3. Nutrition needs during preconception Flashcards
- what is the average time considered for “preconception?
- may be extended to what? to achieve desired health outcomes in prep for pregnancy? (ie reach what?)
- 3 months prior to conception/before egg is fertilized by sperm
- may be extended to 6 months to 1 year –> ie to attain a healthy BMI
*recently, studies show that preconception should be more than 1 year prior to conception to prevent offspring from chronic diseases
why is preconception health a concern?
- key concern?
- are mothers usually health during preconception in NA?
- poor maternal health at conception comprises health of fetus and pregnant mother –> increase risk of pregnancy complications + preterm/low birth weight babies
- key concern: overweight and obesity –> risk of gestational diabetes, pre-eclampsia
- nope! 50% of women are overweight, 24% take multivitamin with folic acid, 23% smoked in 3 months prior to conception (related to preterm birth and low birth weight)
preconception nutrition recommendations based on 4 things ish + should include who?
- intake of sufficient folate
- reduction in anemia (folate, B12, iron)
- being current on important vaccinations
- less weight gain at beginning of pregnancy
(1, 3 and 4 included in –> receiving preconception care services)
- should include both parents
what (4) should be targeted during interconception period?
smoking, folic acid intake, weight management, stress reduction
improving pre-conception health:
- 2 life habits should increase
- 3 life habits should decrease
INCREASE:
- eating “5 a day” (of f& v) for adequate iron and potassium
- taking folic supplement
DECREASE:
- smoking
- alcohol
- overweight/obese
is lifestyle behaviour modification DURING pregnancy enough to limit gestational diabetes/preeclampsia/large for gestation baby?
- solution?
no!
- during pregnancy –> can limit gestational weight gain
- BUT unsuccessful in reducing gestational diabetes, preeclampsia and large for gestation in women with obesity
*need multidisciplinary approche to improve dietary and lifestyle habits during preconception period
fertility vs fecundity?
- fertility affected by (5)
FERTILITY = actual production of children
FECUNDITY = biological capacity to bear children
FERTILITY AFFECTED BY:
- body composition
- nutrition
- health status
- social drug use
- genetic considerations
Infertility vs subfertility
INFERTILITY = inability to get pregnant after 12 or more months of regular unprotected sexual intercourse
SUBFERTILITY = any period of reduced fertility when conception is desired
female vs male infertility proportions?
- 35% cases due to female infertility
- 30% involves problems only due to male infertility
- 20% cases related to both women and men infertility
- 15% remains unexplained
healthy dietary choices for good fertility
- increase (4)
- decrease (3)
*good nutrition –> emphasis on (2) = less infertility
INCREASE:
- dietary fiber
- n-3 fats
- vegetables
- micronutrient rich diet! (high satiety)
DECREASE:
- trans fats
- refined carbs
- added sugars
emphasis on maintaining healthy weight + healthy dietary choices
age at onset of pregnancy affects (2)
- age of woman at onset of pregnancy is increasing/decreasing –> explain + 3 consequences?
- affects fertility and pregnancy outcomes
- increasing! used to be 21, now 27! –> only a set number of eggs –> over time, environmental factors can damage the eggs
1. possible difficulty conceiving
2. increase in potential adverse pregnancy outcomes
3. risk of infertility or subfertility and possibly fewer offspring than desired
consequences of overweight vs underweight at pregnancy
OVERWEIGHT:
- risk in pregnancy: preeclampsia, cesarian
- offspring: macrosomia (excessive weight), breathing problems, BP control
- long term offspring health issues (chronic diseases)
UNDERWEIGHT:
- risk in pregnancy: low birth weight, higher risk of mortality, poor development outcome (neural), higher risk of infection, poor lung health
- risk of metabolic disorders: overweight, T2D, CVD –> Barker’s hypothesis (epigenetics)
*obesity and low body weight combined account for 6% of infertility
obese women that are infertile
- modest weight loss of how much can restore (2)
- BUT consequence?
- modest weight loss of 5-10% body weight can restore ovulation and increase fertility
*because hormonal imbalances lead to poor ovulation + risk of infertility - BUT excessive pre-conceptional weight loss can lead to undesirable pregnancy outcome
obese women:
- high levels of (2) released from what?
- leads to 4 + 4 (more general linked with obesity)
obese men:
- lower levels of (1) + increased (2)
- leads to (3)
OVERALL FOR BOTH: increased what damages both _____ and ________
WOMEN:
- high levels of androgens and leptin from fat
- leads to menstrual-cycle irregularity, amenorrhea (cessation of menstrual cycle), ovulatory failure and anovaluatory cycles + polycystic ovary syndrome + delivery by cesarean section + some birth defects + high birth weight infant
MEN:
- lower testosterone + increased estrogen and leptin levels
- reduced sperm production and quality + erectile dysfunction + impairs offspring’s metabolic and reproductive health
OVERALL
- increased oxidative stress damages both eggs and sperm (ie egg can lose ability for self-division and proliferation)
Women: high BMI before conception impairs (3) things related to lactation
- successful initiation of breastfeeding
- duration of lactation
- amount of milk produced
what (2) interventions can reverse the damaging effects of obesity on sperm function? explain
- diet and exercise!
- poor diet has been linked to male infertility –> need zinc in sperm! studies show that increase zinc = increase sperm quality
3 impacts of being underweight in women vs 2 in men
- women with BMI < ____ encouraged to gain weight
WOMEN:
- certain % of body fat is required to produce hormones necessary to conceive
- may develop amenorrhea
- delayed time to conception
- women BMI < 19 –> encouraged to gain weight
MEN:
- may not be able to produce viable sperm
- may have low sperm production
*importance of body fat for hormone production
What are health issues/diseases that can impact fertility? (7)
- overweight/obesity
- underweight
- Celiac disease
- diabetes
- eating disorders
- hypertension
- poor nutrition
Celiac disease:
- what? –> leads to 5 consequences
- in pregnancy: increases risk of (4)
- how is it treated?
- immune response in small intestine to gluten
- damaged intestinal lining, anemia, bone problems, cancer risk + critical nutrients may not be well absorbed!!!
- increases risk of infertility, miscarriage, low birth weight, premature delivery
- treated by eliminating foods containing gluten
diabetes
- if poorly controlled, can contribute to ________ in who?
- ______ with diabetes = twice as likely to have low __________
- 3 dietary recommendations
- can contribute to infertility in both men and women
*in females with T2D –> specifically CHO metabolism –> might increase blood glucose and ketone levels –> teratogenic - men with diabetes twice as likely to have low testosterone
1. CHO counting = effective
2. protein and healthy fat intake encouraged
3. specific ratio of CHO, prot and fat keeps blood sugar in healthy range
- what are 3 common eating disorders?
- all associated with poor what?
- can lead to (2)
- risk for ________ pregnancy
- how to solve ish?
- bulimia nervosa, anorexia nervosa, binge eating disorder
- all associated with poor nutritional status
- fertility problems + amenorrhea
- risk for unplanned pregnancy –> woman may think she is unable to get pregnant
*more common in adolescence - benefits from psychological counseling prior to becoming pregnant
hypertension
- approximately ___% of women of childbearing age –> 2 symptoms ish
- increases likelihood of what during pregnancy?
- can lead to what? explain
- solution?
- 7.3% –> high blood pressure + protein in urine
- likelihood of preeclampsia
- can lead to fetal growth restriction –> hypertension impedes blood flow of placenta –> impedes optimal delivery of nutrient and O2
- solution = Dietary Approach to Stop Hypertension (DASH) diet –> reduce sodium and increase fruit and vegetable intake = increase potassium
preconception and interconception care/nutrition
- women need (4) + explain
- men need (2) + explain
WOMEN:
- folate –> deficiency can lead to birth defects
- iron –> deficiency = high risk of poor outcomes even if take supplements during pregnancy
- omega-3 fatty acids DHA
- iodine
MEN:
- zinc –> poor zinc status = poor sperm quality –> sperm is highly sensitive to oxidative stress (from smoking, drugs)
- antioxidants –> can protect against oxidative stress
Preconception: folic acid:
- necessary for what?
- critical time for this development is from days ___ to ____ after conception
- fortification?
- should women supplement?
- necessary for neural tube to develop into the brain and spinal cord
- critical time = 17-30 days after conception
*3000 women deliver babies with neural tube defects in USA per year - folic acid fortification to commonly consumed grain foods
- should supplement at least 2-3 months before conception with folic acid daily as part of multivitamin
*especially if some people have difficulty metabolizing folate from fortified foods (bc of SNPs)
