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What are primary nutritional deficiencies and susbequent illnesses in women's health?
- Iron - Anemia
- Calcium - Osteoporosis
- Folate - Neural Tube Defects (Spina bifida & anencephaly)
What is the leading micronutrient def in the world? Who is most at risk for osteoporosis (2) How do you stop osteoporosis*(2)?
Leading: Iron deficiency, esp in 3rd world.
White and Asian women.
Cannot stop! But can decrease amount of bone mass lost and can max amount of bone mass gained before menopause.
What's another name for NTDs? What does it lead to abnormalities in? (3)
When is neural tube completely developed?
CNS closure defects; leads to abnormalities in spine, skull, and brain formation.
3rd-4th week of pregnancy.
How does obesity affect fertility?
Less fertile due to leptin/fat tissue (reservoir for steroid hormones and site of estrogen synthesis)
It can interfere with normal hormone signaling.
What are the 2 long term effects of pregnancy?
Increased risk of CV disease, decreased risk of ovarian cancer.
Define menopause, perimenopause
When is it definitely menopause?
Menopause - permanent cessation of menstruation from loss of ovarian follicular activity
Perimenopause - period before menopause
After 1 year of amenorrhea
What are the next steps for intervention studies? (4)
- 1. More studies that combine diet/physical activity targeted to obese women.
- 2. Must address parenting skills and stressful lives women lead
- 3. Frequent interactions
- 4. Interdisciplinary team that focuses on preconceptional and interconceptional period.
After reading these intervention studies, what can we do now to help women enter pregnancy healthy and have optimal outcomes? (3)
- 1. Conceive at normal prepregnancy BMI (requires preconceptional counseling, contraception, and weight loss for some)
- 2. Gain with guidelines (inform women and healthcare providers and provide individualized assistance in meeting guidelines).
- 3. Explore use of new technology (texting, podcasts, ipod/ipad apps, etc).
What are impacts of induced fetal hyperinsulinemia?
difficult delivery, respiratory problems, muscle weakness, hypoglycemia.
How does pregnancy affect glucose homeostasis? (3)
- 1. Increase in estrogen and progesterone --> B-cell hyperplasia --> increased insulin secretion
- 2. Increased peripheral use of glucose --> lower fasting glucose levels
- 3. Glycogen deposition increases in peripheral tissues and decreases in hepatic glucose production.
What are risk factors for gestational diabetes? Name 4 out of 6
- 1. Family history of diabetes
- 2. Age > 25 y/o
- 3. Previous delivery of baby > 9 lbs
- 4. Glycosuria at first prenatal visit
- 5. Polycystic ovarian syndrome
- 6. Hypertension
What are symptoms of pre-eclampsia? (3)
What is the dietary treatment for pre-eclampsia?
Hypertension, proteinuria, edema.
What four things will happen when maternal supply is inadequate to meet fetal demand?
- 1. Fetus will respond to enhance survival
- 2. Fetus will grow less (esp organs less critical to survival; brain sparing at expense of skeletal organs)
- 3. More metabolically efficient
- 4. Alter endocrine function
How does maternal diet affect fetus? Which vitamins? (3)
Epigenetics - affects gene expression; dietary intake of methyl donors/factors (B9, vitamin B12, B6); hypomethylation is affected with adverse outcomes.
Describe agouti mouse experiment
Genetic expressios? (6)
Young black female mice were fed normal diet/diet supplemented with B9,B12,methionine for 2 weeks prior to mating and throughout lactation --> gave birth to genetically identical offspring.
Conclusion: coat color is regulated by maternal diet; dietary methyl supp SILENCES agouti expression, resulting in darker colored animals.
Also, increased BP, more body fat, abnormal glucose tolerance, hyperphagia (esp with fat diet), impaired inflammatory response, reduced physical activity.
What if pregnant moms are offered a junk food diet vs normal chow?
What happens to pregnant mom? (2)
What happens to offspring? (6 - 4 of these are medical problems)
Pregnant rats eat more and exercise less.
Offspring: heightened pref for same junk foods, higher growth rates (adipose tissue), medical problems: earlier onset of hyperglycemia, hyperinsulinemia and/or hyperlipidemia; nonalcoholic fatty liver disease
What are the key findings from human studies? (5 steps)
Poor maternal diet --> fetal nutritional insufficiency --> altered body comp/metabolism/regulatory mechanism + postnatal dietary adequacy/excess, sedentary behaviors --> increased risk of chronic disease.
How was developmental origins hypothesis refined?
That post natal factors play a role too and synergism and mismatch are important.
How does fast weight gain from 0-2 years old differ for developing countries vs developed countries?
In developing countries, fast weight gain is good. For high income babies, has adverse outcomes.
What was the criteria for making the WIC Food package better? (4)
- 1. Reduction of over/undernutrition
- 2. Contributes to overall dietary pattern consistent with dietary guidelines for Americans of all ages
- 3. Available in forms for low-income persons w/ limited transportation, storage, cooking
- 4. Foods are readily acceptable, widely available, commonly consumed, and takes into account cultural preferences.
What did new WIC packages emphasize? (5)
What was the impact? (4)
Emphasis on whole grains, fresh fruits/veggies over frozen/canned, reduced juice, promoted breastfeeding, less saturated fat.
WIC food packages had healthier foods found in convenience stores/nonchain grocery stores, more formula had been given out than before (FAIL), more whole grains, more fresh veggies, but still need help with breastfeeding.
What are barriers to optimal weight gain and optimal nutrition? (5)
- 1. Exhaustion
- 2. Time
- 3. Nausea
- 4. School/Work
- 5. Lack of self control
What are good resources for pregnant women? (2) Where do most pegnant women go for information on pregnancy? What is missing? (3)
- 1. American Pregnancy Association website
- 2. Women's Health Alliance
Most pregnant women go to their primary provider.
Healthy habits checklist, advanced dietary planning, where to find support groups.
What are benefits of breastfeeding for infants? (7)
6 - which illnesses are prevented? (8)
7 - Which chronic conditions are prevented? (4)
- 1. Less likely to be anemic (Fe is more bioavailable in BM than HMS)
- 2. Human milk has dynamic composition, app balance of nutrients, providing full nutrition to baby with high bioavailability.
- 3. Isosmotic - no need for water intake
- 4. Easily digestible
- 5. More gains in cognitive ability
- 6. Fewer respiratory/GI illnesses, SIDS, celiac disease, IBS, allegies, asthma, ear infections (8)
- 7. Less likely to have chronic condition as adult (obesity, T1D, T2D, hypertension).
How does breastfeeding benefit moms? (5)
5 - which diseases are prevented? (3)
- 1. Oxytocin (minimizes postpartum blood loss)
- 2. Delay between return of fertility (esp important for developing countries)
- 3. Increased self confidence/bonding with child
- 4. Potential weight loss
- 5. Lower risk of breast/ovarian cancer & rheumatoid arthirtis.
Essentially what makes breast milk so special? (9)
- 1. Oral rehydration
- 2. Growth & Devleopment
- 3. Immunizations/antibodies & immunoglobins
- 4. Reduces risk of cancer/chronic disease for mom and infant
- 5. Helps mothers health and survival (oxytocin)
- 6. Birth spacing & fertility
- 7. Free
- 8. Tailored nutrition
- 9. Milk comp changes with each feeding and on each breast: protein decreases, lactose/fat/water levels increase.
How does milk comp change with each feeding? (4)
Protein decreases, lactose/fat/water levels incrase
Describe foremilk (4) and hindmilk (4)
Foremilk is thinner, quenches thirst; lowin fat high in lactose.
Hind milk is thicker, richer in nutrients, making baby fall asleep, thus regulating intake.
What are regular negative effects of HMS? (4)
Recalls, diarrhea, allergies, UTIs.