Chapter 3 Preconception Nutrition

Conditions and Interventions

Nutrition Through the Life Cycle

Judith E. Brown

Key Nutrition Concept #1

• Nutrition & other lifestyle changes are a core component of the treatment of a variety of common health problems of women and men prior to conception.

Key Nutrition Concept #2

• Nutritional and health status before and during the first 2 months after conception influences embryonic development and the risk of complications during pregnancy.

Introduction

• Topics covered include conditions impacting conception & interventions

» PMS

» Obesity

» Hypothalmic amenorrhea

» Female athletic triad

» Eating disorders

» Diabetes

» Polycystic ovary syndrome

» Disorders of metabolism

» Celiac disease

Premenstrual Syndrome

• Characterized by life-disrupting physiological & psychological changes that begin in the luteal phase & end with menses

• Symptoms occur in 40% of women of childbearing age

Common Signs & Symptoms of PMS

Premenstrual Dysphoric Disorder

• PDD-severe form of PMS

• Characterized by marked mood swings, depressed mood, irritability, & anxiety

• Physical symptoms:– Breast tenderness– Headache– Joint & muscle pain

Possible Cause of PMS

• Thought to be related to abnormal serotonin activity following ovulation

• Antidepressants that contain serotonin uptake inhibitors reduce PMS

PMS Treatment

• Caffeine intake & PMS– PMS symptoms increase in severity with

increased coffee intake – Risk of severe symptoms 8 times higher with

8–10 cups compared to non-coffee drinkers

• Exercise & stress reduction– Daily physical activity & reducing daily stress

decrease symptoms

PMS Treatment

• Magnesium, calcium, vitamins D & B6 supplements– Magnesium—200 mg/day – Calcium—1200 mg/day– Vitamin D—706 IU/day – Vitamin B6—50 to 100 mg/day

Obesity and Fertility

• Obesity increases likelihood of reproductive health problems

• Obesity rates in U.S.

Obesity and Fertility

Obesity and Fertility

• Central body fat & fertility– Central obesity increases time required to

conceive

• Weight loss & fertility– Should be the first fertility therapy for obese

people – Loss of 7 to 22 pounds in overweight women &

100 pounds in massively obese men increases fertility

Obesity and Fertility

• Diets for Weight Loss– Diets should be healthful, balanced and provide

all required nutrients

– Diets should be planned around foods that correspond to individual food preferences and resources

Pregnancy after Gastric Bypass Surgery

• In most women and men, after bariatric surgery– Return to normal hormone levels

– Decreased inflammation

– Improved fertility

• Bariatric surgery increases risk for the following deficiencies– Iron, folate, calcium, and vitamins A, B12, and K

• Pregnancy is not recommended during first year after surgery

Metabolic Syndrome

• Cluster of abnormal metabolic & health indicators• Diagnosed if 3 of 5 conditions exist:

1. Waist circumference:

>40” in men & >35” in women

2. Blood triglyceride ≥150 mg/dL

3. HDL-cholesterol:

<40 mg/dL in men & <50 mg/dL in women

4. Blood pressure >130/85 mm Hg

5. Fasting blood glucose ≥110 mg/dL

Metabolic Syndrome

• Prevalence– 1 in 5 U.S. adults

• Consequences– Increases risk of CVD & type 2 diabetes

• Therapy– Dietary modification– Weight reduction– Exercise

A Closer Look at Insulin Resistance

• Insulin stimulates uptake of glucose from blood into cells

• Each cell membrane normally has ~20,000 active insulin receptors that open “doors” for glucose

• Insulin resistant cells only have ~5,000 functioning receptors that lower uptake by cell

• Insulin resistance is a major public health problem

A Closer Look at Insulin Resistance

• Risk factors for insulin resistance– Obesity, central obesity, physical inactivity, & small size

at birth

• Insulin resistance associated with

• Polycystic ovary syndrome

• Metabolic syndrome

• Type 2 diabetes

• Gestational diabetes

• Heart disease

Polycystic Ovary Syndrome

• 10% of women of childbearing age

• The leading cause of female infertility

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

• Cause is uncertain– Insulin resistance a possible factor– Appears to have strong genetic component

Nutritional Management of Women with PCOS

• Primary goal is to increase insulin sensitivity

• Insulin-sensitizing drugs

• Diet recommendations:– Omega-3 fatty acids, whole grains, fruits &

vegetables, regular meals, non-fat dairy, & low-glycemic foods

• Weight loss & exercise improve prognosis

Disorders of Metabolism

• PKU (phenylketonuria)– Elevated blood phenylalanine due to lack of

phenylalanine hydroxylase

• Nutrition management for women with PKU– Low-phenylalanine diet

Disorders of Metabolism

• Celiac disease– Autoimmune disease in people with genetic

susceptibility to protein gliadin found in gluten component of wheat, rye, barley, which causes malabsorption & flattening of intestinal lining

• Prevalence in U.S. is ~1 in 133

• Linked to infertility in some women & men

Nutritional Management of Celiac Disease

• Eliminate gluten in diet

• Look for “gluten free” labels

• Gluten found in many non-grain foods like hot dogs, deli meats, supplements, chips, bouillon, salad dressing, etc.

• Correction of vitamin & mineral deficiencies

• Insert Case Study 3.2

Herbal Remedies for Fertility-Related Problems

• Chaste tree berry extract—may relieve PMS symptoms

• Evening primrose oil—not effective for PMS relief

• Coenzyme Q10 –increases sperm motility

• Bee propolis—increases pregnancy rates in women with mild endometriosis

Additional website

For information on teratogens

• http://www.otispregnancy.org/