Midterm1 Flashcards
fecundity
biological ability to bear children
fertility
actual production of children
infecundity
biological inability to bear children after 1 year of unprotected intercourse
infertility
absence of production of children
approx. what % of couples are infertile/infecund ?
~15%
44% diagnosed as infertile will conceive within 3 years without technology
chance of diagnosed conception within a given menstrual cycle
20 -25% for healthy couples
women born with how many immature ova?
~ 7 million primordial follicles
how many ova will mature and be released during fertile years?
~400-500
women over age ___ more likely to have disorders related to chromosomal defects than younger women
35, sperm production also decreases after 35
purpose of menstrual cycle
prepare ovum for fertilization and uterus for implantation
hormones involved in menstrual cycle
Estrogen gonadotropin-releasing hormone (GnRH) follicle stimulating hormone (FSH) Luteinizing hormone (LH) progesterone
2 phases of menstrual cycle
follicular phase - first half, 1-14
luteal phase - 14-28
___ signals menstruation
drop in progesterone
___ causes release of egg from follicle
LH
if pregnancy occurs…
Progesterone and estrogen stay high to inhibit GnRH
menstruation
decreased estrogen and progesterone and increased prostaglandins result in uterine wall contraction and release of outer wall as menstrual flow
E2 stimulates …
hypothalamus to secrete GnRH
GnRH stimulates ..
pituitary to release FSH and LH
FSH…
promotes growth of follicles, stimulates secretion of E2 by follicle, stimulate maturation of ovum
LH…
surge stimulates release of ovum from follicle, stimulates secretion of E2 and progesterone by follicle…stimulate endometrium to expand and store nutrients in prep for implantation
corpus luteum
formed in luteal phase
secretes progesterone and E2 –> inhibit GnRH and stimulate development of endometrium
if implantation - continues to secrete E2 and P to maintain endometrium
no implantation - E2 and P decrease, removing inhibitory effect on GnRH
FSH stimulated testes to..
release sperm/ production of sperm
prostaglandins cause..
cramps in women and vaginal contractions to push sperm up
in males LH stimulates…
production of androgens (testosterone) by testes
testosterone/androgens stimulate…
maturation of sperm
chronic under nutrition –>
birth of small/frail infants with high likelihood of death in first year
acute under nutrition –>
dramatic decline in fertility that recovers with food intake (more dramatic impact than chronic)
weight loss greater than ____ (and bad effects)
> 10-15% decreased estrogen, LH, and FSH
amenorrhea, anovulatory cycles, short or absent luteal phases
___% of infertility cases related to weight loss
30%
sperm viability and motility decreases when weight drops to _____ below normal and ceases if wt loss exceed ___
10-15%
25% of normal
how obesity decreases fertility
dip in estrogen needed to continue menstrual cycle
fat cells produce estrogen and mask dips
fertility lower with BMI…
lower then 20 or greater than 30
iron and fertility
rate of infertility lower in women who use iron supplements
pre-pregnancy iron deficiency linked to preterm delivery and low iron status of infant
in ___ PMS…
1987, moved from psychogenic to physiological category
PMS diagnosis
dependent on standard questionnaire
1-5 symptoms intense enough to disrupt work or social life for at least 2 consecutive luteal phases
PMS symptoms occur in
40% of women of childbearing age
premenstrual dysphoric disorder (PMDD)
5+ symptoms of PMS for at least 2 consecutive luteal phases, 1 symptom related to mood
dysmenorrhea occurs in ___ phase
follicular
causes of PMS
definite cause unknown
related to changes in serotonin activity following ovulation
nutritional treatment of PMS
calcium - normalize (1000-1200mg)
vit D - above RDA
Vit B - above RDA
hypothalamic amenorrhea
weight related amenorrhea, functional amenorrhea
cessation of menstruation associated with underweight, weight loss…
caused by deficits in energy and nutrients
Leptin
messenger to hypothalamus of peripheral energy status
affected by hypothalamic amenorrhea
released by fat cells
female athlete triad
amenorrhea, disordered eating, osteoporosis
results in decrease in LH, FSH, estrogen
low estrogen –> reduction in bone mass
eating disorders affect ___% of young women
3-5%
obesity rates in US (20-39 yo)
33% of men (>30)
32% of women
5% massively obese (>40)
! cause of infertility of women in US
polycystic ovary syndrome
Diabetes mellitus
intolerance to carbs with fasting glucose >126 mg/dL
type 1 diabetes
own body destroys pancreas and cant produce insulin
10% of cases, 1% of population
autoimmune disease
need insulin administration
type 2 diabetes
body cant use the insulin it produces or does not produce enough
11% of population
usually obese
gestational diabetes
3-7% of pregnancies
usually obese
insulin resistance
cells resist action of insulin in facilitating transport of glucose into cells
cells have 1/4 functioning receptors
glycemic index
how body receives sugar from blood
glycemic load
glycemic index of food multiplied by grams of carbs divided by 100
polycystic ovary syndrome
endocrine disorder characterized by hyperandrogenism and insulin resistance
5-10% of women of reproductive age
majority are obese
any 2 out of 3: oligoovulation and/or anovulation
excess androgen
polycystic ovaries
cause of PCOS
uncertain
insulin resistance probably factor
genetic
androgen secreting tumors
management of PCOS
increase insulin sensitivity
PKU
phenylketonuria , hyperphenylalaninemia
elevated blood phenylalaine from lack of hydroxylase
in pregnancy –> impair CNS development
untreated, ~92% mental retardation
celiac disease
autoimmune disease
genetic susceptibility to gliadin portion of gluten
causes malabsorption and flattening of intestinal lining
~2 million in US
linked to infertility in some women and men because not proper nutrients
natality statistics
summary of pregnancy related and infant related outcomes
periconceptional
month before conception to month after conception
typical pregnancy length
40 weeks
preterm
37 weeks or before
very preterm
less than 34 weeks
embryo
until 12 weeks
fetus
2nd and 3rd trimesters
neonate
newborn
post natal period
after 1 month
neonatal
up to 1 month after birth
miscarriage
first 20 weeks of pregnancy
genetic, uterine, or hormonal abnormalities
fetal death/stillbirth
if after 20 weeks
sequence of changes in maternal body composition
plasma volume - weeks 20 nutrient stores - 20 placental weight - 31 uterine blood flow - 37 fetal weight - 37
2 phases of changes during pregnancy
maternal anabolic phase, week 1-20
catabolic phase, week 20-delivery
anabolic phase
build up nutrients, ~10% of fetal growth occurs
catabolic phase
nutrients delivered to fetus
90% of fetal growth
2nd half and end of pregnancy appetite decreases
preferred energy source for fetus
glucose
mother become slightly diabetic/insulin resistant
key placental hormones
human chorionic gonadotropin (hCG) - maintains corpus luteum to maintain uterus for pregnancy
progesterone
estrogen
human chorionic somatotropin (hCS)
diabetogenic effect of pregnancy
makes women slightly carbohydrate intolerant in 3rd trimester
*to give glucose to fetus
hCS and prolactin inhibit conversion of glucose to glycogen and fat
about ___ lb of protein accumulate during pregnancy
2 lbs (baby, uterus, breasts, placenta, etc)
fat metabolism during pregnancy
stores accumulate in first half (anabolic)
store mobilize is last half, blood lipid levels increase dramatically (50% increase in triglycerides)
placenta
lining of cells separates maternal and fetal blood
hormone and enzyme production
nutrient and gas exchange
removal of waste
epigenetics
fetal environment effects gene expression and later life
critical periods
most crucial during 1st 2 months after conception
when specific cells formed and integrated
characterized by hyperplasia
one way street
AGA
appropriate for gestational age
SGA
small for gestational age, weight <10th% for gestational age
dSGA
disproportionately small for gestational age
2/3 of SGA
low weight but normal length and head circumference
very skinny, nutrients or energy deficiency
malnutrition in 3rd trimester
greater risk of heart disease, hypertension, diabetes
pSGA
proportionately small for gestational age
1/3 of SGA
long term malnutrition in utero
adapted to low nutrient environment, do better
fewer health problems than dSGA
LGS
large for gestational age
weight >90th% for gestational age
prepregnancy obesity or excessive weight gain
delivery complications
___% of embryos are lost <20 weeks
30-50%
fetal-origins hypothesis of later disease risk
exposures to adverse conditions during critical periods of growth and development can permanently affect body structure and functions
___ causes increased risk of diabetes later in life
not enough glucose - receptors not there, stays in blood longer
too much -
greatest maternal weight gain during …
24-28 weeks
mother gains weight before fetus
normal weight mother should gain
25-35 lbs
underweight mother should gain
28-40 lbs
overweigh and obese mothers should gain
15-25 lbs
11- 20 lbs
need ___ additional Kcal/day
~300 additional
total is 80,000 Kcal
minimum carb intake for pregnancy
175g, to meet fetal brain’s need for glucose
45-65%
no pregnant - 130g
protein for pregnancy
+25d/day
or 71 for 2nd and 3rd tri
non preg - 46g
average intake ~78g
fat for pregnancy
energy source for mom, glucose goes to fetus
~33% of total calories
omega 3 fatty acids
EPA and DHA
300 mg
reduce inflammation, dilate blood vessels,
component of cell membranes
higher intelligence, vision, more mature CNS
folate
generic for folic acid
enzyme cofactor in DNA synthesis, gene expression and regulation
converts homocysteine to methionine
600 ug DFE
inadequate folate between ____ days after conception can cause ___
21-27 days after conception
neural tube defects - most common congenital abnormality in infants (anencephaly or spina bifida)
vit A toxicity
from supplements >10,000 IU and use of Accutane and Retin-A (fat soluble can pass through skin)
retinoid acid syndrome - small or missing ears, brain malformations, heart defects
<5,000 IU of retinol in supplements
calcium requirement…
increases by 300 mg/d in 3rd tri
calcium absorption and bone reabsorption increases
caffeine in pregnancy
no apparent long term consequences
4 cups is safe
pica
eating disorder
consuming food you wouldn’t typically consume
geophagia
eating soil
pagophagia
freezer frost eating
amylophagia
eating cornstarch
nausea and vomiting
nausea in 8/10, vomiting 5/10
most common weeks 5-12
treat: B6, multivits, ginger
hyperemesis gravidarum
severe nausea and vomiting throughout pregnancy
exercise recommended for pregnancy
3-5 times week for 30 mins at 60-70% VO2 max
good vs. bad cholesterol
good - HDL
bad- LDL
high LDL in obese mothers
visceral fat
around organs, under muscle
more metabolically active
white fat
bigger effects
subcutaneous fat
under skin surface, above muscles
brown fat
burns to produce heat and warm body
hypertension (HTN)
> 140 mm Hg systolic or >90 mm Hg diastolic
affects 6-10% of pregnancies
chronic HTN
diagnosed before pregnancy or 35 years old, history of HTN
gestational HTN
diagnosed >20 weeks for first time
no proteinuria
tend to be overweight/obese with extra central body fat
6% of pregnancies
preeclampsia/eclampsia
HTN diagnosed >20 weeks and proteinuria
headache, blurred vision, abdominal pain, low platelet count, abnormal liver enzyme levels
eclampsia = seizures
4% of first and 1.7% of subsequent pregnancies
chronic HTN pregnancy risks
preterm delivery, fetal growth retardations, placenta abruption, Cesarean delivery
proteinuria
urinary excretion of >.3 g protein in 24 hour urine sample
cause of preeclampsia/eclampsia
unknown, maybe abnormal implantation and vascularization of placenta with poor blood flow
recommendations for preeclampsia
adequate calcium and vit D, mutivits/minerals, >5 servings of colorful veggies and fruits, fiber, moderate exercise, recommended weight gain
first approach for management of gestational diabetes
medical nutrition therapy to normalize blood glucose levels with diet and exercise
type 1 diabetes during pregnancy
more hazardous than gestational or type 2
kidney disease, hypertension,
newborn mortality, SGA or LGA, hypoglycemia after birth
dizygotic twins
fraternal, 2 eggs fertilized
70% of twins
monozygotic twins
identical, 1 egg
30% of twins
chorion
outer membrane, around amniotic sac
3 possibilities of placentas/sacs
2 amniotic sacs, 2 chorions, 2 placentas
1 amniotic sac, 1 chorion, 1 placenta (most risk for problem because shared sac and placenta)
2 amniotic sacs, 1 chorion, fused placentas
vanishing twin phenomenon
6 to 12% of pregnancies begin as twins with only 3% born as twins
silently occur into uterus within 1ist 8 weeks
___% chance of transmitting HIV to fetus
20% 34 million people have HIV placenta normally barrier for virus and bacteria, can also be passed through breast milk not related to adverse pregnancy outcome
calcium RDA for pregnant teens
1300 mg
alveolus
functional units of mammary gland
hallow cavities
secretory cells with duct in center
letdown
milk ejection
myoepithelial cells contract to cause milk to be secreted into ducts
lobes
groups of alveoli
lactiferous sinuses
dilations behind nipple for storage of milk, drains into opening of nipple
lactogenesis
milk production
lactogenesis I - pre birth to 2-5 days after, begins in form of colostrum
lactogenesis II - 2-5 days after birth, milk “comes in”
lactogenesis III - ~10 days after birth, milk composition is stable
prolactin
produced by pituitary
triggers cells in alveoli to produce milk
released in response to suckling
inhibits ovulation
oxytocin
produced by pituitary
stimulates milk let down from acinus into dcut
tingling of breast
causes uterus to contract
human milk is only food source needed for…
first 6 months
solid food at 4-6 months for jaw development
colostrum
first milk secreted during first few days postpartum
very high in proteins (secretory IgA and lactoferrin)
lower calories
high vit A - yellow color
IgA
component of immune system
starts coating intestinal lining to create barrier against pathogenic bacteria
lactoferrin
barrier to protect bad bacteria, bind to receptors on bacteria and produce peroxides to kill it
energy in human milk
20 Kcal/oz
lower than milk substitute
lipids in human milk
~1/2 energy in human milk
fat content remains stable but depends on what mother eats
casein
main protein in mature human milk
white appearance
total protein content lower than cows milk
whey
proteins the remain soluble in water after casein is precipitated out
non protein nitrogen
20-25% of nitrogen in human milk
used to make non essential amino acids, hormones, etc.
fat soluble vits in human milk
A - most in colostrum D - E K - 5% of breasted infants at risk of deficiency coagulation factors, bleeding k injection at birth
___ expressions/day for first couple weeks are necessary to stimulate adequate milk production
8-12
every 1.5-2 hours
optimal duration of breastfeeding
AAP - 1 year or longer
US surgeon general - exclusively for 6 months and best to breastfeed for 12 months
rooting reflex
turns to side when stimulated on that side
hunger signaled by …
bringing hands to mouth, sucking on them, moving head from side to side
crying
feeding frequency
10-12 feeding/day
stomach emptying occurs in ~1.5 hours
normal weight loss for newborns
~7% of birth weight in 1st week
of 10% needs to be evaluated
by day 5 to 7, infants should have ___ wet diapers and __ soiled per day
6 wet
3-4 soiled
energy needs for lactation
+330 for 1st 6 months, +400 afterward
letdown failure
milk does not eject from breast, very uncommon
oxytocin nasal spray may be prescribed
relaxation techniques
engorgement
when supply and demand process not yet established
most common from day 2-3
mastitis in ___% of breastfeeding women
1-33%
most common at 2-6 weeks
most common reason for cessation of breastfeeding
low milk supply (real or perceived)
from insufficient breastfeeding/pumping, ineffective emptying, stress
drug to increase prolactin (after day or two)
effect is ___ for majority of drugs (for breastfeeding))
unknown
HIV transmission rates for breastfeeding
5 to 20% depending on duration
goes up to 40-50% for 1-2 years
US says don’t do it
choice not clear in developing counties - more risk of death from bad water
alcohol and breastfeeding
passes to breast milk
peak plasma levels 30-60 mins after consumption if w/o food, and 60-90 min if with food
alcohol decreases ….
oxytocin and let down
alcohol and breastfeeding affects…
odor of milk, volume baby wants to consume, sleep pattern
smoking and lactation
health risks for infant
not good, but better than not breastfeeding
1/2 life of nicotine is 95 mins so delay feeding after smoking
milk banks and cost
~12 in north America
$3.50 / ounce
jaundice
yellow color, 40% of full term 80% of preterm
caused by high levels of bilirubin (hyperbilirubinemia)
bilirubin
breakdown product of heme
bilirubin metabolism
fetal stage, high levels of hemoglobin to carry oxygen
high levels of hemoglobin at birth
RBC begin to breakdown after birth, high hemoglobin not needed
usually processed by liver and excreted in stool
liver not fully mature so jaundice is common
Total serum bilirubin (TSB)
balance between rate of production and rate of excretion
physiological jaundice
resolves on own with no damage
begins 1st day, peak 6-7 days
bilirubin <12mg/dL
cause: normal heme breakdown
pathological jaundice
if hyperbilirubinemia become severe, elevated bilirubin can cause permanent neurological damage rises rapidly and lasts longer bilirubin >8mg/dL in 1st day medical intervention with phototherapy cause: various pathological conditions
most frequent cause for hospital readmission for newborn
hyperbilirubinemia
kernicterus or bilirubin encephalopathy
bilirubin toxic to cells and may cause brain damage cells do not regenerate mortality rate 50% survivors: cerebral palsy, etc. baby blood brain barrier not developed
breast non-feeding jaundice/breastfeeding failure jaundice
early onset (Day 1-2), peaks 2-5 due to suboptimal breastfeeding
breast milk jaundice syndrome
late onset (day 3-5), peak 2nd to 3rd week
baby starving
potentially due to substances in milk that increase bilirubin in reabsorption or individual variation in processing
cause is unknown
typically reabsorbs itself and is extension of physiological jaundice
treating jaundice
phototherapy- light absorbed in bilirubin changing it to water soluble product that can be excreted
encourage continuation of breastfeeding
