Download midterm Chs 2-7

Chapter 2: preconception Nutrition
1. Menstrual cycles
a. Follicular phase: GnRH, FSH, estrogen, and progesterone.
b. Luteal Phase: lower estrogen and progesterone, menstrual flow
2. Dietary factors related to infertility in women (RAVAMPEPI)
a. Recent oral contraceptive
b. Anorexia
c. Vegan
d. Age
e. Metabolic syndrome
f. Pelvic Inf. Disease
g. Endometriosis
h. Polycystic ovary syndrome
i. Iron deficiency
3. Nutrition factors related to infertility in men (ZMHESHSS)
a. Zinc deficiency
b. Heavy Metals
c. Halogens
d. Estrogen
e. Sperm defect
f. Heat testes
g. Steroids
h. Soy
4. Fertility is affected in women with a BMI < 20 and > 30.
5. An underweight woman with amenorrhea should increase her weight to normal
6. Recommended daily intake of folate for all women who may become pregnant is 400mcg
7. Exposures to these nutrients would disrupt fetal growth and development
a. Insufficient folate
b. High maternity blood levels of lead
c. Excessive vitamin A
d. Iodine deficiency
e. Iron deficiency
8. What is the primary effect (s) of chronic undernutrition on reproduction in women?
Birth of small and frail infants with a higher likelihood of death in the 1st year of life
9. From the article know how chronic diseases influence conception and some possible interventions:
* Most chronic conditions increase in frequency with age.
* The longer a woman has had a chronic condition the greater her health has been affected.
*Treatments may be teratogenic and/or hazardous to the mother in pregnancy and need to be
modified for women who are pregnant or at risk for conception.
Nutrition, exercise, and reduce smoking and stress are recommended.
Chapter 3 Study Guide
1. What are teratogens?
Teratogens: exposures that produce malformations in embryos or fetuses (alcohol, high blood glucose
levels during first 2 months)
2. Know what comprises the diets developed for people with type 2 diabetes.
Total of kcalories= 15-20% protein, <30% fat, 50% carbohydrates, saturated fat <7%, Trans fats as low
as possible, <200 mg cholesterol, 14g fiber/100kcal, grain intake = 50% whole grains, low glycemic index
foods.
3. Know the clinical signs associated with polycystic ovary syndrome (PCOS).
Insulin resistance, high blood insulin and testosterone levels, obesity, infertility, amenorrhea
4. Dietary recommendations for women with PCOS emphasize which foods?
*Omega-3 fatty acids, whole grains, fruits, and vegetables
*Eat regular meals, non-fat dairy, low-glycenic foods.
5. Be able to identify the three components of the female athlete triad.
Amenorrhea: Intake is 30% less than required
Disordered eating: anorexia and bulimia
Osteoporosis. Vitamin D, and Calcium are needed
6. Which conditions would be seen in higher rates in obese women?
Obesity increases the likelihood of reproductive health problems (PCOS)
7. Know signs and symptoms of celiac disease.
Pica: Autoimmune disease in people with genetic susceptibility to protein gliandin found in gluten
component of wheat, rye, barley, which causes malabsorption and flattening of intestinal lining.
~1 in 133, linked to infertility
Chapter 4 Study Guide
1. What are the changes in lipid blood levels that occurs during pregnancy and why do
they occur?
During pregnancy, increased concentrations of cholesterol, LDL cholesterol, triglycerides, HDL
cholesterol.
Overall, these changes promote the accumulation of maternal fat stores in the first half of pregnancy and
enhance fat mobilization in the second half.
2. What is the preferred source of fuel for the fetus?
Glucose
3. The recommended daily protein intake for pregnant women is 71g. The average intake for females is ~78g.
4. Pregnant women of which ethnicity are more likely to have an eating disorder known
as pica?
Pica: Eating disorder characterized by craving non-food substances. 75% of pregnant women in southern
parts of USA and most common in African Americans.
5. What are some changes a pregnant woman in the anabolic phase of pregnancy can expect? What are some
changes she can expect in the catabolic phase?
Maternal anabolic phase 0-20wks
Maternal catabolic phase 20+ wks
*Blood volume expansion, increased cardiac
output
*Mobilization of fat and nutrient stores
*Buildup of fat, nutrient, and liver glycogen
stores
*Increased production and blood levels of
glucose triglycerides, and fatty acids, decreased
liver glycogen stores
*Growth of some maternal organs
*Accelerated fasting metabolism
*Increased appetite, food intake
*Increased appetite and food intake decline
somewhat near term
*Decrease exercise tolerance
*Increase levels of anabolic hormones
*Increase levels of carbolic hormones
6. Explain why the hemodilution of nutrients occurs during pregnancy.
Concentration of most vitamins and minerals in blood decrease becase the volume of blood increases
during pregnancy (hemodilution), a moderate decrease in the concentration of red blood cells and
hemoglobin is normal
7. Explain the difference between small for gestational age (SGA) and low birth weight.
SGA: Newborn weight is <10th percentile for gestational age
Low birth weight: Newborn weights <2500g (5lb 8oz)
8. Know the probable outcome for a baby born to a single mom who lost her job and experienced a severe food
shortage at the end of her pregnancy (with regards to weight and size).
The baby will be low birth weight and most likely to be small for gestational age (SGA)
9. What are the major functions of the placenta?
It provides the fetus with sufficient energy, nutrients, and oxygen for growth.
10. What are factors related to infants who are large for gestational age (LGA)?
>90% weight for gestational age. Related to pregnancy obesity, poorly controlled diabetes in pregnancy,
excessive weight gain in pregnancy (44lbs) possible other factors.
11. What are the recommended weight gains for women during pregnancy.
Table 4.17
Underweight
28-40lbs
Normal
25-30lbs
Overweight
15-25lbs
Obese
11-20lbs
Twins
25-54lbs
12. The recommended dietary allowance for folate, iron, calcium, DHA and vitamin
D during pregnancy are…..
Folate: 600 IU/day,
Iron: 27/mg/day,
DHA: 250 mg/day,
Calcium: 1000 mg/day,
Vitamin D: 770 IU/day
13. What is the role of edema in pregnancy?
Edema: the swelling due to accumulation of extracellular fluid usually of legs and feet
14. What advice can we give to a woman suffering peristent nausea and vomiting?
*Separate liquid and food intake
*Avoid odors and food that trigger
*Vitamin B6, multivitamins, and ginger
15. Know common pregnancy health problems (i.e. heartburn) and advice to treat them.
Heartburn: Ingest small meals frequently.
Don’t go to bed with a full stomach
Avoid foods that make heartburn worst
Constipation: Consume dietary fiber
Drink water along w fiber
Laxative pills are not recommended
Chapter 5 Study Guide
1. Hypertension is defined as having a blood pressure of > 140mm Hg systolic or > 90mm Hg diastolic
2. Women with which characteristics are at risk of developing preeclampsia?
*Insulin resistance
*Obesity
*>age 35
*High blood triglycerides
*First pregnancy
3. Which nutrients appear to reduce or prevent preeclampsia?
*Colorful fruits and vegetables
*Vitamin D
*Omega-3
*dried beans
*Whole grains
4. Of the hypertensive disorders during pregnancy know which are less serious and which are more serious.
5. Women with preeclampsia are at an increased risk of developing what other types of conditions during
pregnancy?
Gestational diabetes, type 2 diabetes, hypertension, heart disease and stroke
6. Glucose screens are not recommended for women at low risk of developing gestational diabetes during
pregnancy. Who are low-risk women?
Age <25, not Hispanic, African Americans, south or east Asians, Pacific Islanders, no diabetes in first
degree relatives, normal weight
7. For a majority of women with gestational diabetes, what is the primary way to achieve healthy infant
outcomes? (is it medications or lifestyle changes or something else?)
Lifestyle changes like diet and exercise
8. What are the primary goals for women with gestational diabetes?
Normalize blood glucose levels with diet and exercise
9. The Institute of Medicine recommends women gain _____. (know for all BMIs)
Table 4.17
Underweight
28-40lbs
Normal
25-30lbs
Overweight
15-25lbs
Obese
11-20lbs
Twins
25-54lbs
10. The most commonly observed eating disorder in pregnancy is Anorexia Nervosa.
11. Know how we define fetal alcohol spectrum disorders and recommendations for alcohol intake during
pregnancy.
Fetal alcohol spectrum: describes range of effects that fetal alcohol exposure has on mental development
and physical growth. It is recommended that women do not drink alcohol while pregnant.
12. Know what causes gestational diabetes.
Insulin resistance, obesity, weight gain, underweight, >35 age, family history
13. Know components of appropriate dietary advice for women with gestational diabetes.
Whole grain bread, cereal, vegetables and fruits, higher fiber intakes
14. Know components of appropriate dietary advice for women with preeclampsia.
Calcium intake, plant foods, and fiber
15. What are nutrition goals for women with HIV?
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Maintenance of positive nitrogen balance & preservation of lean muscle & bone mass
Adequate intake of energy & nutrients to support maternal physiological changes & fetal growth
& development
Correction of elements of poor nutritional status identified by nutritional assessment
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Adoption of safe food-handling practices
Delivery of a healthy newborn
16. What nutritional and other information should be given to pregnant teens?
They need more kcalories, nutrient dence, calcium, DRI, and psychological support.
Chapter 6 Study Guide
1. Know the different hormones and what they are responsible for.
Estrogen: Ductal growth.
Progesterone: Alveolar development.
Human growth hormone: Development of terminal end buds.
Prolactin: Stimulates milk production and Released in response to suckling, stress, sleep
Human placental lactogen: Alveolar development.
Oxytocin: Stimulates letdown, Tingling of the breast may occur corresponding to contractions in milk
duct, and Causes uterus to contract, seal blood vessels, & shrink in size.
2. Know the maternal benefits of breastfeeding.
Hormonal, physical, and psychosocial benefits
3. Know the different stages of lactogenesis and when milk “comes in”

Lactogenesis I (birth to 2-5 days) milk formation begins
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Lactogenesis II—(begins 2-5 days after birth) increased blood flow to breast; milk “comes in”

Lactogenesis III—(begins at ~10 day after birth) milk composition is stable
4. On the second feeding after birth, a first-time mom was concerned that her infant was not getting enough
milk. What would the lactation consultant want the new mom to know?
Milk does not come right after birth
5. The dominant carbohydrate in human milk is lactose.
6. Know common barriers to breastfeeding initiation.
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Embarrassment
Time and social constraints, and concerns about loss of freedom (particularly tissue of working
mothers)
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Lack of support family and friends
Lack of confidence
7. How does changing the diet change the fat, carbohydrate and protein composition of breast milk?


Fatty acid profile reflects dietary intake of mother.
Very low fat diet with adequate CHO and protein, milk is high in medium-chain fatty.
8. Know what nutrients are missing among women following a strict vegetarian diet and how they can be
obtained.
Low vitamin B12, Iron, Protein, and Zinc
9. Know the effectiveness of breastfeeding as a form of birth control.
Although women usually don't menstruate when they are breastfeeding, breastfeeding is not an effective
birth control.
Chapter 7 Study Guide
1. Know common conditions that may be experienced by a woman who is breastfeeding and how they can be
treated (i.e. sore nipples).
The best prevention of nipple pain and soreness is proper positioning of the baby on the breast.
2. Know symptoms of an infant suffering from an excess of caffeine.
Wakeful, hyperactive, fussy
3. What nutrition interventions are recommended for management of early jaundice?
Breastfeeding
4. Know what foods a nursing mom should avoid because they have the potential to cause gas in her baby.
None
5. Know what medicinal herbs have been shown to be a safe alternative to drugs during lactation.
Chicory, orange spice, peppermint, raspberry, red bush tea, rose hips.
6. Know influence of alcohol on milk production.
Low oxytocin and letdown, affect milk’s odor. Low volume and interfere with sleeping patterns.
7. Know recommendations for alcohol and smoking while breastfeeding.
Alcohol use is ok because breastfeeding far out weights the potential risk from environmental pollutants.