1. Chapter 3 Preconception Nutrition Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown

2. Key Nutrition Concept #1
Nutrition & other lifestyle changes are a core component of the treatment of a variety of common health problems of women and men prior to conception.

3. Key Nutrition Concept #2
Nutritional and health status before and during the first 2 months after conception influences embryonic development and the risk of complications during pregnancy.

4. Introduction
Topics covered include conditions impacting conception & interventions
PMS
Obesity
Hypothalmic amenorrhea
Female athletic triad
Eating disorders
Diabetes
Polycystic ovary syndrome
Disorders of metabolism
Celiac disease

5. Premenstrual Syndrome
Characterized by life-disrupting physiological & psychological changes that begin in the luteal phase & end with menses
Symptoms occur in 40% of women of childbearing age

6. Common Signs & Symptoms of PMS

7. Premenstrual Dysphoric Disorder
PDD-severe form of PMS
Characterized by marked mood swings, depressed mood, irritability, & anxiety
Physical symptoms:
Breast tenderness
Headache
Joint & muscle pain

8. Possible Cause of PMS
Thought to be related to abnormal serotonin activity following ovulation
Antidepressants that contain serotonin uptake inhibitors reduce PMS

9. PMS Treatment Caffeine intake & PMS Exercise & stress reduction
PMS symptoms increase in severity with increased coffee intake
Risk of severe symptoms 8 times higher with 8–10 cups compared to non-coffee drinkers
Exercise & stress reduction
Daily physical activity & reducing daily stress decrease symptoms

10. PMS Treatment Magnesium, calcium, vitamins D & B6 supplements
Magnesium—200 mg/day
Calcium—1200 mg/day
Vitamin D—706 IU/day
Vitamin B6—50 to 100 mg/day

11. Obesity and Fertility
Obesity increases likelihood of reproductive health problems
Obesity rates in U.S.

12. Obesity and Fertility

13. Obesity and Fertility Central body fat & fertility
Central obesity increases time required to conceive
Weight loss & fertility
Should be the first fertility therapy for obese people
Loss of 7 to 22 pounds in overweight women & 100 pounds in massively obese men increases fertility

14. Obesity and Fertility Diets for Weight Loss
Diets should be healthful, balanced and provide all required nutrients
Diets should be planned around foods that correspond to individual food preferences and resources

15. Pregnancy after Gastric Bypass Surgery
In most women and men, after bariatric surgery
Return to normal hormone levels
Decreased inflammation
Improved fertility
Bariatric surgery increases risk for the following deficiencies
Iron, folate, calcium, and vitamins A, B12, and K
Pregnancy is not recommended during first year after surgery

16. Metabolic Syndrome Cluster of abnormal metabolic & health indicators
Diagnosed if 3 of 5 conditions exist:
1. Waist circumference:
>40” in men & >35” in women
2. Blood triglyceride ≥150 mg/dL
3. HDL-cholesterol:
<40 mg/dL in men & <50 mg/dL in women
4. Blood pressure >130/85 mm Hg
5. Fasting blood glucose ≥110 mg/dL

17. Metabolic Syndrome Prevalence Consequences Therapy 1 in 5 U.S. adults
Increases risk of CVD & type 2 diabetes
Therapy
Dietary modification
Weight reduction
Exercise

19. A Closer Look at Insulin Resistance
Insulin stimulates uptake of glucose from blood into cells
Each cell membrane normally has ~20,000 active insulin receptors that open “doors” for glucose
Insulin resistant cells only have ~5,000 functioning receptors that lower uptake by cell
Insulin resistance is a major public health problem

20. A Closer Look at Insulin Resistance
Risk factors for insulin resistance
Obesity, central obesity, physical inactivity, & small size at birth
Insulin resistance associated with
Polycystic ovary syndrome
Metabolic syndrome
Type 2 diabetes
Gestational diabetes
Heart disease

21. Polycystic Ovary Syndrome
10% of women of childbearing age
The leading cause of female infertility
Many with PCOS are obese or have high levels of intra-abdominal fat
Cause is uncertain
Insulin resistance a possible factor
Appears to have strong genetic component

22. Nutritional Management of Women with PCOS
Primary goal is to increase insulin sensitivity
Insulin-sensitizing drugs
Diet recommendations:
Omega-3 fatty acids, whole grains, fruits & vegetables, regular meals, non-fat dairy, & low-glycemic foods
Weight loss & exercise improve prognosis

23. Disorders of Metabolism
PKU (phenylketonuria)
Elevated blood phenylalanine due to lack of phenylalanine hydroxylase
Nutrition management for women with PKU
Low-phenylalanine diet

24. Disorders of Metabolism
Celiac disease
Autoimmune disease in people with genetic susceptibility to protein gliadin found in gluten component of wheat, rye, barley, which causes malabsorption & flattening of intestinal lining
Prevalence in U.S. is ~1 in 133
Linked to infertility in some women & men

25. Nutritional Management of Celiac Disease
Eliminate gluten in diet
Look for “gluten free” labels
Gluten found in many non-grain foods like hot dogs, deli meats, supplements, chips, bouillon, salad dressing, etc.
Correction of vitamin & mineral deficiencies

26. Insert Case Study 3.2

27. Herbal Remedies for Fertility-Related Problems
Chaste tree berry extract—may relieve PMS symptoms
Evening primrose oil—not effective for PMS relief
Coenzyme Q10 –increases sperm motility
Bee propolis—increases pregnancy rates in women with mild endometriosis

28. Additional website For information on teratogens