Chapter 3 Preconception Nutrition Conditions and Interventions Nutrition

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 & B 6 supplements – Magnesium— 200 mg/day – Calcium— 1200 mg/day – Vitamin D— 706 IU/day – Vitamin B 6— 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, B 12, 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/d. L 3. HDL-cholesterol: <40 mg/d. L in men & <50 mg/d. L in women 4. Blood pressure >130/85 mm Hg 5. Fasting blood glucose ≥ 110 mg/d. L

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

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, & lowglycemic 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 Q 10 –increases sperm motility • Bee propolis—increases pregnancy rates in women with mild endometriosis

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