Transcript Maternal- chapter3

Chapter 3
Preconception Nutrition
Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown
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.
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.
Introduction
• Topics covered include conditions impacting
conception & interventions
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PMS
Obesity
Hypothalmic amenorrhea
Female athletic triad
Eating disorders
Diabetes
Polycystic ovary syndrome
Disorders of metabolism
Celiac disease
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
Common Signs & Symptoms of
PMS
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
Possible Cause of PMS
• Thought to be related to abnormal serotonin
activity following ovulation
• Antidepressants that contain serotonin
uptake inhibitors reduce PMS
PMS Treatment
• Caffeine intake & PMS
– 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
PMS Treatment
• Magnesium, calcium, vitamins D & B6
supplements
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Magnesium—200 mg/day
Calcium—1200 mg/day
Vitamin D—706 IU/day
Vitamin B6—50 to 100 mg/day
Obesity and Fertility
• Obesity increases likelihood of reproductive
health problems
• Obesity rates in U.S.
Obesity and Fertility
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
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
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
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
Metabolic Syndrome
• Prevalence
– 1 in 5 U.S. adults
• Consequences
– Increases risk of CVD & type 2 diabetes
• Therapy
– Dietary modification
– Weight reduction
– Exercise
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
A Closer Look at Insulin
Resistance
• Risk factors for insulin resistance
– Obesity, central obesity, physical inactivity, &
small size at birth
• Insulin resistance associated with
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Polycystic ovary syndrome
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Metabolic syndrome
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Type 2 diabetes
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Gestational diabetes
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
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, & lowglycemic foods
• Weight loss & exercise improve prognosis
Disorders of Metabolism
• PKU (phenylketonuria)
– Elevated blood phenylalanine due to lack of
phenylalanine hydroxylase
• Nutrition management for women with
PKU
– Low-phenylalanine diet
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
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
• Insert Case Study 3.2
Herbal Remedies for FertilityRelated 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
Additional website
For information on teratogens
• http://www.otispregnancy.org/