Chapter 3 Preconception Nutrition Conditions and Interventions

1. Chapter 3 Preconception NutritionConditions and Interventions Nutrition Through the Life Cycle Judith E. Brown

2. 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.

3. 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.

4. 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

5. 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

6. Common Signs & Symptoms of PMS

7. 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

8. Possible Cause of PMS • Thought to be related to abnormal serotonin activity following ovulation • Antidepressants that contain serotonin uptake inhibitors reduce PMS

9. 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

10. 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

11. Obesity and Fertility • Obesity increases likelihood of reproductive health problems • Obesity rates in U.S.

12. Obesity and Fertility

13. 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

14. 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

15. 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

16. 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

17. Metabolic Syndrome • Prevalence • 1 in 5 U.S. adults • Consequences • Increases risk of CVD & type 2 diabetes • Therapy • Dietary modification • Weight reduction • Exercise

19. 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

20. 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

21. 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

22. 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

23. Disorders of Metabolism • PKU (phenylketonuria) • Elevated blood phenylalanine due to lack of phenylalanine hydroxylase • Nutrition management for women with PKU • Low-phenylalanine diet

24. 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

25. 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

26. Insert Case Study 3.2

27. 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

28. Additional website For information on teratogens • http://www.otispregnancy.org/