Pre-conception Nutrition 2

Question 1

Undernutrition

Answer 1

Chronic- over time, continuous lack of nutrition often leads to low birth weight with high rate of death in first year of life. Often occurs in the developing world.
Acute- associated with a dramatic decline in fertility which recovers when food intake is returned to an adequate level eg during a famine

Question 2

Body fat and fertility

Answer 2

Decreased fertility seen with too high or too low body fat due to alterations in hormones oestrogen and leptin
Levels increase with high body fat and reduced with low body fat
Optimal fertility bw BMI 20-30
Weight loss of >10-15% of usual weight decreases oestrogen- can result in amenorrhea, anovulatory cycles (has period but does not release egg) and short or absent luteal phase
Or decreases sperm viability and motility in men
Treatment with fertility drug cloned not effective in underweight women

Question 3

Exercise and infertility

Answer 3

Adverse effects of intense physical activity 
Delayed age at puberty 
Lack menstrual cycle 
Appear to be related to hormonal and metabolic changes 
Related to caloric defecit 
Reduced levels of oestrogen 
Low levels of body fat 
Decreased bone density

Question 4

Diet and fertility

Answer 4

Diet may impact hormones

Main dietary practices are vegetarian diets, low fat intake, high fiber intake, soy, caffeine and alcohol

Question 5

Oxidative stress

Answer 5

Can decrease spent motility
Reduced ability of sperm to fuse with an egg
Harm egg and follicular development
Interfere with corpus luteum function
Interfere with implantation of egg
Antioxidants
Vit C, E and selenium and beta carotene
Found in fruit and veg
Protect cells of the reproductive system, including eggs and sperm
Zinc status can reduce oxidative stress, assist sperm maturation, assist testosterone synthesis, researched for role in infertility

Question 6

Plant foods

Answer 6

Low fat high fiber - reduced oestrogen and irregular periods
Isoflavones from soy decrease levels of gonadotropin and oestrogen and progesterone
Rate of infertility lower in women who use iron supplements or iron from plant foods
Prepregnancy iron deficiency linked to preterm pregnancy delivery and low iron status in body
Many women enter pregnancy with inadequate iron stores

Question 7

Caffeine

Answer 7

Appears to prolong time to conception
Daily caffeine intake and reduction in conception is 300 mg = 27% decrease
500mg = 50% decrease

1 coffee contains approx 100mg caffeine

Question 8

Alcohol

Answer 8

May decrease oestrogen and testosterone levels or disrupt menstrual cycles
Weekly drinks consumed:
1-5 decrease 39%
>10 decrease 66%

Question 9

Folate status

Answer 9

Prior to conception if low can lead to neural tube defects - recommend supplements or high folate foods

Question 10

Other factors contributing to infertility in males

Answer 10

Antioxidant nutrients- protects spent from oxidative damage
Vitamin D- low status related to infertility
Alcohol intake- toxic effect on testes
Heavy metal exposure- lead- impacts testes and sperm, mercury- decreases sperm and semen
Halogens
Glycols- synthetic oestrogen DDT, Pe, PCBs (found in plastics and paints)
Heat- sperm count can be reduced by elevating the temperature of the scrotum and tested
Steroid abuse- side effects include atrophy of testes, absence of sperm and decreased libido

Question 11

Premenstrual syndrome PMS

Answer 11

• life distrusting physiological and psychological changes that begin in the luteal phase and end with menses
• symptoms occur in 40% of women at childbearing age
  Fatigue
  Abdominal bloating
  Swelling of hands and feet
  Mood swings
  Social withdrawal
  Cravings

Question 12

Premenstrual dysphoric disorder

Answer 12

PDD- severe form of PMS
- characterised by marked mood swings, depressed mood, irritability and anxiety
- breast tenderness, headaches, joint and muscle pain
Possible causes of PMS
- thought to be related to abdominal serotonin activity following ovulation.
- antidepressants that contain serotonin uptake inhibitors reduce PMS

Question 13

Obesity and fertility

Answer 13

Increases likelihood of reproductive health problems
Men:
Low testosterone and sex hormone biding globulin levels
Elevated leptin, FSH and oestrogen
Decreased sperm count, sperm motility, increased malformed sperm
Women:
High oestrogen, free testosterone and leptin levels
Reduced levels of sec hormone binding globulin
Insulin resistance
Oxidative stress

Central body fat increases time to conceive
Weight loss should be first fertility therapy- 3-10 in females, 45 in mass obese males
Diets for weight loss need to be healthy and obtain all required nutrients

Question 14

Pregnancy after gastric bypass surgery

Answer 14

After bariatric surgery

• return to normal hormone levels
• decreased inflammation
• improved fertility
• risk of deficiencies in iron, folate, calcium and vit A,B12 and K
• pregnancy not recommended during first year post surgery

Question 15

Metabolic syndrome

Answer 15

3 of high Bp, high BGL, high BTGs, low HDL and high waist circ
20-30% Aus adults
Increased risk of CVD and T2DM
Therapy- diet mod, weight red, exercise

Question 16

Hypothalamic amenorrhea

Answer 16

Cessation of menstruation related to changes in hypothalamic signals that maintain secretion of hormones required for ovulation
Caused by defecits in energy and nutrients
Most common in those exposed to social stress or intellectual professionals
Treatment- weight gain through healthy diet, gain of 3-6kg typically restores fertility

Question 17

T2DM prior to pregnancy

Answer 17

High BGL during first 2 months of pregnancy are teratogenic (interfere with foetus development)
Associated with a 2-3 fold increase in congenital abnormalities in newborn
Malformations of pelvis, CNS and heart seen in newborns and higher rates of miscarriage
Critical that only existing diabetes is well managed prior to conception
Insulin resistance risk factors- obesity, central obesity, phys inactivity and LBW
Insulin resistance associated with:
-PCO, metabolic syndrome, T2DM, GDM, heart disease
Reduce risks of T2DM by improving body weight through diet and exercise

Question 18

Polycystic ovary syndrome (PCO)

Answer 18

Leading cause of female infertility (10% of women) 
Many with PCOs are obese/ high ab fat 
Cause- insulin resistance? Genes? 
Nutritional management: 
Primary goal to increase insulin sensitivity, insulin sensitising drugs 
Diet recommendations:
Omega 3 FA
Whole grains
Veg and fruit 
Regular meals 
Non fat fairy 
Low glycaemic foods 
Weight loss and exercise improve prognosis

Question 19

Coealiac

Answer 19

Autoimmune disease in people with a genetic susceptibility to protein gliadin found in the gluten component of wheat, rye, and barley
Causes malabsorption and flattening of intestinal lining
1% of pop

Management:
Eliminate gluten
Gluten may be found in non grain products such as sausages, dressing, deli meats, supplements, stocks and chips
Correction of vitamin and mineral deficiencies