Lecture 2 Flashcards
Preconception, Pregnancy and Lactation
Before pregnancy
Increasing evidence demonstrating that parents diet and lifestyle can have profound implications for the growth, development, and long-term health of their children before their conception.
What has a big influence on the placental development and function
The maternal nutrition at the time of conception
what is directly tied to maternal periconception
Fetal genomic imprinting and programming at conception is directly tied to maternal periconception nutrition and childs long term health
Preconception time frame
The period before (at least 2 years) and between consecutive pregnancies.
What does Preconception improve
To improve health related outcome for women (regardless of their pregnancy status), newborns and children up to 5 years of age.
Boundary of preconception is divided into
Proximal and distal period
Proximal preconception
Period preceding pregnancy (up to 2 years prior to conception
Distal preconception
Adolescence or in general a longer time before pregnancy
Periconception time frame
The period preceding, including and immediately following human conception
what does periconception improve
to improve health related outcomes for women, newborns and children up to 5 years
Periconception boundary
3 months before pregnancy to up to the first trimester
Criticial window of opportunity (5 stages)
- Pre conception
- Pregnancy
- Birth- 6 months
- 6-12 months
- 1-3 years
Number of days for critical window
First 1000 days of life= Critical window
Nutrition during pregnancy and the two years of the childs life is key for
brain development, healthy growth and a strong immune system
The 5 steps to periconception period
Gametogensis
Fertilisation
Implantation
Embryogenesis
Placentation
what are the 5 important factors that we need to keep in mind for a health status
-Optimise Health
-Folic acid
-Iodine
-Healthy diet and lifetyle
-Excess weight
Optimise Health
Ensure any existing health conditions are being treated and managed
Folic acid
Supplement at least a month before trying to conceive
Iodine
Supplement if planning to conceive
Healthy Diet and lifestyle
Follow a healthy diet and lifestyle and cease smoking
Excess weight
Reduce excess weight for both men and women
Obesity generally indicated by a BMI
> 30 kg/ m^2
Are Obese men and women infertile or sub-fertile
Subfertile
Obese women tend to have higher levels of
estrogen, androgens and leptin than non-obese
By how much more of a percent is menstrual cycle irregularity in obese women
as well as
30-47%
ovulatory failure and amenorrhea
Obesity in men is associated with lower levels of
Testosterone and increased estrogen and leptin levels
What are two other things that are increased for obese men
Reduced sperm production and increased erectile dysfunction
weight loss exceeding 10-15% decreases
estrogen, LH and FSH
what is the critical body fat which can sustain normal reproductive functions
BMI >20 kg /m^2
Long term consequences of undernutrition on fertility and offspring health revealed during country famines
Dutch famin in 1944-45
Periconception and the important micronutrients that need to be considered (7)
Choline
Iron
Iodine
Zinc
Omega 3 fatty acids and B12
Multivitamins
Folic acid
Folic acid
Neural tube defects
Congenital Malformations
Preeclampsia
Autism Spectrum Disorder
Increased sperm count and viability
Periconceptional folic acid
2010 Cochrane review confirmed that folic acid supplementation prevents the first and second time occurence of neural tube defects
Neural tube defects happen
even before some women even know they are pregnant
If you are planning a pregnancy you need to take how much folic acid
Take 800mcg folic acid tablet at least 4 wks before and 12 wks after becoming pregnant
Women who ten to take folic acid are people of a
higher education, higher income, older age, NZ European
Unplanned pregnancies
40% mistimed
60% Unwanted
Folic acid fortification
Over 80 countries have introduced mandatory folic acid fortification
Mandatory folic acid fortification in what in NZ
Bread
Bread increases the folic acid amount per day and
Decreases the chance of
136ug folic acid per day to women of childbearing age
expected to reduce the annual rate of NTD-affected pregnancies between 4 to 14
why withdraw from fortification
-Safety concerns
-“Nanny” state critics
-Bakers worried about the cost and safety
There are still concerns for some people in what categories not getting enough folic acid
No gain for individuals with wheat allergy or coeliac disease
Dutch famine = Hunger winter
Famine that took plave in the German ossipied part of the Netherlands especially in the densely populated western provinces, during the winter of 1944-45, near the end of world war II
The dutch famine found that children of pregnant women exposed to the famine were more
susceptible to diabetes, obesity, cardiovascular disease, microalbuminuria and other health problems
Children were not only smaller but
Their children were also smaller
Barker Hypothesis
The fetal origins hypothesis states that fetal under nutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease
New Zealand recommendations supplementation during pregnancy
Folic acid (800ug), iodine (150ug), vitamin D and Iron
Only take other supplements on the advice of a doctor or midwife
