chapter 3 preconception nutrition conditions and interventions nutrition through the life cycle...
TRANSCRIPT
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
» 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– 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
• Polycystic ovary syndrome
• Metabolic syndrome
• Type 2 diabetes
• Gestational diabetes
• Heart disease
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, & low-glycemic 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 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
Additional website
For information on teratogens
• http://www.otispregnancy.org/