Test 1 Lactation Flashcards
Infertility vs subfertility
Infertility: inability to conceive within 12 months of trying
Subfertility: women who have had 2-3 losses or ovulate infrequently or men with sperm abnormalities
Most important micronutrients in the preconception state?
Zinc
Folate
Iron
Vitamin A
Lifestyle for increasing fertility
Adequate weight
Don’t smoke
Limit alcohol
Female diet for increasing fertility
Vitamin D Multivitamin with Folic acid Iron Protein More PUFAs Less caffeine
Male diet for increasing fertility
Vitamin D, C Calcium Zinc Low GI index foods Less caffeine, animal protein and soy
Most important nutrients for fetal brain development
Iron Zinc Iodine PUFA Vitamin A B12 Folate
Physiological changes in blood during pregnancy
- Increased volume
- Water soluble components decrease
- blood lipids increase
Physiological changes in circulatory system during pregnancy
- Increase HR/CO
- low BP first half, high BP second
- low mg/ca intake associate with higher BP
Physiological changes in GI during pregnancy
Heartburn
Nausea/vomiting
Increased transit time (constipation)
Physiological changes in kidneys during pregnancy
- GFR increases 50%
- increased Na retention
Physiological changes in metabolism during pregnancy
-fetus prefers glucose energy (carb intake)
-increased protein synthesis
Decreased nitrogen excretion
-fat storage in first half, mobilization in second half
-increased Ca absorption and mobilization from bone
-increased metabolism (fasts 12+ longer increase many keytones)
Causes of IUGR (intrauterine growth restrictions)
1. Small placenta: less SA for absorption Infection HTN Preeclampsia Malnutrition Small maternal size Young mother Substance abuse
What increases risk of miscarriage
- Underweight mother
- Oxidative stress
- Vitamin E and D deficiency in 1st trimester
What nutrient decreases risk of preterm delivery**?
Folic acid
Supplementation is required at least a year before getting pregnant to have affect
Energy requirements during each trimester
1st: no change
2nd (13-26wks) : +340 cal/d
3rd (27-42wk): +452 cal/day
Carb requirement during pregnancy
175 g/d
Fiber requirement during pregnancy
28 g/d
Most important nutrients DURING pregnancy
Folate B6,12 Vitamin K Iron Ca Iodine Zn Cu
What is choline needed for during pregnancy
Signaling and nerve transmission
What vitamins in supplement form if taken during pregnancy increase risk of preterm labor and decrease birth weight
Vitamin C and E
What vitamin is teratogenic at high doses during pregnancy
vitamin A
What are vitamin D and K good for during pregnancy
Bone health
Severe deficeiency of Iodine during pregnancy can cause what
Impaired fetal neurodevelopment
Deficiency in iron during pregnancy increases risk of what?
Postpartum depression
RDA of what nutrient doubles during pregnancy
Iron
What is epigenetics
Stable changes to a gene structure without changing DNA sequence.
Changes how genes are expressed
What vitamins may have influence on gene expression (epigentics) because they are capable of methylation
B12 and folate
What is fetal programming?
Maternal under or overnutrion can program infant to be predisposed to:
Heart disease Stroke Diabetes Obesity Hypertension
Maternal stress and fetal cortisol relationship
11B-HSD2 produced by placenta and inactivated cortisol.
Increased maternal stress causes decreased expression of 11B-HSD2 and causes increased fetal cortisol
What maternal dietary factors may increase fetal stress and cortisol concentrations
Calorie restriction
Low protein
High fat and sugar
Low Mg, choline, folate
Silence 11B-HSD2
(Hydroxysteroid dehydrogenase)
What dietary factors cause healthy epigenetic alterations?
Polyunsaturated fats
Fruits/veggies (polyphenols)
Folate/Vit B12
Selenium
What is one of the main dietary compounds that influence epeigenetic gene expression
Glucose
Affects methylation patterns
Epigenetic diet
Vitamin C, A, B12 Folate Polyphenols Copper Sulforaphane Omega-3s Zinc
How much weight should a woman gain during pregnancy
Normal weight: 25-35lbs
Twins: 35-45
Overweight: 15-25
What are some side effects of pregnancy and fix?
Constipation
Heartburn: smaller meals, less caffine, stay upright, carbonated beverages
Nausea/vomiting: carb containing meals, ginger, smelling lemons
Hypertension: Ca/Mg/K
Leg cramps/edema: Mg, stretch, increase fluids
What foods should be limited in pregnancy?
- unpasteurized food (soft cheeses)
- no salads from store
- reheat meat (no cold deli meat)
- shark, swordfish, tilefish, mackerel
- albacore/tuna: 6oz/wk
What supplements should pregnant females take
Folic acid
Iron
What nutrients take longest to normalize after pregnancy
2-4 months: Iron
6+ months: folate
What does WHO consider the minimum time between weaning 1 in fact and conception of the next?
18-24 months
Risk decreases with folic acid supplementation
How many extra calories are required during lactation
0-6months: 330 cal/day
6+ months: 400 cal/day
How many carbs are required during lactation
210g/day
What are most important nutrients during lactation
Vitamin D B12 Iron Iodine Zinc
Stages of lactation
Colostrum: 0-5days
Transition milk: 5-14 days
Mature milk: 2+ weeks
Colostrum
-0-5 days Many antibodies Fat-soluble vitamins Electrolytes High in protein
Transition milk
5-14 days
Protein drops
Lactose/fat increase
Mature milk
2+ weeks
40% of energy as lactose
55:45 casein:whey
Foremilk contents
First milk secreted
High in water, cards and water-soluble vitamins
Low fat
Hindmilk contents
High-fat milk
What are galactagogues
Milk production stimulants
Examples of galactagogues (milk production stimulants)
- Oats, barley, beans, almonds
- Dark leafy veggies
- fenugreek milk thistle
- alfalfa
- caraway
Meds: motilium, reglan
What foods may prevent postpartum depression
Omega3 Folate Riboflavin: cows milk/grains B6,12: meats Vitamin D Calcium Iron Selenium: Brazil nuts/anything from ground
What is used to measure postpartum depression
Edinburgh postpartum depression scale
EPDS
