Chapter 3 Preconception Nutrition: Conditions and Interventions

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  • Chapter 3 Preconception Nutrition: Conditions and Interventions
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  • Introduction Topics covered include conditions impacting conception & interventions PMS Obesity Underweight Female athletic triad Eating disorders Diabetes Polycystic ovary syndrome Phenylketonuria Celiac disease
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  • Premenstrual Syndrome Characterized by life-disrupting physiological & psychological changes that begin in the luteal phase & end with menses Symptoms occur in 15-25% of menstruating women
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  • Common Symptoms of PMS
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  • 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
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  • Possible Cause of PMS Cause is not yet clear Thought to be related to abnormal serotonin activity following ovulation
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  • PMS Treatment Antidepressants containing serotonin uptake inhibitors reduce PMS Calcium, B6, chasteberry supplements Calcium1200 mg/day Vitamin B650 to 100 mg/day Chasteberry 20 mg/day Reduced caffeine intake, supplementation of vit D and magnesium - limited results
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  • Weight Status and Fertility Obesity and underweight increase likelihood of reproductive health problems Obesity rates in U.S.
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  • Obesity, Body Fat Distribution, and Fertility Central body fat & fertility Central obesity interferes with reproduction in women and men Weight loss & fertility Should be treatment of first choice for obese people Fertility problems can be reduced or eliminated by weight loss
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  • Weight Reduction Methods Focus on lifestyle changes Decrease calorie intake Increase physical activity levels Weight loss surgery if efforts fail bariatric surgery Obesity, Body Fat Distribution, and Fertility
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  • 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: 130/85 mm Hg 5. Fasting blood glucose 100 mg/dL
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  • Metabolic Syndrome Prevalence 32% in U.S. adults Consequences Increases risk of CVD & type 2 diabetes Therapy Dietary modification Weight reduction Exercise
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  • Pregnancy after Bariatric Surgery Fertility may return after surgery Bariatric surgery increases risk for the following deficiencies Calcium, iron, copper, zinc, thiamin, B6, B12, and D Pregnancy is not recommended during first year after surgery Monitor nutritional status because of poor nutrient status during post-surgery weight loss
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  • Hypothalamic Amenorrhea Hypothalamic Amenorrhea: Cessation of menstruation related to changes in hypothalamic signals that maintain ovulation (functional hypothalamic amenorrhea, weight-related amenorrhea) Caused by deficits in energy & nutrients
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  • Eating Disorders and Fertility anorexia nervosa and bulimia nervosa are linked to hypothalamic amenorrhea in some women More likely to miscarry, have preterm delivery, have low birthweight infants Menses typically resumes with weight gain Care involves evidence based practice interdisciplinary group of experienced health professionals
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  • The Female Athletic Triad and Fertility Triad consists of: Amenorrhea Disordered eating Osteoporosis Triggered when energy intake is ~30% less than requirement Results in decrease in LH, FSH & lack of estrogen Low hormone levels lead to reduction in bone density
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  • Management of the Female Athletic Triad Correction of negative energy balance Correction of eating disorders Vitamin D & calcium supplements to facilitate bone development
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  • Diabetes Diabetes Mellitusintolerance to carbohydrate with fasting glucose 126 mg/dL Types of diabetes Type 1results from destruction of insulin- producing cells (10% of cases) Type 2body unable to use insulin normally, to produce enough insulin or both (90%) Gestationalonset during pregnancy (3-7%)
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  • Diabetes Mellitus Prior to Pregnancy High blood glucose levels during the first 2 months of pregnancy are teratogenic Associated with a 2-3 fold increase in congenital abnormalities in newborn Malformations of pelvis, CNS, & heart seen in newborns, higher rates of miscarriage
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  • Management of Type 1 Diabetes The main goals of management of type 1 diabetes are: Blood glucose control Resolution of coexisting health problems Health maintenance Diets are controlled in carbohydrate content Insulin use Physical activity
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  • Management of Type 1 Diabetes Diet management may be handled in the following ways: Carbohydrate control Carbohydrates raise insulin needs more than proteins and fats Dietary advice must be tailored for every person
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  • Management of Type 1 Diabetes Diet choices are encouraged: Replace simple sugars with reasonable amounts of artificial sweeteners Choose foods low in glycemic index and high in fiber (especially soluble fiber) Encourage brightly colored fruits and vegetables Low fat meat and dairy products, fish, dried beans and nuts & seeds
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  • Management of Type 2 Diabetes Type 2 diabetes may be managed with: Diet and exercise and oral medication to increase insulin production and insulin sensitivity Preferred management program Individualized diet and exercise recommendations Weight loss
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  • Prevention of Gestational Diabetes (GDM) Considered to be a form of type 2 diabetes Pre-pregnancy weight loss, increased fiber intake and exercise reduce risk of GDM Adherence to healthful diet high in fruits and vegetables
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  • Polycystic Ovary Syndrome 5-10% 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
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  • Nutritional Management of Women with PCOS Primary goal is to increase insulin sensitivity Insulin-sensitizing drugs Diet recommendations: Lean proteins, whole grains, fruits & vegetables, regular meals, non-fat dairy, & low-glycemic index foods Weight loss & exercise improve prognosis
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  • Phenylketonuria PKU (phenylketonuria) Elevated blood phenylalanine due to lack of phenylalanine hydroxylase Preventable cause of intellectual disability Nutrition management for women with PKU Low-phenylalanine diet for life
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  • Celiac Disease Celiac disease Autoimmune disease characterized by chronic inflammation of small intestine Inherited sensitivity to gluten in 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
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  • 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
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