Lecture 2: Preconception

Question 1

What is preconception?

Answer 1

“the period before (at least 2 years) and between consecutive pregnancies, to improve health related outcomes for women (regardless of their pregnancy status), newborns and children up to 5 years of age”

Question 2

What is the proximal preconception period?

Answer 2

Period preceding pregnancy (up to 2 years prior to conception)

Question 3

What is the distal preconception period?

Answer 3

Adolescence or in general a longer time before pregnancy

Question 4

Why is preconception important?

Answer 4

Because a mothers health at and before conception influences the course and outcome of her pregnancy

Question 5

What does maternal nutrition at the time of conception influence?

Answer 5

Placental development and function

Question 6

What is directly tied to maternal preconception nutrition and child’s long-term health?

Answer 6

Fetal genomic imprinting and programming at conception

Question 7

What is periconception?

Answer 7

“the period preceding, including and immediately following human conception to improve health related outcomes for women, newborns and children up to 5 years of age”

Question 8

What is the boundary for periconception?

Answer 8

3 months before pregnancy and up to the first trimester

Question 9

When do most reproductive failures occur?

Answer 9

During periconception

Question 10

What is the CRITICAL window of life?

Answer 10

First 1000 days of life

Question 11

What does the first 1000 days of life include?

Answer 11

Pregnancy, and first 2 years of life (not pre-conception)

Question 12

Why is nutrition in the first 1000 days of life the critical window?

Answer 12

Key to brain development, healthy growth and a strong immune system - one of the most modifiable factors

Question 13

What percent of the population are malnourished during the first 1000 days of life?

Answer 13

1/3

Question 14

What does malnourished mean?

Answer 14

Obese, underweight or deficiencies

Question 15

What do majority of infant deaths occur due to?

Answer 15

Malnutrition

Question 16

What is happening during periconception?

Answer 16

The eggs and sperm are being developed. Egg = 14 weeks, Sperm =10 weeks

Question 17

Why should we consider the periconception period longer than 3 months?

Answer 17

Biologically it could be considered 5-6 months

Question 18

What does malnutrition look like around the world?

Answer 18

1.9 billion adults are overweight (>600 million obese)
462 million adults are underweight

Question 19

What does the prevalence of malnutrition look like over time?

Answer 19

Increasing overweight and obesity
Undernutrition prevalence is stabilising or decreasing

Question 20

What BMI indicates obesity?

Answer 20

> 30kg/m2

Question 21

Most obese men and women tend not to be infertile rather…

Answer 21

Sub fertile

Question 22

What is sub-fertile?

Answer 22

difficulty conceiving, pro-longed period of misconception

Question 23

Obese women tend to have higher levels of what?

Answer 23

Estrogen, androgens and leptin than non-obese

Question 24

How does obesity affect the reproductive processes in women?

Answer 24

Menstrual cycle irregularity (30-47%), ovulatory failure and amenorrhea

Question 25

Obesity in men is associated with lower levels of what?

Answer 25

Testosterone and increased estrogen and leptin levels

Question 26

How does obesity affect the reproductive processes in men?

Answer 26

Reduced sperm production and increased erectile dysfunction

Question 27

What BMI indicates a critical level of body fat?

Answer 27

less than 20kg/m2

Question 28

What is low levels of body fat during adolescence related to?

Answer 28

delays in the age of onset of menstruation and reduced fertility later in life

Question 29

What does weight loss exceeding 10-15% decrease?

Answer 29

Estrogen, LH and FSH

Question 30

What are the consequences of weight loss exceeding 10-15%?

Answer 30

Amenorrhea, anovulatory cycles, short or absent luteal phases

Question 31

What can periconceptional micronutrient status influence?

Answer 31

Offspring metabolism, organ growth, development and function, leading to an increased risk of chronic disease

Question 32

What effect does choline have during periconception?

Answer 32

Brain development

Question 33

What effect does iodine have during periconception?

Answer 33

Neurocognitive

Question 34

What effect does zinc have during periconception?

Answer 34

Preterm birth, placental function

Question 35

What effect do omega-3 fatty acids and B12 have during periconception?

Answer 35

Altered lipid metabolism

Question 36

What effect does iron have during periconception?

Answer 36

- Iron deficiency anemia linked with LBW - Delayed development - Preterm birth - Infections - Postpartum hemorrhage

Question 37

What effect does folic acid have during periconception?

Answer 37

- Neural tube defects - Congenital malformations - Preeclampsia - Autism

Question 38

What did the 2010 Cochrane review confirm?

Answer 38

That folic acid supplementation prevents the first and second time occurence of NTD's

Question 39

What are NTD's that effect the brain?

Answer 39

- Craniorachischisis - Anencephaly - Encephalocele - Iniencephaly

Question 40

What are NTD's that effect the spinal cord?

Answer 40

- Spina bifida *** - Spinal dysraphism - Meniogelcele - Myelomenigocele

Question 41

What is the periconceptional folic acid recommendation?

Answer 41

800mcg (0.8mg) daily at least 4 weeks before and 12 weeks after becoming pregnant - first trimester

Question 42

What percent of unplanned pregnancies are mistimed and unwanted?

Answer 42

40% mistimed 60% unwanted

Question 43

What helps bridge the gap for unplanned pregnancies not taking folic acid supplements?

Answer 43

Fortification

Question 44

Why did NZ withdraw from folic acid fortification?

Answer 44

Some unvalidated evidence that folic acid fortification would increase cancer risk, based on the fact that cancer cells need folic acid to replicate + worries over government control + cost for bakers

Question 45

What is the current policy?

Answer 45

Fortification of flour used for bread making in NZ - non-organic wheat flour - no less than 2mg/kg, no more than 3mg/kg - includes imported flour

Question 46

What is the dutch famine?

Answer 46

Took place in german-occupied part of the netherlands, winter of 1944-45 near the end of WWII

Question 47

Why did the dutch famine occur?

Answer 47

German blockade cut off food and fuel shipments - 4.5 million affected: 22,000 died

Question 48

Children of pregnant women exposed to famine are more susceptible to what?

Answer 48

Diabetes, obesity, CVD, microalbuminuria and more

Question 49

What is the Barker hypothesis?

Answer 49

"states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease"

Question 50

What is considered LBW?

Answer 50

Less than 2.5kg

Question 51

What disease is LBW associated with?

Answer 51

Coronary artery disease, impaired glucose tolerance, type 2 diabetes

Question 52

Young mothers are more likely to have babies with lower birth rates. Why?

Answer 52

- Adolescent mother is still growing themselves: there is a competition for nutrients

Question 53

What is Guatemala?

Answer 53

long-term prospective study to determine the effects of maternal nutrition on offspring physical growth and mental development

Question 54

What did Guatemala look at?

Answer 54

What happened when energy and protein supplementation were given to mothers - In those women who complied they had a 50% lower rate of LBW

Question 55

What Vitamins do NZ recommend for supplementation during pregnancy?

Answer 55

Folic acid and iodine

Question 56

What are the folic acid recommendations during pregnancy?

Answer 56

1 800ug daily for 4 weeks pre-pregnancy and until end of first 12 weeks

Question 57

What are the iodine recommendations during pregnancy?

Answer 57

1 150ug iodine-only daily from start of pregnancy to end of breastfeeding

Question 58

What are other supplements on advice for pregnancy?

Answer 58

- Iron (if indicated) - B12 (vegan) - Calcium (subject to diet) - Vitamin D (subject to enviornment)