1. Chapter 2 PRECONCEPTION NUTRITION

2. Chapter Outline Preconception overview Healthy People 2020 Nutrition Objectives Sources of disruptions in fertility ◦Nutrition-related disruptions Nutrition-related concerns during preconception Preconception care Academy of Nutrition and Dietetics’ Nutrition Care Process Model

3. Preconception Overview Human reproduction ◦Occurs smoothly in _______________circumstances ◦Genetic, biological, environmental, behavioral ◦Certain lifestyle factors may compromise health of mother and developing fetus ◦Poor _______________ status

4. Preconception Overview _______________ : the biological capacity to bear children _______________ : the actual production of children ◦Healthy couples have a 20% to 25% chance of conception within a given menstrual cycle _______________ : number of pregnancies _______________ : number of children _______________ : inability to become pregnant ◦Approximately 15% of couples are infertile ◦44% of couples diagnosed as “infertile” will eventually conceive without use of technology _______________ : difficulty getting pregnant _______________ : loss of pregnancy in the first 20 weeks of pregnancy

5. 2020 Nutrition Objectives for the Nation Related to Preconception

6. Sources of Disruptions in Fertility Adverse nutritional exposure Contraceptive use Severe stress Infection Tubal damage or other structural damage Chromosomal damage

7. Factors Related to Altered Fertility

8. Nutrition-Related Disruptions in Fertility Undernutrition Body fat percentage Weight loss Intake of specific foods & food components ◦Antioxidants ◦Zinc ◦Plant foods ◦Folate ◦Iron ◦Caffeine ◦Alcohol High exercise levels

9. Undernutrition and Fertility Undernutrition in women previously well-nourished ◦Associated with a dramatic _______________ in fertility that _______________ when food intake _______________ Food shortages in countries have been accompanied by dramatic declines in birth rates

10. Body Fat and Fertility Decreased fertility seen with ________or ________body fat due to alterations in hormones Estrogen & Leptin ◦Levels _______________ with high body fat ◦Levels _______________ with low body fat ◦Both extremes _______________ fertility Infertility lower with BMI _______

11. Body Fat and Fertility EXCESSIVE BODY FAT Most obese women and men are more likely to be _______________ compared to normal weight individuals Obese women ◦Irregular menstrual cycle Obese men ◦Reduced sperm production and higher rates of erectile dysfunction INADEQUATE BODY FAT Inadequate body fat typically characterized by _______________ Women with inadequate body fat: ◦Delayed onset of menstruation ◦Reduced fertility ◦Amenorrhea Men with inadequate body fat: ◦Lowered libido ◦Reduced sperm production

12. Weight Loss and Fertility Weight loss >10-15% of usual weight _______________ fertility hormones in men and women In women: ◦~30% of impaired fertility cases may be related to weight loss In men ◦Sperm viability & motility decrease when weight reaches 10 to 15% below normal ◦Sperm production ceases when weight exceeds 25% below normal In both men and women, hormone levels return to _______________ when weight is restored

14. Antioxidant Status and Fertility Antioxidants protect cells of the reproductive system, including eggs and sperm ◦_______________ ◦Sunflower seeds, almonds, spinach, red pepper, asparagus ◦_______________ ◦Citrus, melons, berries, green leafy veggies, potatoes, tomatoes ◦_______________ ◦Yellow, orange, and green leafy fruits and vegetables ◦_______________ ◦Seafood, organ meats, enriched grains, dairy

15. Oxidative Stress, Antioxidant Status, and Fertility Oxidative stress occurs when the presence of _______________ exceed the body’s _______________ defenses Oxidative stress in men ◦Decreases sperm motility ◦Reduces ability of sperm to fuse with an egg Oxidative stress in women ◦Harm egg development ◦Interfere with implantation of the egg

16. Zinc Status and Fertility Zinc status and Fertility in Men ◦Plays important roles ◦In the reduction of oxidative stress ◦In sperm maturation ◦In testosterone synthesis ◦Has been investigated for potential role in infertility Dietary sources of zinc ◦Oysters, seafood, red meat, poultry, nuts, whole grains, dairy

17. Plant Foods and Fertility Low- __________, high ___________linked to irregular menstrual cycles Isoflavones (from soy): ◦_______________ levels of reproductive hormones in women ◦Related to _______________ sperm count in men

18. Folate Status and Fertility Intake of multivitamins containing _____________: ◦Associated with decline in ovulatory infertility in women ◦Associated with improved sperm counts, motility, decreased abnormal forms of sperm in men

19. Iron Status and Fertility Rate of infertility _______________ in women who use iron supplements or iron from plant foods 14% of U.S. women enter pregnancy with _______________ iron stores Iron-containing foods: ◦Red meat, pork, poultry, seafood, beans, dark green leafy veggies, dried fruits, iron-fortified products

20. Caffeine and Fertility Study results are mixed on effects of caffeine ◦Some studies have shown increased time to conception, others have failed to find effects If individuals choose to cut back on caffeinated beverages, it is their choice http://www.cspinet.org/new/cafchart.htm

21. Alcohol and Fertility Alcohol may _______________ estrogen & testosterone levels or disrupt menstrual cycles Studies on weekly drinks consumed show: ◦1-5 drinks  39% decrease in conception ◦>10 drinks  66% decrease in conception

22. Exercise and Fertility Adverse effects of _______________ physical activity ◦Delayed age at puberty ◦Lack of menstrual cycles ◦Appear to result from hormonal and metabolic changes related to _______________ _______________ ◦Reduced levels of estrogen ◦Low levels of body fat ◦Decreased bone density

23. Pregnancy Preparation Tips 1. Achieve ideal weight _______________ conception 2. Consume _______________ nutrients ◦Especially folate and iron 3. Avoid substances that are harmful to fetus ◦Alcohol, cigarette smoke, excessive Vitamin A, excessive caffeine, raw meat 4. Participate in _______________ physical activity 5. Manage existing conditions 6. Visit health care provider early

24. Spina Bifida

25. Fetal Alcohol Syndrome

26. MyPlate Recommendations for Preconceptional Women

27. Preconception Care: Preparing for Pregnancy CDC’s Preconception Health Initiative ◦Recommends primary health care visits include: ◦Preconception health & pregnancy outcome education ◦Screening for vaccination, weight, iron & folate status ◦Assessment of alcohol use ◦Management of diabetes & celiac disease ◦Recommends counseling to modify health behaviors that could negatively impact fertility and pregnancy outcomes

28. Nutrition Care Process Nutrition care standards developed by the Academy of Nutrition and Dietetics ◦Part of new technology-based systems ◦To facilitate health-services delivery ◦Cost evaluation ◦Electronic charting: _______________ _______________ ◦Coding and outcome measurement

29. Nutrition Care Process The Nutrition Care Process ◦Step 1: Nutrition _______________ ◦Nutrition-related history, Biochemical data, Anthropometrics, Client history ◦Step 2: Nutrition _______________ ◦PES statement ◦Problem, Etiology, Signs/Symptoms ◦___P___ related to ___E___ as evidenced by ___S___ ◦Step 3: Nutrition _______________ ◦Four categories: ◦Food and/or nutrient delivery; Nutrition education; Nutrition counseling; Coordination of care ◦Step 4: Nutrition _______________ and _______________ ◦Evaluate changes in nutrition-related health status and intervention effectiveness Remember: _______________

30. Any Questions?