NHM201Test1StudyGuideSS.pdf NHM 201
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This 30 page Study Guide was uploaded by Regan Dougherty on Thursday September 24, 2015. The Study Guide belongs to NHM 201 at University of Alabama - Tuscaloosa taught by Denise DeSalvo in Summer 2015. Since its upload, it has received 237 views. For similar materials see Nutrition Through the Lifecycle in Nutrition and Food Sciences at University of Alabama - Tuscaloosa.
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Test date 9292015 Test 1 Study Guide Test covers Chapters 2 7 Chapter 2 Preconception Nutrition Preconception Overview INFERTILITY involuntary absence of production of children INFECUNDITY biological inability to bear children after one year of unprotected intercourse FERTILITY actual production of children FECUNDITY biological ability to bear children Healthy couples have a 25 chance of conceiving during a normal menstrual cycle MISCARRIAGE spontaneous abortion generally defined as the loss of a conceptus in the first 20 weeks of pregnancy can be caused by the development of the fetus or issues with the mother SUBFERTILITY reduced level of fertility characterized by unusually long time to conception over 12 months or repeated early pregnancy losses can be influenced by lifestyle changes Sources of Disruptive Fertility birth control unknown causes 50 of cases adverse nutritional exposure severe stress infection STDs and others structural damage and chromosomal abnormalities Reproductive Physiology OVA eggs of the female produced and stored within the ovaries Test date 9292015 MENOPAUSE cessation of the menstrual cycle and reproductive capacity in females MENSTRUAL CYCLE an approximately 4 week interval in which hormones direct a build up of blood and nutrient stores within the wall of the uterus and ovum maturation and release If the ovum is fertilized by a sperm the stored blood and nutrients are used to support the growth of the fertilized ovum If fertilization does not occur they are released from the uterine wall over a period of 3 to 7 days The period of blood flow is called the MENSES or the menstrual penod PITUITARY GLAND gland located at the base of the brain that produces and secretes growth hormone prolactin oxytocin folliclestimulating hormone luteinizing hormone and other hormones in response to signals from the hypothalamus PROSTAG LANDINS a group of physiologically active substances derived from the essential fatty acids functions in include constrictiondilation of blood vessels stimulation of smooth muscles and the uterus ANDROGENS types of steroid hormones produced in the testes ovaries and adrenal cortex from cholesterol some like testosterone stimulate development and functioning of male sex organs EPIDIDYMIS tissues on top of the testes that store sperm SEMEN seminal fluid the penile ejaculate containing a mixture of sperm and secretions from the testes prostate and other glands rich in zinc fructose and other nutrients PELVIC INFLAMMATORY DISEASE PID general term applied to infections of the cervix uterus fallopian tubes or ovaries ENDOMETRIOSIS a disease characterized by the presence of endometrial tissue in abnormal locations associated with abnormal menstrual cycles and infertility in 30 40 of affected women Factors Related to Impaired Fertility in Women Test date 9292015 oral contraceptives eating disorders athletes highexcessive caffeine intake alcohol vegetarianvegan diets not enough nutrients metabolic syndrome age gt 35 years women are born with a finite number of eggs after age 35 the eggs may be a lower quality PCOS polycystic ovary syndrome leading cause of infertility in women poor iron stores PID endometreosis high fiber diets Factors Related to Impaired Fertility in Men zinc plays a role in sperm production alcohol intake heavy metal exposure can be exposed through jobs automobile manufacturing batteries computer parts halogen in some pesticides and glycol in antifreeze deicers can be exposed through certain work environments Test date 9292015 steroid abuse high intake of soy foods usually vegetarians estrogen exposure sperm defects excessive heat to testes Nutrition and Fertility NutritionRelated Disruptions in Fertility undernutrition acute famine chronic babies will usually die before 1 year frail poor immune system weight loss obesHy high exercise level intake of specific foods and food components alcohol caffeine iron status LEPTIN a protein secreted by fat cells that by binding to specific receptor sites in the hypothalamus decreases appetite increases energy expenditure and stimulates gonadotropin secretion elevated by high and reduced by low levels of body fat BODY MASS INDEX BMI weight in kgheight in m2 lt 185 underweight in women decreases hormones that control menstrual cycle decreases estrogen decreases LH and FSH in men decreased lubdio as well as decreased sperm production Test date 9292015 185 249 normal BMI of about 20 is needed for reproduction 25 299 overweight gt 30 obese BMI above 30 can cause issues with fertility change in hormone levels affect menstrual cycle follicular development ovulation sperm production and erectile disfunction men obesity in men lowers testosterone ANOVULATORY CYCLES menstrual cycles in which ovulation does not occur AMENORRHEA absence of menstrual cycle ANTIOXIDANTS chemical substances that prevent or repair damage to molecules and cells cause by oxidizing agents vitamins C and E selenium certain components of plants FREE RADICALS chemical substances that are missing electrons The absence of electrons makes the substance reactive and prone to oxidizing nearby molecules by stealing electrons from them can damage lipids cell membranes DNA and tissues oxidative stress Nutrition During the Preconceptional Period EMBRYO developing organism from conception through 8 weeks PERICONCEPTIONAL PERIOD the time period around conception DNA METHYLATION modification of a replicated strand of DNA by addition of a methyl group can suppress the activity of certain genes in ways that affect metabolic processes and disease risk normal part of development can be influenced by nutritional and other environmental exposures Test date 9292015 FETUS developing organism from 8 weeks after conception to the moment of birth NEURAL TUBE DEFECTS NTDs group of birth defects that are caused by incomplete development of the brain spinal cord to their protective coverings ex spina bifida Weight Loss Exercise and Fertility in normal weight women weight loss that exceeds 10 15 of usual weight decreases estrogen LH luteinizing hormone FSH results in amenorrhea abnormal absence of menstrual cycle anovulatory cycles shortabsent luteal phases high levels of physical activity delay menarche onset of having a menstrual cycle or interrupt menstrual cycles in normal weight men loss of 10 15 of body weight can cause disruption in sperm viability and fertility problems fertilizing the egg sperm production ceases after 25 of body weight is lost Oxidative Stress Antioxidants and Fertility oxidative stress too many free radicals in the body free radicals are missing electrons making them reactive they damage lipids cell membrane DNA and tissues can alter chemical structure and disrupt cell signaling can cause infertility or miscarriage eat antioxidants to neutralize free radicals antioxidants reduce free radicals found in many plantbased foods PHYTOCHEMICALS plant chemicals that act like antioxidants Alcohol regular intake increases the risk of fetal alcohol syndrome impaired mental and physical development Test date 9292015 Other Nutrients and Foods that Affect Fertility Zinc important for sperm development low levels can lead to poor sperm quality concentrations and abnormal shapes RDA 8 mgday women 11 mgday men meats liver beef crab fortified breakfast cereals beans pecans cashews sunflower seeds works with iron Folate prevents neural tube defectsspina bifida and heart defects folate is now added to grain products RDA 400 microgramsday garbanzo beans cooked spinach cooked collards fortified grain products Iron 14 of women go into pregnancy with low iron results in low iron status in the baby prepregnancy iron deficiency is linked to preterm delivery lt 37 weeks lower infertility rates with use of iron supplements or iron from plant foods works in conjunction with zinc for men RDA 15 mg until 18 gt 18 mg after 18 gt 27 mg during pregnancy women 11 mg in males lean hamburger pork liver raisins prunes plums cooked spinach VitaminA Excessive vitamin A intake increases the risk the fetus will develop facial and heart abnormalities Test date 9292015 Lead high maternal blood levels increase the risk of intellectual disability Iodine Iodine deficiency early in pregnancy increases the risk that children will experience impaired mental and physical development Pant Foods and Fertility low fathigh fiber linked to regular menstrual cycles men who are vegetarian soy influences sperm production Caffeine and Fertility study results are mixed on effects of caffeine some have shown increased time to conception others have failed to find effects Alcohol and Fertility alcohol may decrease estrogen and testosterone levels or disrupt menstrual cycles and testicular function reduce or restrict if trying conceive no alcohol during pregnancy Influence of Contraceptives on Preconceptional Nutrition Status Oral Contraceptives prevent pregnancy by suppressing LH and FSH the suppresses ovulation contain estradiol andor progestin can increase iron status Nutrition issues with progestin fat gain decreased bone mineral accretion Nutrition issues with combination progestin and estradiol lower HDL raise triglycerides LDL glucose and insulin levels increase inflammation fertility returns usually 3 6 months after use Chapter 3 Preconception Nutrition Conditions and Interventions Test date 9292015 PREMENSTRUAL SYNDROME a condition occurring among women of reproductive age that includes a group of physical and psychological symptoms with onset of the luteal phased subsiding with menstrual bleeding thought to be related to abnormal serotonin activity following ovulation treatments increase calcium 1200 mgday vitamin BB 50100 mg reduce caffeine increase exercise reduce stress premenstrual dysphoric disorder PMDD is a severe form of PMS LUTEAL PHASE the second half of the menstrual cycle that occurs after ovulation Weight Status and Fertility Obesity in men reduced sex hormones and sperm count Obesity in women irregularno menstrual cycle reduced sex hormones increased estrogen blood glucose insulin Central obesity interferes with reproduction in women and men Weight loss should be first treatment for infertility in obese people Obesity increases the risk of neural tube defects INSULIN RESISTANCE a condition in which cell membranes have reduced sensitivity to insulin so that more insulin than normal is required to transport a given amount of glucose into a cell CHRONIC INFLAMMATION lowgrade inflammation that lasts weeks months or years Inflammation is the first response of the body s immune system to infectious agents toxins or irritants It triggers the release of biologically active substances that promote oxidation and other reactions to counteract the infection toxin or irritant side effect damages lipids cells and tissues POLYCYSTIC OVARY SYNDROME PCOS a condition in females generally characterized by insulin resistance high blood insulin levels obesity polycystic ovaries menstrual dysfunction amenorrhea infertility hirsutism excess body hair and acne many with PCOS are obese or have high levels of intraabdominal fat 10 Test date 9292015 cause is uncertain it is a syndrome not a disease recommendations increase insulin sensitivity weight loss exercise medication LUTEINIZING HORMONE LH a hormone produced by the pituitary gland that stimulates ovulation the development of the corpus luteum which secretes progesterone and the production of testosterone in males FOLLICLE STIMULATING HORMONE FSH a hormone produced by the pituitary gland that stimulates ovarian follicle growth and maturation estrogen secretion and endometrial changes characteristic of the first portion of the menstrual cycle It stimulates sperm production in males GONADOTROPIN RELEASING HORMONE a hormone produced in the hypothalamus that is responsible for the release of FSH and LH Negative Energy Balance and Fertility low body fatlow calories interfere with hormones in reproduction HYPOTHALAMIC AMENORRHEA a condition characterized by cessation of menstruation due to changes in hypothalamic stimulation which are triggered by an energy deficit AKA functional hypothalamic amenorrhea or weightrelated amenorrhea FEMALE ATHLETE TRIAD a condition marked by the simultaneous presence of an eating disorder menstrual dysfunction and osteoporosis in otherwise healthy female athletes ANOREXlA NERVOSA an eating disorder characterized by extreme weight loss poor body image and irrational fears of weight gain and obesity BULlMlA NERVOSA an eating disorder characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time These episodes are followed by compensatory behaviors such as selfinduced vomiting dieting excessive exercise or misuse of laxatives to prevent weight gain Diabetes Prior to Pregnancy increases risk of maternal and and fetal complications 11 Test date 9292015 fetal malformations excessive infant size development of diabetes in the offspring later in life High blood glucose in first 2 months of pregnancy is teratogenic TERATOGENIC exposures that produce malformations in embryos or fetuses CONGENITAL ABNORMALITY congenital anomalies a structural functional or metabolic abnormality present at birth may be caused by environmental or genetic factors TYPE 1 DIABETES a disease characterized by high blood glucose levels resulting from destruction of the insulinproducing cells of the pancreas called juvenileonset diabetes and insulindependent diabetes in the past TYPE 2 DIABETES a disease characterized by high blood glucose levels due to the body s inability to use insulin normally or to produce enough insulin called adultonset diabetes and noninsulindependent diabetes in the past GLYCEMIC INDEX GI a measure of the extent to which blood glucose levels are raised by consumption of an amount of food that contains 50 grams of carbohydrate compared to 50 grams of glucose Celiac Disease autoimmune disease characterized by chronic inflammation of small intestine results in sub fertility vitamin E sensitivity to gluten in wheat rye and barley causes GI symptoms weight loss because of vitamin 812 malnutrition problems with absorption irondeficiency anemia frustration it s hard to determine which processed foods are gluten free linked to male and female infertility treatment improve quality of diet encourage supplements AUTOIMMUNE DISEASE diseases that result from a failure of an organism to recognize its own constituent parts as self The organism attempts to defend itself from the perceived foreign substance through actions of its immune system Test date 9292015 ex type 1 diabetes lupus rheumatoid arthritis PHENYLKETONURIA PKU hyperphenylalaninemia an inherited error in phenylalanine metabolism most commonly caused by a deficiency phenylalanine hydroxyls converts essential amino acid phenylalanine into the nonessential amino acid tyrosine elevated blood phenylalanine you have to eat a phenylalaninefree diet for life avoid proteins get amino acids through supplements high levels of phenylalanine accumulate in embryofetus and impair central nervous system development seizures abnormal behavior mental retardation can increase risk of heart defects How to change diet not just for diabetes increase complex carbs fiber and whole grains decrease simple sugars increase monounsaturated fats increase antioxidants regular meals and snacks frequent monitoring of blood glucose Chapter 4 Nutrition During Pregnancy Health Objectives for 2020 related to pregnant women and infants reduce occurrence of low birth rate preterm delivery infant mortality improve nutritional status The Status of Pregnancy Outcomes LIVEBORN INFANT the outcome of delivery when a completely expelled or extracted fetus breathes or shows any sign of life Physiology of Pregnancy 12 13 Test date 9292015 1st half of pregnancy mother is building up stores for when the fetus is going to need it anabolic 2nd half of pregnancy fetus utilizes what mother has stored catabolic body water increases from 7 L to 10 L PLACENTA a diskshaped organ of nutrient and gas interchange between mother and fetus at term the placenta weighs about 15 of the weight of the fetus forms from embryonic tissue nutrients are fist used for maternal needs then for placenta the for fetal needs the fetus is harmed more than the mother by poor maternal nutrition EDEMA swelling usually of the legs and feet due to an accumulation of extracellular fluid this is normal as long as the mother s blood pressure is normal STEROID HORMONES hormones such as progesterone estrogen and testosterone produced primarily from cholesterol KETONES metabolic byproducts of the breakdown of fatty acids in energy formation AMNIOTIC FLUID the fluid contained in the amniotic sac that surrounds the fetus in the uterus LARGE FOR GESTATIONAL AGE LGA weight for gestational age exceeds the 90th percentile for gestational age birthweight greater than 4500 g 10 lb Low Birth Weight LBW lt2500g orlt5lb802 Very Low Birth Weight VLBW lt1500gorlt3b502 Extremely Low Birth Weight ELBW lt1000gorlt2b302 Desirable weight 3500 4500 g 7 lb 12 oz 10 lb Pregnancy Weight Gain 14 Test date 9292015 The mother should gain 3 5 lbs during the first trimester The mother should gain about 1 lb per week during the second and third trimesters Recommendations for weight gain are influenced by the pre pregnancy weight status of the mother underweight recommended weight gain 28 40 lb normal 25 35 lb overweight 15 25 lb obese 11 20 lb twin pregnancy 25 54 lb GRAVIDA number of pregnancies a woman has experienced PARITY the number of previous deliveries experienced by a woman nulliparous no previous deliveries primiparous one previous delivery multiparous 2 or more previous deliveries Women who have delivered infants are considered to be parous Nutrition and the Course and Outcome of Pregnancy Energy and Nutrient Needs During Pregnancy average of additional 300 caloriesday additional calories are not generally recommended until the 2nd trimester additional 340 caloriesday in 2nd trimester and additional 452 caloriesday in 3rd trimester 2200 2900 caloriesday on average other factors to consider level of physical activity multifetal pregnancies Caloric intake is most easily assessed by pregnancy weight gain Carbohydrates glucose is preferred 15 Test date 9292015 used for energy antioxidants and to relieve constipation 45 65 of calories minimum of 175 grams of carbs minimum of 28 grams of fiber Protein The mother does not store protein for later needs 925 grams of protein are accumulated during pregnancy used for production of new cells enzymes and maternal hormones and fetal growth recommended additional 25 gramsday for all trimesters about 11 gramskg Fat mother accumulates fat stores in the first half of pregnancy anabolism catabolism in last half mother s blood lipid levels increase mainly triglycerides lipid profile usually returns to normal after delivery increased cholesterol for steroid hormonecell membrane synthesis 33 of calories energy source for fetal growthdevelopment source of fat soluble vitamins essential fatty acids 13 gday linoleic 14 gday linolenic 500 mgday EPA and DHA intelligence vision more mature CNS UL 3 gramsday oily fatty fishes vegetarians do not get enough 16 Test date 9292015 Water 9 cups of fluid per day Vitamins Folate deficiencies lead to abnormal cell division and tissue formation NTDs neural tube defects important early in pregnancy 600 mcg dietary folate equivalents DFEs fruits vegetables whole grains fortified cereals Choline brain development Vitamin A cell differentiation be aware of toxicity Vitamin D immune system development cell growthdifferentiation risk factors for inadequacy vegan little to no milk consumption limited sun exposure sun block dark skin obesity Minerals Calcium needed for fetal skeletal mineralization and to maintain maternal bones low intakes related to increased release of lead harmful to fetus 3 cups milkcalciumfortified soy milk lron deficiency is seen early in pregnancy because of increased blood volume see late in pregnancy because of fetal growth supplement with 30 mgday after 12th week of pregnancy Test date 9292015 60 180 mgday for iron deficiency anemia UL during pregnancy 45 mgday may cause constipation HYPOTHYROIDISM a condition characterized by growth impairment intellectual disabilities and deafness when caused by inadequate maternal intake of iodine during pregnancy Factors Affecting Dietary Intake During Pregnancy nausea and vomiting management separating liquids from solids when eating eating neutral foods that settle stomach avoid foods that trigger nausea maybe recommend a dietary supplement hyperemesis gravidurum severelonglasting nausea and vomiting can last all of pregnancy individuals may need to be hospitalized to get fluid therapy PICA an eating disorder characterized by the compulsion to eat substances that are not food more common in African American women GEOPHAGIA compulsive consumption of clay or dirt PAGOPHAGIA compulsive consumption of ice or freezer frost AMYLOPHAGIA compulsive consumption of laundry starch or cornstarch cultural consideration Other Health Problems heart burn management eat smaller meals cons pa on management fiber good fluid intake fruits vegetables whole grains Food Safety During Pregnancy 17 Test date 9292015 L MONOCYTOGENES Listeria a foodborne bacterial infection that can lead to preterm delivery and stillbirth in pregnant women commonly associated with the ingestion of soft cheeses unpasteurized milk readytoeat deli meats and hot dogs T GONDII Toxoplasmosis a parasitic infection that can impair fetal brain development the source is often hands contaminated with soil or the contents of a cat litter box or raw or partially cooked pork lamb or venison Chapter 5 Nutrition During Pregnancy Conditions and Interventions Obesity and Pregnancy higher rate of gestational diabetes for infants higher rates of still birth large for gestational age csection surgery is risky may increase risk of child becoming overweighthaving type 2 diabetes GESTATIONAL DIABETES carbohydrate intolerance with onset of or first recognition of pregnancy Hypertensive Disorders of Pregnancy Women may become pregnant with preexisting hypertension blood pressure gt 14090 mm Hg blood pressure gt 160110 mm Hg associated with increased risk of fetal death growth retardation preterm delivery Gestational hypertension is hypertension that is diagnosed for the first time after midpregnancy Preeclampsiaeclampsia gt 20 weeks gestation proteinuria high protein in urine gt14011O mm Hg eclampsia seizures could be hospitalized for the duration of pregnancy 18 Test date 9292015 recommendations adequate calcium intake adequate vitamin D status multi vitaminsminerals if needed over 5 servings of colorful fruitsvegetables adequate fiber intake exercise weight gain signssymptoms hypertension proteinuria decreased plasma volume expansion low urine output headaches eye sensitivity to bright light blurred vision abdominal pain and nausea outcomes mother early delivery by csection kidney dysfunction increased risk of diabeteshypertension placenta abruption outcomes newborn preterm delivery growth restriction respiratory distress syndrome fetalmaternal death risk factors first pregnancy obesity central body fat underweight mother s smallness at birth African AmericanNative American history of preeclampsia diabetes gt 35 years multifetal pregnancy insulin resistance high blood triglyceride levels hypertension renal disease poor vitamin D status poor calcium status pro inflammatoryprooxidative stress diet OXIDATIVE STRESS a condition that occurs when cells are exposed to more oxidizing molecules such as free radicals than to antioxidant molecules that neutralize them and help repair cell damage can cause damage to DNA lipids cells and tissues over time PLACENTA ABRUPTION the separation of the placenta from its attachment to the uterus wall before the baby is delivered PROSTACYCLIN a potent inhibitor of platelet aggregation and a powerful vasodilator and blood pressure reducer derived from n3 fatty acids THROMBOXANE the parent of a group of thromboxanes derived from the n6 fatty acid arachidonic acid increases platelet aggregation and constricts blood vessels causing blood pressure to increase Diabetes in Pregnancy Gestational Diabetes predisposed to insulin resistance and have impaired insulin production 19 Test date 9292015 All pregnant women should be tested for diabetes All pregnant women without diabetes should be tested for gestational diabetes by a 75 gm glucose tolerance test at 2428 weeks HEMOGLOBIN AfC a form of hemoglobin used to identify blood glucose levels over the lifetime of a red blood cell 120 days Glucose molecules in blood will attach to hemoglobin and stay attached The amount of glucose that attaches to hemoglobin is proportional to levels of glucose in the blood normal range is 4 to 59 Fetal Alcohol Spectrum Disorders range of effects resulting from fetal alcohol exposure behavioral problems mental retardation aggressiveness nervous short attention span stunted growth birth defects Fetal alcohol syndrome is the most severe abnormal facial features growth problems poor communication skills vision hearing problems more moderate end of the spectrum includes more internal issues organs Nutrition and Adolescent Pregnancy teen growth height and weight at the expense of the fetus Infants born to teens average 155 9 less overweightobese adolescents face the same risks as overweightobese adults dietary recommendations more calories calories should be from nutrientdense foods calcium RDA 1300 mg Vegetarians at risk fro lower levels of 812 D calcium iron zinc DHA and EPA pregnant vegans are at a risk for lower protein intake Chapter 6 Nutrition During Lactation 20 Lactation Physiology Test date 9292015 Breastfeeding is not genetic just because your mother couldn t breastfeed doesn39t mean that you can t breastfeed MAMMARY GLAND the source of milk for offspring also commonly called the breast ALVEOLI a rounded or oblongshaped cavity present in the breast functional unit of mammary gland SECRETORY CELLS cells in the acinus milk gland that are responsible for secreting milk components into the ducts MYOEPITHELIAL CELLS specialized cells that line the alveoli and that can contract to cause milk to be ejected into the ducts OXYTOCIN a hormone produced during letdown that causes milk to be ejected into the ducts LOBES rounded structures of the mammary gland LACTOGENESIS human milk production Stage 1 last trimester through first few days of postpartum milk begins to form Stage 2 2 2 days postpartum and goes to 10 days changes in milk quantity and composition Stage 3 10 days postpartum milk is stabilized fat carbohydrate and protein content is where it should be PROLACTIN a hormone necessary for milk production stimulates milk production infant sucking stimulus stimulates prolactin secretion secreted by pituitary gland promotes continued milk production and release also inhibits ovulation Oxytocin triggers ejection of milk from breast 22 Test date 9292015 stimulated by suckling the letdown reflex milk flows also promotes uterine contractions Other hormones involved in lactation estrogen progesterone human growth hormone human placental lactogen Human Milk Composition COLOSTRUM the milk produced in the first 23 days after the baby is born higher in protein electrolytes and immune factors and lower in lactose carbs fat than milk produced after a milk supply is established produced in Stage 2 of lactogenesis 2 10 mL per feeding 580 700 caloriesliter Mature Milk 065 calmL 20 caloz Lipids fatty acid profile but not fat content varies with mother s diet make sure mother gets DHA developmental advantages and retinal development cholesterol is higher in breastmilk Foremilk watery milk coming from a full breast vs hindmilk creamy milk coming from a nearly empty breast foremilk 4O 45 calories from fat hindmilk 60 80 calories from fat Protein relatively low content compared to cow milk casein and whey both easily digestible Carbohydrate lactose 23 Test date 9292015 Fat Soluble Vitamins vitamin A is highest in colostrum vitamin D varies with maternal diet and sun deficiency rickets supplement 400day vitamin E sufficient for term not for preterm vitamin K injection or oral does at birth blood clotting Water Soluble Vitamins based on the mother s diet vitamin B6 is most likely to be deficient B12 and folate are bound to whey proteins so they are less influenced by maternal diet Minerals lower content than cow s milk easier for kidneys to handle magnesium calcium iron and zinc are highly available to the infant Trace minerals in breast milk are not altered by maternal diet Water is a major component in human milk Babies do not need additional sources of water Breastmilk is isotonic with maternal plasma OSMOLALITY a measure of the concentration of particles in solution MONOVALENT ION an atom with an electrical charge of 1 or 1 Benefits of Breastfeeding Infants optimal nutrition strong bonding Test date 9292015 safe fresh milk enhanced immune system immunoglobulins transferred from mother to child protection against allergies and intolerances promotion of correct jaw and teeth development latching on process reduced risk fro obesity reduced risk of gastroenteritis lower respiratory tract infections and future chronic diseases Mother bonding increased energy expenditure leading to faster weight loss faster shrinking of uterus improved bone density reduced risk of postpartum depression time saving from prep and mixing of formula money savings don t have to buy formula reduced time away from work with sick child because child has good immune system Economic save money on formula fewer health insurance claims if breastfed less employee time off with sick children reduce prevalence of illnesses and thus healthcare costs Environmental no packaging involved transport of formula 24 25 Test date 9292015 MACROPHAGES a white blood cell that acts mainly through phagocytosis NEUTROPHILS class of white blood cells that are involved in the protection against infection TLYMPHOCYTE a white blood cell that is active in fighting infection T stands for thymus coordinate the immune system by secreting hormones that act on other cells BLYMPHOCYTES white blood cells that are responsible for producing immunoglobins EPITHELIAL CELLS cells that line the surface of the body SECRETORY IMMUNOGLOBIN A a protein found in secretions that protect the body s mucosal surfaces from infections one mode is by reducing the binding of a microorganism with epithelial cells present in human colostrum but not transferred across the placenta MORBIDITY the rate of illnesses in a population MORTALITY rate of death COGNITIVE FUNCTION the process of thinking Breast Milk Supply and Demand 1st month 20 ozday 4th5th month 24 28 ozday ranges from 15 40 oz daily supply is related to demand amount consumed Nurse or pump early and often to build a good milk supply Milk supply is related to how vigorously an infant nurses ow much time the infant is at the breast how many times per day an infant nurses The size of the breast does not limit a woman s ability to nurse The Breastfeeding Process 26 Test date 9292015 A Touching the baby s bottom lip with the nipple stimulates the oral search reflex B The infant opens his mouth wide C The infant is brought to the breast with the nipple centered in his mouth D The infant is properly latched at the breast and has all of the areola in his mouth The mother should recognize signs of hunger hands close to mouth sucking on hands shaking head side to side The Breastfeeding lnfant Breastfed infants are typically leaner At first babies feed 10 12 times per day their stomachs are very small Maternal Diet What a mother consumes flavors of fooddrink may be evident in breast milk Public Food and Nutrition Programs Optimal Duration Influential Factors and US Goals for Breastfeeding Suggested Hierarchy of Infant Feeding Choices baby at mother s breast mother s own expressed milk milk from milk bank ex HMBANA Donor milk is not the same as informal sharing wet nurses milk buying milk sharing not condoned in the US Donor milk is screenedtested from infectious diseases cow milk formula soy milkformula Animal milks alone are not appropriate for human babies Test date 9292015 causes problems with iron deficiency 39 NO COW MILK UNTILAT LEAST ONE YEAR OF AGE Human milk is a raw food and food safety measures need to be taken with pumping and storing Optimal duration for breastfeeding is 1 year The mother will produce milk as long as the baby is suckling Healthy term babies know how to breastfeed Breastfeeding Promotion Facilitation and Support Model Breastfeeding Promotion Programs Chapter 7 Nutrition During Lactation 27 Malnutrition It is normal for infants to lose up to 7 of their body weight in the first week after birth Anything gt 10 is a concern Malnourished infants are sleepy non responsive have a weak cry few wet diapers and infrequent stools normal 6 wet diapers 34 soft yellowish stools recommended 400 IU supplement for breastfed babies no fluoride until 6 months of age add if the water has not been treated Breastfed infants rarely have an iron deficiency Baby bottle tooth decay Most women do not experience significant problems with breastfeeding Common Breastfeeding Conditions sore nipples usually due to poor positioning of baby on breast letdown failure usually due to stress overactive letdown engorgement breasts overfilled cause incompleteinefficient milk emptying from baby or pump 28 Test date 9292015 plugged ducts caused by milk stasis cause infrequent breastfeedingpumping incorrect flange size mastitis bacterial infection cause unresolved plugged duct flulike symptoms can cause breast abscess if unresolved tender lump low milk supply most common reason for cessation of breastfeeding causes insufficient breastfeeding or pumping ineffective emptying stress management nurse or pump every 2 3 hours during the day once at night galactogogue may be prescribed Maternal Medications follow dietary guidelines 4 servings of dairy additional 500 calories for first 6 months additional 400 calories for months 6 12 at least 1800 caloriesday even if trying to lose weight drink lots of fluids 200 300 mg of DHAday Vegetarians may need additional 812 Herbal Remedies Fenugreek promotes milk flow There are herbs that are thought to promote and reduce milk flow Alcohol and Other Drugs and Exposures Level of alcohol in breast milk matches the mother s BAC Nicotine 29 Test date 9292015 Marijuana affects DNA and RNA metabolism Moderate caffeine intake is usually not a problem Neonatal Jaundice and Kernicterus HYPERBILIRUBINEMIA elevated blood levels of bilirubin a yellow pigment that is a byproduct of the breakdown of fetal hemoglobin risk factors maternal diabetes rh sensitization previous child with phototherapy East Asian or Mediterranean race risk factors infant premature high bilirubin levels at discharge poor breastfeeding blood group incompatibility ex ABO hemolytic disease can cause jaundice bilirubin cell toxin can result in permanent brain damage byproduct of normal hemoglobin breakdown removed by the liver KERNICTERUS bilirubin encephalopathy the chronic and permanent clinical sequel that are at the end result of very high untreated bilirubin levels excessive bilirubin is deposited in the brain causing toxicity to the basal ganglia and various brainstem nuclei Breastfeeding Multiples MECONIUM dark green mucilaginous material in the intestine of the fullterm fetus lnfant Allergies Possible reasons for allergypreventative effects of breastfeeding low content of allergens transfer of maternal immunity long chain fatty acids and IGA in breastmilk protect against inflammation and infections regulation of infant immunity influence of gut microbial flora 30 Test date 9292015 ALLERGIC DISEASES conditions resulting from hypersensitivity to a physical or chemical agent FOOD ALLERGY hypersensitivity abnormal or exaggerated immunological response to a specific food protein FOOD INTOLERANCE an adverse reaction involving digestion metabolism but not the immune system LatePreterm lnfants Human Milk and Preterm lnfants Medical Contraindications of Breastfeeding 39 HIV Human Milk Collection and Storage Human milk banks provide human milk to infants who cannot be breastfed by their mothers premature or very sick babies Donors are chosen with very strict guidelines breast milk is pasteurized and then stored MD prescription is required may be covered by insuranceMedicaid Model Programs
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