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Lesson 2 Preconception and Pregnancy Chapters 2-4

Lesson 2 Preconception and Pregnancy Chapters 2-4. “ Everyone is kneaded out of the same dough but not baked in the same oven.” Yiddish proverb. Preconception Key Nutrition Concept .

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Lesson 2 Preconception and Pregnancy Chapters 2-4

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  1. Lesson 2Preconception and PregnancyChapters 2-4 “Everyone is kneaded out of the same dough but not baked in the same oven.” Yiddish proverb

  2. PreconceptionKey Nutrition Concept • Optimal nutritional status prior to pregnancy enhances the likelihood of conception & helps ensure a healthy pregnancy & robust newborn. Key Concept

  3. Nutrition-Related Disruptions in Fertility • Undernutrition • Weight loss • Obesity • High exercise levels • Intake of specific foods & food components

  4. Undernutrition and Fertility • Chronic undernutrition • primary effect: birth of small & frail infants with high likelihood of death in the first year of life • Acute undernutrition • associated with a dramatic decline in fertility that recovers when food intake does

  5. Body Fat and Fertility • Decreased fertility seen with low or high body fat due to alterations in hormones • Estrogen & leptin • levels increased with high body fat & reduced with low body fat • both extremes lower fertility • Infertility lower with BMI <20 or >30

  6. Weight Loss and Fertility in Females • Weight loss >10-15% of usual weight decreases estrogen • Results in amenorrhea, anovulatory cycles, & short or absent luteal phases • Treatment with fertility drug Clomid not effective in underweight women

  7. Diet and Fertility • Diet may impact hormones • Vegetarian diets - low-fat, high fiber linked to reduced estrogen & irregular periods • Isoflavones (from soy) decrease levels of gonadotropins, estrogen, & progesterone • Excess caffeine & alcohol have been shown to be be detrimental

  8. Preconception Iron Status, Fertility, & Pregnancy Outcome • Rate of infertility lower in women who use iron supplements or iron from plant foods • Pre-pregnancy iron deficiency linked to preterm delivery & low iron status of infant • ~1/2 of U.S. women enter pregnancy with inadequate iron stores

  9. Caffeine appears to prolong time to conception Daily caffeine intake & reduction in conception is: 300 mg results in ~27%  500 mg results in ~50%  Caffeine and Fertility

  10. Alcohol and Fertility • Alcohol may decrease estrogen & testosterone levels or disrupt menstrual cycles • Studies on weekly drinks consumed show: • 1-5 drinks  39%  in conception • >10 drinks  66%  in conception

  11. Nutritional Exposures Before and Very Early in Pregnancy that Disrupt Fetal Growth and Development

  12. CDC’s Preconceptional Health Initiative • Recommends that primary health care visits include: • Preconception health & pregnancy outcome education • Screening for vaccination, wt, iron & folate status • Assessment of alcohol use • Management of diabetes & celiac disease

  13. PregnancyKey Nutrition Concept • Many aspects of nutritional status, such as dietary intake, supplement use, and weight change, influence the course and outcome of pregnancy. Key Concept 1

  14. Key Nutrition Concept • The fetus is not a parasite; it depends on the mother’s nutrient intake to meet its nutritional needs. Key Concept 2

  15. Key Nutrition Concept • Critical Periods of rapid growth & development of fetal organs & tissues occur during specific times during pregnancy. Essential nutrients must be available in required amounts during these times for fetal growth & development to proceed optimally. Key Concept 3

  16. Key Nutrition Concept • The risk of heart disease, diabetes, hypertension, and other health problems during adulthood may be influenced by maternal nutrition during pregnancy. Key Concept 4

  17. Key Terms • Gestation – intrauterine fetal growth period from conception to birth (40 weeks). • Embryo- developing organism from conception to 8 weeks gestation. • Fetus – developing organism from 8 weeks gestation until birth.

  18. Stages of Prenatal and Infant Life • Conception- begins when ovum is fertilized with sperm = day 1 • Prenatal period – conception to birth • Perinatal period – 20 wks gestation – 28 day old infant • Neonatal period – birth to 28 day old infant • Postneonatal - 28 day old infant to 1 year old.

  19. Time-related Terms Before, During, and After Pregnancy

  20. Key Terms • Natality statistics: • Status of reproductive outcomes that are assessed through examination of statistical data • Infant mortality • Death that occurs in first year of life • Infant morbidity • Illnesses that occur in first year of life

  21. The Status of Pregnancy Outcomes • Infant mortality: • reflects general health status of a population • decreases in mortality related to improvements in social circumstances, safe & nutritious food supply, & infectious disease control

  22. Natality Statistics: Rates, Definitions, and Trends in the Rates in the United States

  23. Chronology of Events Related to Declines in Infant Mortality in the United States

  24. Low Birthweight, Preterm Delivery, and Infant Mortality • Low birthweight (LBW) or preterm infants at high risk of dying in 1st year of life • 8.2% of births are LBW yet comprise 66% of infant deaths • 12.7% are born preterm yet account for high incidence of infant deaths 

  25. Range of Birthweights by Gestational Age, U.S.

  26. Reducing Infant Mortality and Morbidity • Improve birthweight of newborns • Desirable birthweight = 3500-4500 g(7 lb. 12 oz. to 10 lb.) • Infants born with desirable wt less likely to develop: • Heart and Lung diseases • Diabetes • Hypertension

  27. Health Objectives for 2010 for the Nation Related to Pregnant Women and Infants

  28. Maternal Physiology • Changes in maternal body composition & functions occur in specific sequence

  29. Normal Physiological Changes during Pregnancy • Two phases of changes: • Maternal anabolic changes -Build mother’s capacity to deliver nutrients to fetus -~10% of fetal growth occurs -Weeks 1-20 • Maternal catabolic changes: -Nutrients delivered to fetus -~90% of fetal growth occurs -Weeks 20-delivery ~40

  30. Summary of Maternal Anabolic & Catabolic Phases of Pregnancy

  31. Components of Increased Oxygen Consumption in Normal Pregnancy

  32. Body Water Changes • Body water • Increases from ~7 L to 10 L • results from increased plasma & extracellular volume & amniotic fluid • Edema • swelling due to accumulation of extracelluar fluid

  33. Hormonal ChangesKey placental hormones and their roles

  34. Maternal Nutrient Metabolism • Pregnancy: A Pro-Oxidative State • Increased oxidation & free radical formation results from: • Increased energy production in mitochondria • Insulin resistance, diabetes, preeclampsia, obesity & infections • Excess iron supplementation

  35. Carbohydrate Metabolism • Glucose is preferred fuel for fetus • “Diabetogenic effect of pregnancy” results from maternal insulin resistance • Early pregnancy: High estrogen & progesterone stimulate insulin which increases glucose glycogen & fat • Late pregnancy: hCS & prolactive inhibit conversion of glucose to glycogen & fat

  36. Plasma Glucose and Insulin Levels in Nonpregnant Women and in Women Near Term

  37. About 925 g of protein accumulate during pregnancy Protein & amino acids conserved during pregnancy Protein Metabolism

  38. Fat Metabolism • Fat stores accumulate in first half of pregnancy with enhanced fat mobilization in last half • Blood lipid levels increase dramatically • Increased cholesterol is substrate for steroid hormone synthesis

  39. Mineral Metabolism • Calcium • increased bone turnover • Sodium • accumulation in mother, placenta, & fetus • restriction of sodium potentially harmful

  40. The Placenta • Functions: • Hormone & enzyme production • Nutrient & gas exchange • Remove waste from fetus • Structure: • Double lining of cells separating maternal & fetal blood

  41. -Maternal arteries & veins are part of the maternal circulation, whereas umbilical arteries & veins are part of the fetal circulation. -Blood enters the fetus through umbilical veins & exits through umbilical arteries. Structure of the Placenta

  42. The Placenta • Nutrient Transfer • Small molecules pass through most easily • Large molecules aren’t transferred at all • The fetus is not a parasite • Nutrients first used for maternal needs, then for placenta & last for fetal needed

  43. Embryonic and Fetal Growth and Development

  44. Variation in Fetal Growth • Variations linked to: • Energy, nutrient, & oxygen availability • Genetically programmed growth & development • Insulin-like growth factor (IGF-1) is main fetal growth stimulator

  45. Newborn Weight Classifications • Terms to describe newborn size • SGA (small for gestational age) • dSGA (disproportionately small for gestational age) • pSGA (proportionately small for gestational age) • LGA (large for gestational age)

  46. Fetal-Origins Hypothesis of Later Disease Risk • Theory that exposures to adverse nutritional & other conditions during critical or sensitive periods of growth & development can permanently affect body structures & functions • Changes may predispose individuals to CVD, type 2 diabetes, hypertension & other disorders in later life

  47. Pregnancy Weight Gain Recommendations

  48. Composition of Weight Gain

  49. ~2-5 pounds in first trimester Gradual & consistent gains thereafter Rate of Pregnancy Weight Gain

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