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HUNT243 > Lecture 2: Preconception > Flashcards

Lecture 2: Preconception Flashcards

1
Q

What is preconception?

A

“the period before (at least 2 years) and between consecutive pregnancies, to improve health related outcomes for women (regardless of their pregnancy status), newborns and children up to 5 years of age”

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2
Q

What is the proximal preconception period?

A

Period preceding pregnancy (up to 2 years prior to conception)

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3
Q

What is the distal preconception period?

A

Adolescence or in general a longer time before pregnancy

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4
Q

Why is preconception important?

A

Because a mothers health at and before conception influences the course and outcome of her pregnancy

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5
Q

What does maternal nutrition at the time of conception influence?

A

Placental development and function

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6
Q

What is directly tied to maternal preconception nutrition and child’s long-term health?

A

Fetal genomic imprinting and programming at conception

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7
Q

What is periconception?

A

“the period preceding, including and immediately following human conception to improve health related outcomes for women, newborns and children up to 5 years of age”

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8
Q

What is the boundary for periconception?

A

3 months before pregnancy and up to the first trimester

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9
Q

When do most reproductive failures occur?

A

During periconception

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10
Q

What is the CRITICAL window of life?

A

First 1000 days of life

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11
Q

What does the first 1000 days of life include?

A

Pregnancy, and first 2 years of life (not pre-conception)

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12
Q

Why is nutrition in the first 1000 days of life the critical window?

A

Key to brain development, healthy growth and a strong immune system - one of the most modifiable factors

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13
Q

What percent of the population are malnourished during the first 1000 days of life?

A

1/3

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14
Q

What does malnourished mean?

A

Obese, underweight or deficiencies

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15
Q

What do majority of infant deaths occur due to?

A

Malnutrition

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16
Q

What is happening during periconception?

A

The eggs and sperm are being developed. Egg = 14 weeks, Sperm =10 weeks

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17
Q

Why should we consider the periconception period longer than 3 months?

A

Biologically it could be considered 5-6 months

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18
Q

What does malnutrition look like around the world?

A

1.9 billion adults are overweight (>600 million obese)
462 million adults are underweight

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19
Q

What does the prevalence of malnutrition look like over time?

A

Increasing overweight and obesity
Undernutrition prevalence is stabilising or decreasing

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20
Q

What BMI indicates obesity?

A

> 30kg/m2

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21
Q

Most obese men and women tend not to be infertile rather…

A

Sub fertile

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22
Q

What is sub-fertile?

A

difficulty conceiving, pro-longed period of misconception

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23
Q

Obese women tend to have higher levels of what?

A

Estrogen, androgens and leptin than non-obese

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24
Q

How does obesity affect the reproductive processes in women?

A

Menstrual cycle irregularity (30-47%), ovulatory failure and amenorrhea

25
Q

Obesity in men is associated with lower levels of what?

A

Testosterone and increased estrogen and leptin levels

26
Q

How does obesity affect the reproductive processes in men?

A

Reduced sperm production and increased erectile dysfunction

27
Q

What BMI indicates a critical level of body fat?

A

less than 20kg/m2

28
Q

What is low levels of body fat during adolescence related to?

A

delays in the age of onset of menstruation and reduced fertility later in life

29
Q

What does weight loss exceeding 10-15% decrease?

A

Estrogen, LH and FSH

30
Q

What are the consequences of weight loss exceeding 10-15%?

A

Amenorrhea, anovulatory cycles, short or absent luteal phases

31
Q

What can periconceptional micronutrient status influence?

A

Offspring metabolism, organ growth, development and function, leading to an increased risk of chronic disease

32
Q

What effect does choline have during periconception?

A

Brain development

33
Q

What effect does iodine have during periconception?

A

Neurocognitive

34
Q

What effect does zinc have during periconception?

A

Preterm birth, placental function

35
Q

What effect do omega-3 fatty acids and B12 have during periconception?

A

Altered lipid metabolism

36
Q

What effect does iron have during periconception?

A
  • Iron deficiency anemia linked with LBW
  • Delayed development
  • Preterm birth
  • Infections
  • Postpartum hemorrhage
37
Q

What effect does folic acid have during periconception?

A
  • Neural tube defects
  • Congenital malformations
  • Preeclampsia
  • Autism
38
Q

What did the 2010 Cochrane review confirm?

A

That folic acid supplementation prevents the first and second time occurence of NTD’s

39
Q

What are NTD’s that effect the brain?

A
  • Craniorachischisis
  • Anencephaly
  • Encephalocele
  • Iniencephaly
40
Q

What are NTD’s that effect the spinal cord?

A
  • Spina bifida ***
  • Spinal dysraphism
  • Meniogelcele
  • Myelomenigocele
41
Q

What is the periconceptional folic acid recommendation?

A

800mcg (0.8mg) daily at least 4 weeks before and 12 weeks after becoming pregnant - first trimester

42
Q

What percent of unplanned pregnancies are mistimed and unwanted?

A

40% mistimed
60% unwanted

43
Q

What helps bridge the gap for unplanned pregnancies not taking folic acid supplements?

A

Fortification

44
Q

Why did NZ withdraw from folic acid fortification?

A

Some unvalidated evidence that folic acid fortification would increase cancer risk, based on the fact that cancer cells need folic acid to replicate + worries over government control + cost for bakers

45
Q

What is the current policy?

A

Fortification of flour used for bread making in NZ
- non-organic wheat flour
- no less than 2mg/kg, no more than 3mg/kg
- includes imported flour

46
Q

What is the dutch famine?

A

Took place in german-occupied part of the netherlands, winter of 1944-45 near the end of WWII

47
Q

Why did the dutch famine occur?

A

German blockade cut off food and fuel shipments - 4.5 million affected: 22,000 died

48
Q

Children of pregnant women exposed to famine are more susceptible to what?

A

Diabetes, obesity, CVD, microalbuminuria and more

49
Q

What is the Barker hypothesis?

A

“states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease”

50
Q

What is considered LBW?

A

Less than 2.5kg

51
Q

What disease is LBW associated with?

A

Coronary artery disease, impaired glucose tolerance, type 2 diabetes

52
Q

Young mothers are more likely to have babies with lower birth rates. Why?

A
  • Adolescent mother is still growing themselves: there is a competition for nutrients
53
Q

What is Guatemala?

A

long-term prospective study to determine the effects of maternal nutrition on offspring physical growth and mental development

54
Q

What did Guatemala look at?

A

What happened when energy and protein supplementation were given to mothers
- In those women who complied they had a 50% lower rate of LBW

55
Q

What Vitamins do NZ recommend for supplementation during pregnancy?

A

Folic acid and iodine

56
Q

What are the folic acid recommendations during pregnancy?

A

1 800ug daily for 4 weeks pre-pregnancy and until end of first 12 weeks

57
Q

What are the iodine recommendations during pregnancy?

A

1 150ug iodine-only daily from start of pregnancy to end of breastfeeding

58
Q

What are other supplements on advice for pregnancy?

A
  • Iron (if indicated)
  • B12 (vegan)
  • Calcium (subject to diet)
  • Vitamin D (subject to enviornment)

HUNT243 (11 decks)

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