Midterm1 Flashcards
(178 cards)
1
Q
fecundity
A
biological ability to bear children
2
Q
fertility
A
actual production of children
3
Q
infecundity
A
biological inability to bear children after 1 year of unprotected intercourse
4
Q
infertility
A
absence of production of children
5
Q
approx. what % of couples are infertile/infecund ?
A
~15%
44% diagnosed as infertile will conceive within 3 years without technology
6
Q
chance of diagnosed conception within a given menstrual cycle
A
20 -25% for healthy couples
7
Q
women born with how many immature ova?
A
~ 7 million primordial follicles
8
Q
how many ova will mature and be released during fertile years?
A
~400-500
9
Q
women over age ___ more likely to have disorders related to chromosomal defects than younger women
A
35, sperm production also decreases after 35
10
Q
purpose of menstrual cycle
A
prepare ovum for fertilization and uterus for implantation
11
Q
hormones involved in menstrual cycle
A
Estrogen gonadotropin-releasing hormone (GnRH) follicle stimulating hormone (FSH) Luteinizing hormone (LH) progesterone
12
Q
2 phases of menstrual cycle
A
follicular phase - first half, 1-14
luteal phase - 14-28
13
Q
___ signals menstruation
A
drop in progesterone
14
Q
___ causes release of egg from follicle
A
LH
15
Q
if pregnancy occurs…
A
Progesterone and estrogen stay high to inhibit GnRH
16
Q
menstruation
A
decreased estrogen and progesterone and increased prostaglandins result in uterine wall contraction and release of outer wall as menstrual flow
17
Q
E2 stimulates …
A
hypothalamus to secrete GnRH
18
Q
GnRH stimulates ..
A
pituitary to release FSH and LH
19
Q
FSH…
A
promotes growth of follicles, stimulates secretion of E2 by follicle, stimulate maturation of ovum
20
Q
LH…
A
surge stimulates release of ovum from follicle, stimulates secretion of E2 and progesterone by follicle…stimulate endometrium to expand and store nutrients in prep for implantation
21
Q
corpus luteum
A
formed in luteal phase
secretes progesterone and E2 –> inhibit GnRH and stimulate development of endometrium
if implantation - continues to secrete E2 and P to maintain endometrium
no implantation - E2 and P decrease, removing inhibitory effect on GnRH
22
Q
FSH stimulated testes to..
A
release sperm/ production of sperm
23
Q
prostaglandins cause..
A
cramps in women and vaginal contractions to push sperm up
24
Q
in males LH stimulates…
A
production of androgens (testosterone) by testes
25
testosterone/androgens stimulate...
maturation of sperm
26
chronic under nutrition -->
birth of small/frail infants with high likelihood of death in first year
27
acute under nutrition -->
dramatic decline in fertility that recovers with food intake (more dramatic impact than chronic)
28
weight loss greater than ____ (and bad effects)
>10-15% decreased estrogen, LH, and FSH
| amenorrhea, anovulatory cycles, short or absent luteal phases
29
___% of infertility cases related to weight loss
30%
30
sperm viability and motility decreases when weight drops to _____ below normal and ceases if wt loss exceed ___
10-15%
| 25% of normal
31
how obesity decreases fertility
dip in estrogen needed to continue menstrual cycle
| fat cells produce estrogen and mask dips
32
fertility lower with BMI...
lower then 20 or greater than 30
33
iron and fertility
rate of infertility lower in women who use iron supplements
| pre-pregnancy iron deficiency linked to preterm delivery and low iron status of infant
34
in ___ PMS...
1987, moved from psychogenic to physiological category
35
PMS diagnosis
dependent on standard questionnaire
| 1-5 symptoms intense enough to disrupt work or social life for at least 2 consecutive luteal phases
36
PMS symptoms occur in
40% of women of childbearing age
37
premenstrual dysphoric disorder (PMDD)
5+ symptoms of PMS for at least 2 consecutive luteal phases, 1 symptom related to mood
38
dysmenorrhea occurs in ___ phase
follicular
39
causes of PMS
definite cause unknown
| related to changes in serotonin activity following ovulation
40
nutritional treatment of PMS
calcium - normalize (1000-1200mg)
vit D - above RDA
Vit B - above RDA
41
hypothalamic amenorrhea
weight related amenorrhea, functional amenorrhea
cessation of menstruation associated with underweight, weight loss...
caused by deficits in energy and nutrients
42
Leptin
messenger to hypothalamus of peripheral energy status
affected by hypothalamic amenorrhea
released by fat cells
43
female athlete triad
amenorrhea, disordered eating, osteoporosis
results in decrease in LH, FSH, estrogen
low estrogen --> reduction in bone mass
44
eating disorders affect ___% of young women
3-5%
45
obesity rates in US (20-39 yo)
33% of men (>30)
32% of women
5% massively obese (>40)
46
#! cause of infertility of women in US
polycystic ovary syndrome
47
Diabetes mellitus
intolerance to carbs with fasting glucose >126 mg/dL
48
type 1 diabetes
own body destroys pancreas and cant produce insulin
10% of cases, 1% of population
autoimmune disease
need insulin administration
49
type 2 diabetes
body cant use the insulin it produces or does not produce enough
11% of population
usually obese
50
gestational diabetes
3-7% of pregnancies
| usually obese
51
insulin resistance
cells resist action of insulin in facilitating transport of glucose into cells
cells have 1/4 functioning receptors
52
glycemic index
how body receives sugar from blood
53
glycemic load
glycemic index of food multiplied by grams of carbs divided by 100
54
polycystic ovary syndrome
endocrine disorder characterized by hyperandrogenism and insulin resistance
5-10% of women of reproductive age
majority are obese
any 2 out of 3: oligoovulation and/or anovulation
excess androgen
polycystic ovaries
55
cause of PCOS
uncertain
insulin resistance probably factor
genetic
androgen secreting tumors
56
management of PCOS
increase insulin sensitivity
57
PKU
phenylketonuria , hyperphenylalaninemia
elevated blood phenylalaine from lack of hydroxylase
in pregnancy --> impair CNS development
untreated, ~92% mental retardation
58
celiac disease
autoimmune disease
genetic susceptibility to gliadin portion of gluten
causes malabsorption and flattening of intestinal lining
~2 million in US
linked to infertility in some women and men because not proper nutrients
59
natality statistics
summary of pregnancy related and infant related outcomes
60
periconceptional
month before conception to month after conception
61
typical pregnancy length
40 weeks
62
preterm
37 weeks or before
63
very preterm
less than 34 weeks
64
embryo
until 12 weeks
65
fetus
2nd and 3rd trimesters
66
neonate
newborn
67
post natal period
after 1 month
68
neonatal
up to 1 month after birth
69
miscarriage
first 20 weeks of pregnancy
| genetic, uterine, or hormonal abnormalities
70
fetal death/stillbirth
if after 20 weeks
71
sequence of changes in maternal body composition
```
plasma volume - weeks 20
nutrient stores - 20
placental weight - 31
uterine blood flow - 37
fetal weight - 37
```
72
2 phases of changes during pregnancy
maternal anabolic phase, week 1-20
| catabolic phase, week 20-delivery
73
anabolic phase
build up nutrients, ~10% of fetal growth occurs
74
catabolic phase
nutrients delivered to fetus
90% of fetal growth
2nd half and end of pregnancy appetite decreases
75
preferred energy source for fetus
glucose
| mother become slightly diabetic/insulin resistant
76
key placental hormones
human chorionic gonadotropin (hCG) - maintains corpus luteum to maintain uterus for pregnancy
progesterone
estrogen
human chorionic somatotropin (hCS)
77
diabetogenic effect of pregnancy
makes women slightly carbohydrate intolerant in 3rd trimester
*to give glucose to fetus
hCS and prolactin inhibit conversion of glucose to glycogen and fat
78
about ___ lb of protein accumulate during pregnancy
2 lbs (baby, uterus, breasts, placenta, etc)
79
fat metabolism during pregnancy
stores accumulate in first half (anabolic)
| store mobilize is last half, blood lipid levels increase dramatically (50% increase in triglycerides)
80
placenta
lining of cells separates maternal and fetal blood
hormone and enzyme production
nutrient and gas exchange
removal of waste
81
epigenetics
fetal environment effects gene expression and later life
82
critical periods
most crucial during 1st 2 months after conception
when specific cells formed and integrated
characterized by hyperplasia
one way street
83
AGA
appropriate for gestational age
84
SGA
small for gestational age, weight <10th% for gestational age
85
dSGA
disproportionately small for gestational age
2/3 of SGA
low weight but normal length and head circumference
very skinny, nutrients or energy deficiency
malnutrition in 3rd trimester
greater risk of heart disease, hypertension, diabetes
86
pSGA
proportionately small for gestational age
1/3 of SGA
long term malnutrition in utero
adapted to low nutrient environment, do better
fewer health problems than dSGA
87
LGS
large for gestational age
weight >90th% for gestational age
prepregnancy obesity or excessive weight gain
delivery complications
88
___% of embryos are lost <20 weeks
30-50%
89
fetal-origins hypothesis of later disease risk
exposures to adverse conditions during critical periods of growth and development can permanently affect body structure and functions
90
___ causes increased risk of diabetes later in life
not enough glucose - receptors not there, stays in blood longer
too much -
91
greatest maternal weight gain during ...
24-28 weeks
| mother gains weight before fetus
92
normal weight mother should gain
25-35 lbs
93
underweight mother should gain
28-40 lbs
94
overweigh and obese mothers should gain
15-25 lbs
| 11- 20 lbs
95
need ___ additional Kcal/day
~300 additional
| total is 80,000 Kcal
96
minimum carb intake for pregnancy
175g, to meet fetal brain's need for glucose
45-65%
no pregnant - 130g
97
protein for pregnancy
+25d/day
or 71 for 2nd and 3rd tri
non preg - 46g
average intake ~78g
98
fat for pregnancy
energy source for mom, glucose goes to fetus
| ~33% of total calories
99
omega 3 fatty acids
EPA and DHA
300 mg
reduce inflammation, dilate blood vessels,
component of cell membranes
higher intelligence, vision, more mature CNS
100
folate
generic for folic acid
enzyme cofactor in DNA synthesis, gene expression and regulation
converts homocysteine to methionine
600 ug DFE
101
inadequate folate between ____ days after conception can cause ___
21-27 days after conception
| neural tube defects - most common congenital abnormality in infants (anencephaly or spina bifida)
102
vit A toxicity
from supplements >10,000 IU and use of Accutane and Retin-A (fat soluble can pass through skin)
retinoid acid syndrome - small or missing ears, brain malformations, heart defects
<5,000 IU of retinol in supplements
103
calcium requirement...
increases by 300 mg/d in 3rd tri
| calcium absorption and bone reabsorption increases
104
caffeine in pregnancy
no apparent long term consequences
| 4 cups is safe
105
pica
eating disorder
| consuming food you wouldn't typically consume
106
geophagia
eating soil
107
pagophagia
freezer frost eating
108
amylophagia
eating cornstarch
109
nausea and vomiting
nausea in 8/10, vomiting 5/10
most common weeks 5-12
treat: B6, multivits, ginger
110
hyperemesis gravidarum
severe nausea and vomiting throughout pregnancy
111
exercise recommended for pregnancy
3-5 times week for 30 mins at 60-70% VO2 max
112
good vs. bad cholesterol
good - HDL
bad- LDL
high LDL in obese mothers
113
visceral fat
around organs, under muscle
more metabolically active
white fat
bigger effects
114
subcutaneous fat
under skin surface, above muscles
brown fat
burns to produce heat and warm body
115
hypertension (HTN)
>140 mm Hg systolic or >90 mm Hg diastolic
| affects 6-10% of pregnancies
116
chronic HTN
diagnosed before pregnancy or 35 years old, history of HTN
117
gestational HTN
diagnosed >20 weeks for first time
no proteinuria
tend to be overweight/obese with extra central body fat
6% of pregnancies
118
preeclampsia/eclampsia
HTN diagnosed >20 weeks and proteinuria
headache, blurred vision, abdominal pain, low platelet count, abnormal liver enzyme levels
eclampsia = seizures
4% of first and 1.7% of subsequent pregnancies
119
chronic HTN pregnancy risks
preterm delivery, fetal growth retardations, placenta abruption, Cesarean delivery
120
proteinuria
urinary excretion of >.3 g protein in 24 hour urine sample
121
cause of preeclampsia/eclampsia
unknown, maybe abnormal implantation and vascularization of placenta with poor blood flow
122
recommendations for preeclampsia
adequate calcium and vit D, mutivits/minerals, >5 servings of colorful veggies and fruits, fiber, moderate exercise, recommended weight gain
123
first approach for management of gestational diabetes
medical nutrition therapy to normalize blood glucose levels with diet and exercise
124
type 1 diabetes during pregnancy
more hazardous than gestational or type 2
kidney disease, hypertension,
newborn mortality, SGA or LGA, hypoglycemia after birth
125
dizygotic twins
fraternal, 2 eggs fertilized
| 70% of twins
126
monozygotic twins
identical, 1 egg
| 30% of twins
127
chorion
outer membrane, around amniotic sac
128
3 possibilities of placentas/sacs
2 amniotic sacs, 2 chorions, 2 placentas
1 amniotic sac, 1 chorion, 1 placenta (most risk for problem because shared sac and placenta)
2 amniotic sacs, 1 chorion, fused placentas
129
vanishing twin phenomenon
6 to 12% of pregnancies begin as twins with only 3% born as twins
silently occur into uterus within 1ist 8 weeks
130
___% chance of transmitting HIV to fetus
```
20%
34 million people have HIV
placenta normally barrier for virus and bacteria,
can also be passed through breast milk
not related to adverse pregnancy outcome
```
131
calcium RDA for pregnant teens
1300 mg
132
alveolus
functional units of mammary gland
hallow cavities
secretory cells with duct in center
133
letdown
milk ejection
| myoepithelial cells contract to cause milk to be secreted into ducts
134
lobes
groups of alveoli
135
lactiferous sinuses
dilations behind nipple for storage of milk, drains into opening of nipple
136
lactogenesis
milk production
lactogenesis I - pre birth to 2-5 days after, begins in form of colostrum
lactogenesis II - 2-5 days after birth, milk "comes in"
lactogenesis III - ~10 days after birth, milk composition is stable
137
prolactin
produced by pituitary
triggers cells in alveoli to produce milk
released in response to suckling
inhibits ovulation
138
oxytocin
produced by pituitary
stimulates milk let down from acinus into dcut
tingling of breast
causes uterus to contract
139
human milk is only food source needed for...
first 6 months
| solid food at 4-6 months for jaw development
140
colostrum
first milk secreted during first few days postpartum
very high in proteins (secretory IgA and lactoferrin)
lower calories
high vit A - yellow color
141
IgA
component of immune system
| starts coating intestinal lining to create barrier against pathogenic bacteria
142
lactoferrin
barrier to protect bad bacteria, bind to receptors on bacteria and produce peroxides to kill it
143
energy in human milk
20 Kcal/oz
| lower than milk substitute
144
lipids in human milk
~1/2 energy in human milk
| fat content remains stable but depends on what mother eats
145
casein
main protein in mature human milk
white appearance
total protein content lower than cows milk
146
whey
proteins the remain soluble in water after casein is precipitated out
147
non protein nitrogen
20-25% of nitrogen in human milk
| used to make non essential amino acids, hormones, etc.
148
fat soluble vits in human milk
```
A - most in colostrum
D -
E
K - 5% of breasted infants at risk of deficiency
coagulation factors, bleeding
k injection at birth
```
149
___ expressions/day for first couple weeks are necessary to stimulate adequate milk production
8-12
| every 1.5-2 hours
150
optimal duration of breastfeeding
AAP - 1 year or longer
| US surgeon general - exclusively for 6 months and best to breastfeed for 12 months
151
rooting reflex
turns to side when stimulated on that side
152
hunger signaled by ...
bringing hands to mouth, sucking on them, moving head from side to side
crying
153
feeding frequency
10-12 feeding/day
| stomach emptying occurs in ~1.5 hours
154
normal weight loss for newborns
~7% of birth weight in 1st week
| of 10% needs to be evaluated
155
by day 5 to 7, infants should have ___ wet diapers and __ soiled per day
6 wet
| 3-4 soiled
156
energy needs for lactation
+330 for 1st 6 months, +400 afterward
157
letdown failure
milk does not eject from breast, very uncommon
oxytocin nasal spray may be prescribed
relaxation techniques
158
engorgement
when supply and demand process not yet established
| most common from day 2-3
159
mastitis in ___% of breastfeeding women
1-33%
| most common at 2-6 weeks
160
most common reason for cessation of breastfeeding
low milk supply (real or perceived)
from insufficient breastfeeding/pumping, ineffective emptying, stress
drug to increase prolactin (after day or two)
161
effect is ___ for majority of drugs (for breastfeeding))
unknown
162
HIV transmission rates for breastfeeding
5 to 20% depending on duration
goes up to 40-50% for 1-2 years
US says don't do it
choice not clear in developing counties - more risk of death from bad water
163
alcohol and breastfeeding
passes to breast milk
| peak plasma levels 30-60 mins after consumption if w/o food, and 60-90 min if with food
164
alcohol decreases ....
oxytocin and let down
165
alcohol and breastfeeding affects...
odor of milk, volume baby wants to consume, sleep pattern
166
smoking and lactation
health risks for infant
not good, but better than not breastfeeding
1/2 life of nicotine is 95 mins so delay feeding after smoking
167
milk banks and cost
~12 in north America
| $3.50 / ounce
168
jaundice
yellow color, 40% of full term 80% of preterm
| caused by high levels of bilirubin (hyperbilirubinemia)
169
bilirubin
breakdown product of heme
170
bilirubin metabolism
fetal stage, high levels of hemoglobin to carry oxygen
high levels of hemoglobin at birth
RBC begin to breakdown after birth, high hemoglobin not needed
usually processed by liver and excreted in stool
liver not fully mature so jaundice is common
171
Total serum bilirubin (TSB)
balance between rate of production and rate of excretion
172
physiological jaundice
resolves on own with no damage
begins 1st day, peak 6-7 days
bilirubin <12mg/dL
cause: normal heme breakdown
173
pathological jaundice
```
if hyperbilirubinemia become severe, elevated bilirubin can cause permanent neurological damage
rises rapidly and lasts longer
bilirubin >8mg/dL in 1st day
medical intervention with phototherapy
cause: various pathological conditions
```
174
most frequent cause for hospital readmission for newborn
hyperbilirubinemia
175
kernicterus or bilirubin encephalopathy
```
bilirubin toxic to cells and may cause brain damage
cells do not regenerate
mortality rate 50%
survivors: cerebral palsy, etc.
baby blood brain barrier not developed
```
176
breast non-feeding jaundice/breastfeeding failure jaundice
```
early onset (Day 1-2), peaks 2-5
due to suboptimal breastfeeding
```
177
breast milk jaundice syndrome
late onset (day 3-5), peak 2nd to 3rd week
baby starving
potentially due to substances in milk that increase bilirubin in reabsorption or individual variation in processing
cause is unknown
typically reabsorbs itself and is extension of physiological jaundice
178
treating jaundice
phototherapy- light absorbed in bilirubin changing it to water soluble product that can be excreted
encourage continuation of breastfeeding
