increased levels of anabolic hormones (like insulin)
What occurs during the catabolic phase (20+weeks)
mobilization of fat and nutrient stores
increase production of serum levels of BG, TG, fatty acids, decreased liver glycogen stores
accelerated fating metabolism
increased appetite and food intake decline what near term
increased catabolic hormones
Body water increases from ~7 L to
10 L
Body water increase is a result of increased
intracellular, blood and extracellular volume and amniotic fluid
"dilution effect"
some vitamins and minerals in blood test will seem lower due to hypervolemia
maintains early pregnancy by stimulating the corpus luteum to produce estrogen and progesteron. Stimulates growth of the endometrium
human chorionic gonadotropin (hCG)
*made by the placenta
maintains the implant; stimulated growth of the endometrium and its secretion of nutrients; stimulates breast development; promotes lipid deposition
progesterone
*Made by the placenta
increases lipid formation and storage, protein synthesis, and uterine blood flow; promotes uterine and breast duct development
estrogen
*made by the placenta
increases maternal insulin resistance to maintain glucose availability for fetus; promotes protein synthesis and lipolysis for energy for maternal use
human chorionic somatotropin (hCS)
*made by the placenta
tissue that forms after follicle releases egg
corpus luteum
metabolic changes in mother can be seen in
the first few weeks after conception
Preferred source of fuel for fetus
glucose
continued supply of glucose to the fetus accomplished through metabolic changes to promote maternal _____ ______
insulin resistance
causes women to be slightly glucose intolerance in the 3rd trimester so glucose can be used by baby
"diabetogenic effect of pregnancy"
High levels of estrogen and progesterone in first half of pregnancy stimulate
insulin production which increases conversion of glucose to glycogen and fat
in second half of pregnancy, increased levels of human chorionic somatotropin and prolactin inhibit conversion of
glucose to glycogen and fat
goal of second half of pregnancy in CHO metabolism
ensure that there is a constant supply of glucose to the fetus for fetal growth and development
in the second half of pregnancy there is an increased production of
glucose by the liver and insulin resistance
With fasts >12 hours, pregnant women more rapidly convert to ____ _____
fasting metabolism
using gluconeogenic amino acids, fat oxidation and ketone production
fasting metabolism
What is the purpose of the fasting metabolism?
to allow the mother to use stored fat for energy and spare glucose and amino acids for fetal use
Prolonged fetal utilization of ketones associated with
reduced growth and intellectual disability
How is protein conserved during pregnancy?
By reducing nitrogen excretion
True/False: the mother's body stores protein early in pregnancy to prepare for later needs
False, no evidence of this
Maternal and fetal needs must be met by....
mother's intake of protein
When do fat stores accumulate?
In first half of pregnancy
When does enhanced fat metabolism happen?
in second half of pregnancy
Increased ____ is used by the placenta for steroid hormone synthesis and by fetus for nerve and cell membrane formation
cholesterol
calcium metabolism occurs in pregnancy because
there is increased bone turnover and reformation
mineral that accumulates in mother, placenta and fetus
sodium
*aldosterone increases and retains Na
Functions of the placenta (3)
hormone and enzyme production
nutrient and gas exchange between mother and fetus
removal of waste from fetus
True/False: placenta is a barrier to all bacteria and viruses
FALSE
Viruses: measles, HIV, rubella
Bacteria: lysteria
^Can pass through
Double lining of cells separating maternal and fetal blood
structure of placenta
true/false: alcohol, excessive levels of some vitamins and some drugs pass through the fetus
true
Does insulin cross the placenta?
no
Which molecules cross the placenta the easiest?
small molecules with little to no charge (water)
lipids
Large particles (like insulin and enzymes) are not transferred
water, some AA, glucose, free fatty acids, cotton, vitamins E and K, Na, Cl and gases all use ____ diffusion
passive
iron, vitamins A and D use ____ diffusion
facilitated
water-soluble vitamins, some minerals (Ca, Zn,Fe, K), amino acids use ____ _____ to cross the placenta
active transport
immunoglobulins and albumin use ____ to cross the placenta
endocyotsis
True/False: the nutrients are first used to meet the fetal needs and then the mothers
FALSE
First used to meet maternal needs, then placenta, THEN baby
True/False: the fetus is harmed more than the mother by poor maternal nutrition
true
the rate of human growth and development is higher during ____ than any other period of life
gestation
Genetically pre-programmed time periods during embryonic and fetal development when specific cells, organs and tissues are formed and functional levels are established
critical periods of growth and development
when is the most intense critical period?
during the first 2 months when the majority of organs and tissues begin to form
____ is the primary stimulator of fetal growth
Insulin-like growth factor (IGF-1)
IGF-1 levels are decreased by
maternal unernutrition
Newborns whose weight is less than the 10th percentile for gestational age
Small for gestational age
weight is <10th percentile but have normal length and head circumference)
Disproportionately small for gestational age (dSGA)
weight, length and head circumference are <10th percentile
Proportionately small for gestational age (pSGA)
weight is > 90th percentile for gestational age
Large for gestational age (LGA)
With dSGA babies, utero malnutrition is experienced in
the 3rd trimester compromising liver glycogen and fat storage
LBW related to short-term episodes of malnutrition such as maternal weight loss or low weight gain late in pregnancy
dSGA
if a baby is looking skinny and wasted with small abdominal circumference they are...
dSGA
Risks for dSGA at birth
hypoglycemia
hypocalcemia
hypothermia
if a baby is looking small but well-proportioned they are....
pSGA
with pSGA babies, utero malnutrition is
long-term
Exhibit few health problems at birth than dSGA, but catch-up growth is harder for these infants and they have reduced number of cells in organs and tissues
pSGA
Birthweight that is >4500 g (10lbs)
LGA
birth weight that is related to pre-pregnancy obesity, poorly controlled DM during pregnancy, and excessive weight gain during pregnancy
LGA
if infant is ___ there is an risk of delivery complications for mother (C-section, postpartum hemorrhage, shoulder dystocia)
LGA
Nutrition risk factors for miscarrages (3)
Maternal underweight prior to pregnancy
high levels of oxidative stress in 1st half of pregnancy and men prior to conception
vitamin D and E deficiency in 1st trimester
Risk for pre-term babies (5)
neurological problem and low IQ scores
ADHD
congenital malformations
cerebral palsy
death
Risk for pre-term delivery (4)
genital tract infections
insufficiency uterine-placental blood flow
shorter inter-pregnancy interval (<6 months)
high levels of psychological stress
the ability of a fetus to modify gene function when exposed to adverse conditions that threaten its immediate chances of survival leading to increased risk for chronic diseases later in life
"fetal origins theory"
Possible nutritional protective factors from pre-term delivery
