HUN 3403 Wk1 D2b

Chapter 3

Preconception Nutrition: Conditions and Interventions

Introduction

• Topics covered include conditions impacting conception & interventions

» PMS» Obesity» Underweight» Female athletic triad» Eating disorders» Diabetes» Polycystic ovary syndrome» Phenylketonuria» Celiac disease

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

Common 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

• Cause is not yet clear

• Thought to be related to abnormal serotonin activity following ovulation

PMS Treatment

• Antidepressants containing serotonin uptake inhibitors reduce PMS

• Calcium, B6, chasteberry supplements– Calcium—1200 mg/day– Vitamin B6—50 to 100 mg/day– Chasteberry – 20 mg/day

• Reduced caffeine intake, supplementation of vit D and magnesium - limited results

Weight Status and Fertility

• Obesity and underweight increase likelihood of reproductive health problems

• Obesity rates in U.S.

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

• 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

Metabolic Syndrome

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

1. Waist circumference:>40” in men & >35” in women2. Blood triglyceride ≥150 mg/dL3. HDL-cholesterol: <40 mg/dL in men & <50 mg/dL in women4. Blood pressure >130/85 mm Hg5. Fasting blood glucose ≥100 mg/dL

Metabolic Syndrome

• Prevalence– 32% in U.S. adults

• Consequences– Increases risk of CVD & type 2 diabetes

• Therapy– Dietary modification– Weight reduction– Exercise

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

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

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

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

Management of the Female Athletic Triad

• Correction of negative energy balance

• Correction of eating disorders

• Vitamin D & calcium supplements to facilitate bone development

Diabetes

• Diabetes Mellitus—intolerance to carbohydrate with fasting glucose ≥126 mg/dL

• Types of diabetes – Type 1—results from destruction of insulin-

producing cells (10% of cases)– Type 2—body unable to use insulin normally, to

produce enough insulin or both (90%)– Gestational—onset during pregnancy (3-7%)

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

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

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

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

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

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

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

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

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

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

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