Fertility and Pregnancy

Question 1

5 Factors involved in healthy conception?

Answer 1

1) Release of a healthy, non-damaged oocyte.
2) Production of sperm with adequate motility, DNA integrity, count and morphology.
3) Adequate transport of sperm and egg to Fallopian tubes
4) Penetration of the sperm into the oocyte.
5) Implantation of the embryo into a healthy uterus lining.

Question 2

What are 5 female structural abnormalities that may impair fertility?

Answer 2

1) Cervical stenosis: Narrow / closed cervix.
2) Uterine septum: Poor environment for embryo to implant due to poor vascular supply of blood
3) Uterine polyps and fibroids: May disrupt implantation.
4) Fallopian tube / obstruction: Pelvic inflammation, STDs, endometriosis (scar tissue), ectopic pregnancy.
5) Ovarian cysts: Can cause infection and scars of fallopian tubes.

Question 3

What are 5 female hormonal issues that may impact fertility?

Answer 3

1) Polycystic Ovarian Syndrome — elevated androgens, anovulation,
irregular cycles, ↓ uterine lining development, implantation issues.
2) Hyper or hypothyroidism — irregular cycles, ovulatory disorders, miscarriage, pre-term birth, pre-eclampsia.
3) Amenorrhoea — due to hypothalamic dysfunction, , excess exercise, undereating, low BMI, high stress (ACTH / cortisol).
4) Obesity / insulin resistance — lack of ovulation / ↑ androgen levels.
5) Premature ovarian failure — loss of ovarian function < 40 due to chemotherapy / radiotherapy, genetic, SLE.

Question 4

Compare oestrogen and progesterone including roles regarding to conception/ fertility , where they are produced, and signs of dominance for each hormone.

Answer 4

Oestrogen:
* Highest in first half of the menstrual cycle.
* Creates proliferative endometrium.
* Important for ovulation.
Dominance= Fibroids, Endometriosis, PCOS, Heavy bleeding, Tender and swollen breasts, PMS, Shorter menstrual cycles, Poor memory, Brain fog, Hypothyroidism, Fatigue, Mood swings, Miscarriages

Progesterone:
* Highest in second half of menstrual cycle.
* Maintains secretory endometrium.
* Important for implantation and
the survival of the embryo.
Dominance: Breast tenderness, Water retention, Bloating, SOB, Dizziness, Drowsiness / lack of concentration, Sense of physical instability, Long luteal phase, Discomfort in the legs * Decreased libido, Weight gain, Insomnia, Light periods

• Both hormones are produced in the ovaries, adrenals and placenta.
• Both are stored in the adipose (fat) tissue.

Question 5

5 ways to optimise the oestrogen/ progesterone ratio?

Answer 5

Reduce stress — regular healthy meals, optimise sleep, ↓ over-exercising, address emotional stressors.
* Optimise liver function — to detoxify excess oestrogen.
* Avoid endocrine disruptors (e.g., home / personal products).
* Avoid alcohol — ↑ oestrogen levels by promoting the induction of aromatases and by impairing hepatic oestrogen metabolism.
* Reduce body weight if obese — oestrogen is stored and produced in fat cells.
* Optimise digestion and elimination —to excrete excess oestrogen.
* Consider herbs such as Vitex agnus castus.

Question 6

3 drugs that may impact female fertility and why?

Answer 6

1) NSAIDs (long-term use or ↑ dosage) — inhibit ovulation and lower progesterone levels.
2) Chemotherapy — damage / depletion of oocytes.
3) Antipsychotic medicines — increase prolactin levels leading to anovulation and amenorrhoea.
4) Corticosteroids — suppress immune function, affect gut microbiome, elevate blood pressure and blood sugar levels.
5) Antihistamines — dry the mucous membranes.

Question 7

3 environmental factors that may affect female fertility?

Answer 7

1) Excessive radiation (mobile phones, x-rays and radiotherapy, frequent flying) — damages oocytes.
2) Environmental toxin exposure (e.g., mercury, lead, phthalates, solvents)
3) Chronic alcohol consumption — diminished ovarian reserve and ovulatory dysfunction.
4) Caffeine — increases cortisol production, slows COMT (oestrogen dominance).
5) Xenoestrogens, pesticides and endocrine disruptors (e.g., plastics, cans, detergents, candles, flame retardants, cosmetics).

Question 8

Which immunological
events must occur to prevent foetal rejection?

Answer 8

1) Tissue type compatibility — if mother’s immune system responds negatively to paternal HLA proteins, this can affect implantation / pregnancy outcome.

2) Blood clotting defects — ↑ risk of early / late term loss, risk of maternal embolism / stroke, placental blood flow restriction.

3) High uterine NK cells — can trigger ↑ TNF-alpha, cytokines- early pregnancy loss. High BPA exposure linked to NK cell activity.

4) Autoimmunity — immune system rejects the embryo.

Question 9

5 structural reasons that may contribute to male infertility?

Answer 9

1) Congenital defect of testes or ejaculatory tract.
2) Undescended testes ― ↓ sperm count and quality due to heat.
3) Testicular cancer ― caused by the disease or treatment that damages sperm
4) Surgery or injury to testes such as testicular torsion, being kicked; bicycle injury.
5) Infections (STIs and post-pubertal mumps) cause permanent damage to the testes, vas deferens or epididymis. Impacts transport of semen to ejaculatory ducts.

Question 10

Name 6 hormonal or health conditions affecting male fertility?

Answer 10

Hormonal:

1) Hypogonadism ― ↓ function of gonads and ↓ production of sex hormones. Causes: tumour, illegal drugs, or Klinefelter syndrome (a genetic condition where an additional X chromosome interferes with male sexual development and ↓ testosterone)

2) Obesity-Increased peripheral conversion of testosterone to oestrogen (aromatisation) and decreased luteinising hormone.

3) Cushing syndrome- Increased cortisol results in low sperm count.

Other health conditions:

1) Diabetes mellitus ― neuropathy, neurogenic impotence, and retrograde ejaculation (= semen in bladder).

2) Haemochromatosis ― systemic inflammation- hypogonadism and androgen deficiency.

3) Scrotal varicocele ― blocked / enlarged veins scrotal temperature = ↓sperm production.

Question 11

What are 3 drugs that could impact male fertility?

Answer 11

Sulfasalazine — (DMARD) (RA, UC and Crohn’s) ↓ sperm count whilst taking the drug.
* Anabolic steroids — increase levels of testosterone but impairs body’s own production ↓ sperm count / sperm mobility.
* Chemotherapy — severely reduces sperm production.
* Medical drugs, alcohol, cigarettes, caffeine and marijuana reduces sperm count, concentration and motility.

Question 12

3 environmental factors affecting male fertility?

Answer 12

Environmental:
* Pesticides and endocrine disruptors.
* Mobiles ― interfere with spermatogenesis- heat, radiation, EMFs, ↑ oxidative stress.
* Heavy metals (e.g., lead and mercury) and chemical toxins (e.g., BPA, phthalates) have been shown to damage sperm.
* Heat exposure to the testicles compromises sperm production
hot baths, cycling, tight underwear, mobile phone in pocket.
* Excessive oxidation (poor diet, smoking, obesity, alcohol etc.) can cause DNA fragmentation and reduced sperm morphology).

Question 13

How can peridontal disease affect fertility?

Answer 13

(mother) ― lengthens the time to conceive by approx. 2 months:
* It can prevent ovulation — increases inflammatory markers (IL-1). IL-1 inhibits GnRH production.
* Metabolic waste products from oral bacteria and can cross the placenta and affect the foetus.
* Fusobacterium nucleatum has been isolated from the amniotic fluid and placenta of women delivering prematurely.
(father):
* Causal links exist between oral infections and infertility. Treatment of oral infections = 20% improvement in spermatic parameters.

Question 14

Describe the seminal microbiome?

Answer 14

comes from the GIT, mouth, vagina (sexual partner and mother).
* aids conception, supports health of offspring and modulates immune responses.
*more diverse but has lower bacterial concentrations than the vagina. diversity is thought to help expose and train the VMB and immune system to aid pregnancy and conception.
* The SMB should be lactobacillus dominant (like the VMB) — it has
been shown that these bacteria prevent sperm damage by ROS.
Sex during IVF increases implantation
; the semen (with the SMB) prompts the cervix to release immune signalling molecules such as regulatory T-cells.
* The SMB is negatively impacted by antibiotics, antifungals, STIs, prostatitis, lubricants, smoking, alcohol, obesity and poor penile hygiene practices.
* Ureaplasma urealyticum is a frequent causes of male infertility, E.coli, prevotella,chlamydia, gonorrhoea, bacteroidetes and firmicutes also implicated

Question 15

Which bacteria species positively and negatively impact the vaginal microbiome?

Answer 15

healthy fertile VMB is normally associated with: dominance of the lactobacilli species, low diversity of other species. Creates an acidic, inhospitable environment which prevents the overgrowth of potential pathogens.
* Lactobacillus crispatus is associated with a higher implantation rate in IVF if it is in high abundance
* The presence of bacterial vaginosis, such as ureaplasma and gardnerella, when coupled with low lactobacilli species and a higher pH, can increase the chance of miscarriage.
* Mycoplasma, ureaplasma and chlamydia trachomatis are examples of bacteria that have been negatively associated with fertility.

Question 16

How can you negatively and positively impact the vaginal microbiome?

Answer 16

The vaginal microbiota can be negatively impacted by STIs, alcohol, smoking, poor vaginal or oral
hygiene, increased blood glucose levels, copper
IUD coil, a low vitamin A, D, C and E status etc.
* A low oestrogen environment can impact the
growth of the VM. Cervical fluid is important as a
fuel source to feed lactobacilli as it is rich in glycogen.
* You can positively impact the vaginal microbiota by reducing
infections, improving blood glucose levels, improving oestrogen
levels, and supporting lactobacilli growth with pre and probiotics.

Question 17

Describe how exercise can affect fertility

Answer 17

Moderate exercise improves circulation and insulin resistance which increases the likelihood of conception:
* Intensive exercise is deleterious for fertility,it raises cortisol production = ↓ progesterone.
* Excessive secretion of endorphins interferes with production of FSH and LH, in turn inducing ovulatory disorders and luteal phase dysfunction, which accounts for lack of embryo implantation and first-trimester miscarriages.
* In males, excessive exercise has been associated with oligospermia

Question 18

How can stress affect fertility?

Answer 18

The release of cortisol, adrenaline and noradrenaline inhibits the release of GnRH (downregulates LH and FSH)- disrupts steroidogenesis in testes/ ovaries
* Under stress, the body will prioritise cortisol, leading to reduced progesterone production.

Question 19

How can age affect fertility?

Answer 19

• Women are born with all the oocytes they will ever have. Oocyte numbers / quality diminish with age
  
  • Chromosomal abnormalities, poor embryonic development, implantation failure and miscarriage risk increase with age. Abnormalities: 1:500 aged 20; 1:400 aged 30; 1:60 aged 40+.
• sperm morphology and motility tend to decline with age

Question 20

How can poor methylation impact fertility, and how can you naturally support this with nutrients?

Answer 20

SNPs in MTHFR (C677T) folate-metabolising enzyme crucial for reproductive function. leads to impaired folate metabolism and elevated homocysteine (poor egg maturity and egg quality, ↑ oestrogen).
* neural tube defects, pre-eclampsia and gestational hypertension.
* C677T SNP is associated with ↓ fertility in men, possibly through changes in sperm maturation.
Support with:
Dietary folate (DGLV, avocado, legumes, poultry), methylfolate supplement
Vitamin B12- dietary or methylated supplement
B6- whole grains, sunflower seeds, fish
B2 essential component of the coenzyme FAD, cofactor for the MTHFR enzyme.
* Mushrooms, spinach, organic soybeans, beet greens, avocados, eggs.
Methionine : beef, brazil nuts, wholegrains

Question 21

Describe 5 orthodox fertility investigations?

Answer 21

Ultrasound scans: To rule out any structural abnormalities.

Serum FSH, oestrogen and progesterone: Day 1–5 oestrogen test, Day 21 progesterone test

Thyroid function: full thyroid panel (TSH, T3,T4, thyroid antibodies, possibly rT3).

Glucose levels and insulin resistance:
can affect ovulation / cycle length.

AMH (anti- Mullerian hormone) combined with AFC (antral follicle count):
a protein that is used as a marker of ovarian reserve.
* ↑ AMH could be PCO. ↓ AMH / reserve is likely to respond poorly to IVF drugs.
* AFC is done via ultrasound scan to check numbers of follicles in both ovaries.

Sperm sample:
* To check for sperm motility and morphology, as well as semen volume (see earlier).

Question 22

Name 5 functional fertility investigations

Answer 22

• Toxic metal hair / urine mineral analysis
• MTHFR and COMT genetic variations, DNA testing; COMT SNPs disturb oestrogen balance
• ↑ homocysteine levels can indicate methylation issues.

-Adrenal stress profile:
* Can highlight a need for support (suppressive effects of cortisol on fertility)

Oxidative markers (e.g. Genova Oxidative Stress test or DUTCH) ‘8-OHdG’ is measured in DUTCH

Immune investigations:
* NK cells, HLA, antiphospholipid antibodies.

Serum or urine analysis of amino acids (male):
* can affect sperm count

Vaginal ecology:
* Evaluate the VMB ― look for evidence of BV etc.

Comprehensive hormone panels:
* Genova Rhythm Plus (saliva ― female): oestrogen, progesterone and testosterone that spans a full 28 days.
* DUTCH test: Comprehensive assessment of sex and adrenal hormones + their metabolites. Includes 8-OHdG.

• AMH (female) —tested if undergoing ART.

Question 23

What are 3 types of assisted reproductive technologies?

Answer 23

In vitro fertilisation (IVF): Stimulation of ovaries, egg retrieval, fertilised in vitro with sperm, fertilised embryos transferred into uterus.
* Intracytoplasmic sperm injection (ICSI) (sperm abnormalities) Sperm is injected into egg in vitro
* Intrauterine insemination (IUI) — sperm is placed inside uterus around ovulation to facilitate fertilisation.

Question 24

What are 5 risks associated with IVF?

Answer 24

• Multiple births
• Premature delivery and low birth weight
• Ovarian hyperstimulation syndrome — swollen and painful ovaries due to injected fertility drugs such as hCG.
• Egg retrieval procedure complications bleeding, infection or damage to the bowel, bladder or a blood vessel.
• Ectopic pregnancy — 2–5% of women who use IVF.
• Cancer — egg growth stimulation drugs are linked development of a specific type of ovarian tumour.

Question 25

5 dietary suggestions to improve fertility

Answer 25

1) Avoid Processed food ―promotes oxidative damage. * Caffeine- increases cortisol production, slows COMT (oestrogen dominance), * Alcohol ― impacts ovulation; ↓ sperm motility and count. 2) Whole foods, nourishing diet. * Local, seasonal foods prepared to maintain optimum amounts of nutrients * Encourage optimal digestion — chew food well, avoid drinking during meals etc. 3) Antioxidant rich foods ― i.e.,C, E, carotenoids, selenium etc., to reduce oxidative stress and improve sperm quality. -Eat the rainbow (phytonutrients), DGLV and crucifers (also for liver detoxification I3C stimulates CYP1A1. Consume 1–2 cups with each meal daily. 4) Beans and legumes ― rich in fibre, aids bowel transit and toxin elimination, balance blood sugar (crucial for hormonal health). Contain phytoestrogens that modulate oestrogen and disrupt aromatase. Consume 3 x week. 5) Mostly plant protein with some high-quality animal protein: * Organic eggs- cholesterol for steroid hormone production, Choline for neural development. * Wild caught fish and seafood — high in zinc for ovarian hormone production, spermatogenesis, GI tight junction support and superoxide dismutase production. ‘SMASH’ fish to optimise DHA * Organic liver — high in vitamin A, B vitamins, iron, copper, choline. Consume 2 x month. 6) High quality fats: * Monounsaturated fats improve insulin sensitivity and secretion, ↓ inflammation, assist fertility. * Daily omega-3 fatty acids (oily fish, flaxseeds etc.) ― support cell membranes * Nuts (walnuts, macadamia nuts, almonds). * Moderate use of coconut oil and organic butter (if tolerated). 7) saffron ―boosts libido and NS support. Crocetin enhances nitric oxide synthase activity in the vascular endothelium

Question 26

Other than dietary, 4 other natural support recommendations that can help fertility?

Answer 26

1) Optimise body composition: * Help clients achieve a BMI of 20–25, Obesity increases the risk of birth defects and gestational diabetes. * Aim for a body fat percentage of 20–25% (less than 17% can induce amenorrhoea). 2) Reduce stress: work life balance, walking, take time off 3) Minimise exposure to environmental toxins: * Reduce BPAs, phthalates * avoid excessive mobile phone and WiFi exposure 4)8 hours of uninterrupted sleep per night. 5) Include mindset work: – Visualisation, affirmations, journalling, gratitude. 6) Explore holistic therapies: * Acupuncture, homeopathy, herbal medicine to support the body’s homeostatic mechanisms. * Arvigo Maya abdominal massage (increases blood flow to reproductive organs, improves digestion and nutrient absorption, relieves stress). * Reflexology (relieves stress, can regulate menstrual cycle). 7)regular intercourse 5 days prior to ovulation, and 3 days after.

Question 27

5 supplements that can help with male fertility?

Answer 27

1) Selenium: 100 mcg / day * Improves sperm motility and structural stability- needed for GPO ― protects sperm against ROS. 2) Zinc: 15–45 mg daily * antioxidant effects-protects sperm from ROS * required for spermatogenesis and sperm motility. 3) CoQ10 (ubiquinol (200 mg daily) * key antioxidant and nutrient for the electron transport chain ― ↑ sperm concentration and motility. 4) Fish oil: at least 900 mg DHA * Omega-3 FAs required for cell membrane fluidity — needed for the acrosome reaction. (DHA) 5) L-carnitine: 1000 mg daily, * Highly concentrated in the epididymis, crucial role in sperm metabolism and maturation. * energy substrate for sperm, assisting their motility. antioxidant working well with CoQ10. 6) N-acetyl-cysteine:( 600 mg x day for 3 months) * Supports glutathione production- primary antioxidant system utilised in spermatozoa.

Question 28

6 supplements to help with female fertility

Answer 28

1) Vitamin A: Cod liver oil 1 tsp / day- stop during pregnancy * An antioxidant critical for cell division and differentiation 2) CoQ10: 200mg per day. * Important for oocyte development. Improves ovarian response to IVF / ICSI treatment. 3) Myo-inositol: 2000 mg per day for 26 weeks. * Promotes ovarian function, enhances oocyte quality, encourages regular cycles., increased pregnancy rates in IVF 4) L-carnitine: 500–1000 mg until embryo transfer. * Increases endometrial thickness, Enhances oocyte ATP production. 5) Alpha lipoic acid: 300 mg of R-alpha lipoic acid or 600 mg normal ALA. * Antioxidant, has immunomodulatory effect, aids in chelation of heavy metals, aids insulin sensitivity. 6) Folate: 400 mcg daily (800 mcg in high risk) a * Required for RNA and DNA synthesis, neural tube development. * Females with an MTHFR polymorphism should take methyl-folate. 7) Vitamin B3: 100 mg (as part of complex * deficiency in NAD can cause recurrent miscarriages and birth defects.

Question 29

2 herbs for female fertility?

Answer 29

1) Vitex agnus castus:15–20 drops in the morning. (3–6 months for effect) 1 tsp dried berries decocted 1–2 daily. * -Regulates the cycle * Regulates prolactin levels (binds to dopamine D2 receptors ↓ prolactin pituitary secretion) - enhances corpus luteum development - corrects luteal phase progesterone deficiency. 2) Shatavari root: 2–4 ml of tincture, 3 x daily. 1–2 tsp powder / day.. * Ayurvedic female fertility tonic, promotes hormonal balance. Good for a low sperm count.

Question 30

4 ways to pinpoint ovulation?

Answer 30

1) Ovulation strips: Measure the amount of LH in your urine, start testing about cycle day 9 2) Mucus secretion reaches its maximum approximately 24–48 hours before ovulation- becomes thin, watery, alkaline, elastic and looks like egg-white. 3) Temperature charting: * Just before ovulation BBT drops then rises 0.5° C until menstruation, due to the extra progesterone. * Interrupted sleep can affect temperature reading. * Alcohol consumption can ↑ temperature and invalidate readings. 4) Cervical position: * The cervix is normally low, firm and closed throughout the cycle. * As ovulation approaches, it becomes higher, softer and more open.

Question 31

How might cervical mucous secretion be effected and you can it be improved?

Answer 31

hormonal changes and medications such as the OCP, clomiphene citrate, surgical procedures, infections, hypoestrogenism and radiation therapy. * Cigarette smoking decreases the production of cervical mucus. * If cervical mucus is scanty: increase fluid intake take evening primrose oil use a fertility friendly lubricant that does not affect the pH

Question 32

What are the 3 stages of foetal growth?

Answer 32

* Blastogenesis stage (2 weeks): Fertilised ovum divides and implants itself in the uterus. * Embryonic stage: Principal organs / membranes develop. * Foetal stage (3rd month til term): The most rapid period of growth.

Question 33

How can nutrition during pregnancy affect health of the baby?

Answer 33

* Undernutrition during pregnancy epigenetically increases the risk of diabetes mellitus and cardiovascular disease. * Excess and unbalanced food choices lead to higher birth weight, increasing risk of obesity, cancer and asthma later in life. * Maternal high-fat diets can cause epigenetic DNA modifications passed on to future generations

Question 34

How should herbs be used during pregnancy?

Answer 34

* Most herbs should be avoided during pregnancy and lactation * Herbal teas safe for pregnancy (in small doses) include ginger, peppermint and chamomile. These will stimulate the uterus. * Avoid emmenagogue herbs (e.g., parsley, rosemary, basil, yarrow, wormwood, black cohosh- can stimulate the uterus * Red raspberry leaf tea is a uterine tonic which can be used in the last month of pregnancy to encourage parturition.

Question 35

What is toxoplasmosis?

Answer 35

an infection caused by a protozoan parasite found in cat faeces. It can also be present in raw / undercooked meat and soil left on unwashed fruit and vegetables. * can be passed to the unborn baby, as miscarriage, stillbirth, damage to baby’s brain and organs.

Question 36

7 key nutrients needed for pregnancy

Answer 36

1) Protein:Extra 6–10 g / day * supports foetal, placental and maternal tissue growth. * Restricted protein intake leads to t dyslipidaemia, obesity, hypertension, hyperinsulinemia in offspring. 2) Calcium: 1000 mg daily needed * Ossification of the foetal skeleton, teeth and neural development, and protection of maternal bones. 3) Magnesium: 360–400 mg * Increased need, Deficiency increases risk of pre-eclampsia, foetal growth retardation, pre-term labour, metabolic dysregulation and SIDS. 4) Iron: * Increased requirements- growth demands of the foetus and placenta, and to support increased production of erythrocytes. * Essential for oxygen transport. 5) Vitamin A:> 5000 IU / day.* foetal growth, development of vision, hearing, immune, respiratory functions. * neurogenesis in the embryo and control of neural plasticity. * Pre-formed vitamin A in excess of 10,000 IU has teratogenic effects so source from beta-carotene in pregnancy. * Approximately 50% have reduced BCO1 activity- needed to convert beta carotene to retinol. 6) Vitamin D: 2000 IU needed / day in pregnancy. * In pregnancy, vitamin D is especially important for calcium homeostasis, cell differentiation and immune function. * Low vitamin D can ↑ pre-eclampsia risk. 7) EPA and DHA:Fish oil 200–300 mg DHA + EPA during pregnancy. important for neurodevelopment and are associated with: * Healthy birth weight. * Increased gestational length. * Healthier BMI. * Improved infant visual performance * Lowered allergic response. * Better mental processing.

Question 37

What can influence gut flora in pregnancy and birth, and how can you optimise this?

Answer 37

* Birth method will influence the baby’s microbiome (vaginal birth vs. caesarean) and breastfeeding). * Excessive pre-or pregnancy weight can (↑ bacteriodes, ↑ E.coli, ↓ bifido - predispose the child to obesity. Optimise: * Supplementation of 10 billion Lactobacillus rhamnosus GG 4 weeks before labour to 6 months postpartum can moderate weight gain and reduce eczema development , and protect against allergy development * Natural childbirth and breastfeeding. * Avoidance of antibiotic use. * Pets in the home. * Avoidance of hyperclean environment (‘hygiene hypothesis’). and playing outside

Question 38

What is morning sickness, why might it occur and what can you do naturally to help?

Answer 38

characterised by nausea and vomiting, aversions to certain foods, a metallic taste in the mouth, h, and relief from nausea by eating. * at any time of the day and common between week 5 of pregnancy until the 2nd trimester. Possible contributing factors include: * Rising hCG levels in first trimester (higher in women with twins or with hyperemesis gravidarum (severe / prolonged vomiting). * High oestrogen (oestradiol). * Enhanced sense of smell. * Poor nutritional status and poor blood sugar control. To alleviate: * Take supplements with food. * Stay hydrated. * Make time to relax/ sleep during the day. * 25mg of vitamin B6, three times a day for four days. * Ginger (e.g., ginger tea). * Eat smaller, frequent meals including protein and carbohydrates.

Question 39

What is pre-eclampsia? Risk factors? symptoms? Ways to help naturally?

Answer 39

Pregnancy-induced hypertension associated with protein in urine and oedema, around 20 weeks of pregnancy. * Risk factors include: Advanced maternal age (40+), first pregnancy, twin pregnancy, family history, hypertension, chronic autoimmune disease, BMI >35. * Symptoms include: Water retention, severe headaches, vision problems, pain below ribs. Complications: Poor foetal growth, eclampsia (fits), stroke, organ problems, liver and blood clotting disorder * Support: Low serum levels of calcium, magnesium, zinc, vitamin D and omega-3s have been associated with ↑ risk of pre-eclampsia. * Get adequate rest and manage stress. Supplementations: * 2 g calcium in second and third trimester. * 200 mg CoQ10 from week 20 onwards. * 500–750 magnesium (although reduce in third trimester as it can interfere with contractions

Question 40

What is GDM? risk factors? Ways to help naturally?

Answer 40

Gestational diabetes mellitus (GDM): * Affects 2–5% of pregnant women, pregnancy hormones make the body insulin resistant. * ↑ chance of mother and infant developing diabetes mellitus. * Increases risk of larger birth weight, caesarean birth and neonatal hypoglycaemia. * Risk factors include family history of diabetes and obesity, history of large birth weight. * Low GI diet, daily exercise (e.g., a walk after meals) and possible supplementation of 4–8 mcg x kg of chromium picolinate

Question 41

Why does pregnancy heartburn occur and how might you help naturally?

Answer 41

- hormonal changes can allow the muscles in the oesophagus to relax more -In the third trimester, the enlarging uterus and baby reduces the space for the digestive organs. * Avoid trigger foods: Spicy foods, chocolate, caffeine, tomatoes. * Avoid eating before bed. Raise the head of the bed with a wedge-shaped pillow and sleep on the left side (right side will position the stomach higher than the oesophagus).

Question 42

Why might pregnancy constipation occur and how can you help this?

Answer 42

-Enlarging uterus reduces digestive organ space -Also the increase in progesterone relaxes the intestinal muscles. * Increase fluids and fibre-rich foods. * Consider ground flaxseeds mixed in water * Probiotic-rich foods or probiotic supplementation * Supplement with magnesium citrate.

Question 43

Ways to optimise post-partum care?

Answer 43

* Crucial to have a support network in place for the parents. * Allow the mother to rest and establish breastfeeding - Staying in bed * Stock up the freezer with nourishing meals. * Integrate baby into everyday life — encourage baby wearing.

Question 44

What can post-partum hormonal changes lead to and why?

Answer 44

- postpartum affective instability, incl. rapidly fluctuating mood, tearfulness, irritability and anxiety:- -huge drop in progesterone and increase in prolactin and oxytocin (contracts the womb back to its size and stimulates lactation, can also increase anxiety). * Symptoms peak on the fourth or fifth day after delivery and can last for many days (‘baby blues’). If symptoms persist for longer than two weeks to include: * Difficulty in bonding with the baby. * Withdrawing from the family. * Feeling of hopelessness. * Excessive crying. * Severe anxiety. * Thoughts of harming self or the baby. * Refer the client (these are red flags).

Question 45

3 post-partum investigations to consider?

Answer 45

1)Thyroid function — postpartum thyroiditis is often common after giving birth (incidence of 4–9%)-can mimic symptoms of anaemia and postpartum depression. ‒ In most cases it is autoimmune: shift in Th1 cell function, loss of tolerance for foetal antigens and enhanced IgG secretion, 2) Anaemia screening — as it can cause similar depressive symptoms. 3) Mum MOT’ — pelvic floor examination, diastasis recti, screening for bladder, bowel or sexual dysfunction.

Question 46

Which 4 immunological factors are implicated in female fertility?

Answer 46

1) Anti-sperm antibodies (ASAs) — sometimes, a woman’s immune system will produce ASAs which destroy sperm, leading to fertilisation difficulties or miscarriage. 2) Antiphospholipid syndrome — autoimmune disorder which causes increased risk of blood clotting and ↑ miscarriage and stillbirth risk. 3) Thyroid antibodies — Leading to autoimmune thyroiditis and ↑ miscarriage and pre-term labour risk. 4) Ovarian antibodies affects egg and embryo development, ↓ fertilisation and pregnancy rates, implantation failure.