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Preconception Nutrition

• Adequate health and nutrition are needed for successful reproduction.
• Conception may still occur with poor nutritional status, but it will compromise the fetus's growth, development, and the mother’s health.

Preconception Definitions & Stats

• Fertility is the actual production of children and best applies to vital statistics.
• Fecundity is the biological ability to bear children.
• Healthy couples have an approximate 30% chance of conception within a menstrual cycle.
• Infecundity (infertility) is defined as the biological inability to bear children after one year of unprotected intercourse, and it affects 18% of couples in the Western world.
• A miscarriage is the loos of conception in the first 20 weeks with the causes can be defects in the fetus, maternal infection, structural abnormalities of the uterus, or endocrine or immunological disturbances.
• Subfertility is reduced fertility characterized by an unusually long time for conception.

Reproductive Physiology

• Reproductive systems develop in utero and continue growing until puberty.
• The ability to reproduce occurs during puberty due to hormonal changes, stimulating the maturation of the reproductive system.

Female Reproductive System

• Females are born with a lifetime supply of immature ova (~7 million), and are stored in the ovaries; with 400-500 eggs maturing and being released (eggs).
• Chromosomal damage of ova occur with age, oxidation, stress, radioactive exposure, etc.
• The menstrual Cycle (~4 week interval) has hormones that direct a buildup of blood & nutrients within uterus.
• The purpose of the menstrual cycle is to prepare the ovum for fertilization by sperm and the uterus for implantation of a fertilized egg.

Hormonal Changes during Menstrual Cycle

• Gonadotropin-releasing hormone (GnRH) is secreted by the hypothalamus and Stimulates pituitary to release FSH & LH.
• Follicle-stimulating hormone (FSH) stimulates maturation of ovum & sperm production.
• Luteinizing hormone (LH) stimulates ovulation and secretion of estrogen, progesterone, & testosterone.
• Estrogen stimulates release of GnRH in follicular phase and inhibits it in luteal phase, as well it stimulates vascularity & storage of glycogen & other nutrients within uterus.
• Progesterone prepares uterus for fertilized ovum, increases vascularity of endometrium and it stimulates cell division of fertilized ova.

Phases of Menstrual Cycle

• Follicular Phase is the first 14 days, has follicle growth & maturation and increased LH causes ovum release from follicle which is called ovulation.
• The Luteal Phase (last 14 days) forms corpus luteum (formed from follicle; produces estrogen & progesterone).

If not fertilized, decrease in both estrogen & progesterone stimulate menstrual flow. Prostaglandins cause cramps & uterus contractions, releasing stored blood & nutrients. If fertilized, it implants 8-10 days later.

Male Reproductive System

• Sperm production begins during puberty but decreases after age 35 as lifetime production of sperm.
• FSH and LH signal testosterone by testes.
• Sperm maturation takes 70-80 days, then transported to epididymis.
• Upon ejaculation, it mixes with other secretions to form semen.
• Semen is rich in zinc, fructose, and Vitamin E.

Factors Related to Impaired Fertility

• For both males and females, weight loss of greater than 15% of normal weight, negative energy balance, inadequate or excessive body fat, extreme levels of exercise, high alcohol intake, endocrine disorders, structural abnormalities of the reproductive tract, celiac disease, crowding, severe stress, infection, or diabetes can impair fertility.
• In women, recent oral contraceptive use within 2 months, anorexia nervosa, bulimia nervosa, high coffee/caffeine intake, a high-fiber intake and Vegetarian diets can impair fertility.
• In men, inadequate zinc status, inadequate antioxidant status, heavy metal exposure, estrogen exposure, chromosomal abnormalities in sperm, excessive heat to testes or steroid abuse can impair fertility.

Nutrition and Fertility

• Nutrition primarily affects fertility by alternating environment that allows the sperm and eggs will develop.
• Nutrition modifies hormone levels that involve reproductive processes.

Undernutrition

• Chronic undernutrition's primary effect causes low birth weight (LBW) infants, which leads to high death rates in the first year of life.
• Acute undernutrition is associated with a dramatic decline in fertility that recovers when food intake does.

Body Fat Levels

• Decreased fertility is seen in both low and high body fat due to alterations in hormones.
• Estrogen, testosterone & leptin are produced by fat cells.

Levels of body fat in Women with high levels are increased and low levels are reduced. In Men, obesity lowers testosterone & increases leptin. Both extremes of body fat levels lower fertility.

• Lower fertility also occurs with BMI <20 or >30.

Obesity and Underweight Causes

• Both Obesity and being underweight contribute to menstrual cycle irregularities and it can lead to infertility.

short or absent luteal phases (less than 10 days). anovulatory cycles: Ovulation doesn't occur. amenorrhea: Absence of menstrual cycle.

• In men, obesity and underweight reduces sperm viability and motility and decreases sperm production.

Excessive Exercising

• Delayed onset of menstruation and abnormal cycles in competitive athletes.
• Abnormal cycles normally due to calorie deficits, not necessarily the exercise amount.

Periconceptional Period

• This is the time around conception representing a critical time when nutrition and other exposures can impact conception, pregnancy maintenance, and the growth, development and future health of the offspring.

Preconception Counseling

• Primary health care visits should include

preconception & pregnancy outcome education screenings for vaccinations, weight status, iron & folate levels assessment of drug & alcohol abuse management of current diseases (DM, celiac disease, etc.)

Key Terms

• Infant mortality is the death that occurs in the first year of life.
• Liveborn infant is when a completely expelled or extracted fetus breathes or shows any signs of a heart beat, pulsations of the umbilical cord, or definite movement of voluntary muscles.

Physiology of Pregnancy

• Gestational age is calculated from the time of conception, approximately 38 weeks.
• Menstrual age is calculated from LMP, approximately 40 weeks, which includes 2 nonpregnant weeks.

Maternal Physiological Changes

• Plasma volume and maternal nutrient stores increase around week 20.
• The placental weight and uterine blood flow increase around week 31.
• Fetal weight increases by week 37.

Maternal Changes

• Anabolic state occurs during 0-20 weeks when mother's body is in "building" where It increases capacity to deliver blood, oxygen, and nutrients to fetus, and it only accounts for 10% of fetal growth.
• Catabolic state occurs during is 20+ weeks when stored energy and nutrients are delivered to fetus which make up to 90% of fetal growth

Hormonal Changes

• Human Chorionic Gonadotropin (hCG) stimulates corpus luteum to produce estrogen & progesterone until the placenta takes over after 2 months and it stimulates endometrium growth. _ Progesterone (“pro-gestational” hormone) maintains implantation by keeping uterine lining thick, relaxes smooth muscles in the uterus & GI tract, & increases secretions from sweat glands.
• Human Chorionic Somatotropin (hCS) alters mother's metabolism to use more FA for energy and increases glucose availability for fetus. Estrogen helps uterus grow & thickens uterine wall, as well it promotes breast growth.
• Oxytocin prepares uterus for contractions before, during & after delivery and prompts mammary glands to secrete milk.

The Placenta's Role

• Umbilical cord connects placenta to fetus.
• Placenta is both needed for waste removal and nutrient & gas exchanges.
• Placenta is expelled after birth.
• Double lining of cells separate maternal & fetal blood and if the mother is RH- they must receive a shot to protect against antibody formation to RH+ fetus
• Nutrients first used for maternal needs, then for placenta & last for fetal needs.
• Undernourished mothers and underweight women need to increase nutrient amounts and weight during pregnancy.

Fetal Growth and Development

• Growth is the increase in size through cell replication and enlargement,
• Development is the progression of physical and mental capabilities through growth and differentiation of organs, tissues, and integration of functions.

There are 4 key stages of growth, hyperplasia, hyperplasia & hypertrophy, hypertrophy and finally maturation.

Factors Affecting Fetal Growth

• Key factors affecting the growth include the availability of energy, nutrient, and oxygen.
• Insulin-like growth factor-1 (IGF-1) is primary growth regulator.

promotes uptake of nutrients & inhibits fetal tissue breakdown it is sensitive to maternal nutrition. low levels produce asymmetrical growth.

Newborn Weight Classifications

• LBW (Low Birth Weight) is classified < 2500 g (5.5 lbs)
• VLBW (Very Low Birth Weight) is classified <1500g (3.3 lbs)
• ELBW (Extremely Low Birth Weight) is classified <1000g (2.2 lbs)
• SGA (Small for Gestational Age) is a birthweight at < 10th percentile.
• AGA (Appropriate for Gestational Age) is a birthweight between 10th and 90th percentile.
• LGA (Large for Gestational Age) is a birthweight >90th percentile.

Pregnancy Weight Gain Recomendations

• First trimester :~2-5 lbs
• 2nd and 3rd Trimesters: ~ 1 lb/wk

Dietary Needs During Pregnancy

• Energy: Increase by +342 cal/day in the 2nd trimester and +452 cal/day in the 3rd trimester
• CHO: 50-65% of calories (175g)
• Protein: 1.1g/kg BW (71g)
• EPA & DHA: 300 mg/day but no more than 2g/day, which boosts brain and nervous system development, increasing high IQ and lengthening gestation time.
• Water: 3L/day
• Folate: 600µg/day (400µg from supplements or fortified foods). From supplemet on empty stomach to food sources like dark leafy greens

Neural tube defects (NTDs)

• Refers to malformations of the brain and spinal cord.

• Can included

  • Spina Bifida: failing of spinal cord to close
  • Anencephaly: absence of brain or spinal cord
  • Encephalocele: protrusion of the brain through the skull

• Vitamin A is not good to consume in high doses

• Calcium: Additional 300mg/day required

• Iron: 27 mg/day and supplement an additional 1000mg

  • 300 mg used by fetus and placenta
  • 250mg lost at delivery.
  • 450 mg used to increase RBC mass

Glucose Screening

• Is administered from weeks 24-28
• Acceptable Values
  • Fasting : <95 mg/dL
  • 1 hour post prandial : 110-140 mg/dL
  • 2 hours post prandial : 100-120 mg/dL
• Inital Step
  • normalize blood glucose levels with diet and exercise
• Step To Do After
  • Postprandial Glucose remains to high despite diet and exercise changes. Metformin and our insulin injections are added
• Medical Nutrition Therapy Decrease risk of adverse perinatal outcomes.
  • Exercise helps with BG Control

Multifel Pregances

• Have increased in US due to assisted reproductive Technologies
• Considered high risk and additional Precations taken
• In 2023,3.1% of births resulted in multiples
  • Twin Birth Rate : 31.2
  • Triplet / Higher birth rate : 78.9

Dizgotic vs monozygotic

• Known as Fraternal Twins
  • 2 eggs are fertilized by 2 different sperm
  • Same sex half the time
  • Different genetic fingerprints
• Monozygotic
  • AKA Identical
    • 1 egg is fettilized then forns 2 egs
    • always same sex

Recommended weight gain in MultiPregacies (Number of Babies)

• Twin
  • 37-54 normal weight
  • 32-50 overweight
  • 25-42 Obese
• Weight Gain in Triplet pregnancy
  • Normal Is gain of ~ 50 Pounds

Fetal Alcohol Spectrum Disorders

• Describes a range of effects that fetal alcohol effects have on mental development and physical growth
• Can include
  • Behavioral Problems, Mental retardation, aggressiveness, stunting growth and birth defects
• No safe dose has been identified therefore women should not drink when Preganat

Changes in "TERM" Guidelines

• For Gestation*
• early term (37 0/7 weeks)
• full term (39 0/7 weeks)
• late term (41 0/7 weeks),
• postterm (42 0/7 weeks)

Preeclampsia

• Characterized by high blood pressure after 20 weeks
  • Can include Edema and Headacehs with blurred vision, and Decrease of Urinal Outlput

Risk Factors For Preeclampsia

• First Pregnancy, Obesity, American, or African American, and History of Preclampsia in prior pregnancies and Renall Disiese

Treatment

• Delivery Baby by C- Section

###Gestational Diabetes

• Occurs 6-9% of pregnancies
• Predisposed to insulin resistance and type 2 DM
  • Increased Glucose in mother reaches fetus and can cause birth defects

Chapter 6: Lactation

Lactation Physiology Terms

• Source of milk for offspring (aka breast)
• Rounded or oblong shaped cavity present in breast
• Cells in acinus (milk gland) that are responsible for secreting milk components into ducts
  • Myoepithelial cells - Line the alveoli can contract cause milk to be secreted into ducts
  • Oxytocin
    • Hormone Produced during letdown that causes milk into ducts
  • Lactiferous sinuses
    • Storage of Milk behind Nipple

Mammary gland development during Puberty

o the ovaries mature with increases in estrogen & progesterone (cyclic releases causes breast development)

Hormone levels change to Breast feed

Composition milk changes in lactation

• Lactogenesis 1(milk formation begins)

  • stage 2 increased blood flow
    • Milk comes In
    • Begins about 10 days after delivery

• water and energy - Isotonic with maternal plasma

  • lipids
    • Effect of maternal on fat composition
    • Fatty acid profile
    • DHA (docosaherxaenoic acid)
      • essential for eye retinal
      • higher IQ

Oligsaccarides - Stimulates growth if bifidus which Prevent - infection/dhiheria

Breast Feeding For Mother

• risk of cancer lower
• increases oxycontin to return to pre pregnancy
• delay in ovulation
• increased self-confidence & bonding with infant

For Infant - Nutritional benefits

- Immunaological Benefits 	- Decrease infant mortality or acute illnesses
- Reductions in chronic illnesses
- Cognitive 
- Socicoenecomci 
-	Analgesic effects

Feeding Tips

• Make 10 -12 day amount for new borns
• Make sure baby is fully drained for proper nutrition
• New born stomach size - Small like marble will grow

Diet

• Increase 500 cal
• Make sure take water

Mastits

• Backterial Infection
• Usually At 2-3 weeks

Tobacco

• Is 3x levels when consuming smoking products

Alcohol

• Affects Oder, Volume, and Sleep Patterns

Guidlines for storage of human milk

• Freshly expressed into 	- 6-8 hrs 
  

  -Refrigerator - 3 - 5 days -Frozen - 3/6 months

-Human Milk Banks