Pre-Conception Flashcards
List and explain the 3 primary preconception health concerns in the US.
1) 31% of pregnant women are obese
2) 60% do not take folic acid
3) 3% take medications known to cause birth
Define preconception care. When should it begin? What are the 4 improved outcomes for women receive care prior to pregnancy?
Definition: medical care from a health professional that focuses on health related to having a healthy baby
Timing: at least 3 months before pregnancy
4 outcomes:
1) increased folic acid intake
2) more likely to be current on vaccinations
3) experience less weight gain at beginning of pregnancy
4) fewer complications
Define infertility and subfertility. List and explain 8 conditions that affect fertility.
Infertility: the inability to get pregnant after 12 or more months of regular, unprotected sex (15-20% of couples)
Subfertility: any period of reduced fertility when conception is desired
Conditions affecting fertility: age, endometriosis, body weight, polycystic ovary syndrome, diabetes, celiac disease, hypertension, sexually transmitted infections
Age. How does age affect fertility in women? How does age affect fertility in men? Outcomes?
Women: fertility decreases sharply at age 35, increased risk for Down syndrome
Men: fertility declines every year, sperm quality declines, age contributes to down syndrome, children of older men may have higher risk for schizophrenia
Endometriosis. What is endometriosis? How may it affect fertility?
Occurs when bits of endometrial tissue grow on other organs such as fallopian tubes or ovaries - the tissue still responds to hormones like regular endometrial tissue does. can cause scar tissue to form. affects 5-10% of women and can be painful
Impacts: decreased fertility
Body Weight. What health risks related to reproduction are associated with excess bodyweight in women? Men?
Women: irregular menstrual cycle, elevated insulin, reduced ovulation, PCOS, increased risk for surgical deliveries and LGA babies, breastfeeding challenges (losing 5-10% of weight may restore ovulation)
Men: lower testosterone, reduced sperm quality (bettering lifestyle can improve this)
Body Weight. List the fertility risks of being underweight during preconception for women and men.
Women: reduced hormone production, amenorrhea
Men: lower testosterone, reduced sperm quality
PCOS. What is PCOS? What are the 8 characteristics of polycystic ovary syndrome? What are the 3 potential causes? Treatments? If a woman with PCOS becomes pregnant, what 3 health risks does she face?
-Polycystic ovary syndrome characteristics:
Small cysts on ovaries, high levels of androgens, high Insulin, amenorrhea, male pattern hair growth, acne/oily skin, abdominal fat, pelvic pain
Causes: genetics, hyperinsulinemia, Intrauterine programming
Treatments: weight loos, taking metformin
Pregnancy risks: gestational diabetes, gestational hypertension, babies small for gestational age
Diabetes. List and briefly describe the 3 forms of diabetes. What are the risks associated with poor blood glucose control for women? If a woman with diabetes does conceive, what are 3 risks associated with poor blood glucose control?
Forms: Type I, Type II, gestational
Risks: infertility
Conceiving risks: birth defects, babies large for gestational age, and complications during pregnancy
Celiac Disease. Define celiac disease and explain how individuals with this condition may have poor nutrient status. How might this affect pregnancy outcomes? How is this condition treated?
-autoimmune disorder that occurs when body reacts to gluten (wheat, rye, barley, and contaminated oats)
Causes: flattening of intestinal lining which decreases nutrient absorption
Results: infertility, increased risk of miscarriage, LBW and pre-term delivery
Treatment: life-long gluten-free diet
Hypertension. What 3 groups are at risk for hypertension? What are lifestyle correlates? How does hypertension impact pregnancy? What diet is used to reduce blood pressure?
At risk groups: older adults, obese people, African Americans
Lifestyle correlations: smoking, being sedentary, diet high in processed foods, trans fat, sugars, salt; low in vegetables, fruit, seeds
Impact: 8% of women child bearing age have hypertension, increases frequency of experiencing preeclampsia
Diet treatment: DASH diet
How can men improve their sperm health with respect to diet, lifestyle choices, weight, etc.? List nutrients that are important, and lifestyle practices that may impact sperm quality.
Diet: zinc, lots of produce for antioxidants and folate, make half of grains whole grains, healthful fats
Lifestyle: less than 2 alcoholic drinks, no recreational drugs, no smoking, avoid obesity, saturated fat, radiation, and environmental toxins
List nutrients of primary concern for women prior to pregnancy
folic acid, iron, iodine, choline, omega 3 fats
Folic acid. Compare folic acid and folate. How do labels provide information about the quantity of this nutrient (i.e. what units are used)? What are the 2 ways that folic acid works with respect to pregnancy? Why is folic acid status so important prior to pregnancy (address the function and statistics about pregnancies)? When, during pregnancy, is the critical window during which folic acid is needed to prevent birth defects? What are the 2 primary causes of poor folic acid status?
What is the DRI for folic acid before and during pregnancy (include units)? What are specific recommendations for women regarding diet and folic acid supplement intake prior to pregnancy? What are recommendations for women with a previous history of neural tube defect deliveries? List several food sources that would support intake of 400 DFE/day intake) in addition to processed foods.
- Folate is found in food (50% absorption), folic acid is the supplement form that’s more bioavailable (100% absorption)
-Labels are reported as Dietary Folate Equivalents (DFE) which taken into account both versions
-Folic acid is involved in DNA synthesis and DNA methylation (CLOSES NEURAL TUBE)
-important to address intake prior to pregnancy because neural tube closes 17-30 days after conception before most women know they are pregnant (half pregnancies unplanned, 3000 births/year with NTDs - March of Dimes, adequate Intake In child bearing aged women can help avoid NTDs)
-2 Causes: low Intake In diet, or genetics having a single nucleotide polymorphism that codes for MRHFR enzyme
-Folic acid DRI: Not PG Is 400 DFE, PG Is 600 DFE, previous history of NTD need 400 DFE daily
Food sources: oranges, orange juice, black-eyed peas, kidney beans, spinach, asparagus, broccoli, fortified cereal, boiled eggs, enriched pasta or rice
Iron. With respect to reproductive health, what are critical roles for iron? What are the potential effects of deficiency for the mother? Child? What is the DRI for iron before pregnancy, during pregnancy, and during lactation? What are specific recommendations regarding dietary intake of foods to promote good iron status?
Critical roles: synthesis of hemoglobin, myoglobin, electron transport system, neurotransmitter synthesis, cognitive development
Deficiency effects on mother: depleted stores, anemia
Deficiency effects on child: impaired cognitive function - IQ, language skills, gross motor skills, attention, behavior
DRI - before PG 18 mg, PG 27 mg, lactation 9 mg
Dietary recommendations: Vit C pairs with heme iron, limit oxalates
