Lesson 2 Preconception and Pregnancy Chapters 2-4

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 lt20 or gt30

6
Weight Loss and Fertility in Females

• Weight loss gt10-15 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 and Fertility

• Caffeine appears to prolong time to conception
• Daily caffeine intake reduction in conception
  is
• 300 mg results in 27 ?
• 500 mg results in 50 ?

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
• gt10 drinks ? 66 ? in conception

11
Nutritional Exposures Before and Very Early in
Pregnancy that Disrupt Fetal Growth and
Development
12
CDCs 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
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Key Nutrition Concept

• The fetus is not a parasite it depends on the
  mothers 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
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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
(No Transcript)
21
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

22
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

23
Natality Statistics Rates, Definitions, and
Trends in the Rates in the United States
24
Chronology of Events Related to Declines in
Infant Mortality in the United States
25
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

?
26
Range of Birthweights by Gestational Age, U.S.
27
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

28
Health Objectives for 2010 for the Nation
Related to Pregnant Women and Infants
29
Maternal Physiology

• Changes in maternal body composition functions
  occur in specific sequence

30
Normal Physiological Changes during Pregnancy

• Two phases of changes
• Maternal anabolic changes
• -Build mothers 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

31
Summary of Maternal Anabolic Catabolic Phases
of Pregnancy
32

• Components of Increased Oxygen Consumption in
  Normal Pregnancy

33
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

34
Hormonal ChangesKey placental hormones and their
roles
35
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

36
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

37
Plasma Glucose and Insulin Levels in Nonpregnant
Women and in Women Near Term
38
Protein Metabolism

• About 925 g of protein accumulate during
  pregnancy
• Protein amino acids conserved during pregnancy

39
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

40
Mineral Metabolism

• Calcium
• increased bone turnover
• Sodium
• accumulation in mother, placenta, fetus
• restriction of sodium potentially harmful

41
The Placenta

• Functions
• Hormone enzyme production
• Nutrient gas exchange
• Remove waste from fetus
• Structure
• Double lining of cells separating maternal
  fetal blood

42
Structure of the Placenta

• -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.

43
The Placenta

• Nutrient Transfer
• Small molecules pass through most easily
• Large molecules arent transferred at all
• The fetus is not a parasite
• Nutrients first used for maternal needs, then for
  placenta last for fetal needed

44
Embryonic and Fetal Growth and Development
45
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

46
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)

47
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

48
Pregnancy Weight Gain Recommendations
49
Composition of Weight Gain
50
Rate of Pregnancy Weight Gain

• 2-5 pounds in first trimester
• Gradual consistent gains thereafter

51
The Institute of Medicines Prenatal Weight-gain
Graph
52
Key Terms

• Trimester 1/3 of the normal duration of
  pregnancy
• Recommended weight gain by trimester
• Trimester Weight Gain
• 1st 0-13 weeks 2-5 lbs.
• 2nd 14-26 weeks 1 lb per week
• 3rd 27-40 weeks 1 lb per week

53
Weight Gain Assessment

• Susie is 33 weeks pregnant and has gained 30 lbs
  thus far. Prior to becoming pregnant, her BMI was
  22.
• What is your assessment? Has she gained adequate
  or excess weight?
• What is your recommendation?

54
Weight Gain AssessmentSolution

• 33 weeks 13 weeks for 1st trimester 20 weeks
• 20 weeks x 1 lb/week 20 lbs. 5 lbs for 1st
  trimester 25 lbs. healthy weight gain
• Susie has gained too much weight!

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Assessment Tool

• G2P0010
• G Gestation 2
• P Partum 0
• Pre-term Labor 0
• Abortion/miscarriage 1
• Living Kids 0

56
Postpartum Weight Retention

• Much concern over pregnancy weight gain and
  long-term obesity
• 15 pounds lost at delivery
• Wt loss difficult in women who gained gt45 pounds
  or with low activity levels
• Women with recommended wt gain in pregnancy are
  2 pounds heavier at 1 yr postpartum
• Lactating women lose slightly more

57
Practice PlottingAssess weight gain and give
recommendations

• Lisa is 52 115lbs. before pregnancy.
• 15 wks 120 lbs
• 30 wks 130 lbs
• Juanita is 510 200 lbs. before pregnancy
• 35 wks 220 lbs.
• 38 wks 230 lbs.