Nutrition Study Guide Test 1 PDF

Nutrition Study Guide Test 1 Chapter 1: Carbohydrates Simple Sugars - Monosaccharides: glucose, fructose, galactose - Disaccharides: sucrose, maltose, lactose Complex Carbohydrates - Starches: plant form - Glycogen: animal form - fiber Alcohol Sugars, Al...

Nutrition Study Guide Test 1 Chapter 1: Carbohydrates Simple Sugars - Monosaccharides: glucose, fructose, galactose - Disaccharides: sucrose, maltose, lactose Complex Carbohydrates - Starches: plant form - Glycogen: animal form - fiber Alcohol Sugars, Alcohol (ethanol) Recommended intake level - 45-65% - 21-25 grams fiber (female) - 30-38 grams fiber (male) Protein High quality proteins - Milk, cheese, meat, eggs, etc.  Recommended protein intake - 10-35% Fats Lipids - Fats: solid at room temp - Oils: liquid at room temp Triglycerides - 3 fatty acids to glycerol Essential fatty acids - Linoleic acid: parent omega-6 (seed oils) - Alpha-linolenic: parent omega-3 (sea fish and flax seeds) Hydrogenation and trans fat - Adds hydrogen to unsaturated fatty acids - Changes structure of fatty acid from cis to trans structure Dietary Cholesterol - Fat-like, clear liquid in animal products - Precursor to vitamin d, estrogen, testosterone - Egg yolks, meat, milk, milk products, fats (butter) Recommended intake - 20-35% - No trans fats Vitamins Fat-soluble vitamins - A, D, E, K Water Soluble Vitamins - Thiamin, Riboflavin, Niacin, B6, Folate, B12, biotin, pantothenic acid, choline, vitamin c Minerals 15 essential minerals - Calcium, phosphorus, magnesium, iron, zinc, fluoride, iodine, selenium, copper, manganese, chromium, molybdenum, sodium, potassium, chloride Water Adults are 60-70% water - 15-16 cups (male) - 11 cups (female) - Nutrition Assessment ABCDs of nutrition assessment -Anthropometric measures - Biochemical tests - clinical observations - Dietary intake Chapter 2:Preconception Nutrition Begin preparing 3 months Infertility - 15% couples infertile - 44% couples eventually conceive - 20-25% healthy couples conceive Miscarriage: loss of conceptus first 20 wks pregnancy - Defects in fetus - Maternal infection - Structural abnormalities of uterus - Endocrine or immunological disturbances Subfertility: reduced level fertility characterized by unusually long time for conception - 18% couples - Sperm abnormalities - Multiple miscarriages - Infrequent ovulation Female Reproductive system and Hormone Menstrual Cycle- 28 days - Follicular phase (1st) - Luteal phase (2nd)  - 4 hormones- follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone Hormonal eaects during menstrual cycle - Gonadotropin-releasing hormone (GnRH) Stimulates pituitary to release LH and FSH - Follicle-stimulating hormone (FSH) Stimulates growth of ova - Luteinizing hormone Stimulates secretion of progesterone  Follicular Stage: - Anterior pituitary released FSH and LH travel to ovaries - 15-20 eggs then grow, in own follicle - Estrogen levels rise because of increase in FSH - Enough estrogen is released, FSH is turned oa, limiting number of follicles that mature - One follicle becomes dominant and mature Luteal Stage - 14 days after Follicular stage - Estrogen stimulates the release of LH, which causes the follicle to release its egg from the ovary (ovulation occurs) - Empty follicle becomes corpus luteum, which secretes progesterone - Progesterone readies the uterus for a fertilized egg - Egg not fertilized, menstruation occurs Contraceptives contain forms of estrogen (birth control) - Estradiol and progestin suppress the action of LH and FSH thereby ovulation - Progestin blocks LH and ovulation and induces a barrier to sperm by causing cervical mucus to become thick and sticky Chapter 3: Preconception Nutrition: Conditions and Intervention Obesity /Overweight Lose 5-10% of body weight to restore ovulation Cause PCOS, insulin resistance, issues with menstruation and ovulation Increased fat tissue enhances endogenous and exogenous steroidal hormones and increase storage of lipid soluble steroids Change in metabolism and excretion of hormones or altered production or steroid binding proteins (SHBG) Product too much estrogen from adrenal androgens Excessive estrogen feedback to HPO axis and inhibits ovary function Diabetes and Infertility Type 1, 2 Gestational - Chronic high blood glucose levels aaect hormone levels Carbohydrate counting to manage Polycystic Ovary Syndrome (PCOS 5-10% women High levels of intra-abdominal fat Insulin resistance is the leading cause Hyperinsulinemia linked to hyperandrogenemia - Insulin acts with LH to enhance androgen production in the ovary - Insulin decreased hepatic synthesis and secretion of sex hormone- binding globulin, hormone that binds testosterone in circulation, increasing the amount of free testosterone Increase insulin sensitivity - Insulin-sensitizing drugs Diet recommendations - Lean proteins, whole grains, fruits and vegetables, regular meals, non-fat dairy, and low-glycemic index carbohydrates Underweight Low BMIS may develop anovulation and amenorrhea Reduced hypothalamic production of gonadotropic releasing hormone To increase BMI, eat more food Hypothalamic amenorrhea - Loss of menstrual cycles due to absence of ovulation - Deficits of energy and nutrients Anorexia nervosa and bulimia nervosa are linked to hypothalamic amenorrhea - More likely to miscarry, have preterm delivery, and deliver low birthweight infants Theory of nutritional infertility - Low fuel detected by neuron cells - Release neuropeptide Y and catecholamines - Work on hypothalamus to block GnRH so that no ovum or sperm will grow Negative Energy Balance Female athletic triad Energy intake is 30% less than required Decrease in LH, FSH, and estrogen Treatment includes - Correction of negative energy balance - Restoration of ovulation - Bone mass accretion Vitamin and Mineral Deficiencies untreated Celiac Disease Folate- lactose maldigestion, intolerance Vitamin B12- weight loss Vitamin A- anemia Vitamin D- osteoporosis Vitamin E- Subfertility Vitamin K- growth failure, irritable bowel disease Calcium and Iron - Treat celiac disease by eliminating foods that have gluten and replacing them with rice, soy, corn Nutritional recommendations During Conception Women need folate, iodine, DHA, multivitamins  Men need zinc and antioxidants Iron - Creates hemoglobin which attaches to red blood cells and delivers oxygen throughout the body - 27 mg per day - Iron supplements Iodine - Thyroid function - Drink water, iodized salt, seafood - Reduce stress, increase exercise Multivitamin - Prenatal vitamin Coaee - No more than 200 mg - Caaeine contributes to miscarriage and low birth weight Chapter 4-1: Nutrition During Pregnancy Status of pregnancy outcomes Low birthweight (2500 g), preterm delivery, infant mortality - 8% (66% of infant deaths) LBW - 11.4% born preterm Reducing infant mortality and morbidity - Desirable birth weight: 3500-4500 grams (7lbs 12oz- 10lbs) - Less likely to develop heart and lung diseases, diabetes, and hypertension Physiology of Pregnancy Gestational age (doctors) - Assessed date of conception - 38 wks Menstrual age - Assessed day of last period - 40 wks Maternal anabolic phase: first 20 weeks of pregnancy - Mother’s body builds capacity to deliver all blood, oxygen, and nutrients to fetus required during the second half of pregnancy - Mothers symptoms: increased appetite, increase in anabolic hormones, decreased exercise tolerance Maternal catabolic phase: last 20 weeks of pregnancy - Mobilization of stored nutrients - Mothers symptoms: increase in catabolic hormones, increase in exercise tolerance Insulin Development of placenta - Large endocrine organ that develops in the uterus within first several weeks of conception - Secretes vital hormones - Fights internal infections - Exchanges nutrients and oxygen from the mother to the fetus  - Removes waste product from the fetus to the mother’s blood supply Change in hormones - Expecting mother relies on Specific hormones such as progesterone, estrogen, human chorionic gonadotropic (hCG), leptin, and human chorionic somatomammotropin Changes in body water Increase 7-10 L Building blood and tissues first trimester First weeks: 50 ml during 10th week to 800 mL 20th week of gestation Maternal nutrient metabolism during pregnancy - Calcium metabolism occurs with bone turnover and reformation - Increased levels of body water and tissue synthesis require sodium and other minerals Embryonic and Fetal Growth and Development Hyperplasia Hyperplasia and Hypertrophy Hypertrophy Maturation Insulin-like growth factor (IGF-1) is the main fetal growth stimulator Pregnancy Weight Gain Normal is 25-35 lb 1/3 weight gain goes to fetus Increase body fat helps meet nutritional needs of the mother and fetus 30,000 calories Nutrient needs: - Carb intake: 45-65% - Alcohol: none - Protein intake: increase - Fat: 33% - Need omega-3 fatty acids, EPA, DHA Carbohydrate metabolism - Glucose preferred fuel for fetus (50-80%) - Early pregnancy: high estrogen and progesterone stimulate insulin need more glucose to conversion to glycogen and fat - Late pregnancy: human chorionic somatotropin (hCS) and prolactin inhibit conversion of glucose to glycogen and fat Protein Metabolism - Maternal protein accumulates in blood, uterus, breasts, fetus, placenta, and amniotic fluid - Need high amounts for rapid growth of maternal and fetal tissues (2nd and 3rd trimesters) - Natural decline in total nitrogen Fat metabolism - Fat stores accumulate in first half and enhance fat mobilization in last half - Blood lipid levels increase - Increase cholesterol is used for steroid hormone synthesis and by the fetus for nerve and cell membrane function - Does not increase risk of atherosclerosis Vitamins and Minerals during pregnancy - Folate - Iron - Vitamin A - Vitamin D - Calcium  - Sodium Water - 300 mL/day - Help with prevention of edema Sweeteners - FDA approved: acesulfame K, aspartame, saccharin, sucralose (Splenda) - Consume in moderation Lead exposure - Impact children’s cognitive function - Elevated blood lead levels can be toxic to developing brain - Interferes with calcium and iron absorption - Slow growth and shorter stature Gastrointestinal disturbances - Nausea, vomiting, diarrhea, and constipation Nausea and vomiting - 6th week, stop around 12th week - Fluid intake Diarrhea - Causes include infectious agents, medications, food poisoning, food intolerances, lactose, fructose, sorbitol and mannitol intolerances; inflammatory bowel disease (IBD); IBS - Rehydrate and electrolytes - High fiber diet, stool bulking agents, and adequate fluids Heartburn - Relaxation of GI muscles secondary to an increase in estrogen and progesterone - Stomach contents move into esophagus, causing heartburn or more severely gastroesophageal reflux disease (GERD) - Pressure from uterus and fetus can cause heart burn Gastroesophageal reflux disease - Impact of fluctuating hormones on the function of the lower esophageal sphincter - Triggers are eating before bed, intake of fatty or spicy foods, caaeine, mints, chocolate, and side eaects of medication Constipation - Third trimester  - Increase fiber and fluid - Do not take laxatives Pregnant women still need 30 minutes of exercise five times a week or 150 minutes total Anxiety and depression most common mental health issues Chapter 4-2: Nutrition During Pregnancy Vitamins and Minerals During Pregnancy Folate - Metabolic reactions - Deficiencies lead to congenital abnormalities - Check folate status by assessed by serum and red cell folate levels - Vegetables and fruit - 600 mcg Neural Tube Defects Failure of the neural tube to close early in gestation Diagnosis: alpha-feta protein and fetal ultrasound 4 mg folic acid Anencephaly and spina bifida - Ectoderm folds and eventually forms a tube - Tube closes day 22-28 of gestation - Forms spinal cord and brain Causes of NTD - Lack of folic acid or vitamin B12, magnesium, zinc - Obesity - Glucose intolerance/diabetes - MTHFR genotype (methylenetetrahydrofolate reductase) - Women who take anti-seizure drug valproate without appropriate folic acid supplementation Dietary Folate equivalents (DFE) 1 mcg food folate 0.6 mcg folic acid consumed in fortified, or a supplement taken with food 0.5 mcg of folic acid taken as a supplement on an empty stomach The need for vitamins and minerals during pregnancy Choline: B-complex vitamin - RDA: 450 mg Vitamin A - Needed for baby’s embryonic growth, including the development of the heart, lungs, kidneys eyes and bones as well as the circulatory, respiratory, and central nervous systems - Helps postpartum tissue repair  - Helps maintain normal vision, fights infection, supports your immune system and helps with fat metabolism - (4000 IUS – no more than 8000 IUS Vitamin D - Supports fetal growth - RDA: 15 mcg (600IU) - Upper limit: 4000IU - Deficiency leads to smaller bones, poorly calcified bones and abnormal enamel, dental cavities - Higher risk for preeclampsia, preterm birth, maternal infection - Obese and vegan at risk Calcium - Needed for fetal skeletal mineralization and maternal bones - Three cups of milk or calcium-fortified soymilk or other adequate sources Iron - 300mg for fetus and placenta - 250 mg lost at delivery - 450 mg for increased red blood cell mass - iron deficiency: depleted iron stores - Weakness, fatigue, short attention span, poor appetite, increased susceptibility to infection and irritability - Iron deficiency anemia: low hemoglobin - Paleness, exhaustion, rapid heart rate - Iron deficiency anemia in pregnancy can lead to preterm delivery and low birth weight - Can be improved by regular consumption of vitamin C (watch calcium intake) - 18-27 mg of elemental iron - Mild anemia: no eaect - Moderate anemia: increased weakness, lack of energy, fatigue and poor work performance - Severe anemia: palpitations, tachycardia, breathlessness, increased cardiac output leading o to cardiac stress which can cause de- compensation and cardiac failure - Baby could be born preterm and have low birth weight, stillbirth, newborn death, anemia in future  - 30-mg iron supplement daily Iodine - Required for thyroid function and energy production and for fetal brain development Sodium - Bodies water balance - No restriction Coaee/Caaeine - 3 cups daily Water - 9 cups fluid a day Chapter 5: Nutrition During Pregnancy: Conditions and Interventions Obesity and Pregnancy Several unfavorable metabolic changes - Increased blood glucose levels - Blood concentration of insulin - Insulin resistance - Blood pressure - High C-reactive protein levels - Low HDL-cholesterol Eaect on Mothers 1. Hypertension 2. Gestational diabetes 3. Thromboembolism 4. Obstructed sleep apnea 5. Hemorrhage 6. Labor problems 7. Pregnancy loss Eaect of Baby 1. Malformation 2. Macrosomia 3. Birth injury 4. Perinatal death 5. Later diabetes & obesity Consume variety of basic foods Physical activity Weight loss not recommended Pregnancy weight gain - Underweight: 28-40lb - Normal: 25-35lb - Overweight: 15-25lb - Obese: 11-20 lb - Twin Pregnancy: 25-54 Pregnancy after bariatric surgery - Deficiencies of many nutrients - Thiamin, vitamins D, B12, folate, iron and calcium Inadequate weight gain during pregnancy  Need to eat a balanced diet of meals and snacks, listen to hunger and fullness cues, and engage in physical activity Diabetes in Pregnancy Gestational Diabetes - Predisposed to insulin resistance and have impaired insulin production - 2-12% (88% of pregnancy diabetes) - Increased risk of spontaneous abortion, stillbirth, congenital abnomalies, neonatal death - Linked to excess body fat, unhealthy diets, low physical activity levels Diagnosis of Gestational Diabetes - Pregnant women without diabetes: 75-mg oral glucose tolerance test 24-28 wks - Fasting plasma glucose > 92 mg/dL - 1-hr plasma glucose> 180 mg/dL - 2-hr plasma glucose > 153 mg/dL - Pregnant women with preexisting diabetes - Hemoglobin A1c > 6.5% - Fasting plasma glucose> 126 mg/dL - Two-hour glucose > 200mg/dL after 75-gram oral glucose load - Symptoms hypeglycemia - Random plasma glucose> 200 mg/dL Impacts of GMD on mother and child - Stillbirth, birth trauma, cesarean section, pre-eclampsia, respiratory distress, hypoglycemia, hyperbilirubinemia - Neonatal adiposity with its long-term eaects such as childhood obesity and diabetes Management of gestational diabetes - Nutrition therapy - Low calorie intake, avoid elevated ketones - Take oral medication (metformin or glyburide) - Regular aerobic exercise - Eat whole-grain breads and cereals, vegetables, fruits and high-fiber foods - Limit sugar intake - Low-glycemic index foods  - Unsaturated fats - 6 weeks Postpartum need to be tested using fasting blood glucose measurements on two occasions or a 2-hr oral 75-g glucose tolerance test - Normal< 140 mg/dL - Impaired>140 200 mg/dL Type 2 diabetes in Pregnancy - Maintain normal blood glucose - Hyperglycemia/ hypoglycemia Type 1 diabetes in Pregnancy - More hazardous - Mother at risk for kidney disease, hypertension, preclampsia - Newborn at risk for mortality, SGA or LGA, hypoglycemia within 12 hour after birth - Control blood glucose levels - Weight gain Hypertensive Disorders of Pregnancy 5-10% pregnancy, stillbirths, fetal and newborn deaths Related to chronic inflammation, oxidative stress, nd damage to endothelium of blood vessels - Impaired blood flow, increased tendency to clot, and plaque formation Chronic Hypertension - Prior to pregnancy or diagnosed before 20 wks - Older women , high blood pressure - Focus on vitamin D, C, calcium, fiber, and antioxidant Gestational Hypertension - Occurs during pregnancy - Increased risk of developing preeclampsia later in pregnancy or first week postpartum, chronic hypertension later in life Preeclampsia-eclampsia - Pregnancy-specific - Signs: high blood pressure, liver complications, protein in urine, water retention and swelling, seeing double, vomiting, vaginal bleeding, headache above eyes, belly ache  - Characteristics of preeclampsia - Oxidative stress inflammation, endothelial dysfunction - Platelet aggregation and blood coagulation - Blood vessel spasms and constriction - Increased blood pressure - Insulin resistance - Adverse maternal immune system responses to placenta - Elevated blood levels of triglycerides, free fatty acids, and cholesterol Manage preeclampsia - Calcium and vitamin D - Five or more servings of colorful vegetables and fruits daily - Fiber - Moderate exercise Why is calcium associated with hypertension? - In heart: heart pumping blood - Kidney: regulate the blood pressure through renin-angiotension- aldosterone system - Pituitary gland: Antidiuretic hormone secretion for water secretion Chapter 6: Nutrition during Lactation: Lactation Physiology Alveoli: rounded or oblong shaped cavity present in breast Secretory cells: responsible for secreting milk Myoepithelial cells: surround secretory cells and contract to cause milk ejection into ducts Mammary gland develops 12 to 18 months Hormonal control of lactation - Prolactin: hormone that promotes milk production (sucking) - Oxytocin release: responsible for ejection of milk from the milk gland (suckling or nipple stimulation)  Stages of Lactogenesis - Lactogenesis I (before birth and 2 days adter birth colostrum): milk formation begins - Lactogenesis II (two to five days after birth, transitional milk): increased blood flow to breast: milk “comes in” - Lactogenesis III (10 days after birth, mature milk): milk composition is stable Colostrum - First milk - High in proteins, secretory IgA and lactoferrin Water - Isotonic with maternal plasma Energy - 0.65 kcal/mL - Fewer calories than human milk substitute (HMS) Lipids Provide half the calories in human milk - In hindmilk less in foremilk DHA: retinol development Trans fatty acids: present in human milk from maternal diet Cholesterol: needed for cell replication Proteins Lower amount Antiviral and antimicrobial eaects Casein - Main protein - Calcium absorption Whey proteins - Soluble protein that precipitates by acid or enzyme - Some mineral, hormone, and vitai-binding proteins part of whey - Lactoferrin Nonprotein nitrogen - 20-25% nitrogen in milk - Non-essential amino acids Carbohydrates Lactose - Enhances calcium absorption - Dominant Oligosaccharides - Medium length - Prevent binding of pathogenic microorganisms, which prevents infection - Develop immune system Fat Soluble Vitamins Vitamin A - Colostrum has approximately twice the concentration of vitamin A as mature milk does - Yellow color from beta-carotene Vitamin D - Most 25-OH2 vitamin D and D3 - Reflective of mother’s exposure to sun -  Vitamin E - Linked to milk’s fat content - Level not adequate to meet needs of preterm infants Vitamin K - 55 of breastfed infants at risk for deficiency on clotting factors - Infants who did not receive K injection may be deficient Water Soluble Vitamins Content reflective of mother’s or supplements Folate - Bound to whey proteins - Less influenced maternal intake Minerals Contribute to osmolality - Content decreased over first four months, except magnesium Bioavailability - Lost risk of anemia (breastfed infants) Zinc - Bound to protein and highly available - Rare defect can cause diaper rash Trace Minerals - Copper, selenium, chromium, manganese, molybdenum, nickel, and fluoride - Not altered by mother’s diet except fluoride Human milk vs formula High protein Immunoglobin: sIgA Lactoferrin Oligosaccharides Lysozyme EPA and DHA More cholesterol Bioactivity higher for minerals WHO recommendations for breastfeeding Begin hour after birth On demand No bottles or dummies  Exclusive breastfeeding first 6 months Complementary breastfeeding should occur until 2 16 weeks oa of work Benefits of Breastfeeding Hormonal benefits - Increased oxytocin stimulates uterus to return to prepregnancy status Physical benefits - Delay in monthly ovulation resulting in longer intervals between pregnancy Benefits for Baby - Optimal nutrition - Balanced nutrients - Isosmotic human milk - Meets protein needs without overloading kidneys - Contains soft, easily digestible curd - Provides generous amounts of the right lipids - Long-chain polyunsaturated fatty acids are present - Enhanced availability of minerals - Infection protection - Reduce risk of celiac disease, IBS, leukemia, allergies and asthmatic disease The Breastfeeding infant Infant reflexes - Gag: prevents infant from taking food and fluids into lungs - Oral search: infant open mouth wide when close to breast and thrusting tongue forward - Rooting: infant turns to side when stimulated on that side Identifying breastfeeding malnutrition - 7% of birthweight in first five days - Malnourished infants become sleepy, non-responsive, have a weak cry, and wet few diapers - Day 5 or 7 infants should have 6 wet and 3-4 soiled diapers Tooth decay - Caries - Frequent nursing at night after one year - See 6 months after first tooth erupts  Vitamin Supplements - Vitamin K: receive injections - Vitamin D: exclusively breastfed infants need supplements at two months - No recommendations for fluoride or iron Maternal Diet Energy and nutrients needed - Energy for milk production in first six months: 500 calories Infant colic - Defined as crying for more than 3 hours with no medical cause - Cows milk, onions, cabbage, broccoli, and chocolate in maternal diet could cause colic Chapter 7: Nutrition During Lactation: Conditions and Interventions Sore Nipples Prevented by proper positioning of baby on breast Flat or Inverted Nipples Not impact breastfeeding - If diaicult to latch: roll nipple between fingers or use a breast pump prior to feeding Letdown Failure Milk does not eject from the breast - Oxytocin nasal spray may be recommended - Relaxation techniques may help enhance letdown Hyperactive Letdown Streams of milk come from breast - If too active may cause infant to cough, choke, or gulp - to manage: wait for milk flow to slow down before putting the infant to the breast - express milk until the flow slows then allow infant to nurse Hyperlactation Milk volume produced exceeds intake - Symptoms in mother: breasts not drained completely or plugged ducts, leaking between feedings, pain with letdown or deep in breast - Symptoms in baby: spitting up, poor weight gain, diaiculty maintaining latch - To manage cabbage leaves or cold compresses may be used to decrease production - Nurse baby on one side only and express for comfort on the other Engorgement Breasts are overfilled with milk - Results when supply and demand process is not yet established, and milk is abundant - Nurse frequently to prevent, newborns may nurse every hour and a half, cabbage leaves may be used to reduce discomfort Plugged Duct Localized blockage of milk resulting from milk stasis - Caused by mik staying in ducts - Painful knot may form in breast - Treated by massage and warm compress  - Prevented by complete emptying of breasts and changing position of infant while feeding Mastitis Inflammation of breast - Infective or non-infective - 33% - Result in sore or cracked nipples of missing a feeding Low Milk Supply most common reason for cessation of breastfeeding - may be real or perceived - nurse or pump every 2 to 3 hours during day and once at night - galactagogue may be prescribed Maternal Medications Most medication are excreted in breast milk Milk/plasma drug concentration ratio - Ratio of concentration of drug in milk to the concentration of drug in maternal plasma Exposure index - Average infant milk intake per kilogram body weight per day x 100 Drug categories - Cytotoxic drugs - Drugs of abuse - Radioactive compounds - Drugs with unknown eaect - Drugs with significant eaect - Medications compatible with breastfeeding - Agents with no eaect on breastfeeding Safety of oral contraceptives use during lactation - Evidence suggests combined oral contraceptives may reduce breast milk volume - Avoid use of OCs from 6 weeks to 6 months postpartum Medicinal herbs should be viewed as drugs Specific herbs used in the United States - Echinacea: insuaicient data - Ginseng root: not advisable - St. Johns wort: male reduce milk supply - Fenugreek: may increase milk supply; infants may have reactions  - Goats rue and milk thistle/blessed thistle: increasingly used as galactagogue Alcohol - Quickly passes to breast milk - Level of alcohol in breast milk is same as in maternal plasma - Peak plasma level occur at 30-60 minutes after consumption if consumed without food and 60-90 minutes if consumed with food Impact on alcohol on lactation - Decreases oxytocin and letdown - Aaects odor of milk - Decreased volume consumed by infant - Interferes with infant sleep pattern Nicotine - Health risks such as, otitis media, exacerbation of asthma, respiratory infections, gastrointestinal dysregulation - Levels are 1 ½ to 3 times higher in breast milk that mothers blood Marijuana - Transferred and concentrates in breast milk and is metabolized by the nursing infant - May change DNA/RNA formation and neurotransmitter systems needed for growth Caaeine - Moderate intake - Level in breast milk is only one percent of that in maternal plasma - May accumulate in infants younger than three to four months - May interfere with sleep or cause hyperactivity and fussiness Other drugs of abuse - Amphetamines, cocaine, heroin, phencyclidine (angel dust, PCP) are classified by the AAP as drugs of abuse that are contraindicated during lactation Neonatal Jaundice and Kernicterus Neonatal Jaundice - Yellow color of the skin - 40% full term and 80% preterm infants - Elevated bilirubin can cause permanent neurological damage is not resolved - Most frequent cause for hospital readmission for newborns Bilirubin Metabolism By product of the normal physiologic degradation of hemoglobin - After birth, released hemoglobin is broken down by the reticuloendothelial system - Bilirubin is released into the circulation bound to albumin or another transport protein - Production in neonate is double an adult because of breakdown of fetal erythrocytes Physiologic vs Pathologic Newborn Jaundice Physiological - Begins after the first day of birth rising steadily with peak around 5th day - Bilirubin is usually less than 12 mg/dL - Conditions resolve within a few days Pathological - Begins within first day after of birth, rises fast and lasts longer - Bilirubin greater than 8 mg/dL in the first day - Medical intervention with phototherapy Hyperbilirubinemia and Breastfeeding Early jaundice: breast-nonfeeding jaundice or breastfeeding jaundice Lat: break milk jaundice Breast non-feeding jaundice - Infants nursing infrequently or ineaiciently are at risk for elevated bilirubin levels - Usually resolved after 1-2 weeks of birth Breast milk jaundice - Apparent after 3rd day - Cause: substance in most mothers’ milk that increases intestinal absorption of bilirubin - Individual variations in the infant’s ability to process bilirubin Prevention and treatment of Severe Jaundice AAP guidelines recommend phototherapy using fluorescent lights - Light is absorbed in bilirubin changing it to a water-soluble product - Encourage continuing breastfeeding Only some jaundice causes will develop into hyperbilirubinemia and kernicterus Infant Allergies At least 4 months of exclusive breastfeeding - Protects of dermatitis and wheezing Food allergies - Genetics, duration of breastfeeding, time of introduction of other foods, maternal smoking, air pollution, exposure to infectious disease, and maternal diet and immune system Food intolerance - Low allergen maternal diet associated with reduction in distressed behavior (colic) - Allergenic foods eliminated were cow’s milk, eggs, peanuts, tree nuts, wheat, soy and fish