Chapter 3 Preconception: Conditions and Interventions Nutrition

what nutrition-related conditions influence fertility or the outcome of pregnancy?

obesity, underweight, negative energy balance, eating disorders, diabetes, polycystic ovary syndrome, phenylketonuria, celiac disease, etc.

what are weight loss benefits?

• weight loss can reduce or eliminate fertility problems

• focus on behavorial goals and skills: meal planning and portion sizes

• encourage aerobic exercise to improve insulin resistance

• supportive and individualized strategies most effective

what is metabolic syndrome?

a cluster of abnormal metabolic and other health indicators

metabolic syndrome can be diagnosed when three of the five 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 highest

• fasting blood glucose 100 mg/dL or higher

metabolic syndrome increases risks of developing?

• cardiovascular disease

• type 2 diabetes

• chronic inflammation and oxidative stress

women with low BMI can develop…?

• May develop anovulation and functional hypothalamic amenorrhea

• May have impaired gonadotropin-releasing hormone secretion

• Are at increased risk of

  • Preterm delivery

  • Small for gestation age newborns

how does anorexia nervosa/bulimia nervosa affect fertility?

• Related to the development of hypothalamic amenorrhea

Women with these conditions 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

treatment for fertility issues of the female athletic triad

• Correction of negative energy balance through dietary changes

• Restoration of ovulation

• Bone mass accretion

  • Vitamin D, calcium, and other supplements may be needed to facilitate bone development

what happens if you have diabetes prior to pregnancy?

poorly controlled blood glucose levels during the preconceptional period increase the risk of maternal and fetal complications during pregnancy

what is type 1 diabetes?

results from destruction of insulin-producing cells

• Originally called juvenile-onset and insulin-dependent diabetes

what is type 2 diabetes?

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

• Increasing in prevalence in young adults and children due to obesity

what is gestational diabetes?

onset during pregnancy

• Significantly increases risk of developing type 2 diabetes later in life

what is the nutritional management of diabetes prior to pregnancy?

Main goals are blood glucose control, resolution of coexisting health problems, and health maintenance

what is prevention of gestational and type 2 diabetes?

• Pre-pregnancy weight loss

• Increased fiber intake

• Consumption of a healthy dietary pattern

• Regular exercise

what is polycystic ovary syndrome (PCOS)?

• Leading cause of female infertility

  • Absence of ovulation common

  • Diagnostic criteria (two of the following three)

    • Hyperandrogenism

    • Ovulatory dysfunction - missed

    • Polycystic ovaries

• Many with PCOS are obese or have high levels of intra-abdominal fat and are insulin resistant

what is the nutritional managment of PCOS?

• Increase insulin sensitivity through healthy dietary patterns

• Weight loss

• Regular exercise

• Education on PCOS long-term health risks

what is phenylketonuria (PKU)?

• most frequently inherited disorder of amino acid metabolism

• Occurs in 1:10,000 individuals

• Preventable cause of intellectual disability

• Causes elevation in blood phenylalanine levels due to very low levels or lack of the enzyme phenylalanine hydroxylase

• If present during pregnancy, high levels of phenylalanine accumulate in the embryo and fetus, impairing normal CNS development

• PKU screening part of newborn screening in all 50 U.S. states

what is the nutritional management for PKU?

•High-protein foods (meats, fish, eggs) and wheat are excluded

•Low-phenylalanine specialty formulas, breads, and bakery products are available

what is celiac disease?

• auutoimmune disease in 1 percent of U.S. population

• related to somewhat higher rates of infertility

• related to substantially higher rates of subfertility

• untreated celiac disease in men increases alterations of androgens, delayed sexual maturation, and hypogonadism

• untreated celiac disease in women increases amenorrhea, rates of miscarriage, fetal growth restriction, low birthweight deliveries, and short duration of lactation

• untreated celiac disease is related to malabsorption-induced nutrient deficiencies and inflammatory damage of intestinal and other tissues

what is nutritional management for celiac disease?

• Elimination of gluten from the diet

• Correction of vitamin and mineral deficiencies (see Table 3.7)

  • Folate

  • Vitamins: B₁₂, A, D, E, K, and folate

  • Minerals: calcium and Iron

• Correction of health problems, including symptom relief and small intestine damage recovery (refer to Table 3.7)

• Long-term maintenance of health

what is wheat intolerance syndrome?

• Formerly called nonceliac gluten sensitivity

• Related to ingestion of wheat but not the gluten component of wheat and associated with fatigue, diarrhea, foggy mind, and muscle pain

what is wheat allergy?

• Allergic reaction onset within minutes to hours after wheat ingestion

• Symptoms (which can be severe) include rash, gastrointestinal upsets, and respiratory problems