GTN218 Nutrition in Life Cycle Pre-Pregnancy Nutrition PDF

GTN218/3 – Nutrition in Life Cycle Topic 2: Pre-Pregnancy Nutrition (Part 2) DR NUR NADIA BINTI MOHAMED [email protected] 09 797 7550 Excessive Body Fat & Fertility Obesity among men & women increases the risk of infertility...

GTN218/3 – Nutrition in Life Cycle Topic 2: Pre-Pregnancy Nutrition (Part 2) DR NUR NADIA BINTI MOHAMED [email protected] 09 797 7550 Excessive Body Fat & Fertility Obesity among men & women increases the risk of infertility FAT CELLS produce Testosterone Estrogen Leptin  Weight Loss & Fertility The best treatment for infertility among obese individuals = WEIGHT LOSS Walking & jogging can Weight reduction methods improve insulin resistance Healthy food Healthy snack Regular physical Healthy meal plan Portion size preparation choices activity Medication for Weight Loss & Fertility Can obese woman take weight loss medication while trying to conceive? Further research is needed on the safety of weight loss medications before pregnancy & the experiences of women using them for fertility reasons* *https://doi.org/10.1111/cob.12690 Bariatric Surgery for Weight Loss & Fertility Can obese people have bariatric surgery before pregnancy?  Bariatric Surgery for Weight Loss & Fertility Bariatric surgery effectively improves fertility outcomes for men & women* Improve anovulation & lead to spontaneous fertility Spontaneous pregnancy can happen within a year after surgery – due to high level of sex hormone binding globulin & FSH and reduction in androgens level Conception is not recommended during the first year after bariatric surgery when weight loss is most rapid Loss of adiposity after surgery reduces aromatase activity, improves insulin sensitivity, regulates sex hormone levels, decreases estradiol production & increases testosterone hormone levels, SHBG, FSH & LH in the body – regulates spermatogenesis *https://doi.org/10.1016/j.amsu.2022.103881 Types of Bariatric Surgery Bariatric surgery prior to pregnancy Lower the risk of developing diabetes & hypertension during pregnancy Monitor & maintain dietary Increased risk of nutrient intake deficiencies (vitamins D, E, K, Taking highly absorbable of B12, thiamin, riboflavin, niacin, vitamin & mineral folate, zinc, iron & copper) supplements (e.g. chewable vitamins) At risk of low protein energy Undernourished & small-for-gestational- availability during pregnancy If unmonitored age newborns  Underweight and Fertility Ovulatory processes are sensitive to energy balance Can be disrupted by a negative calorie balance, weight loss & low body fat. Women in negative energy balance & low BMI may develop anovulation & functional hypothalamic amenorrhea due to impaired gonadotropin-releasing hormone (GnRH) secretion. cause the testicles to make testosterone Function of GnRH cause ovaries to make estrogen & progesterone Anovulation – the egg does not mature and the person does not ovulate Functional hypothalamic amenorrhea – when the hypothalamus causes the menstrual cycle to stop  Diabetes Prior to Pregnancy High blood glucose levels during the first 2 months of pregnancy are teratogenic Incidence of congenital abnormalities in newborns E.g. malformations of the pelvis, central nervous system & heart High blood glucose during the first 2 months also increases the risk of miscarriage. Teratogenic – Exposures that produce malformations in embryos or fetuses Congenital abnormality – A structural, functional or metabolic abnormality present at birth. Nutritional Management of Diabetes Prior to Pregnancy Blood glucose control Manage comorbid health issues Health maintenance Reduce intake of Consume low glycemic index food & Increase physical added sugar food high in fiber activity Nutritional Management of Diabetes Prior to Pregnancy What is Glycemic Index? Consume low glycemic index food & high in fiber Nutritional Management of Diabetes Prior to Pregnancy Glycemic Index (GI) A number from 0 to 100 assigned to food based on how quickly they raise blood sugar level Value of < 55 = low glycemic > 70 = high glycemic Foods with high GI tend to raise blood glucose & insulin levels more than low GI food  Prevention of Gestational & Type 2 Diabetes Gestational diabetes mellitus increases the risk of type 2 diabetes in later life Healthy dietary Increased dietary pattern fibre intake Reduce risk of gestational diabetes Weight loss Regular exercise (if overweight) Exercise improves physical fitness Weight loss should be achieved before pregnancy levels, general health & insulin → It is not recommended during pregnancy sensitivity  Women, Exercise & Fertility Treatment of infertility related to physical activity-induced energy deficit focuses on improving energy balance through: Restoration of Bone mass Dietary changes ovulation accretion The effect of high levels of physical activity on reproductive hormones in overweight women appears to be different from that experienced by lean athletes Overweight women who engage in long-distance running, fast cycling & other aerobic physical activities have improvements in reproductive hormone levels & increased fertility  Pre-Pregnancy Phenylketonuria Phenylketonuria (PKU) Presence of phenylalanine in the urine Caused by a deficiency of phenylalanine hydroxylase (PAH) enzyme in the liver Phenylalanine (essential amino acid) cannot be converted to tyrosine (nonessential amino acid) Phenylalanine accumulates Damage the brain and LEARNING in blood nervous system DISABILITIES  Pre-Pregnancy Phenylketonuria 92% chance of delivering newborn with intellectual disabilities 73% chance the infant will be born with an abnormally small head (microcephaly) Increase the risk of heart defects Untreated women Risk of seizures, hyperactivity & with PKU abnormal behavioral patterns later in life Nutritional Management of PKU Consume low-phenylalanine diet PKU diets are individualized based on blood phenylalanine response to protein foods. Exclude high phenylalanine protein food E.g. Meat, fish, eggs, wheat PKU diet is beneficial throughout life It is critical to adhere during conception & maintained throughout pregnancy. Celiac Disease An autoimmune disease characterized by chronic inflammation of small intestine due to an inherited sensitivity to the gliadin portion of gluten in wheat, rye & barley It is associated with the malabsorption of nutrients, nutrient deficiencies & an increased risk of other immune disorders  Untreated Celiac Disease Leads to alteration in the actions of androgens, delayed sexual maturation & hypogonadism Associated with amenorrhea, increased rates of miscarriage, fetal growth restriction, low birth-weight deliveries & short duration of lactation The effects of celiac disease on reproductive functions probably related to malabsorption- induced deficiencies of nutrients (e.g. zinc, folate & iron) and direct effects of inflammation on intestinal & other tissues. Hypogonadism is marked by a deficiency of sex hormones & poor development & functioning of the reproductive system  Nutritional Management of Celiac Disease Elimination of gluten from Correction of vitamin & Long-term maintenance of the diet mineral deficiencies health Normal reproductive functions generally return after celiac disease has been stabilized with a nutritionally adequate gluten-free diet.