation starts again

Can beocme pregnant before the first menstruation

97
Q

When does baby get its Fe stores form mom?

A

3rdT

-enough for up to 4 months

98
Q

What happens if baby doesn’t get enough Fe?

A

cant come back from Fe deficiency as a baby during this time in utero, leads to neurological development delays

*Mom Fe deficiency is linked to preterm labour

99
Q

What time of day produces the biggest signals for producing milk?

A

12-5 am biggest signals for producing milk, and. This is the time where women start to menstruate again

100
Q

What is PCOS?

A

Polycyclic ovary syndrome

-leading cause of infertility

101
Q

What are the symptoms of PCOS?

A

Insulin resistance
Increase blood insulin and testosterone levels
Obesity
Menstrual dysfunction, amenorrhea, infertility
Hirsutism
Acne

102
Q

Why is PCOS bad?

A

Increases risk of:

  • hypertension
  • gestational and type 2 diabetes
  • CVD
  • Spontaneous abortion
103
Q

What is the treatment for PCOS?

A

Weight loss and medicaition (metformin) to:

  • -decrease insulin resistance, blood insulin, testosterone and BP
  • Increase fertility
  • Diet and exercise
104
Q

How do you know If you have DM before pregnancy?

A

Increased glucose concentrations

-Teratogenic during first 2 months of pregnancy

105
Q

Why is DM bad for pregnancy?

A

Increase risk of maternal and fetal complications

Increase rate of congenital abnormalities (birth defect)

  • structural and functional
  • metabolism
106
Q

Why are eating disorders bad?

A

Low body fat leads to:

  • irregular release of GnRH
  • decrease estrogen
107
Q

What is CPNP?

A

Canada prenatal nutrition program

  • comprehensive program for women most at risk to provide:
  • -Food supplementation
  • -Nutriton Counseling
  • -Support education
108
Q

Why did CPNP start?

A

People with low SES more likely to have malnutrition which leads to LBW babies

  • 10% of birth are at risk due to poor health and malnutrition of mom
  • determining factor in 2/3 of newborn deaths
109
Q

What is the target population for CPNP?

A 
Pregnant in violent situations
First nations
Refugees
Living in isolation
No access to services
Youth in poverty
Adolescents 
Abuse

FN 2241 (12 decks)

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