Midterm 2 Section 6 Flashcards
Weeks of gestation
first trimester: 12 weeks or less
second trimester: 13-28 weeks
third trimester: 29-delivery
preterm babies:20-36 weeks
term babies: 37+ (40 weeks is typical)
post 40 weeks requires medical intervention
placenta anatomy
metabolically active organ that connects baby and mother, blood never mixes
Fetal blood vessels project into placenta, in pool of mother’s blood coming from outer side of placenta
Fetal veins transport excreted products back to mother for external excretion
Fetus is entirely dependent on this system for respiration, nutrition and excretion
placenta functions
supply of nutrients and waste-removal system
produces hormones that maintain pregnancy and prepare body for lactation such as lactogen, estrogen and progesterone
progesterone - growth of uterus and block contractions
estrogen peaks towards the end of pregnancy and also helps uterus and fetus grow but stimulates contractions
lactogen adapts metabolic state of mom to to feed baby
when is the blastocyst implanted?
when is a fetus considered living?
when should the neural tube be closed by?
after 1 week post conception
after 11 weeks
6 weeks
when is the critical period of development?
first 2-3 months
folic acid fortification reduced neural tube defects from?
4 out of 1000 to .4 out of 1000
energy requirements per trimester
first trimester - nothing additional
second trimester -340 kcal extra
third trimester - 450 kcal extra
carbohydrates - 175g daily, 135g minimum
protein DRI during pregnancy
fat recommendations
25g additional per day
additional omega 3/6 including 200mg DHA per day
5oz fish per week (2 servings)
tuna to choose
tuna UL for pregnant women
low mercury fish
light tuna has lower mercury than white albacore tuna
not more than 300g (2 cans) of albacore tuna per week
small fish and seafood
calcium and iron DRI for pregnancy
same calcium DRI because absorption doubles during pregnancy
iron absorption increases 3x because fetus takes priority over mother’s needs
vitamin A during pregnancy
DRI is reduced to avoid teratogenic effects
at risk births
young women, many previous pregnancies, short intervals between pregnancies, history of trouble pregnancies, chronic disease, socioeconomic status, smoking, drugs, multiplies, weight gain too high or too low during pregnancy
risks related to weight prior to conception
underweight: increased pre-term and infant deaths
overweight/obese: gestational diabetes, large babies, gestational hypertension, complications for mother, health risks like heart problems for infants
weight gain recommended for BMI categories
under weight <18.5 gain 28-40lb
healthy 18.5-24.9 gain 25-35
overweight 25-29.9 gain 15-25
obese >30 gain 11-20
weight gain patterns
healthy: 3.5 lbs first trimester, 1lb per week after that
underweight: 5 lbs first trimester, 1lb per week after
overweight: 2lbs first trimester, 2/3lb per week after
components of weight gain during pregnancy
increased breast size, increased fluid, placenta, increased blood, amniotic fluid, infant, uterus and uterine muscle growth
what is considered a small size baby?
preterm or 5 1/2 lbs or less
higher risk of complications
gestational diabetes
can develop during 2nd half of pregnancy
leads to complications during labor, high infant birth weight, increased risk of type II later in life
hypertension in the mother
Preeclampsia
existing hypertension: risk of heart attack, stroke
risk of low weight birth and stillbirth
gestational hypertension: second half of pregnancy
preeclampsia: gestational hypertension with protein in the urine, diminished blood flow decreases fetal development, can progress to eclampsia (risk of mother convulsions and death)
treatment is to induce birth before it becomes eclampsia
risks for older birth
older father: risk of preterm, LBW, medical problems and ventilation needs
older mother: chronic conditions, maternal death rates, preterm birth, LBW and amniocentesis recommended over age 35 to do genetic testing on amniotic fluid
smoking during pregnancy risks
other things to avoid during pregnancy
decreased bloodflow to infant, decreased lung growth, sudden infant death syndrome, reduced brain size
mercury, lead, drugs, alcohol, herbal supplements, over the counter drugs
food borne illness in pregnancy
Listeria can cause miscarriage or impact brain/vital organ development
No soft cheeses, pasteurized products, washed produce, uncooked meats or fish, paté, refrigerated smoked seafood
Alcohol effects on fetal development
crosses placenta and is directly toxic
limits oxygen delivery
slows cell division
reduces number of cells organs produce
Fetal Alcohol Syndrome: alcohol related neurodevelopmental disorder, alcohol related birth defects (malformations)
birth defects: smaller eyes more spaced apart, receding forehead, small jaw, uneven ears, drooping eyes, flat upper lip
4 drinks per day malformations will be likely, 1 drink per day neurology and behavior can be affected, do abstinence
hormones for lactation
hormones promote growth and branching of duct system and development of milk producing cells
prolactin: milk production hormone
oxytocin: let down reflex of milk release signaled by suckling
breast milk qualities
unique composition for baby, changes as needs change
contains immune protective factors that also adjust to needs
poor source of vitamin D, requires 400IU supplementation for first year of life
milk is produced as breasts are emptied (more made to meet demand, if demand goes down, production decreased)
naturally sterile, colostrum is thick serum with antibodies and white blood cells to inactivate bacteria, bifidus factors to build gut biome
let down reflex pathway
suckling stimulus signals hypothalamus
hypothalamus signals pituitary gland
prolactin and oxytocin release simultaneously
breast milk composition compared to cow’s milk
breast milk: 6% lactalbumin protein, 55% fat (EFAs), 39% lactose with ample vitamins and minerals excluding vitamin D
cow’s milk: 21% protein (casein), 26% fat, 53% lactose
additional benefits of breastfeeding for mother and child
child: may protect against chronic disease development later in life, protects against food allergies
mother: contracts uterus to return to normal size, delays return of ovulation preventing births too close together, conserves iron stores, may protect against ovarian and breast cancer
nutrition during lactation
500 kcal extra: 330 from diet, 170 from fat stores
3.8L of fluid per day
accelerated weight loss in women who breast fed 3+ months
if mother is nutritionally deprived, breast milk will
be reduced in quantity, not quality at the expense of maternal stores
breastfeeding stats
87% in Canada start breastfeeding, 77% in US start breastfeeding (maternity leave legislature)
to avoid during lactation
alcohol - infants drink less bc it affects taste, and inhibits oxytocin
some drugs can affect milk production or be secreted into breast milk
smoking reduces milk volume
formula feeding
iron fortified formula
no immune protection or unique adjustments
no falling asleep with bottle - can risk tooth decay from pooling milk in mouth
transition to cow’s milk at 12 months, whole milk (3.25%)
being breastfed reduces risk of
overweight/obesity, type 1 diabetes, asthma,
longer duration breast feeding associated with lowered risk of type I and asthma
if not breastfeeding or not breastfeeding for 1 year
infant formula for 12 months, other foods can be introduced at 6 months
Complementary food and beverage
Nutrients to focus on with CFB
No CFB before 4 months, start between 4-6 months
Iron, vitamin C and zinc rich foods: meats, seafoods and eggs and iron-fortified cereals and then vitamin-C rich foods like pureed fruit and veg
how to prevent food allergies
tiny exposure of allergenic foods after 6 months old (but not before 4 months), especially egg and peanut
food allergy definition
food proteins elicit immune response involving antibody production
reaction can be immediate or delayed up to 24 hours
can trigger anaphylactic shock
treatment requires elimination from diet, some research into low dose immunotherapy, epinephrine when acute
food intolerance definition
production of symptoms without immunological response
common symptoms: stomach aches, headaches, rapid pulse, nausea, wheezing, coughing, hives
top food allergens
most common: peanuts, milk, eggs, wheat, soybeans, fish/shellfish
others: mustard, sesame seeds, sulphites, tree nuts, triticale
what developments at 6 months old make a child ready for CFB?
swallowing and gag reflex developed
able to sit up and control head movement
kidneys are more mature
iron stores are depleted
energy intake during infancy and childhood
weight changes over first year
100kcal per kg (compared to 30-40kg per day for adults)
1 year old - 800kcal
6 year old - 1600 kcal
10 year old - 2000 kcal
doubles by 5 months, triples by 1 year
infant feeding behavior to encourage
avoid
self-feeding/baby led weaning, cut food into thin strips, try new foods, stress-free meals
hard, round foods like cherries, hot dog, popcorn and grapes b/c choking hazard
avoid honey for 1 year, because babies can’t metabolize botulinum spores
self-feeding promotes
hand eye coordination, self-regulation and independence
cow’s milk transition
after 12 months
only whole milk until year 2, no soy or other alternatives
DRI carbohydrates, fiber and fat for children
1-3 years: 130g carbohydrate, 19g fiber and 30-40% of energy fat
4-8 years: 130g carb, 25g fiber, 25-35% energy as fat
BMI for age percentiles for boys and girls
ages 2-5: 3rd-85th percentile is healthy
85th-97th is risk for overweight
97th-99.9th is overweight
99.9 and above is obese
ages 5-19:
below 3rd percentile is underweight
85th-97th is overweight
97th-99.9th is obese
99.9 and above is severely obese
iron deficiency behavioral symptoms
reduced energy, affects mood, attention span and learning ability
iron supplements can only be prescribed by health care providers for children
increased television watching impacts children’s nutrition
reduces metabolic rate, reduces active time, increases snacking, least likely to eat fruits and vegetables and become obese
a healthy 24 hours guideline for children
sweat for 60 minutes
a few hours of light physical activity
9-11 uninterrupted hours of sleep
no more than 2 hours of screen time
severe acute malnutrition (SAM) categories
under -3 STD from the mean is severely wasting
< -2 STD is wasting, > +2 STD from mean is overweight
further from mean, the higher risk of mortality from wasting or chronic disease from overweight
lactogen
placental hormone - modifies metabolic state of mother during pregnancy to feed fetus
progesterone during pregnancy
estrogen during pregnancy
Progesterone levels slowly increase during pregnancy
Progesterone helps the uterus (womb) grow during pregnancy and keeps it from having contractions
estrogen levels increase steadily during pregnancy and reach their peak in the third trimester and help the fetus to grow and develop
WHO charts for under 2 years old weight categories
from 2-19 years old
girls and boys length for age and weight for age, head circumference and weight for length
also height for age and weight for age
to prevent iron deficiency in children:
7-10mg per day in iron intake from dietary sources
fortified grains, mushrooms, plums, beans and meats
