NUTRITION DURING THE PRECONCEPTION PERIOD Recommended dietary intakes for preconceptional women Consume folate Limit Vitamin A supplements (from retinol or retinoic acid) Limit or omit alcohol Follow choosemyplate guidelines/eating a well-balanced diet Nutrient dense foods
PERICONCEPTIONAL PERIOD Periconceptional period = time around conception 8-10 days after ovum fertilized Implants in uterine wall 1 st month Embryo grown from single cell to millions of cells Basic organ structures formed Time to establish optimal health and nutrition status is before conception Challenges?
NUTRITION DURING THE PERICONCEPTUAL PERIOD Very-early-pregnancy nutrition exposures Weight status, nutrient status, alcohol intake Folate status prior to conception Neural tube defects – develop during 3 rd or 4 th week Helps prevent small for gestational age Iron status prior to conception Iron deficiency is most common deficiency worldwide Easier to build up iron stores before pregnancy
CONDITIONS AND INTERVENTIONS
INTRODUCTION Specific preconceptional and periconceptional nutrition-related conditions May influence fertility or the course and outcome of pregnancy Obesity, underweight, negative energy balance, eating disorders, diabetes, polycystic ovary syndrome, phenylketonuria, celiac disease, etc.
WEIGHT STATUS AND FERTILITY Obesity and underweight increase disruptions in fertility Obesity rates in U.S. 35.1 percent of adults have obesity 33.9 percent have overweight 1.7 percent of adults are underweight
OBESITY, BODY FAT DISTRIBUTION, AND FERTILITY Obesity marked by excess intra-abdominal fat Can interferes with reproduction in women and men Insulin resistance and high androgen Increased androgen production by ovaries Excess androgen Anovulation, irregular menstrual cycles and delayed time to conception Metabolic profiles Metabolically healthy individuals are at lower risk (regardless of obesity status) Many physicians will not use ART to treat those with elevated BMIs - the evidence behind this is mixed
OBESITY, BODY FAT DISTRIBUTION, AND FERTILITY Weight loss benefits Many recommend that it should be treatment of first choice for those with obesity and fertility problems Some fertility problems can be reduced or eliminated by weight loss… However: Weight loss IS NOT EASY And we should not assume that excess weight is the cause (leads to a lot of weight stigma) Increase exercise – improve insulin resistance
OBESITY, BODY FAT DISTRIBUTION, AND FERTILITY Bariatric surgery (will come back to this later this semester) Most effective weight loss treatment Promotes rapid weight loss in first year post surgery Lower risk of developing diabetes or hypertension during pregnancy Increased risk for nutrient deficiencies Iron, Vitamin D, Folate, Calcium and B12 Supplementation important Pregnancy is not recommended during first year after surgery
UNDERWEIGHT AND FERTILITY Hypothalamic amenorrhea Loss of menstrual cycles due to the absence of ovulation
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- Nutrition, Fertility, Increase