Chapter 2: Nutrition Needs During Preconception

Data showing women of childbearing age are in less than optimal preconception health

o   50% of women of childbearing age are overweight

o   Only 23.9% take a multivitamin with folic acid

o   23% smoked in the 3 months prior to conception

What can poor preconception health lead to?

pregnancy related complications (gestational diabetes) and may result in infant death or premature birth with birth defects, etc.

The importance of having a plan for pregnancy

• should include both parents

• USDA and HHS provides recommendations on intake of sufficient folate, reduction of anemia, receiving preconception care services

Preconception health care

the medical care a person receives from a doctor or other health professionals that focuses on the parts of health that have been shown to increase the chance of having a healthy baby

• improves folic acid, vaccinations, less weight gain at beginning of pregnancy, fewer complications

Interconception care

• the time between the end of one pregnancy and the beginning of the next one

• should begin at least 3 months before a woman becomes pregnant

• fewer pregnancy’s complications, fewer preterm/LBW babies

Menstrual cycle

28 days, 2 phases (follicular then luteal), 4 major hormones (Follicle-stimulating hormone, Luteinizing hormone, estrogen, and progesterone)

Follicular phase

16 days, brain releases FSH and LH, estrogen rises in response, FSH is turned off, one follicle becomes dominant

Luteal phase

12-14 days, estrogen stimulates LH which causes follicle to release egg, egg is captured by fallopian tubes (ovulation), empty follicle becomes corpus luteum which releases progesterone to ready uterus for fertilized egg, if egg is not fertilized menstruation occurs

3 major male hormones

FSH (spermatogenesis), LH (makes testosterone), and testosterone (form sperm, development of male characteristics)

changing demographic of chosen age to get pregnant

• Delayed childbearing increases the risk of conception problems

• Since the 1970s, the average age of women having their first child increased from 21.5 years old to 27 years old, with the highest rates occurring around 30-34 years old

Infertility

the inability to get pregnant after 12+ months of regular unprotected sex

• affects 10-15% of couples

subfertility

any period of reduced fertility when conception is desired

Assisted reproductive technology (ART)

• use of fertility medications, artificial insemination, in vitro fertilization, and surrogacy

• ovaries are stimulated through medications to produce multiple eggs, then the eggs are surgically removed and fertilized in a lab, and finally the embryo is transferred back to the woman

•  First ART baby was in 1978

• There are some risks: higher number of twins and multifetal pregnancies, prematurity, etc.

How does body weight affect fertility and health?

Infertility caused by weight extremes results from altered hormone levels that negatively affect ovulation

Overweight

women of reproductive age should receive counseling on the roles of diet and exercise in reproductive health prior to pregnancy, during, and between

What can being overweight or obese cause?

can cause fertility issues and have a negative impact on baby (baby may be prone to weight issues)

Risks associated with BMI in obese range

• irregular menstrual cycles/ovulation (anovulation)

• polycystic ovarian syndrome (PCOS)

• C-sections

• birth defects

• high birth weight baby (eating sugar from mom)

High BMI before conception is inversely related to:

• successful initiation of breastfeeding

• duration of lactation

• amount of milk produced

Effects of obesity on male fertility

• reduces sperm quality

• impairs baby’s metabolic and reproductive health

How to reverse damaging effects of obesity on sperm function

diet and exercise interventions

How much weight loss is necessary to improve possibility of conception

Even a modest loss of 5-10% of body weight can restore ovulation and increase fertility

Underweight

• Certain % of body fat needed to produce hormones necessary to conceive

• women with BMI less than 19 should be encouraged to gain weight

what may underweight women develop?

Amenorrhea

Underweight men

may not produce viable sperm

What is celiac disease?

autoimmune disorder where body triggers an immune response in the small intestine when a person consumes gluten

• damages intestinal lining; risks anemia, bone problems, and cancer

• critical nutrients may not be well absorbed

• treated by eliminating foods containing gluten from diet

Risks of celiac disease on pregnancy/fertility

infertility, miscarriage, low birth weight, premature delivery

•  Important that blood levels of vitamins and minerals be tested and supplementation started prior to pregnancy

Poorly controlled diabetes

• can contribute to infertility in men and women

• chronic high blood glucose levels affect hormone levels

• weight in stomach area leads to insulin resistance

Men with diabetes

twice as likely to suffer low testosterone meaning fewer healthy sperm

Key to treating diabetes

following dietary recommendations

• Carbohydrate counting: menu-planning strategy where a person is allotted a specific number of grams of carbs per day

• protein and healthy fats

• specific ratio of carbohydrate, protein, and fat keeps blood sugar in healthy range

Risks of eating disorders

•  Bulimia nervosa, anorexia nervosa, and binge eating disorder can cause fertility issues

• may cause amenorrhea: can increase risk of unplanned pregnancy (woman thinks she is unable to get pregnant)

Recommendations for women with eating disorders

Psychological counseling prior to pregnancy will benefit

Endometriosis

• Lining of uterus grows outside uterine cavity

• Can cause pain, cysts, and formation of scar tissue

• Likely leads to infertility as the endometrium may block the egg or not allow egg and sperm to unite

• 5-10% of women

Endometriosis treatment

• pain meds

• hormones

• surgical removal of endometrial tissue

• hysterectomy

Hypertension (high blood pressure) risks

Chance of getting preeclampsia is higher (high BP and protein in urine occur and can lead to fetal growth restriction)

hypertension treatment

DASH diet (dietary approaches to stop hypertension)

• recommended reducing sodium and increasing fruit and vegetable intake

Polycystic Ovary Syndrome (PCOS)

• Hormonal imbalance, most common endocrine disorder in women

• Top reason why women have trouble conceiving

• almost all affected have ovarian cysts

• causes women to produce androgens, which cause anovulation, facial hair growth, and acne

• causes body to produce excessive insulin—often causes insulin resistance

PCOS risks

-       When pregnant with PCOS, she is at higher risk for gestational diabetes, high BP, baby born smaller

PCOS treatment

-       Taking metformin (diabetes med) appears to help to become pregnant, may result in anemia though

-       A low-calorie anti-inflammatory diet high in fiber proved to help most

Sexually transmitted infections (STIs) risks

•  Having an STI can cause fertility issues, complications during pregnancy, and even affect the baby for many years

• some can be treated/cured prior to pregnancy; if not, meds can reduce risk of transmission to baby

Human immunodeficiency virus (HIV)

• pregnancy is possibly but recommendations should be followed

• HIV testing recommended to all men and women as part of preconception care

Nutrition for Men: antioxidants

• molecules that inhibit the oxidation of other molecules, interfere with this oxidative chain reaction before damage can be done

• Play important role in fertility

• Should be in diet to ward off oxidative stress

Nutrition for Men: Zinc

powerful antioxidant and important to sperm development

Nutrition for Men: folate

Supplements can help increase sperm production

Nutrition for Men: Soy

Moderate soy intake recommended

Nutrition for Men: Alcohol consumption

may affect male reproductive hormones and impair sperm

Nutrition for Men: Smoking

May cause erectile dysfunction and harm sperm function

Nutrition for Women: diets associated with difficulty becoming pregnant

Eating high carb foods, foods with high glycemic index, and diet high in saturated fats

Nutrition for Women: Fertility diet

• includes multivitamin and iron supplement

• plant protein rather than animal protein had much lower risk of ovulatory infertility in women

Importance of Folic Acid

• B vitamin, helps produce and maintain each cell in the body

• supports DNA synthesis

• Necessary for the neural tube to develop into brain and spinal cord (critical time for this development is 17-30 days after conception)

• US government mandated folate be added to commonly consumed grain foods

Nutrition for Women: Folic Acid Supplementation

• supplement at least 2-3 months before conception with 0.4-1.0 mg of folic acid daily as part of a multivitamin

• continue through pregnancy and breastfeeding

• should talk to doctor if woman has history of neural tube defects

Nutrition for Women: Iron

• plays critical role in creating hemoglobin (attaches to RBCs and delivers oxygen throughout the body

• Anemic women during pregnancy can have babies with more delays in development so it’s important a woman begins pregnancy with adequate iron stores

Nutrition for Women: Iron recommended intake

• 27mg/day

• iron supplements are recommended prior to conception and continue throughout pregnancy and while breastfeeding

• vitamin C enhances iron absorption

Nutrition for Women: DHA

• an omega-3 fatty acid

• important for brain development

• 200 mg

Nutrition for Women: Iodine

• trace mineral, necessary for proper thyroid function

• thyroid dysfunction may result in subfertility

Nutrition for Women: Iodine sources

water and foods (seafood, iodized salt, fruits & veggies in soil with iodine)

Nutrition for Women: Foods that interfere with thyroid production

Broccoli, brussels sprouts, cabbage, cauliflower, kale, turnips, bok choy

Nutrition for Women: Helping thyroid function

• stress management

• exercise (stimulates thryoid hormone secretion), increases tissue sensitivity to thyroid hormones

Nutrition for Women: Multivitamins

• prenatal vitamins are designed to provide all of the additional vitamins and minerals a developing baby needs

• Similar to daily multivitamins but prenatals contain higher levels of folic acid and iron

• women are encouraged to check with a healthcare provider to assess their need for a prenatal vitamin and mineral supplement

Nutrition for Women: Alcohol and other recreational drugs

• teratogens during pregnancy; intake can cause stillbirth, preterm birth, and miscarriage

o   Both men and women who consume alcohol 3 months prior to conception put fetus at risk for congenital heart disease

o   Women should not drink at least 1 year before conception, men at least 6 months

Nutrition for Women: Birth Control

• concern they delay or impair fertility

• can cayse increased cholesterol levels, higher BPs, higher triglycerides

Nutrition for Women: Caffeine

no more than 200mg per day for women who are pregnant and also women who are trying to get pregnant

Epigenetics

• changes in the expression of DNA without changing the actual genes

• due to the environment, health habits, or chronic conditions

• Paternal obesity associated with enlarged fat cells, diabetes, and obesity among offspring

• Maternal obesity contributes to future childhood obesity through changes in hormones and metabolic markers

• interventions recommended during preconception period

Smoking

• limits amount of oxygen available to the baby and can cause tissue damage

  • can lead to fewer nutrients being delivered and less waste being removed leading to birth complications and low birth weight

• can make it harder for a woman to get pregnant