FND-252IS Nutrition in the Lifecycle
Exam #1 Review Sheet
This exam will contain multiple choice, T/F and short answer questions. You
should be familiar with the following items below; this is not an all-inclusive list
of everything that may be on this exam. You should be able to apply the following; not just regurgitate information.
1. Know the outcomes that low and high maternal weight gain are associated
with
a. Low maternal weight gain: increased risk of low birthweight, infant
death, poor child growth and development, chronic diseases later in
life for the infant
b. High maternal weight gain: increased risk of LGA infants, caesarean-section deliveries, postpartum weight retention, insulin resistance, higher newborn body fat levels
2. Know the IOM Pre-pregnancy weight classifications, BMI’s and appropriate weight gain for each
a. Underweight (BMI <18.5) – 28-40 lb
b. Normal weight (BMI 18.5-24.9) – 25-35 lb
c. Overweight (BMI 25-29.9) – 15-25 lb
d. Obese (BMI ≥30) – 11-20 lb
e. Twin pregnancy – 25-54 lb
3. Know the definitions of fertility and infertility
a. Fertility: actual production of children; the word best applies to specific vital statistic rates, but it is commonly taken to mean the ability
to bear children
b. Infertility: involuntary absence of production of children
4. Know information about nutrition factors that influence fertility including
factors in both females and males
a. Undernutrition in women decreases fertility
b. Excessive and inadequate levels of body fat are related to decreased fertility in women and men
c. Low antioxidant intake associated with infertility in women and men
d. Zinc deficiency related to infertility in men
e. Poor iron status is related to reduced fertility in women
f. Excess alcohol intake (>1 drink/d for women or >2 drinks/d for men)
may reduce fertility
5. Know the specific nutrients that need to be monitored during pre-conception (iron, calcium, folic acid)
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a. Adequate folate status prior to pregnancy substantially reduces the
risk of neural-tube and other defects in newborns. Some cases of
inadequate folate status are related to gene variants that increase
the need for folate.
b. Low iron status prior to pregnancy increase the risk of iron deficiency during pregnancy, preterm delivery, and low iron stores in
the infant. Iron stores can be more effectively accumulated prior to
rather than during pregnancy.
c. Calcium is needed in pregnancy for fetal skeletal mineralization and
maintenance of maternal bone health. Intake is inadequate for most
women of child bearing age. (Average 500-600 mg/d; RDA is 1000
mg/d)
6. What are NTDs and what is the major nutritional deficiency that causes
them?
a. Neural tube defects: a group of birth defects that are caused by incomplete development of birth defects that are caused by incomplete development of the brain, spinal cord, or their protective coverings.
b. Approximately 50% of NTDs are caused by inadequate folate status.
7. Know the concerns about using supplements and alcohol during the preconception period
a. Alcohol intakes >1 drink/day may modestly reduce fertility. Alcohol
intake during pregnancy increases the risk of fetal alcohol syndrome and fetal alcohol effects.
b. Exposure to high amounts of vitamin A in the form of retinol or retinoic acid from supplements increases risk the fetus will develop facial and heart abnormalities.
8. Know about diabetes, PKU, eating disorders and PCOS in relationship to
pre-conception nutrition
a. Diabetes: Poorly controlled blood glucose levels during the periconceptional period increase the risk of maternal and fetal complications during pregnancy. High blood glucose in the first two months
of pregnancy is associated with congenital abnormalities and miscarriage.
b. PKU: PKU is a genetic disorder that causes blood phenylalanine
levels to rise to toxic concentrations in untreated individuals. Untreated PKU can produce malformations, neurological disorders,
and severe mental retardation in children and adults.
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c. Eating disorders: Chronic energy deficits in women with eating disorders are related to reduced fertility. Women with eating disorders
are also more likely to miscarry, experience preterm delivery, and
deliver low birthweight newborns.
d. PCOS: PCOS is a disorder primarily characterized by androgen excess, polycystic ovaries, and ovulatory dysfunction. It is the leading
cause of female infertility.
9. Know the following definitions: trimesters, developmental stages of pregnancy, gravidity, parity, gestational age and average length of pregnancy
a. Trimesters:
i. First trimester: 0-12 weeks
ii. Second trimester: 13-26 weeks
iii. Third trimester: 27-40 weeks
b. Developmental stages of pregnancy:
i. Blastogenic period: the first stage of gestation, during which
tissue proliferation by rapid cell division begins
ii. Embryonic period: The embryonic stage lasts through the
eighth week following fertilization, after which the embryo is
called a fetus. The embryonic stage is short, lasting only
about seven weeks in total, but developments that occur during this stage bring about enormous changes in the embryo
iii. Fetal period: extends from the beginning of the ninth week
after fertilization to about 38 weeks after fertilization, which is
the average time of birth. The fetal stage lasts a total of approximately 30 weeks
iv.
c. Gravidity: number of pregnancies a woman has experienced
d. Parity: the number of previous deliveries a woman has experienced
e. Gestational age: the common term used during pregnancy to describe how far along the pregnancy is. It is measured in weeks,
from the first day of the woman's last menstrual cycle to the current
date. A normal pregnancy can range from 38 to 42 weeks.
f. Average length of pregnancy: 40 weeks (37-42 weeks)
10. Know what is meant by the fetal-origins hypothesis
a. “Exposures to adverse nutritional and other conditions during critical or sensitive periods of growth and development can permanently affect body structures”
b. Now known as the developmental origins of health and disease
11. Know the changes that occur due to hormones during pregnancy including: progesterone, estrogen, prolactin, leptin, insulin
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a. Progesterone: Increases early in pregnancy; results in relaxation of
uterine muscles to allow for fetal growth, muscle relaxation in GI
tract, promotes maternal lipid deposition, may be responsible for increasing muscle sensitivity to CO2
b. Estrogen: change in levels throughout pregnancy; promotes growth
of uterus, promotes lipid formation and storage, promotes ligament
flexibility, stimulates renin-angiotensin system (fluid retention)
c. Prolactin: insulin resistance and fat breakdown
d. Leptin: appetite regulation and fat utilization
e. Insulin: basal levels increased in pregnancy; resistance increases
in later pregnancy  maternal glucose utilization, glucose for fetus,
maternal lipolysis
12. Know the changes that occur to the cardiovascular system, GI system and
maternal nutrient metabolism during pregnancy
a. Cardiovascular: plasma volume increases 40-50%, cardiac output
increase, slight cardiac hypertrophy, smaller increases in blood volume associated with poor birth outcomes
b. GI: lower esophageal sphincter pressure (heartburn), intestinal motility (transit time), gall bladder enlarged and empties slowly
c. Nutrient metabolism: Diabetogenic effect of pregnancy (increased
insulin production in first half of pregnancy, increased insulin resistance in second half), accelerated fasting metabolism (increased
glucogenesis and ketosis)
13. Know the CDC guidelines for anemia as well as what happens to blood lipid and glucose levels during pregnancy
a. CDC guidelines:
i. Non-pregnant women: <12 gm/100 ml
ii. 1st trimester: <11 gm/100 ml
iii. 2nd trimester: <10.5 gm/100 ml
iv. 3rd trimester: <11 gm/100 ml
b. Blood lipids: FFA increase during 3rd trimester, cholesterol levels increase regardless of diet
c. Blood glucose: decreased BG, insulin resistance
14. Know the following about the placenta: what it is, its function, nutrient
transfer and potential disorders
a. Definition: disk-shaped organ of nutrient and gas exchange between mother and fetus; at term, the placenta weighs about 15% of
the weight of the fetus
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b. Function: hormone and enzyme production, nutrient and gas exchange between mother and fetus, removal of waste products from
fetus
c. Nutrient transfer:
i. Primary mechanisms: passive diffusion, facilitated diffusion,
active transport, endocytosis
ii. Placenta uses 30-40% of glucose delivered by maternal circulation
iii. Placenta’s needs take priority over fetal nutrient needs
iv. May be compromised to sustain maternal health in starvation
d. Potential disorders:
i. Placenta abruption: separation of the placenta from its attachment to the uterus wall before the baby is delivered;
consequences range from mild to severe for mother and fetus depending on blood loss, extent of fetal distress, gestational age, and other factors
ii. Placenta previa: partially or completely covering the opening
of the cervix
iii.
15. Know what amniotic fluid is, why it is important and disorders that can occur
a. Definition: the fluid contained in the amniotic sac that surrounds the
fetus in the uterus
b. Importance: fetus absorbs water, minerals, nitrogenous waste products, and other substances in the amniotic fluid in the 2nd half of
pregnancy
c. Disorders:
i. Oligohydramnios: deficiency of amniotic fluid
ii. Anhydramnios: lack of amniotic fluid
iii. Polyhydramnios: excess of amniotic fluid
16. Know the amounts of where weight is gained during pregnancy
a. Fetus: 3550g (7.8lb)
b. Placenta: 670g (1.5lb)
c. Uterus: 1120g (2.5lb)
d. Amniotic fluid: 896g (2lb)
e. Breasts: 448g (1lb)
f. Blood supply: 1344g (3lb)
g. Extracellular fluid: 3200g (7lb)
h. Maternal fat stores: 3500g (7.7lb)
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17. Know the weight gain recommendations for twins and triplets as well as
the amounts for each trimester
a. Twins: 25-54lb
b. Triplets: 50-60lb
c. 1st trimester: 2-7lb
d. 2nd trimester: 14-20lb
e. 3rd trimester: 25-35lb
18. Know information about postpartum weight reduction
a. Lose about 14lb within the first 6 weeks after delivery
b. For those within IOM guidelines during pregnancy, average gain is
2lbs at 1 year PP
19. Know how many calories are needed for pregnancy and lactation per day
on average
a. Extra 300kcal per day in second and third trimesters
20. Know the energy (kcals), protein, lipids (including essential fatty acids especially DHA), folate, iron and calcium needs during pregnancy and why
they are important
a. Energy:
b. Protein: 85 g/d
c. Lipids: 30%kcal from fat
i. 13 gm/d linoleic acid
ii. 1.3 gm/d alpha linolenic acid
iii. DHA 300 mg/d
d. Folate: 600 mcg DFE/d
e. Iron: 27 mg/d
f. Calcium: 1000 mg/d
21. Know the risk factors for poor pregnancy outcome prior to conception and
during pregnancy
22. Know the nutrition related risk factors (why they happen and how to solve)
during pregnancy: nausea, hyperemesis gravidarum, constipation, heartburn, pica, preeclampsia, gestational diabetes
23. Know the nutrition and increased needs for special populations during
pregnancy: adolescents, vegetarians, lower SES
24. Know the nutritional recommendations for pregnancy based on MyPlate
25. Know what you should look for if weight gain is inadequate or in excess
and ways to resolve
26. Know about the following food related substances that may contribute to
poor birth outcomes: caffeine, alcohol, mercury, food borne illness, herbal
teas and supplements
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