FN 124 LE 1 - Pregnancy Flashcards
(196 cards)
1
Q
Conditions/Factors to consider during preconception care
A
o Care before pregnancy
o Fertility
2
Q
o To motivate potential new parents to participate in
advanced planning of pregnancies
o Risks prior to conception include medical, social, psychological, or lifestyle conditions
A
preconception care
3
Q
component of preconception care that includes:
o Individual and social conditions o Adverse health behaviors
o Medical conditions
o Psychological conditions
o Environmental conditions
o Barriers to Family Planning, Prenatal Care, and Primary
Health Care
A
Risk Assessment
4
Q
component of preconception care that includes:
o Promotion of behaviors
o Counseling about the availability of social and financial
assistance programs
o Advice on family planning, birth spacing
o Counseling on the importance of prenatal care o Identification of barriers to care
A
Health Promotion
5
Q
component of preconception care that includes:
o Treatment of medical conditions
o Referral for treatment of adverse health behavior(s) o Rubella and hepatitis immunization (free)
o Counseling to reduce psychosocial risks
o Nutrition counseling
A
Interventions to Reduce Risks
6
Q
refers to nutrition during the time of
pregnancy
A
Perinatal Nutrition
7
Q
what does Maternal Dietary Practices prior to pregnancy (always start with studying their dietary patterns) determine
A
(1) fertility, (2) pregnancy, and (3)
course of pregnancy
8
Q
Stages of menstrual cycle
A
- Follicular Phase
- Ovulation – release of the egg cell
- Luteal Phase
9
Q
In this stage of the menstrual cycle, the egg is released from day 20-24
A
Ovulation
10
Q
In this stage of the menstrual cycle, it is the optimal time for conception (when egg is most ready)
A
Ovulation
11
Q
appetite-suppressing hormone produced by
adipocytes
A
Leptin
12
Q
High leptin production result to?
A
creation of cysts in
the ovaries (PCOS)
12
Q
what does high amounts of adipocytes result result to?
A
high leptin prod
13
Q
Major preventive measure for PCOS
A
weight loss
13
Q
Patients with PCOS are prescribed with?
A
Metformin treatment
14
Q
an Oral Hypoglycemic Agent/Drug (OHA) that causes weight loss as one of its side effects
A
Metformin
15
Q
What does undernutrition do to fertility?
A
can cause delayed puberty and amenorrhea
15
Q
Individual experiences puberty, menarche, and ovulation as expected
A
Normal Nutrition
16
Q
Besides undernourished mothers, ______ is usually experienced by female athletes
A
amenorrhea
17
Q
being overweight/obese can result to
infertility
A
Overnutrition
18
Q
Factors acting in fetal life that can affect future fertility of the baby
A
o Lifestyle, diet, environmental chemicals
18
Q
Increased leptin production results in:
A
o Anovulation
o Hirsutism – hair in other parts of the body due to increase in androgen production
19
Q
Factors acting in pregnant mother that can affect fetal
development
A
o Hormone changes due to over/undernutrition
19
Q
Factors affecting future fertility that are already determined at
birth up to 1 year of age
A
o Health status of infant
* Female vs. male infants are affected by different factors
19
Factors acting in adulthood that can affect fertility for females
Female adult – diet, season, occupation, lifestyle
20
Factors acting in adulthood that can affect fertility for males
Male adult – season, occupation, scrotal heating (time
spent seated)
21
Role in Spermatogenesis: RNA and DNA synthesis
Cobalamin
21
Role in Spermatogenesis: Promotes healthy sperm
Folate
22
Role in Spermatogenesis: Spermatogonia differentiation
Vitamin A
23
Role in Spermatogenesis: Protects sperm from oxidative stress
Vit C
23
Role in Spermatogenesis: Defends sperm from ROS-related events
Vit E
24
Role in Spermatogenesis: Initiate sperm motility
Calcium
24
usually not consumed by pregnant women due to their side effects, primarily diarrhea
antibiotics
25
Role in Spermatogenesis: formation of the flagella
Selenium
25
Role in Spermatogenesis: Enhances sperm motility
Zinc
25
Role in Spermatogenesis: sperm production
Nickel
25
diarrhea during pregnancy lead to:
dehydration (due to water loss) where Less nutrients are available for the fetus since the GI tract is compromised and is unable to absorb
26
Expansion in red cell mass is proportionally smaller than that in plasma, resulting in the so-called ________
physiologic anemia of pregnancy
26
amount of volume of blood pumped
by the heart
Cardiac ouput
26
volume of blood pumped from
the left ventricle per contraction
Stroke volume
26
Due to the increase nutrients and the need of
something to transport them
Increased blood volume
26
usually decreased (1st and
2nd trimesters) under blood volume changes
arterial pressure
26
Induces changes in blood flow
Increased blood volume
26
occurs from
10-12wk through 33-35wk
Progressive plasma volume expansion
26
Weekly increments are maximal during _____
mid-gestation (5-6 months)
26
Blood pressure tone _____ and peripheral vascular resistance _____
decreases; falls
26
blood vessels far from the heart
Peripheral vascular system
26
blood vessels have decreased resistance to improve blood flow
Blood pressure tone
27
Resistance to blood _____ to induce better blood flow
decreases
27
Arterial pressure falls during the ______
1st trimester
27
used as the baseline to evaluate
pregnancy-induced hypertension (PIH) to the 3rd
trimester
Arterial pressure during the 1st trimester
27
Changes in regional blood flow: uterine blood flow increases from ______ in non-pregnant to ______ near term
15- 20 ml/min; 500-600 ml/min
28
Adjustments in respiration: results in increased intraabdominal pressure and elevation of the diaphragm
enlarging uterus
29
Resting ventilation increases by about ____
48%
30
Changes in Renal Function (4)
(1) urethral dilation, (2) slowed velocity of urine, (3) increased susceptibility to UTIs, and (4) uterine compression of the ureters
31
Renal blood flow and Glomerulus flow rate (GFR) are ______
increased
32
increase in ___ presents the tubules with greater quantities of nutrients than they can absorb
GFR
33
Changes in Gastrointestinal Function
(1) taste changes, (2) heartburn, (3) nausea & vomiting, and (4) constipation
34
detected by pregnancy tests through urine
HCG
35
Released after embryogenesis is completed
HCG
36
Some proteins cause unappetizing
smells/tastes/sensations for pregnant women
Taste changes
37
o Caused by relaxation of the esophageal sphincter (acids can more easily move through GI tract)
o Becomes normal through the 3rd trimester
Heartburn
37
Caused by the relaxation of GI muscles, reducing its motility (movement), resulting in difficulty of defecation
Constipation
38
Changes the progesterone causes:
* Relaxation of the smooth muscles in the uterus for expansion
* Relaxation of the GI muscles, thus reducing motility
* Induces fat deposition
* Reduces alveolar and arterial pressure (CO2)
* Increases renal sodium excretion
39
____ is lower than progesterone during the 1st few months but rises sharply near term
Estrogen
40
Functions of estrogen
o Promotes growth and controls the function of
the uterus
o Alters the structure of the mucopolysaccharides
in the connective tissues (for flexibility and
water retention)
40
Excess fluid is a hallmark of _____
preeclampsia
(hypertension during delivery)
41
usually rises by the 4th month
BMR
42
The BMR increased by ____ by term and returns to normal 5-6 days postpartum
15-20%
43
reflects increased oxygen demands of the uterine placental fetal unit, as well as O2 consumption from increased maternal cardiac work
Elevated BMR
43
50-70% of the kcal needed by the fetus in the 3rd
trimester is derived from _______
glucose
44
20% is from _______; and the rest is from _____
amino acids; fats
45
when maternal blood glucose ____, the rate of glucose transfer to the fetus declines and ____ will be the more dominant fuel source
falls; fatty acids
45
The net effect of maternal fuel adaptations is to increase the use of ___ as fuel by the mother and conserve ____ to the fetus
fat; glucose
46
contain fetal blood vessels and extend into the pool of mother’s blood
Fingerlike projections (placental villi)
47
requires channels and carriers that are potassium and protein-dependent
Active transport
47
Recite transport mechanism and substance transported
(table for diffusion and transport)
48
Hormone produced by placenta
Human Chorionic Gonadotropin (HCG)
49
Produced by Trophoblasts
HCG
49
Postulated mechanisms responsible for placental and fetal growth retardation as seen with maternal malnutrition
Recite the table
50
Decreased placental size due to
lack of hPL produced
51
Reduced nutrient transfer – due to
impaired transfer system
52
Alters maternal physiology to ensure fetal nutrition in utero (inside the uterus)
ENDOCRINE FUNCTION OF FETAL PLACENTAL TISSUE
52
Alters maternal pituitary function and mammary development to ensure ongoing fetal nutrition after birth (lactation)
ENDOCRINE FUNCTION OF FETAL PLACENTAL TISSUE
53
Determines the time of labor and delivery (parturition)
ENDOCRINE FUNCTION OF FETAL PLACENTAL TISSUE
54
Fetal testosterone production
placenta
55
Male differentiation of the reproductive system before the fetal
hypothalamus and pituitary develop into a functional axis
placenta
56
take about 6 days to complete
Events between fertilization and implantation
57
occurs at about day 22 of the menstrual cycles
Implantation
57
At this time, ovary is in the midluteal phase and secreting large amounts of progesterone
Implantation
58
to maintain fetus... (“pampakapit”)
progesterone
59
Stimulates secretion from the uterine glands, which provide
nutrients to the embryo (Histiotropic nutrition)
progesterone
60
Inhibits myometrial contraction and prevents release of
paracrine factors
* Example: Cytokines, prostaglandins, chemokines, and
vasoconstrictors for menstruation
progesterone
60
Induces the “window of receptivity” in the uterine
endometrium (D20-24)
progesterone
61
optimal time in which oocyte
can receive the sperm
window of receptivity
62
oocyte is released and no longer waits
for a sperm cell
After Day 24
63
_____
levels can be used as one measure of fetal health
estriol/ estrogen
64
Human chorionic somatomammotropin (hCS)
HPL
65
placenta grows during
gestation, ____ secretion increases
hPL
65
protein anabolic and lipolytic
hPL
65
antagonistic action to insulin is the major basis for the diabetogenicity of pregnancy
hPL
65
Antagonistic to insulin – counteractive action to insulin
(which decreases blood glucose)
hPL
66
But if blood glucose is excessively high and goes
past the limit, it can induce ____ to the mother
gestational diabetes
66
Insulin production and insulin sensitivity of cells is affected by ______
hPL and other hormones
67
____ inhibits maternal glucose uptake and use, thereby _____ serum glucose levels.
hPL; increasing
68
hPL ____ fetal glucose availability
increases
69
THE THREE MAIN PLAYERS OF PREGNANCY
The Mother, the Placenta, and the Fetus
70
did
not reach the uterus, embedded in the lines of the fallopian
tubes or ovaries
Ectopic pregnancy
70
a stage in the development of the embryo in o which cells are arranged in a single layer to form a hollow
sphere
blastocyst
70
A newly fertilized ovum is about the size of a period at the end of this sentence
zygote
71
solid mass of cells representing a mulberry,
formed by cleavage of a fertilized ovum
morula
72
at less than one week after fertilization is not much bigger and is ready for implantation.
zygote
73
five weeks after fertilization is about 1⁄4 inch long.
embryo
74
expected due to release of HCG (normal)
morning sickness
75
measures close to 20 inches in length. From eight weeks to term, this infant grew 20 times longer and 50 times heavier.
infant
75
The fertilized egg divides into cells that fold in on one
another
Blastogenesis Stage
76
after 11 weeks of development is just over an inch long. Notice the umbilical cord and blood vessels connecting the fetus with the placenta.
fetus
77
An inner cell mass evolves giving rise to the embryo and an
outer coat which becomes the placenta
Blastogenesis Stage
78
The stage is complete in 2 weeks after fertilization
Blastogenesis Stage
79
outer layer giving rise to the brain, nervous system, hair, and skin
ectoderm
80
middle layer that produces all of their voluntary muscles, bones, cardiovascular, and excretory systems
mesoderm
81
inner layer forms the digestive & respiratory systems, and the glandular organs
endoderm
81
Period of most rapid growth
Implications to diet – time to increase caloric intake
Begins from the 3rd month until term
Fetal weight increases (from 6g to 3,000-3,500 at birth)
Fetal stage
82
After __ days of gestation, all major features of the human infant have been achieved
60
83
(conception to 2 weeks)
o Implantation into uterine wall
zygote
84
o Rapid cell division (1.25 inches)
o Complete CNS, beating heart, digestive system (immature)
Embryo (2 weeks to 8 weeks)
85
Each organ has defined growth rate
Birth (38 weeks to 42 weeks)
Fetus (8 weeks to birth)
85
o After birth, before a baby becomes an infant (months
old)
Neonate
86
Normal head circumference and skeletal growth but poorly developed muscles and no subcutaneous fat
Type I: Growth retardation primarily affecting weight
86
weight of < 2500 g, irrespective of gestational age
low birth weight
87
the first weight of the fetus or newborn obtained after birth; ideally measured within the first hour of life
birth weight
88
Worse condition because at least Type II retains proportionality (all organs are within proportion of each other)
Type I: Growth retardation primarily affecting weight
89
o Size of all body parts are reduced proportionally
Type II: Growth reduction in both weight and height
90
Babyisstillalivebutsurvivalisthequestion
Very low birth weight (< 1500 g)
91
Extremely low birth weight
< 1000 g
92
height and pre-pregnancy weight of
the mother
maternal body size
93
amount of weight gained by the
mother during pregnancy
maternal weight gain
94
Peak age of reproduction
25-28
95
Normal weight gain is about ______
11 to 15 kg
96
the remainder in of maternal weight gain?
maternal
reproductive tissues, fluid, blood, and “stores” (fat)
96
Less than 1⁄2 of the total weight gain where?
fetus,
placenta, and amniotic fluid
96
Low birth weight is primarily related to:
o Low pre-pregnancy BMI (kg/m2)
o Low gestational weight gain
97
determinant for how much you should gain
height
98
These anthropometric factors reflect inadequate food intake, which may be related to:
o Poverty
o Cultural ideas of thinness
99
Lessens later in the pregnancy due to less release of HCG
Nausea and vomiting
99
components of weight gain table
recite the table
100
Due to enlargement of uterus and stomach linings
Heartburn
101
Intestines are crowded (“naiipit”), decreasing motility of
the GI Tract
Constipation
102
Cravings are usually a sign of nutrient deficiency like
_____ and _____
calcium and iron
103
factors that determine energy requirements
(1) Changes in the mother’s usual physical activity; and
(2) Increase in her metabolism to support the work
required for fetal growth and accessory tissues
104
Cumulative energy cost of pregnancy
* 40,000 to 70,000 kcal
* Extra 200-300 kcal for the 2nd and 3rd trimesters
104
About ____ CHON are deposited in a normal weight fetus and in the maternal accessory tissues divided by the ___ days of gestation = ___ of added CHON daily
925 g; 280; 3.3g
105
can cause other nutrient deficiencies in both, improper bone matrix formation, and infertility
Protein deficiency
106
in protein, leads to unhealthy and excessive maternal weight gain; impairs normal fetal development, inhibits fetal growth due to possible development of other nutrient deficiencies
excess intake
107
____ kcal distribution for CHO
50-70%
107
Required for cell division to proceed
folate
108
Deficiency affects cells that have a high rate of turnover
(e.g. RBC and the CNS)
folate
109
recommendation for folate
Recommendation: 300-400 μg/day
110
important contributor to the process of cell division
B12
111
concerned with amino acid metabolism and CHON
synthesis; believed to provide relief for nausea and
vomiting during early months of pregnancy
B6
111
serve as coenzymes for energy production
B1, B2, B3
111
believed to help alleviate symptoms of preeclampsia
and premature rupture of the cell membranes
C
111
positive effects on calcium balance and neonatal calcium homeostasis
D
112
fetal storage of the vitamin
A
113
believed to prevent spontaneous abortion
E
113
blood coagulation after giving birth
K
114
Needed to manufacture hemoglobin for both maternal and
fetal needs
Iron
115
Fetus acquires most of its ____ in the 3rd trimester when skeletal growth is maximum, and teeth are being formed
Ca
116
During 3rd trimester, fetus draws ___ mg per hour of Ca from the maternal blood _____ mg/day
13 mg; 250-300 mg/day
117
Believed to prevent pregnancy-induced hypertension
Calcium
118
Loss of teeth and hair during
pregnancy
Calcium Deficiency
119
Loss of calcium stores in mothers lead to early
______
osteoporosis
119
Excess _____ is detrimental for calcium
absorption (uses the same enzymes for digestion and
absorption)
phosphorus
120
Primarily important for males (spermatogenesis)
zinc
121
* Component of insulin
* Part of an enzyme that helps maintain acid-base
balance in tissues
* Acts in the synthesis of DNA and RNA
zinc
121
____ deficiency in rats has led to the development of congenital malformation
zinc
122
Maternal ____ deficiency has led to cretinism at birth
iodine
122
inadequate length and/or height
cretinism
123
________ during conception brings out
children with autism
Hypo or hyperthyroidism
124
_______ → role in iodine regulation
Thyroid
125
2nd trimester onwards ONLY
vit A
126
given in the 1st trimester
Iron and folate
127
Additional energy intake during last half of gestation
o Additional 200-300 kcal
127
Critical nutrients during 1st trimester
o Protein
o Folic Acid
o Vitamin B12
o Zinc
128
Critical nutrients during 2nd and 3rd trimester
o Protein
o Iron
o Calcium
o Magnesium
o B Vitamins
o Omega-3-fatty acid, docosahexaenoic acid (DHA)
129
Coffee max. amount
2 cups/day
130
need to provide supplements because diet will never be sufficient
iron
130
Cups of fluid
9-10
131
Amount of fiber per day
(20-25 g/day)
132
* Low nasal bridge, flat midface, indistinct philtrum, thin upper lip, short nose, minor ear abnormalities, microcephally, very low-low IQ
FAS
133
* Mice – decreased brain and liver weight
* Rats – reduced growth
Caffeine effect
134
sugarcannotentercells
hyperglycemia
135
Hyperglycemia in mother results in hyperglycemic child because placenta is immersed in the maternal blood
Causesmacrosomicinfant(excessivefetalgrowth
and fat deposition)
135
sign to stop exercise: labored or difficulty in breathing
dyspnea
135
Fetal pancreas is overworked in releasing insulin to lower glucose stores (Hyperglycemia)
Leads to hyperinsulinemia -> Macrosomic Infant
136
sign to stop exercise: lightheadedness, muscle weakness, blurred vision, feeling faint
presyncopal
