Preconception Nutrition Conditions and Interventions

Obesity

excess intra-abdominal fat

• insulin resistance and elevated levels of insulin

• chronic inflammation

• oxidative stress

• metabolic syndrome

• changes in hormones

Weight loss is the first choice of treatment

Focus on behavioral goals and skill

Metabolic Profile

determines risk of disease development

• increasing physical activity decreases negative effects of obesity

Metabolic Syndrome

a cluster of abnormal metabolic and other health indicators

Diagnosed if 3 out of 5 of the following conditions exist

• waist circumference 40 in men and 35 in women

• blood triglyceride 150 mg/dL or higher

• HDL cholesterol <40 mg/dL men and <50 mg/dL women

• Blood pressure of 130/85 mm Hg or higher

• Fasting blood glucose 100 mg/dL or higher

Increases risk of developing cardiovascular disease, type 2 diabetes, chronic inflammation and oxidative stress

Underweight

Women may develop anovulation and functional hypothalamic amenorrhea

may impair GnRH secretion

increased risk for preterm delivery and small for gestation age newborns

Anorexia nervosa and bulimia nervosa

related to the development of hypothalamic amenorrhea

Women with condition are more likely to experience

• lower fertility and increased miscarriages

• preterm delivery and low birthweight newborns

• reduced estrogen production

Ovulation and menstruation resume with normal eating behaviors and weight gain

Female Athletic Triad

• amenorrhea

• eating disorder

• osteoporosis

triggered when energy intake is 30% less than required

Treatment:

• correction of negative energy balance through dietary changes

• restoration of ovulation

  • bone mass accretion

Diabetes Prior to Pregnancy

increase risk of maternal and fetal complications during pregnancy

• high blood glucose levels in the first 2 months of pregnancy teratogenic

Main goals:

• blood glucose control

• resolution of coexisting health problems

• health maintenance

Type 1 Diabetes

results form destruction of insulin producing cells

Type 2 Diabetes

body is unable to use insulin normally, to produce enough insulin, or both

Gestational Diabetes

onset during pregnancy

significantly increases the risk of developing type 2 diabetes later in life

Prevention:

• pre-pregnancy weight loss

• increase fiber intake

• consumption of a healthy dietary pattern

• regular exercise

Polycystic Ovary Syndrome (PCOS)

Leading cause of female infertility

• absence of ovulation common

Diagnosis criteria: (2 of the 3 needed)

• hyperandrogenism

• ovulatory dysfunction

• polycystic ovaries

Many are obese or have high levels of intra abdominal fat and are insulin resistant

Treatment:

• increase insulin sensitivity through healthy dietary patterns

• weight loss

• regular exercise

• education on long term health risks

Phenylketonuria (PKU)

Inherited disorder of amino acid metabolism

• Preventable cause of intellectual disability

Causes elevation in blood phenylalanine levels due to very low levels or lack of the enzyme phenylalanine hydroxylase (can not break down phenylalanine)

• High levels of phenylalanine accumulate in the embryo and fetus

• Impairing normal CNS development

Management:

• Exclude high-protein foods and wheat

• individualized based on blood phenylalanine responses to protein foods

Maternal PKU

PKU diet should be maintained through adolescence and continue into adulthood

• Increases the risk for the fetus to be harmed due to high maternal phenylalnine levels

  • high levels can accumulate in embryo and fetus

Celiac Disease

Autoimmune disease

• related to somewhat higher rates of infertility

• related to substantially higher rates of subfertility

Men: increases alterations of androgens, delayed sexual maturation, and hypogonadism

Women: increase amenorrhea, rates or miscarriage, fetal growth restriction, low birth weight deliveries, and short duration of lactation

Untreated can lead to malabsorption induced nutrient deficiencies and inflammatory damage of intestinal and other tissues

Management:

• elimination of gluten from the diet

• correction of vitamin and mineral deficiencies

Wheat Intolerance Syndrome

related to ingestion of wheat but not the gluten component of wheat

• fatigue, diarrhea, foggy mind, and muscle pain

Wheat Allergy

Allergic reaction onset within minutes to hours after wheat ingestion

• symptoms can be severe: rash, gastrointestinal upsets, respiratory problems

Premenstrual Syndrome (PMS)

life disrupting physiological and psychological changes

• Begins in the luteal phase of the menstrual cycle

• usually ends within 2 days of onset of menses

Severe form Premenstrual dysphoric disorder (PMDD)

Physical Symptoms:

• tender breasts

• abdominal bloating

• swelling

• headache

Psychological:

• angry outbursts

• depression

• irritability

• confusion

• anxiety

• social withdrawal

Treatment = symptom relief