Pre-Pregnancy Nutrition Part 2

Pre-Pregnancy Nutrition (Part 2)

• Excessive Body Fat & Fertility: Obesity in men and women increases the risk of infertility. Fat cells produce hormones like testosterone, estrogen, and leptin, but excessive levels can disrupt these hormone balances.
• Low testosterone, increased estrogen and leptin levels, reduced sperm production, erectile dysfunction, and irregular menstrual cycles (including anovulatory cycles and amenorrhea) are all potential consequences.
• Aromatase: An enzyme that converts testosterone to estrogen.
• Weight Loss & Fertility: The best way to improve fertility for obese individuals is weight loss.
• Weight reduction methods include healthy meal planning, healthy food preparation, healthy snack choices, portion size control, and regular physical activity which combats insulin resistance.
• Medication for Weight Loss & Fertility: Further research is needed to determine the safety of weight loss medications during pregnancy.
• Bariatric Surgery & Fertility: Could potentially improve fertility outcomes for men and women, with anovulation potentially improving and spontaneous pregnancy rates increasing within one year. However, conception is generally not recommended in the first year post-surgery due to rapid weight loss and hormone shifts. Types of bariatric surgery include gastric sleeve, gastric bypass, gastric band, and intragastric balloons.
• Bariatric Surgery Prior to Pregnancy: Bariatric surgery can reduce the risk of diabetes and hypertension during pregnancy, but there's an increased risk of nutrient deficiencies, such as vitamins D, E, K, B12, thiamin, riboflavin, niacin, folate, zinc, iron, and copper. At-risk individuals are also predisposed to low protein and energy availability during pregnancy, which could impact the newborn, potentially leading to undernourishment and small-for-gestational-age newborns.

Underweight & Fertility

• Energy Balance & Ovulation: Ovulation is sensitive to energy balance and can be disrupted by negative calorie balance and weight loss.
• Hypothalamic Amenorrhea: Women with a negative energy balance and low BMI could experience anovulation and developing functional hypothalamic amenorrhea due to impaired gonadotropin-releasing hormone (GnRH) secretion. GnRH affects testosterone production in testicles, and estrogen & progesterone production in ovaries.

Diabetes Prior to Preganancy

• Teratogenic Effects: High blood glucose levels during the first two months of pregnancy are teratogenic (harmful to development), possibly causing congenital malformations in the pelvis, central nervous system, and heart of the unborn child.
• Miscarriage Risk: High blood glucose during first two months of pregnancy also increases the risk of miscarriage.

Nutritional Management of Diabetes Prior to Pregnancy

• Blood Glucose Control: Proper blood glucose control is essential.
• Manage Comorbid Issues: Managing any associated health problems is crucial.
• **Dietary Changes:**Reducing added sugars and consuming low glycemic index foods with high fiber content are necessary steps.
• Increased Physical Activity: Increased physical activity is a key aspect of management.

Glycemic Index (GI)

• GI Definition: A number from 0 to 100 that classifies foods based on how quickly they raise blood sugar levels. (< 55 is considered low GI, > 70 is considered high GI).

Prevention of Gestational & Type 2 Diabetes

• Healthy Dietary Habits: A healthy pattern and an increased fiber intake are critical in reducing risks of gestational diabetes.
• Weight Management: Achieving a healthy weight prior to pregnancy reduces the risks of gestational diabetes.

Women, Exercise & Fertility

• Energy Balance: Treatment for infertility related to physical activity often focuses on improving energy balance.
• Dietary Changes: Dietary changes are crucial to balance energy expenditure.
• Ovulation Restoration: Restoration of ovulation can promote healthy fertility potential.

Pre-Pregnancy Phenylketonuria (PKU)

• Metabolic Disorder: PKU is a metabolic disorder caused by a deficiency of the phenylalanine hydroxylase (PAH) enzyme.
• Phenylalanine Accumulation: This leads to the accumulation of phenylalanine in the blood, which can damage the brain and nervous system.
• Symptoms: Untreated PKU can result in a 92% chance of intellectual disabilities in the newborn, a 73% chance of microcephaly (abnormally small head), and an increased risk of heart defects, seizures, hyperactivity, and abnormal behavioral patterns in the child.

Nutritional Management of PKU

• Low-Phenylalanine Diet: A low-phenylalanine diet is crucial for managing PKU throughout life and especially important during conception and pregnancy. It involves excluding high-phenylalanine foods (like meat, fish, eggs, and wheat) and consuming low-phenylalanine foods.

Celiac Disease

• Autoimmune Disorder: Celiac disease is an autoimmune disorder characterized by inflammation in the small intestine due to an inherited sensitivity to the gliadin section of gluten in wheat, rye, and barley.
• Malabsorption: It can cause nutrient malabsorption, leading to deficiencies.
• Untreated Celiac Disease and Reproduction: Untreated celiac disease can result in altered androgen effects and delayed sexual maturation (hypogonadism), amenorrhea, high miscarriage rates, restricted fetal growth and a shorter lactation period.

Nutritional Management of Celiac Disease

• Gluten-Free Diet: Completely eliminating gluten from the diet is essential.
• Vitamin & Mineral Correction: Correcting any vitamin and mineral deficiencies is a crucial part of management.
• Long-Term Health Maintenance: Following a well-managed healthy diet will help normal reproductive functions to return.