Study Guide for Exam 1
Study Guide for Exam 1 NUTR 365
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This 10 page Study Guide was uploaded by Elissa Emily on Thursday February 12, 2015. The Study Guide belongs to NUTR 365 at Purdue University taught by Mayfield in Winter2015. Since its upload, it has received 200 views. For similar materials see Life Cycle Nutrition in Nutrition and Food Sciences at Purdue University.
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Date Created: 02/12/15
Study Guide for Exam 1 Lecture1 Welcome What are the main 2020 Health objectives for the nation related to pregnant women and infants Main objectives 2020 reduced rates of fetal and infant deaths reduced low bw and very low bw reduced preterm births 114 goal increased percentage of women getting prenatal care increased abstinence of alcohol use increased proportion of women who gain the proper weight How do indicators of maternal and infant health vary by race and ethnicity 0 Infant deaths reported as rate per 1000 live births 0 Black and American Indians way higher death rates Lecture 2 Pre and Peri Conceptual Nutrition How do statistics CDC related to maternal and infant health in Indiana relate to the national averages o Overweight higher in Indiana Indiana is lower than US for ideal weight Anemia in 3rd trimester is a larger problem in IN WIC is higher in IN prepreg supple Are lower than US Smoking is higher during and before pregnancy in IN 0 Low bw is preterm is increased breastfeeding ever is decreased According to results from early famine studies how does maternal nutrition and food availability affect fertility and pregnancy outcome 0 Early during the famine there was a decrease in birth weight and an increase in fetal deaths because mothers conceived before famine so continued development suffered 0 Later during the famine there was a decrease in births because harder to conceive o Took more than 4 months to recover fertility Describe lifestyle choices that effect fertility for both men and women 0 Erratic eating patterns alcohol use and obsessive exercisedecrease in energy intake and low body fat can mess with hormones decrease fertility 0 Smoking 9 oxidative stress damage Vitamin C can help counter 0 Age decreases for both 0 Smoking for men9 decrease in motility and concentration and morphology What are the factors that determine optimum male fertility 0 Age gt 40 9 decrease in motility decrease in volume decrease in healthy sperm and an increase in oxidative stress damage 0 Obesity 9 decrease in motility increase in ROS and an increase in scrotal temp Parameters Volume pH 000000 0000 Sperm concentration count Motility morphology Vitality WBC Lecture 3 Life Before Birth Review Life Before Birth questions and answers document posted on Blackboard that you filled in as you viewed the movie Lecture 4 Physiology of Pregnancy What are the effects of increased levels of estrogen and progesterone during pregnancy 0 Estrogen maintain pregnancy estrogen increases to allow ovulation Growth and control of uterus Increases hygroscopic properties of CT which allows stretch Affects thyroid function needed for fetus brain dev o Progesterone maintinas placenta and prevents contractions from occurring relaxes GI tract maintains endometrium in Luteal phase What are the changes that occur in the cardiovascular renal and GI systems during pregnancy CVS 0 Increase in plasma volume cardio output stroke volume red cell volume comparably less heart rate to keep up with tissue needs for nutrients and blood organ blood flow 0 Decrease in TPR if it doesn t then it would result in High BP 0 Increased body water volume placenta and uterus need H20 0 1518 wg and 70 extracellular 0 increased GFR filtration 0 decreased serum albumin lower osmotic pressure 0 decreased efficiency of nutrient reabsorption GI Tract o progesterone causes relaxation especially in end of pregnancy 0 spinchters relax heart burn o constipation due to relaxed GI and decreased motility and increased transit time 0 position of stomach changes 0 gallbladder function decreases which increases gallstone likelihood How do these changes facilitate the optimum growth and development of the fetus 0 These all work together to make the most productive and efficient system to ensure growth and development of the fetus 0 Blood flow increases to allow more transportation of blood and nutrients to the fetus 0 Renal needs to produce more H20 because placenta and uterus need to stay hydrated to promote proper function 0 GI tract stomach moves to make room for baby GI relaxes to prevent contractions Lecture 5 Nutritional Needs of Pregnancy How do the macronutrients that the mother consumes become available to the fetus Describe specific mechanisms 0 Diffusion facilitated diffusion active transport endocytosis CHO facilitated GLUT 1 amp GLUT 3 Protein active transport Cholesterol amp FFA passive diffusion Triglycerides and phospholipids break down into FA because they do not cross placenta Which vitamins and minerals have highest increase in requirements during pregnancy and why 0 Iron needed for Hgb neural development during the last 3 mo Detus is storing Fe for the first 6 mo of life 0 Vit A vision growth cell differentiation Vit D bone growth dental enamel Calcium mineralization of fetal skeleton and teeth Does not need increase Able to increase absorption lf unable to get adequate amount through diet and supplements then fetus takes from mothers bones harms mother Vit B12 may lead to birth defects Thiamin Niacin Riboflavin needed because they are cofactors in metabolism Folate neural tube defects Vit C Zinc many enzymes synthesis of RNA and DNA preterm birth and intensive labor absorption doesn t increase Therefore need to obtain it through diet or supplement especially important in 3rd trimester mothers serum zinc decreases often in third trimester due to baby taking from mother if deficient in diet 0 Magnesium increased risk of miscarriage IUGR preterm delivery need more evidence and iodine minor When a pregnancy women is deprived of sources of energy how does her body adapt to meet the needs of the growing fetus o Reduces BMR weight gain fat gain placenta weight and birth weight to use this energy RECOMMENDED MACRONUTRIENT NEEDS Energy 300500 kcal increase Protein 2125 gd Lecture 6 Epigenetics Dr Stefanska What constitutes the epigenome DNA methylation Histone modifications Noncoding RNA RNA binds but not perfectly reduced What is the role of DNA methylation in the regulation of gene transcription SAM is a methyl donor 0000 00000 Hypermethylation silencing transcription inactive Hypomethylation 9 active transcription active How does nutrition play a role in the epigenome Food is needed as a methyl donor to help SAM Bioactives in fruit vegetables and spices can act similarly to SAM and cause methylation which can reverse cancer to normal cells How do paternal and maternal experiences affect future generations Parental foot shock causes fear in father passes this to offspring Because olfactory receptor increases in sperm because methylation Mother malnutrition and gestational diabetes leads to type two diabetes 0 Undernutrition and obesity affect fetal health How are transgenerational effects studied Mice are used to studies theses effecs Agouti mice body weight amp hair color Axin change in shape Lecture 7 Weight Gain Recommendations What are the prenatal weight gain guidelines UndenNeight 2840 lbs Normal weight 2535 lbs ovenveight 1525 lbs obese 1120 lbs Twins normal 3754 lbs in 2009 BMI changes occurred from the 1990 undenNeight lt198 to lt 185 Normal weight 19826 to 185 to 249 ovenveight Grew on both sides obese Heavier gt29 to gt30 weight gain guidelines also changed in 2009 obese needed to gain less in 1990 at least 15 not it is 1120 twins needs increases in 2009 from 1990 What information is needed to plot weight gain How is this information obtained Prepregnancy weight in order to follow above guidelines LMP last menstrual period EDC estimated date of confinement DUE DATE OBTAINED EDC LMP 40 W What outcomes are more common when women gain more or less than the amount recommended MORE 0 LGA large gestational weight for age shoulder dystocia birth injury 0 C section because baby is too large risk of maternal injury or death 0 PPWR post partum weight retention is higher 0 Child ovenveight childhood obesity risks increase LESS 0 Small for gestational age 9 low birth weight and length How does a woman s diet need to change to support an adequate weight gain 1st trimester No additional kcals 2nd trimester 340 additional kcals 3rd trimester 452 additional kcals Need to monitor weight gain in order to make sure eating the proper amount Protein lncrease to 2125 gramsday CHO 45 gd fat 8 gd eat foods rich in Fe Zn Mg Ca Vit A D B folate Lecture 8 Lifestyle Choices What are the major lifestyle choices that may have a negative impact on the outcome of a pregnancy O 0000 Smoking lllegal drugs OTC and prescription drugs Alcohol use Diet amp exercise How do these choices affect the fetus and why 0 Smoking causes low birth weight 20 preterm deliveries 10 of all infant deaths increased risk in asthma and wheezing Why smoking can cause placenta previa position of placenta blocking the vagina PROM premature rupture of membrane which causes early delivery SlDS 2x as likely for women who smoke Smoking reduces 02 transport to the fetus constricted umbilical cord placenta perfusion and nicotine receptors in fetus develop early which can lead to NS brain and lung issues lllegal drugs miscarriages LBW premature labor placenta abruption congenital heart defects fetal death maternal death Also due to reduced oxygen Addictive drugs can lead to fetal withdraw after delivery OTC don t take anything you don t NEED Avoid NSAIS in large doses asprin ibuprofen naproxen 0 Early preg complications miscarriages necrotizing entercolitis 0 Late preg complications blood flow problems bleeding during amp after delivery reduction in fluid around fetus Prescription drugs Category C amp D and X talk to medical provider for advice Alcohol ARND neuro ARBD birth defect FAS Can cause growth retardation neural developmental abnormalities characteristic facial features Alcohol can cross the placenta therefore it has a worsen impact on babies development It can cause baby s brain to be smaller and less developed it can cause hypoxia decrease in Oxygen decrease in neural growth and cell growth decrease in protein synthesis altered hormone levels effects on differentiation and genesis What are the advantages of exercise during pregnancy and which forms of exercise are most appropriate 0 Advantages Increase blood flow Increase oxygen flow 0 Appropriate forms regular noncompetitive exercise HRlt 140 Duration 1530 min Relaxation and stretching before and after lncrease periods of rest especially in 3rd trimester What food safety practices are advised for pregnant women 0 Listeria monocytogenes 20x more likely in pregnant women Safety steps Cook raw food thoroughly Wash raw vegetables thoroughly before eating Keep uncooked meats separate from other food Avoid soft cheeses Deli foods may be source of contamination Lecture 9 Complications of Pregnancy Describe the pattern of insulin secretion with gestational diabetes as compared to normal glucose tolerant women 0 Increase in insulin secretion in both 0 Glucose stimulated insulin secretion is greater in NGT 0 Peak of plasma insulin during an OGTT occurs later in women with GDM 0 First phase of insulin response to iv glucose increases more during preg With NGT o Increases in 2 phase of insulin responses are of similar magnitude What is the appropriate screening tool for gestational diabetes and when should it take place 0 Proper screening tool is 75 g 2 h OGTT fasting 8h 1 2 h Fasting gt 92 1 h gt 180 2 h gt 153 0 should be done 2428 weeks unless family history then done sooner Describe physiological changes that can occur as a result of hypertensive disorders of pregnancy 0 Chronic inflammation 0 Oxidative stress 0 Damage to endothelium of blood vessels These cause impaired blood flow increased tendency to clot plaque formation TYPES 0000 Chronic HTN present before pregnancy or diagnosed within first 20 W Gestational HTN after middle pregn 20W returns to normal 12 W after birth Preeclampsia occurs before 20 W9 increase BP proteinuria renal involvement Eclampsia CNS involvement occurrence of seizures occurs if preeclampsia isn t managed o HELLP hemolysis elevated liver enzymes low platelets What are the major nutritional recommendations that are appropriate for women with hypertensive disorders of pregnancy 0 000000 0 Adequate Ca 15002000 Adequate Vit D No high dose Fe Supplement bc increase inflammation Reducing Na does NOT help 5 or more servings of green or red veggies fruits antioxidants adequate fiber gt21 g moderate exercise 30 min follow wt gain recs Lecture 10 Benefits of Breastfeeding What are the recommendations for breastfeeding Are we achieving them 0 O Breastfeeding is recommended to be used exclusively for the first 6 months and then used 612 months with other food complimenting We are not achieving this What are unique characteristics of breastmilk not present in formula Colostrum Antibodies protective aspect safer than formula Growth factors Milk changes during feedingfore milk 9 hind milk higher in fat to fill baby up Ready whenever What are benefits of breastfeeding to baby To mother BABY MOTHER trust Promotes weight lose suppresses ovulation Specialized for needs Protects from diseases saves money bond Improves rest and well being safer Attachment and bonding Enjoy eating Enjoy feeding What are barriers to initiating breastfeeding To continuing to breastfeed INITIATING CONTINUING Cultural norms Lack of support in work place too Family attitudes Lack of acceptance by society Lack of knowledge Promotion of formula Personal beliefs amp discomforts Unsupportive hospital practices Lack of confidence Misperception about milk supply Hospital practices No timely fu to questions Bottle feeding in mass media Lecture 11 Physiology of Lactation What is the main anatomy that leads to successful milk production and lactation o Alveoli rounded oblong shaped cavity present in breast contains secretory cells and myoepithelial cells Secretory cells are responsible for secreting milk components into ducts Myoepithelial cells contracted to cause milk to be secreted by the secretory cells into the ducts Nipple mechanoreceptors9 hypothalamus oxytocin contraction of myoepithelial cells secretory cells ducts nipples What are the characteristics of human milk that make it a perfect food for infants Be specific 0 Protein whey instead of casein because it is more soluble and easier to digest low in phenylalanine and tyrosine which cause neural complications high in taurine which promotes myelination and brain development 0 Carbohydrates lactose is primary human milk contains amylase which helps digestion because babies have a slow development of lactase system 0 Fats 90 triglycerides rich in cholesterol DHA AA and linoleic and oleic which promote brain development Minerals and vitamins easier to absorb because renal solute load is lower Protective molecules Lactoferrin binds to iron to make unavailable for bacteria in GI tract slgA intestinal epithelial barrier function bile salt stimulated lipase helps hydrolyze milk triglycerise to ease fat digestion lysozyme lyses bacteria by destroying cell walls ADVANTAGES decreased renal solute load increases immunoglobic growth and trophic factors which decreases illness and infection and allergies improves digestion and absorption How can feeding practices of infants lead to jaundice o Breastnonfeeding Jaundice can be caused by infrequently or inefficiently nursing of the infant Have delayed or inadequate stool which increases bilirubin absorption usuay resolves after 12 weeks 0 Breastmilkjaundice 13 breastfed infants are jaundice at 3 weeks cause is unknown but thought that more bilirubin is reabsorbed due to factors in breast milk promoting its absorption typically resolves itself Lecture 12 CounselingEducation During Pregnancy Review the portion of today s lecture about counseling pregnantbreastfeeding women 0 More effective than counseling when not pregnant How does effective counseling take into consideration characteristics common to women in this life stage 0 Support and encourage her desire to be healthy and have a healthy baby o If she doubts herself describe ways that her body is amazing and protects her baby 0 Prioritize messages give simple practical advice 0 Address conflicting messages with respect What are contraindications to breastfeeding O 0000 Infant with Galactosemia Mother uses illegal drugs Mother undergoing chemotherapy Mother has active turbiculosis HIVAIDS in US How can we promote and support breastfeeding OOOOOOOOO Educate about benefits prenatally Recognize and overcome challenges address individual concerns Respectfully empower women to make informed decisions Provide peer support involve family Provide realistic expectations Show women how to do it Provide referrals to lactation consultants Provide pumps and other supplies Promote babyfriendly hospital workplaces and communities Lecture 13 Breastfeeding Management What promotes successful breastfeeding 0 0000000 Educated on what top expect during her hospital stay Skin to skin Delayed routine procedures Feeding baby on cue Rooming in No bottle or pacifiers Limiting visitors No formula How can you determine that a baby is nursing properly OOOOO Mouth covers nipple and large amount of areola Chin touching breasts Nose is clear of orjust touching breasts Mouth wide chin dropped tongue down latched on to nipple Bottom and top lip are like fish How are breastfeeding problems managed 0 Seek help What are signs of hunger O Smack lips or move mouth suck on fingers hands or roots move head bobs What are signs that a baby is getting enough 0 O O 0 Let baby stop on own Always offer both breasts 812 x in 24 hours 68 wet dippers and 3 BM by day 4
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