Preconception Ch 2-3

Question 1

What is a miscarriage?

What are the common causes of miscarriage?

Answer 1

MISCARRIAGE: Spontaneous abortion in 1st 20 weeks of pregnancy

Defect in fetus
Maternal infection
Structural abnormalities of uterus
Endocrine or immunological disturbances

Question 2

What hormones are involved in the reproductive physiology of females

Answer 2

LH: stimulates secretion of progesterone & testosterone
FSH: stimulates maturation of ovum, sperm, & production of estrogen
FOLLICULAR PHASE:
- Follicle growth & maturation -
Main hormones: GnRH, FSH, estrogen, & progesterone
Luteal Phase
- After ovulation
- Formation of corpus luteum
- estrogen & progesterone
stimulate menstrual flow
- Prostaglandins & cramps

Question 3

What hormones are involved in the reproductive physiology of males

Answer 3

Interactions among hypothalamus, pituitary gland, and testes
-fluctuating levels of GnRH
-Signal the release of FSH and LH
Trigger production of Androgens ( Testosterone )

Question 4

What are the nutrition-related disruptions in fertility? (5)

Answer 4

Undernutrition
Weight loss
Obesity
High exercise levels
Intake of specific foods & food components

Question 5

NOT ON SG: what are the sources of disruptions in fertility? (6)

Answer 5

Adverse nutritional exposure
Contraceptive use
Severe stress
Infection
Tubal damage or other structural damage
Chromosomal damage

Question 6

Describe nutrition-related disruptions in fertility: UNDERNUTRITION

Answer 6

UNDERNUTRITION in women previously well-nourished
-Asso w/ dramatic ↓ in fertility (recovers
when food intake is re-est)
-Food shortages => dramatic ↓ in birth rates

Question 7

Describe nutrition-related disruptions in fertility: BODY FAT

Answer 7

↓ fertility w/ low or high body fat bc of alterations in hormones
Estrogen and leptin
-Levels increased w/ high body fat & reduced with low
body fat
-Both extremes lower fertility
Infertility lower w/ BMI 30 (∴ fertility: 20-30 BMI)

Question 8

Describe nutrition-related disruptions in fertility:

WEIGHT LOSS in W (3)

Answer 8

Weight loss >10-15% of usual weight ↓ estrogen, LH, FSH
Results in amenorrhea, anovulatory cycles, & short or absent luteal phases
*Treatment with fertility drug Clomid not effective in underweight women

Question 9

Describe nutrition-related disruptions in fertility:

WEIGHT LOSS in M (2)

Answer 9

• studies fm WWII: 50% ↓ in male fertility during starvation

- sperm viability & motility ↓ w/ wt. 10-15% below normal & cease at wt. loss exceeding 25% of normal

Question 10

Describe nutrition-related disruptions in fertility:

OXIDATIVE STRESS in M (2)

Answer 10

↓ sperm motility

↓ ability of sperm to fuse w/ an egg

Question 11

Describe nutrition-related disruptions in fertility:
OXIDATIVE STRESS in F (3)
exercise, iron status, and alcohol intake

Answer 11

1. Harm egg and follicular development
2. Interfere with corpus luteum function
3. Interfere with implantation of the egg

Question 12

Describe nutrition-related disruptions in fertility: 
IRON STATUS (3)
 exercise,  and alcohol intake

Answer 12

1. Poor iron status = ↓ fertility
2. Rate of infertility ↓er in W (who use iron
   supplements/consumed iron from plant sources)
   * 14% of U.S. women of childbearing age have inadequate iron stores

Question 13

Describe nutrition-related disruptions in fertility:

EXERCISE

Answer 13

Adverse effects of intense physical activity ↑ deficits:
from hormonal and metabolic changes
-Delayed age at puberty
-Lack of menstrual cycles  
Related to :
-Caloric deficits
-Low levels of body fat
-↓ levels of estrogen
-↓ bone density

Question 14

Describe nutrition-related disruptions in fertility:

ALCOHOL INTAKE

Answer 14

Alcohol may ↓ estrogen & testosterone levels or disrupt menstrual cycles

Studies on weekly drinks consumed by women show:
1-5 drinks/week -> 39% ↓ in conception
>10 drinks/week -> 66% ↓ in conception

Question 15

What is metabolic syndrome?

What are the components of metabolic syndrome?

Answer 15

Cluster of abnormal metabolic & health indicators
Diagnosed if 3/ 5 conditions exist:
1. Waist circumference: >40” in men & >35” in women
2. Blood triglyceride: ≥ 150mg/dL
3. HDL-cholesterol: < 40mg/dL M &130/85mmHg
5. Fasting blood glucose: ≥100mg/dL

Question 16

Describe consequences*, prevalence, & therapy of MS.

Answer 16

CONSEQUENCES
Increases risk of CVD & type 2 diabetes
Characterize by chronic inflammation and oxidative stress
PREVALENCE
32% in U.S. adults
THERAPY
-Dietary modifica/on
-Exercise
-Weight reduction

Question 17

What is hypothalamic amenorrhea?

Answer 17

aka “functional hypothalamic amenorrhea” / “weight- related amenorrhea” : ending of menstruation related to changes in hypothalamic signals that maintain ovulation

• Reduced produc/on of GnRH (FSH and LH) (affects next steps)
• Caused by deficits in energy & nutrients (@L: 30% caloric deficit)

Question 18

What is the relationship between body fat and hormones?

Answer 18

body fat ↑ = hormones ↑ (esp estrogen)

-can suppress hormones & affect ovulation

Question 19

Describe the relationship between eating disorder & fertility

Answer 19

Anorexia nervosa & bulimia nervosa linked to hypothalamic amenorrhea in some women
- > likely to miscarry, have preterm delivery, have low birthweight infants
-Menses typically resumes w/ wt gain
Care - involves evidence based practice
-interdisciplinary group of experienced health professionals

Question 20

What is female athlete triad? How it affects fertility?

Answer 20

Triad consists of: Amenorrhea, Disordered eating, Osteoporosis
Triggered when energy intake is ~30% less than requirement
∴ ↓ in LH, FSH & lack of estrogen
Low hormone levels -> ↓ in bone density

Question 21

Differentiate between type 1 diabetes, type 2 diabetes, and gestational diabetes

Answer 21

Diabetes Mellitus: intolerance to carbs w/ fasting glucose ≥126 mg/dL (high glucose)

Type 1: results fm destruction of insulin-producing cells
(10% of cases)
-beta cells in pancreas can’t produce insulin
Type 2: body unable to use insulin normally, to produce enough insulin or both (90%)
-highly related to lifestyle
Gestational: onset during pregnancy (3-7%)

Question 22

What are the key components of the nutritional management of PCOS? (4)

Answer 22

Primary goal is to ↑ insulin sensitivity
- Insulin-sensizing drugs
Diet recommendations:
-Lean proteins, whole grains, fruits & vegetables, regular
meals, non-fat dairy, & low-GI foods
-Weight loss & exercise improve prognosis

Question 23

What is PCOS? (7)

Answer 23

POLYCYSTIC OVARY SYNDROME
*5-10% of women of childbearing age
leading cause of female infertility: absence of
ovulation
many are obese / have ↑ levels of intra-abdominal fat
Cause is uncertain
-Insulin resistance a possible factor
-Appears to have strong genetic component

Question 24

What is PKU? How do you manage PKU?

Answer 24

PHENYLKETONURIA : Elevated blood phenylalanine (protein in milk) due to lack of phenylalanine hydroxylase (enzyme)
-Preventable cause of intellectual disability

Low-phenylalanine diet for life

Question 25

What is celiac disease? (3)

Answer 25

*prevalence in U.S. is ~1 in 133
:autoimmune disease characterized by chronic
inflammation of small intestine
Inherited sensitivity to gluten in wheat, rye, barley, which causes malabsorption & flattening of intestinal lining

Question 26

How do you manage celiac disease?

Answer 26

Eliminate gluten in diet
-Look for “gluten free” labels
Gluten found in many non-grain foods like hot dogs, deli meats, supplements, chips, bouillon, salad dressing, etc.
-Correction of vitamin & mineral deficiencies

Question 27

What are the consequences of untreated celiac disease? (3)

Answer 27

multiple vitamin and mineral deficiencies
impaired fertility
fetal growth disruption