prenatal prescription

The Prenatal PrescriptionThe Prenatal Prescription

From a book by: Peter Nathanielsz

Pennington Biomedical Research Center


Division of Education

The following The following information has been information has been obtained from:obtained from:

The Prenatal Prescription

A state-of-the-art program for optimal prenatal care

Copyright © 2001 by Peter Nathanielsz, M.D., Ph.D.

HarperCollins Publishers


Prenatal ProgrammingPrenatal ProgrammingBelieved that nutritional health during

pregnancy imprints us for health during the rest of our life, and that the chronic diseases we may experience later, either begin or are prevented during prenatal life.

Dr. David Barker was the originator of this idea

He related the high rates of heart disease in middle aged men to industrial and coal mining areas of England and Wales.


Prenatal ProgrammingPrenatal Programming: : The New Science of Life in the WombThe New Science of Life in the Womb

States that our bodies are programmed in analogous and far-reaching ways by our experiences before birth. The events to which we are exposed as we develop our body’s structure and functions during our life in the womb can improve or worsen our:

–Emotional resilience–Intelligence–Susceptibility to Cancer–Resistance to Infection

–Blood Pressure–Cardiovascular health–Eating patterns–Tendency to gain weight


Prenatal ProgrammingPrenatal Programming: : The New Science of Life in the WombThe New Science of Life in the Womb

In short, prenatal programming affects every aspect of our

physical and mental health, at ever stage of our lives.


Findings:Findings: From Chapter 1From Chapter 1

Leading researchers studying prenatal life now believe that the nutritional quality of the womb environment is often a more important predictor for risk of heart disease than either genetic predisposition or post-birth influences like diet and exercise.

Studies show that blood pressure in mothers during pregnancy correlate directly with the blood pressure of their offspring in adulthood.

Newborns who have a disproportionate head-to-waist size, a hallmark of detrimental prenatal programming due to poor nutrition, are more likely to develop elevated levels of cholesterol as adults.


10 Principles:10 Principles: Of Prenatal PlanningOf Prenatal Planning 1. There are critical periods of vulnerability to

sub-optimal conditions for the fetus during development in the womb, occurring at different times for different organs in the body.

2. Programming has permanent effects that alter the body’s responses in later life and can modify susceptibility to disease.

3. Fetal development is actively dependent. Normal development is dependent on the baby’s continuing normal activity in the womb.

4. Programming involves several different structural changes in important organs.

5. The placenta plays a key role in programming.


10 Principles10 Principles: : Of Prenatal PlanningOf Prenatal Planning

6. Compensation carries a price. In unfavorable environments, the developing baby makes attempts to compensate for deficiencies .

7. Attempts made after birth to reverse the consequences of programming may have their own unwanted consequences.

8. Fetuses react differently to sub-optimal conditions than do newborn babies or adults.

9. The effects of programming may pass across generations by mechanisms that do not involve changes in the genes.

10. Programming has different effects in males and females.


Principle #1 says:Principle #1 says:There are critical periods when certain

parts of the fetus are vulnerable to stress from exposure to toxins or from lacking nutrients or lacking oxygen.

Cells must make a fundamental choice between growth and specialization.

These can become competing processes.

Each cell must make a choice to divide or specialize at some point, and the process is irreversible.


Principle #1cont.Principle #1cont.Some types of cells, like nerve

cells, never divide again after they specialize.

It is very important that each developing cell makes the right decision at the right time.

If a decision is made too early, an organ will end up with too few cells and thus be unequal to the challenges of later life.


Principle #2 says:Principle #2 says:That programming has permanent effects.When nutrition is deficient in the womb

early in gestation, cells divide less frequently, resulting in fewer total cells in the baby’s body.

So, this fetus would be smaller overall, but all the body parts will be proportionately relatively normal, known as symmetrical growth retardation.

However, when stress is making things difficult in the 2nd and 3rd trimester, the cellular community of the growing fetus prioritizes where nutrients will go.


Principle #2 cont.Principle #2 cont.Since the brain is the organ most important for

survival both inside and outside the womb, the largest share of blood, nutrients, and oxygen gets routed towards the head.

Many other tissues suffer and don’t grow as they should, leading to a newborn with a head that is slightly large in comparison to the body, referred to as asymmetrical growth .


Available OptionsAvailable OptionsResearchers recently found that not only

did girls born with low birth weights have a smaller final stature when they grew to their full height decades later, but also that many such girls reached sexual maturity an average of 1.6 years earlier than girls with normal birth rate.

Which makes evolutionary sense in some ways

If a girl had been born into a world that was dangerous, or subject to famine, it would have made sense to reproduce early, since there were no guarantees that she would have survived long enough to reproduce otherwise.


Principle #3 says:Principle #3 says:

Fetal development is activity dependent, or as put, the fetus must “use it or lose it”.

The way that fetal cells develop depends on how the fetus is using his body.

He is able to swallow and suck at birth because he is practicing sucking and swallowing the amniotic fluid that bathes him in the womb.

The nerve cells in the brain wire up correctly because signals are running through them, testing them, throughout the whole time they are developing.



Programming involves structural changes in the developing organs.

One cause of the structural changes is the altered growth of blood vessels in a challenged fetus.

If an organ developed too few blood vessels in utero, it will be harder for the body to increase the blood supply to that organ during times of need later in life.


Example of a Structural Example of a Structural ChangeChangeFingerprint PatternsFingerprint PatternsFingerprints are not solely

determined by your genes.The specific pattern of fingerprint

ridges that form is determined by the extent of swelling in the finger pads when fingerprints are forming, ~ the 10th week of development.

When the prenatal environment is challenging, the fetus makes a priority of getting blood to the brain, thus pushing more blood upwards and into the developing finger pads.


Example: Fingerprint Example: Fingerprint PatternsPatternsMore swelling produces a whorl

pattern; whereas, the loop or arch pattern is observed with less swelling.

If the fetus has been short on oxygen for a prolonged period around the time when fingerprints are forming, it is very likely for the whorl pattern to be observed.


Principle #5 says: Principle #5 says: The placenta is a crucial organ in

development, the bridge between you and your child.

The baby’s placenta not only acts as a gatekeeper for everything that comes into and leaves your baby, but it is an important hormone-producing organ that affects the way you and your child change physically and psychologically.



Compensation for shortcomings during development carries a price.

An example is how your baby’s digestive tract and liver are affected by detrimental conditions.

Since most of the baby’s waste can be processed by the mother’s liver, and glucose comes across the placenta all the time from the mother’s bloodstream, the baby’s liver operates at less than 100 percent efficiency until after birth.


CompensationCompensationWhen oxygen or

nutrients are low, the baby tries to adapt.

The baby deprives the unessential organs of blood, sending the majority of the blood supply to the essential organs.

However, the rerouting of blood away from the liver forces the baby to grow a small liver.

As a result, the organ continues to function less than it should throughout life.

The liver and cholesterol transport


CompensationCompensationSince the liver is central in

regulating cholesterol, it is not hard to see why growing a small liver, thereby reducing abdominal girth, will lead to higher cholesterol later in life.

Inadequate growth of the liver and the pancreas is likely responsible for the glucose control problems in later life, which can lead to adult-onset diabetes (Type 2 DM).


Principle #7 says:Principle #7 says:Attempts made to reverse programming

after birth can have unwanted consequences.

This is because so many of the decisions that cells make during growth are irreversible.

For a baby who had little food during intrauterine life, he/she may not be able to cope with plentiful, rich food afterwards and will have a greater likelihood of becoming obese.

In animal studies, food restriction during prenatal life actually led to shorter life during plenty after birth.


Principle #8 says:Principle #8 says:Fetuses react differently to sub-

optimal conditions than do adults.

Growing cells need more oxygen, amino acids, vitamins, and glucose than those that are not trying to expand their activities.

Small shortages can actually kill cells during development.

These may never be replaced.


Principle #9 says:Principle #9 says: The prenatal effects may carry from one

generation to another. For example, if the developing fetus is female

and has to compromise leading to smaller organs, when she grows up and becomes pregnant, those smaller organs may not be able to keep up with the demand, affecting her fetus.

Another example would be if there were blood sugar problems during your pregnancy damaging the blood sugar regulation in your daughter. This could lead to the same problems during her pregnancy, and so on through generations.



Programming is different in male and female fetuses.

Boys and girls grow in slightly different hormonal environments.

These differences are subtle but may play a major role in behavioral and other functional differences between men and women.


The First and Best Home The First and Best Home for your Baby: for your Baby: The The placentaplacenta

The placenta has its own blood supply that is kept separate from the mothers.

The placenta takes the place of the lungs, kidney, and digestive system for baby

The biochemistry of the body changes to promote energy conservation over usage.

Sound, touch, and taste are developed in utero.

Biorhythms

Chapter 2


The PlacentaThe PlacentaThe placenta shared with your baby is

probably the most talkative and bossy biological organ there is.

It sends firm instructions to you as well as to the baby.

Placental lactogen is one of the many hormonal signals that the baby and placenta send to reshape your body and bend it to the baby’s needs.

The baby always gets top priority between the two of you.


The FetusThe Fetus

The fetus keeps tabs on energy supply.If there is a shortage of energy, he learns

to prepare for shortage of food and how to cope with it later.

The baby also monitors the mother’s stress level, and high stress hormone levels will make the baby hypersensitive to stress hormones after birth.

It is important for the mother to monitor stress levels throughout pregnancy.


Biochemistry of the Body:Biochemistry of the Body: SoundSound

Hearing is a critical skill after birth, and preparation to hear what is going on in the world has to begin long before delivery.

The womb is awash with sound that can help the brain wire up its sound circuits.

Research has shown that newborns prefer the sound of their own mother’s voice over the voices of others, since her voice has been the clearest and most familiar sound all through pregnancy.


Biochemistry of the Body:Biochemistry of the Body: TouchTouchThe gentle bump and caress of the

womb’s wall is a critical part of learning to respond to touch.

The occasional gentle contractions of the mother’s womb during pregnancy – known as contractures - stimulate the baby’s nervous system to begin working properly.

Helps to integrate sensory and motor neurons in the body and brain


Biochemistry of the Body: Biochemistry of the Body: TasteTaste

Even while in the womb, your baby is swallowing fluid and taste buds are learning to recognize differing tastes.

Some recent research suggests that taste preferences for garlic, spices, an other foods may be set and programmed before birth.

The idea is that these flavors filter into the amniotic fluid from the mother’s blood .


Biorhythms Biorhythms

Certain chemical compounds have distinct twenty-four-hour rhythms in your blood even when you are not pregnant.

Stress hormones, kidney hormones, and melatonin naturally rise and fall over the course of the day and night.

Human fetuses seem to use these signals to learn about the cycles of the world outside and to try to adapt their own cycles to them.


Nutrition in the WombNutrition in the Womb

Nutritional status before conception is probably as important as nutrition during pregnancy.

The mother’s nutritional status during pregnancy is the single most important factor in baby’s growth.

Deprivation during pregnancy can take generations to overcome.

The effects of poor nutrition vary according to the trimester in which problems occur.

Chapter 3


Prenatal Eating HabitsPrenatal Eating HabitsOver the whole course of prenatal

development, the kind of food your child gets before birth can affect his lifelong:

WeightBlood PressureBlood sugar profileCardiovascular Health


Dutch Hunger WinterDutch Hunger Winter Winter 1944-1945Winter 1944-1945

Individuals affected by the famine were only receiving 450 to 750 calories a day compared to 2500 kcal/day before that.

Babies that were conceived where the entire intrauterine life was deprived of calories and nutrients were small and light weight and had the most health problems growing up.

Mortality was ten times higher than normal in these individuals.

Those that had starvation in the first half of pregnancy had the most incidence of obesity in later life.


Modern Effects of Past Poor Modern Effects of Past Poor Nutrition…Nutrition… Animal studies have shown that

poor nutrition in the womb alters the growth of the pancreas and the functions of insulin.

Diabetes can be thought of as a “cash flow” disease, where glucose is the main form of “cash” that makes the body run.

When you eat, glucose leaves the gut and enters the bloodstream.

In response to the rising blood glucose, the pancreas releases insulin, which allows glucose to leave the bloodstream and enter muscle and fat cells where it can be used.


Modern Effects of Past Poor Modern Effects of Past Poor Nutrition…Nutrition… In diabetes, the insulin doesn’t work as it

should. These starved cells are forced to consume

their own fats and proteins as an alternate source of energy.

When there is a high level of fat circulating, it deposits in wrong places and can weaken cells and produce problems with eyes, heart and many other precise organs.


Special Components of a Special Components of a Healthy DietHealthy Diet Iron:

◦ Needed in order to allow your blood supply to increase and

help your baby build her own blood supply from scratch

◦ 30-60 mg a day in pregnancy

◦ Found in red meat (especially liver), eggs, and dried beans

Calcium:

◦ Main building block of bones and teeth, and also critical for

the proper function of your own and your baby’s nerve

cells and muscles

◦ 1200-1500 mg per day in pregnancy

◦ Found in milk and cheese, also in broccoli, kale, legumes,

and tofu


Special Components of a Special Components of a Healthy DietHealthy DietChromium

◦ Helps insulin work to keep your baby’s blood sugar

at the right level

◦ 50-200 micrograms per day in pregnancy

◦ Found in whole grains, meats and brewer’s yeast

Zinc

◦ Important for tissue growth and the reproduction of

genes in DNA

◦ 15 mg per day in pregnancy

◦ Found in whole grains, nuts, dried beans, meat, and

eggs


Special Components of a Special Components of a Healthy DietHealthy DietFolic Acid:

◦ Vital for the synthesis of DNA every cell in your

baby’s body and the placenta need an adequate supply

◦ 400 micrograms a day in pregnancy

◦ Found in enriched flours, fresh fruit, and green

vegetables

Vitamin A:

◦ Helps build key components of the baby’s skin, eyes,

and other tissues

◦ 800 IU (international units) a day in pregnancy

◦ Found in fruits and vegetables (equivalents), meat and

dairy


Special Components of a Special Components of a Healthy DietHealthy DietVitamin B6:

◦ Helps baby create new tissue he needs to grow, especially in the brain

◦ ~2.2 mg per day in pregnancy◦ Found in eggs, whole grains, lean meat, oatmeal,

nuts, dried beans, peas, and bananasVitamin B12

◦ Plays a central role in the production of new DNA your baby needs as cells multiply

◦ 2.0-2.2 micrograms a day in pregnancy◦ Found in meat, fish, eggs, and cheese

Vitamin C:◦ Crucial for cell repair after injury and for the

development of new tissues◦ 70 mg per day in pregnancy◦ Found in fruits (especially citrus), and dark green,

leafy vegetablesPennington Biomedical Research Center

Nutrition by Trimester: Nutrition by Trimester: FirstFirst

You should only gain a pound a month in the first trimester; therefore, an increase in caloric intake shouldn’t be necessary.

Iron is crucial for the expansion of the blood supply.

Meeting folic acid requirements is very important in the first trimester because this is when the spinal cord is being created.

If morning sickness leads to vomiting, extra fluids and salts like potassium will be required.

These can come from sports drinks; however, they should not be the main source of fluid since they contain a lot of glucose.


Nutrition by Trimester: Nutrition by Trimester: SecondSecond

Consumption of 300 calories more per day Protein intake, along with iron and calcium are

crucial. Even if you don’t have gestational diabetes, you

may have some episodes of hyperglycemia that are exacerbated by pregnancy.

Keep trying to eat small snacks more often. Avoid fatty or oily foods because fats interfere

with insulin activity. Eat carbohydrate products made with whole

wheat, bran, or other fiber sources.


Nutrition by Trimester: Nutrition by Trimester: ThirdThird

Calcium continues to be a focus of the diet. The baby is becoming much more physically

demanding and he is growing rapidly, needing more nutrients daily.

Frequent small meals are still important . You should continue to gain about a pound a

week, and if you do happen to be gaining more, never try to lose weight during the pregnancy, you should speak with the doctor about possibly cutting back a little on total caloric consumption.


Stress in the WombStress in the Womb

High Maternal Stress can:Put the pregnancy at a riskHave lifelong effects on how the baby’s brain and body developAffect the child’s temperamentMake the child overreact to stressMake child more susceptible to depression later in life

Chapter 4


Effects of StressEffects of StressPeople under stress tend not to eat well.They either eat too much, too little, or the

wrong kind of food.Our bodies respond to stress by releasing

cortisol and other hormones that give us energy to respond to a crisis.

With stress present all the time, the individual will have a higher than normal cortisol level, causing the baby to be hyper sensitized to stress.

The child is then more likely to be unable to concentrate, leading to learning difficulties later in life.


Defeating StressDefeating Stress It is very important that the mother is not

overly stressed during pregnancy and is allowed to relax and enjoy things.

Good ideas for stress relief include the following:

ExerciseProgressive relaxation

MeditationYoga


Exercising for TwoExercising for Two

A mother in good shape creates a healthier newborn with higher initial scores on tests of physical well-being.

Exercise helps to:◦ Allow mothers to cope with stress,

lessening mood swings◦ Lessen many of the bothersome physical

side effects of pregnancy◦ Make labor and delivery easier and faster

Chapter 5


The History: The History: Exercise during Exercise during PregnancyPregnancy

Exercise during pregnancy was generally not accepted by doctors or the women themselves in the past.

During this time, women under physical or psychological stress did not fare well.

This began to change in the 1950’s when a French doctor started to study the effects of exercise on pregnancy .

He found that when the woman eats healthily, does not have psychological stress, and exercises within reason, it is good for the mother and the baby.


Exercise: Exercise: The benefitsThe benefits

Exercise fosters growth of new blood vessels and increases cells metabolic efficiency.

The body also learns to dissipate the heat better with regular challenges.

When the woman exercises, she also provides small physical challenges for the baby, making the baby better able to handle stress later in life.

Also, stimulation of the baby in the womb also helps in brain development.


Important Considerations:Important Considerations: During ExerciseDuring Exercise

Don’t overheatBe sure to take in enough fluids

and saltsStop if you feel painMake the exercise a positive

experienceDo it right


A Woman Should Absolutely Not A Woman Should Absolutely Not Exercise Exercise

If any of the following conditions existIf any of the following conditions exist

History of miscarriagesIncompetent cervixPersistent bleedingPlacental diseasePoor fetal growth

Premature labor

Pregnancy-induced hypertension

Ruptured membrane

Twins or other multiple pregnancy


A Woman Should Probably Not Be A Woman Should Probably Not Be Exercising:Exercising:

If any of the following conditions existIf any of the following conditions exist

Anemia

Breech presentation after 28-weeks

Early pregnancy bleeding

Extremely overweight or underweight for your

height

History of poor fetal growth

History of rapid labor

Palpitations or arrhythmia of the heart

Sedentary lifestyle prior to pregnancy


Drinks, Pills, and Toxic SpillsDrinks, Pills, and Toxic SpillsScientists are finding that:Scientists are finding that:

The fetus is very vulnerable- Substances can be toxic or challenging to the fetus in ways that these substances are not for adults.

Smoking is bad for the fetus in many ways.Alcohol has clearly defined adverse effects on the

embryo and fetus.Coffee, in high doses, can cause problems during

pregnancy.Some OTC medications can be very toxic.Health foods, nutritional supplements, and herbal

teas can be bad.

Chapter 6


Negative Effects: Negative Effects: Of SmokingOf Smoking

The fetus is more vulnerable to the effects of cigarettes than anyone else.

Tobacco is a powerful drug which acts on the neurotransmitter system that controls the heart.

It also causes constriction of blood vessels in the placenta, causing increased blood pressure and heart rate.

When the mother smokes, she increases the concentration of carbon monoxide and reduces oxygen levels to the baby.

Smoking slows the growth of the placenta. It disrupts sleep of the baby and reduces REM sleep.


Negative Effects: Negative Effects: Of AlcoholOf Alcohol

Alcohol cuts the blood supply to fetal brain & affects how nerves

communicate.

In 1968, scientists from France were the first to describe fetal

alcohol syndrome (FAS), in which babies repeatedly exposed to

alcohol in the womb are born with mental retardation and

physical abnormalities.

But, how much is too much?

Research shows that the likelihood of miscarriage in the first

trimester is doubled in women who drink as little as one ounce

of alcohol twice in a week.

Also, drinking as little as two drinks a week has shown increased

agitation and stressful behavior in newborn babies.


Negative Effects: Negative Effects: Of CaffeineOf Caffeine

Caffeine is not eliminated as efficiently during pregnancy and the concentration can get high quickly.

It speeds up cell activity and acts as a stimulant.

Caffeine seems to be safe in terms of miscarriage risk if you limit yourself to one or two cups of coffee a day.

In high amounts, coffee has been shown to potentially increase the risk for miscarriage, along with interfering with the baby’s sleep patterns in the womb.


OTC Meds and Health foodsOTC Meds and Health foods

It is important to talk to your doctor about any prescription or over the counter meds you are taking.

Also, health foods may have high bacterial counts, may be contaminated with heavy metals or other contaminants, or may contain a naturally occurring drug or stimulant.


Preventing Premature DeliveryPreventing Premature Delivery

Babies born before 37 weeks of gestation are considered premature.

Premature birth often happens because the baby is under some sort of stress.

It may be that when conditions in the womb environment become overly threatening to the babies health, the child has a better chance of surviving outside the womb rather than within it.

The most common reasons for this are infection in the womb or birth canal, and stressful situations for either mother or child.

Chapter 7


Premature Delivery Premature Delivery StressStress

When the baby finds that there is no more room to grow or when there is a lack of food or oxygen, stress hormone concentrations in the baby’s blood may rise, stimulating the production of estrogen and the beginning of labor.

And if the mother is under enough stress, her increased production of androgen may cause the level of estrogen to rise far sooner than it should, initiating premature delivery.


Ways to Help Prevent Premature Ways to Help Prevent Premature DeliveryDelivery

Avoid stress most of all◦ Learn stress management◦ Learn coping skills for emotional stress

Treat all cuts and blisters promptly◦ A small bit of redness around a cut is

extremely unlikely to contribute to premature labor, but if an infection gets started and spreads to surrounding tissue or throughout the body it can set off the immune and hormonal changes that stimulate contractions .


Ways to Help Prevent Premature Ways to Help Prevent Premature DeliveryDelivery

Brush and floss teeth regularly

◦ Recent studies have shown that women with gum

disease have perhaps six times the risk of

premature labor compared to women with normal

gums.

Don’t smoke

◦ Smoking increases the risk of premature labor by

25%.

◦ Smoking also promotes gum disease because it

lowers the normal resistance to bacteria in the

mouth.


Birth and BeyondBirth and Beyond

Researchers have found that:The baby’s environment after birth influences the quality of neural connections in the growing brain.The amount and quality of breast milk is directly related to the mother’s diet and stress levels.Antibodies in breast milk beneficially change the baby’s immune system.Touching, talking to, and playing with your infant can actually affect neural development and improve brain growth.Growth promoting factors are present in breast milk.

Chapter 8


Recommendations: Recommendations: For For

MothersMothers Try to breast-feed your infant for at least the first three

months.Use stress reduction techniques in your daily life.Continue to exercise benefits you and your babyEnjoy your baby!

◦ Playing, hugging, touching, and talking with your baby creates the physical and mental foundation upon which she will build future security and happiness


Breastfeeding Breastfeeding Requires that the mother consume 500 more

calories per day than the pre-pregnancy dietMothers will also need to eat more:

◦ Protein◦ Calcium◦ Iron◦ Fats

Alcohol and drugs pass through the breast and into the baby.

As well as painkillers and OTC medications.Also caffeine. Important to avoid these toxins the same as

during pregnancy.


Information provided by:

The Prenatal PrescriptionBy: Peter Nathanielsz, M.D., Ph.D

Images provided by: http://www.google.com/imghp?hl=en&tab=wi&q


AuthorsAuthors• Heli J. Roy, PhD, RD

• Shanna Lundy, BS

• Beth Kalicki, BS

• Phillip Brantley, PhD, Director

• Division of Education

• Steven Heymsfield, MD, Execute Director

• Pennington Biomedical Research Center


The Pennington Biomedical Research Center is a world-renowned nutrition research center.

Mission:To promote healthier lives through research and education in nutrition and preventive medicine.

The Pennington Center has several research areas, including: Clinical Obesity ResearchExperimental ObesityFunctional FoodsHealth and Performance EnhancementNutrition and Chronic DiseasesNutrition and the BrainDementia, Alzheimer’s and healthy agingDiet, exercise, weight loss and weight loss maintenance

The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis.

The Division of Education provides education and information to the scientific community and the public about research findings, training programs and research areas, and coordinates educational events for the public on various health issues.We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000.


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