Unit 1 Flashcards
Preconception, Pregnancy and Lactation
Preconception nutrition
The time before conception (before pregnancy)
Preconception
The period (at least 2 years) before and between pregnancies, to improve health related outcomes for women (regardless of their pregnancy status), newborns and children upto 5 years
Preconception Proximal period
Period preceding pregnancy (up to 2 years prior to conception)
Preconception Distal period
Adolescents or in general a longer time before pregnancy
Periconception
The period preceding including and immediately following human conception, to improve health related outcomes for women, newborns and children up to 5 years
Preconception boundary
3 months before pregnancy to up to the first trimester
Critical window
First 1000 days (2 years)
key to brain development, healthy growth and a strong immune system
The periconception period
3 months prior to conception
*biologically 5-6 months
Why does excess body fat decrease fertility?
- higher estrogen, leptin, androgen (males and females and lower testosterone in males)
- menstrual cycle irregularity (30-47%)
- reduced sperm production and erectyle disfunction
Why does inadequate body fat decrease fertility?
- Weight loss exceeding 10-15% decreases estrogen, LH and FSH = amenorrhea, anovulatory cycles, short/absent luteal phases
- Critical level of body fat (BMI>20kg/m2) REQUIRED to trigger and sustain normal reproductive functions
- Low levels of body fat during adolescence delays onset of menstruation and reduces fertility
- LT consequences of undernutrition revealed during famine (Dutch famine 194/5)
What does Periconceptional nutritional status influence?
offspring, metabolism, organ growth, development and function, leading to increased risk of chronic disease
Choline
Brain development
Iron
Iron deficiency anemia linked with LBW, delayed development, preterm birth, infections, postpartum hemorrhages
Iodine
- Thyroid and metabolism
- Neural growth and development of fetus (Neurocognitive)
- Iodine deficiency: adversely affect neurological and psychological development and can cause intellectual disability (SEVERE)
- RDI: 160mcg/ day
- RDA: 220mcg/d
- *In NZ pregnant women are at risk of mild iodine deficiency so supplement is needed (along with use of iodised salt)
Zinc
Preterm birth, placenta function
Omega-3 fatty acids and B12
altered lipid metabolism
Multivitamins
- Neural tube defects
- Congenital heart defects
- Urinary tract defect
- Limb reduction defect
- preeclampsia
Folic Acid
- Neural tube defects
- Congenital malformations
- Preeclamsia (BP, fluid retiontion)
- autism
- increased sperm count and viability
- 800mcg/day (4w before pregnancy and 12w after)
- contains gluten
Periconceptional folic acid
Prevents(1st and second) /reduces neural tube defects (spine and brain)
1st trimester
Conception to 12th week
Estimated date of delivery (EDD)
counted from 1st day of LMP (40 weeks from here/38 weeks after conception)
2nd trimester
Week 13-28
3rd trimester
Week 28 to birth
Pre-term (premature)
<37 weeks
Term
37-43 weeks
Post-term (postmature)
> 42 weeks
Placenta
- Temporary organ grown during pregnancy and feeds the baby and
carries O2, antibodies and nutrients (also removing waste from fetus to mother e.g. CO2) - Starts implantation of the blastocytes
- Placenta (trophoblast) are outer cells of the fetus (embryoblast)
- Fully formed by 18-20 weeks
- Takes over hormonal role of ovary
- Connected to the fetus(embryo) by umbilical cord
Human Chorionic gonadotropin (HCG)
- pregnancy hormone (recognizes if pregnancy is viable)
- Prevents release of more eggs for fertalisation
- Combination of controlling other hormone in body (increased estrogen etc)
- peaks at early stages of pregnancy and maintains pregnancy
Umbilical arteries
carry deoxygenated blood from fetal circulation to placenta
Umbilical veins
carry newly oxygenated blood and nutrient rich blood to fetus
Teratogens
- Distubing development of an embryo or fetus.
Can cause birth defects in the child or - halt pregnancy
e.g. Radiation, maternal infections, chemicals, drugs
Physiological changes during pregnancy
- Weight gain: 12-15kg
- Hormonal: increase
- Metabolic and renal: increase in fluid
- Cardiovascular: increase in HR & BP
- Respiratory: difficulty breathing due to pressure on lungs
- Hematological: Increase in plasma volume and decrease in hemoglobin (RBC), iron deficiency
- Gastrointestinal: Decreased GI motility from elevated progesterone relaxing smooth muscle and pressure on colon and rectum causing constipation (also due to iron supplements).
Hormonal changes during pregnancy
- Continually Increased progesterone and estrogen (via placenta), suppressing hypothalamic axis thus menstrual cycle and promoting prolactin = milk hormone
- Increased parathyroid hormone for calcium uptake (gut) and reabsorption (kidney)
- Increased cortisol and aldosterone (adrenal)
- Placenta produces HLP (only present when pregnant)
Human Placental Lactogen (HPL)
Hormone produced by plancenta when pregnant.
- Decreases insulin sensitivity and glucose utilizations = raises blood glucose level for adequate fetal nutrition.
- Increases gluconeogenesis to increase glucose for availability for fetus
- Chronic hypoglycemia leads to rise in HPL.
- HPL includes lipolysis, release of FFA to fuel mother. Ketones formed by FFA can be used for fetus as well as glucose.
*these functions help to support fetal nutrition even in the case of malnutrition
Hematological changes in pregnancy
- Increase in BV proportionally to CO (40/5%)
- BV increases in early pregnancy (faster than RBC) :. *More plasma volume than RBC in early pregnancy
- increased plasma volume DECREASES RBC (dilutional anemia)
GI changes in pregnancy
Constipation:
- enlarged uterus puts pressure on rectum and lower colon
- Decreased gi motility from increase in progesterone relaxing smooth muscle
- Iron supplements
- Heart burn and belching from delayed gastric emptying
- Gastroesphegal reflux due to lower esophegeal spincter relaxing
Lower HCI :. Ulcer uncommon
Hyperemesis gravidarum (HP)
Extreme form of NVP / Sever morning sickness
- weight loss, electrolyte imbalance and dehydration requiring hospitalisation.
- Poor outcomes
- Impacts neuro development and increased risk in respiratory and cardiac disorders
- Hormone growth differentiation factor 15 (GDF15) and NVP link
- Sensitivity to GDF15 influences severity
- Higher maternal levels = increased vomiting
Pregnancy outcomes with NVP or NP
Pelvic girdle pain (126% greater odds) high blood pressure (40% greater odds), proteinuria (50% greater odds), preeclampsia (13% greater odds),
18% more likely to be a girl baby
Delivery/birth outcomes with NVP or NP
Gestational length, c-section delivery, mortality, growth of infant
WITH NVP or NP = More likely to develop pregnancy complications but do exhibit mostly favorable delivery and birth outcomes
true
NVP mangement
- reduce sympotoms via diet/environment
- correct/prevent consequenses or complications of NVP
- minimise fetal effects of maternal NVP and their treatments
Assisted reproductive techniques (ART)
Scientific methods for fertility
e.g. In vitro fertilization-embryo transfer (IVF-ET), Gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), Frozen Embryo transfer (FET)
ART eligibility criteria
- <35 BMI and drop to <32, <40y/o (F) and <55y/o (M)
- unsuccessful with pregnancy after 12 months of intercourse
- non-smoker for 3 months
- can not have 2+ children
- nz citizen
Single/lesbian/gay: Anovulation or very irregular periods (<20 or <42 days), Known tubal infertility, Severe endometriosis
common health problems that women experience during early pregnancy
· Nausea and vomiting
· Heartburn
· Fatigue
· Constipation/Hemorrhoids
Food aversions
Ginger
- improve symptoms of nausea and is more effective than vitamin B6.
- Dose and frequency: ~ 1 g/d (550 – 1050 mg per day) divide twice to 4 times per day (to manage symptoms) via food or beverages Ginger can have positive effects in early pregnancy - NOT be taken in third trimester or close to labour (contra-indication).
· Communicate that some ginger supplements contain agents with questionable safety in pregnancy.
- Dose and frequency: ~ 1 g/d (550 – 1050 mg per day) divide twice to 4 times per day (to manage symptoms) via food or beverages Ginger can have positive effects in early pregnancy - NOT be taken in third trimester or close to labour (contra-indication).
What is vitamin D required for?
calcium absorption/uptake important during pregnancy or could specify support fetal bone health
What is the recomended does of vitamin D for pregnant women?
5 mcg/d
important nutrients for pregnant women
Iron: + 1 g of for pregnancy (specifically for the fetus and placenta, during delivery, and to increase red blood cell mass
Vitamin C: iron absorbtion
Folate: 800 mg (neural tubal)
Vitamin B6: fortified cereal
Vitamin B12: dairy
Zinc: deficiency can increase risk of fetal loss, congenital malformations, low birth weight
Iodine: (brain development) 150mg
listeriosis
a food-borne infection that results from eating food contaminated with Listeria a common bacterium that can be harmful to the fetus
- sealed packs; eat cold or cooked within two days of opening pack
- reheat leftovers to piping hot >70degrees
- fresh/washed vegetables vs deli)
· was the rocket washed
*for pregnant, hummus and sprouts is advised not to eat – sesame seeds raw, including in tahini, are a risk) and avoid fresh juice that is unpasteurised
food safety concerns
Listeriosis and Toxoplasmosis
Recommendations for total and rate of weight gain during pregnancy
12-15kg and 0.42kg per week in trimester 2&3
*higher for twins (17-25kg)
Components of gestational weight gain (GWG)
- Water (62%)
- Fat Mass (30%)
- Fat-free mass (8%)
1/4 from fetus as 90% fetal growth occurs later in pregnancy
Rate of gestational weigth gain (GWG)
1st trimester: low
2nd trimester: reflects deposition and expansions of maternal tissue (1/3)
3rd trimester: fetal, placental and accumulation of amniotic fluid (2/3)
Overweight & obese are more likely to overestimate weight gain than normal weight women (T or F)?
True
Healthy weight gain advice
-30 mins moderate intensity PA 5 or more times a week
- Healthy eating
- Awareness of weight gain guidelines
Monitor weight - target weight gains are strongly associated with actual gains
What % of pregnant women don’t have healthy weight gain?
75%
under (23%)
over (50%)
Over weight & obese pregnancy Risk factors for baby
- caecereans
- gestational diabetes
- macrosomia (<4kg birth weigth)
- small gestational age (SGA) and large gestational age (LGA), preterm birth
71% women in counties Manukau (deprived decile) had high weekly GWG (similar to European women) (T or F)?
True
Midwives experiences, challenges, interventions. (themes)
- Emotion and weight: empathy v judge, sensitive subject, midwives frustration
- Ability to influence: roles & responsibilities, midwives body image
- Practical challenges
and strategies for success: knowledge, time/priorities, personal strategies, interventions
Postpartum weight retention
increases BMI, visceral fat and fat mass
Metabolic consequences: increased risk of GDM, preeclampsia, hypertension, diabetes (type 2), cardiovascular disease, metabolic syndrome
Implications of obesity for mother
- Miscarriage and still birth
- Pregnancy-induced hypertension (PIH): High blood pressure and protein in urine
- High BP
- Venous thromboembolism (blood clot which can be fatal if travel to right side of heart and into lungs (pulmonary embolism)
- Delivery complications: induction and Caesarean (1.3 more likely)
- Gestational diabetes mellitus (GDM)
Implications of obesity for the baby
- Increased risk of congenital (present from birth) abnormalities e.g. CNS, heart, cardiovascular defects, orofacial clefts, hydrocephalus (fluid under brain) and limb reductions
Every increase in BMI, increases the risk of birth defects by 7% (high)
Gestational diabetes mellitus (GDM)
- Temp diabetic during pregnancy (3-10%)
High blood glucose levels during pregnancy; few symptoms - diagnosed via screening
Pathophysiology (cause): unknown, however, hormonal changes (developing insulin resistance - like type 2 diabetes)
reversable from help with dietitian to control blood glucose
Risk factors for GDM
- Being overweight/obese increases risk by a factor 2.1, 3.6, 8.6
- Previous diagnosis of gestational diabetes or prediabetes, impaired glucose tilerance or impaired fasting glycemia
- Family history of T2DM
- Maternal age (>35)
Prev child with high birth weight (>90 centile or >4kg/macrosomia
Gestational diabetes, complications for the baby
- High maternal blood glucose exposes the fetus to higher glucose (placental diffusion facilitated by GLUT3 carriers) -> Increased fetal levels of insulin (insulin can not cross the placenta)
- excessive growth of the baby (macrosomia >4kg) or fetal overgrowth
high risk of getting type 2 diabetes later in life due to genetics (T2DM)
Gestational diabetes, complications for the mother
- Greater risk of developing gestational diabetes during future pregnancy and developing type 2 diabetes
- Caesarean birth
Induction of labor
When is GDM diagnosed?
if fasting blood glucose is greater than 5.5mmol/L and/or greater than 9 mmol/L 2 hours post load
Small for gestational age (SGA)
- below 10th percentile, for age
- 18% inscedence of SGA from obese women
- Obese mother stillborn infant is smaller than normal body weight mother
(biological mechanism is unknown)
Large for gestational age (LGA)
“fetal overgrowth”
- above 90th percentile for agr
macrosomia (>4kg)
- delivery of infanct >4kg = increased risk of cecearan delivery, fetal hypoglycemia and shoulder dystocia
Mortality rate of neonates born to obese mothers
4 times greater risk when mother is obese preterm (47%) than healthy weight mothers (9%)
Basal energy expendature (BEE)
attributed to maintinece
Increases over the non-pregnant state due to added metabolism of uterus and fetus and increasing work of maternal heart and lungs
Recommended energy intakes for pregnant women
1st trimester: not required
2nd trimester: 1,400kj (340kcal/day)
3rd trimester: 1,900kj (452kcal/day)
ferritin
iron stores
is Ferrous or ferric iron best absorbed?
Ferrous
Toxoplasmosis
- Infection when exposed to parasite called toxoplasma gondi
- eye and brain damage to unborn baby
Does supplementation with myo-inositol, probiotics, and micronutrients reduce the incidence of rapid weight gain and obesity at 2 years among offspring?
yes
How does Toxoplasmosis occour?
- unwashed vege
- under cooked meat or ready to eat e.g. salami and ham
- unpasturised/raw milk
- cross -contamination of food after gardening in areas where cat faeces or direct contact with cats
What are the features of fetal alcohol syndrome (FAS)?
- growth deficiency of prenatal onset/retardation
- CNS disfunction, developmental delays (not picked up until school)
- facial features e.g. Short palpebran fissures (eye opening), thin upper lip, smooth or long philtrum (top lip)
Alcohol related neurodevelopment disorder (ARND)
Difficulties with math, memory or attention, poor school performance, poor impulse control and judgment
Alcohol related birth defects (ARBD)
Heart, kidney, bone, hearing problems
What does fetal alcohol syndrome include?
-Exposure of fetus to regular heavy alcohol intake or very high concentrations at critical developmental period
-Alcohol related neurodevelopment disorder (ARND)
-Alcohol related birth defects (ARBD)
un necessary iron supplement use may lead to?
- GI diabetes
- oxidative stress
- preeclampsia (high BP, fluid retention)
What is the recommended weight gain for pre-pregnancy healthy weight women in a twin pregnancy?
is between 17-25 kg
How much extra energy (dietary intake) is required per day above a singleton pregnancy for a woman carrying twins?
265 calories more per day during twin pregnancy vs singleton (1 mark)
OR
theoretically increase 150 calories per day to theoretically achieve ~ 18.2 kg weight gain or 4.5 kg more than in singleton pregnancy.
Why is there a higher caloric intake needed for pregnant women?
- Tissue growth and maintenance and development of fetus
- Increased levels of maternal blood, extracellular fluid and placental and foetal growth
LCPUFA’s – Long-chain polyunsaturated fatty acids
- Neural and visual functions
- Development of cell membranes
Linoleic acid (LCPUFA’s)
10g / day
essential fatty acid (body cannot produce)
must obtain them from the diet.
used to make long-chain polyunsaturated fatty acids (LCPUFAs)
Alpha-linoleic acid (LCPUFA’s)
1g/day
essential fatty acid (body cannot produce)
must obtain them from the diet.
used to make long-chain polyunsaturated fatty acids (LCPUFAs)
What is the recomendation of total omega-3 LCPUFA’s.
115mg/day
200-300 mg/day
Calcium
- mothers bone maintence
- fetus bone development and formation
- 1000mg/day
Iron
- fetal erythropoiesis and creation of the blood system
- maternal blood volume
- ensure healthy red blood cells
Systematic review
Critical examination of a large body of research on a specific topic according to pre-determines search and inclusion criteria
- More reliable of information than reading randomly selected individual studies
- As a synthesis of a large range of studies on the topic
- If 1-2 years old they are mostly likely the most up to date
- More than one processor/researchers
Which gland produces milk?
Mammary gland
15-20 lobes, 20-40 lobules, 40-100 alveoli, 1 alveolus
Oxytocin hormone
Causes myoepithelial / secretory cells to contract for ejection of milk into the ducts via sucking
‘let down’: tingling, tightening, shooting pain (contractions)
-uterus contractions after delivery to pre pregnancy size
*Duct secrets milk to longer ducts which release milk (‘tree like’)
why are alveoli well vascularized?
so oxytocin can access the myoepithelial cells to control, squeezing milk out from lactocytes
Which hormones cause maturation of breast tissue IN PUBERTY? E.g. lobular structures, ductal system
Progesterone and estrogen
Occours 12-18 months after first menstruation/period (menarche)
Which hormone is responsible for mammary gland development IN PREGNANCY?
Human chorionic gonadotropin (HcG) and placental lactogen (HPL) allow further preparation
Estrogen: develops glands which produce milk
Progesterone: elongating tubuals and duplicating lining epithelial cells
Prolactin hormone
stimulates milk production via suckling and secretion
Hypothalamus (3rd trimester)
Lactogenesis 1 is known as
Colostrum
Immunity (white blood cells) Vtamin A , high protein, low fat
Lactogenesis 2 is known as
Transitional milk
onset of milk secretion
1 - 10 days
stimulated by hormones
marks the transition from the production of colostrum to the production of mature milk.
Lactogenesis 3 is known as
Mature milk
10 days post partum
~780ml consumed by infant during exclusive breast feeding (0-6m)
When does breast feeding initiation occour?
- Within the FIRST HOUR of birth
Born with reflexes to feed e.g. gag to prevent fluid into lungs
Suck and swallow: in coordinated pattern
Ora search reflex: open mouth and thrusting tonge when near breast
Rooting reflex: turning of head to side when stimulated on side of lip
Establishing breast feeding
- Skin to skin contact
- Staying hydrated
- Responsive feeding
- Emptying breast - removal signals production
What is the typical milk production?
1st month: 600ml
4-5month: 750-800ml
What is breast milk made of?
- Water (88.1%), carbs/lactose (7%), fats (3.8%), protien (0.9%)
- other (0.2%) vitamins&minerals, human milk oligosaccharides, antibodies, immune cells, hormones - - - and ~800 strains of bacteria
How much energy is in breast milk per ml?
0.65-0.7 kcal/ml
Foremilk
Produced at the START of feed
LOW fat
High nutrients
Hindmilk
Produced at the END of feed
HIGH fat
Lipids in breast milk
Comp of fat is related to mothers diet (inc trans fatty acids)
Contains cholesterol which is essential for cell membrane
Protien in breast milk
Low in mature milk
Whey, Casein, non-protien nitrogen (necleotides)
Carbs in breast milk (lactose)
The lactose ENHANCES calcium absorbtion
Human Milk Oligosaccharides (HMOs)
Are Indigestible CHO, complex
- naturally produced in human milk
- medium-length with lactose on one end
- Prebiotioc for healthy gutmicrobiome (not energy)
What is the role of prebiotics in breast milk?
- Stimulates growth of bifidus bacteria - - Inhibits escherichia coli
- Prevents infection
- Part of immune protection
Iron in human milk:
- Low concentration (0.35mg/L)
- Highly bioavailable
- 50% is absorbed - 10% absorbed from cows milk based formulas
Lactoferrin
Protein with anti-tumor effect, has been found to significantly inhibit growth of cancerous cells
*found in human milk
Which micronutrients are affected by maternal ststus?
Thiamin
Riboflavin
Vit B6,12
Vit A
Iodine
Selenium
*if mum is deficient then milk also is
What is the estimated energy requirement of lactating?
*above non-lactating women
0-6months: 2000 kilojules (~500cal)
6+ months: 1680 kilojules (400cal)
What is the mean milk volume produced per day?
780ml/day
What is the energy density of milk?
2.8kj/g
Exclusive breastfeeding
No other food or drink, (not water) except breast milk for 6 months of life. But allows the infant to receive ORS, drops and syrups (vit, mins and medicines).
Global Prevalance: 48% (target = 70%)
Exclusively breastfeeding benefits for baby
Reductions in
- morbidity e.g. diseases and illnesses which reduce mortality/death
- Protects from gi infections which cause diarrhea and dehydration AND
Protection of respiratory illnesses :. Reduced
- Reduces Bacteria causing infection like otitis media
- Reduces sudden death by 62%
- Reducing ear infections from sucking
- Reduces chronic diseases e.g. Allergies, type 2 diabetes, obesity in child
Increases cognitive function
Exclusively breastfeeding benefits for mother
- Protected health
- Reduced risk of uterine bleeding and shrinks to normal size
- Reduces post partum depression and cancer (breast and ovarian) - more for upto2 years
- Delays new pregnancy (lactational amenorrhea) “contraception” - not very reliable
Helps mother return to pre-pregnancy weight more rapidly
What are the 10 specific steps to successful breast feeding?
- Policy communicated to all staff
- Train in skills to implement this policy
- Inform about benefits
- Helping mothers to initiate within first hour
- Showing mothers how to maintain lactation even when separated from infant
- Don’t feed water or food
- Allow to be together 24h day
- Encourage breast feed on demand
- No teats or pacifiers
Refer to support groups upon discharge from hospital
- Refer mothers to support groups on hospital discharge
Can alcohol cross easily into breast milk and to the baby?
yes - can remain in milk for several hours (Depends on weight and metabolism)
Adverse effects of drinking alcohol while breast feeding?
Limits oxytocin causing a delay in ‘let down’ of milk and decreasing milk production.
Alcohol may remain in breast milk for several hours
Effects baby’s sleep patterns and behavior causing irritability and not feed properly.
Casiene:Whey ratio of breast milk
40:60
breast milk is whey dominant (easier to digest)
*same as whey dominant formula
Soy-based infant formula
- Soy protien isolate
- High digestible protein
- Supplemented with EAA
Recommended for older than 6months
Why do formula fed infants have greater weight gain the breast fed infants?
greater protein content (increases overweight and obesity) *may be long term effects
formula: 2.2g / 100 cal
breast milk: 1.5g / cal
proposed to keep protien to a min of 0.45g /100kj
What is the major cho in all milk?
Lactose
- lactose intollerance is rare in infants
- primary lactase enzyme deficiency (uncommon before 2)
- Secondary lactase enzyme deficiency is more common but ST. Small bowel injury from non-IgE-mediated cows milk allergy or viral gastroenteritis
- Lactose free formula e.g. soy - contain corn-syrup as a sub
- Lactose and glucose polymers = preffered cho in formula
*Sucrose and fructose are not recommended
Fat (oils) in infant formula
-40-50% energy
- Ratio of polyunsaturated fat in milk affects digestibility and facilitates absorption of calcium and fat and fat soluble vitamins e.g. A,D,K,E from the gut
- Main sources are vege oils (corn, soy, coconut)
- Required ratio of PUFA (omega 3 and 6 / linoleic and alpha linolenic acid)
Risks of EARLY introduction of weaning to solid / complementary foods
eczema
respiratory problems
gut infections
Risks of LATE introduction of weaning to solid / complementary foods
iron deficiency
feeding difficulties
growth issues
Acute starvation
400-800 cal/day
1,600kj -3,000 kj/day
over 6 months
LT effects of nutrient deficiency
(relative to the timing of the insult)
Early: glucose metabolism and obesity, lipid profile, cornary heart disease, breast cancer, cognition, stress responsiveness, depression
Mid: glucose metabolism, lung-disease, renal function
Late: glucose metabolism
Effects of babies born to mothers from dutch fammine in their adulthood
More susceptible to
- Diabetes
- Obesity
- Cardiovascular disease
- Protein in urine disease (Microalbuminuria)
also epigenetic changes - them and their offspring were SMALLER
Barker hypothesis
Fetal origins of adult disease (FOAD) / developmental origins of health and disease (DOHaD)
The fetal origins hypothesis states that:
Fetal under nutrition mid-late gestation which leads to disproportionate fetal growth, programmes later coronary heart disease.
- lower birth weight - more likely to have Coronary heart disease and impaired glucose tollerance -> diabetes (T2DM)
Infertility influences
Health: weight loss struggles
Health care: “white space” in clinic.
Cultural: blessings / permission from village and family
Spiritual: repent to god. “meat to me”
Socio-economic: cost of fertility treatment (ARTS)
Pacific Strategies and recommendations
Family: open discussions with eachother
Community: more suppourtive e.g. social media groups
School: educated in curriculum (pacific females and PCOS
Service providers: need to be culturally appropriate when addressing and understanding pacific issues with infertility as is “white space” dominant
Research: need more around pacific by pacific for pacific
Retinoc acid syndrome
birth defects from excess mounts of Retinol or retinoic acid (vitamin A) in maternal diet (>10,000IU/day or 3,000RE/day)
- small, missing ears and ear canals
- cv, craniofacial, small head (microcephaly) , thymus dysfunction
Vitamin D defficency
Maternal: gestational dibetes and pre-eclamsia (High bp and protein in urine)
Infant: 3 times more likely to have tooth decay by 6 years old, low birth weight, dental decay, acute respiratory infections
supplement when no sun exposure
food with sun exposure e.g. oily fish, including salmon, mackerel, and sardines. Other sources include egg yolks, red meat, and liver
