Preconception and Prenatal Nutrition. Introduction: Infant mortality- the odds that a newborn will live past its first month is one of the most important measures of a country’s quality of life. An article in USA Today, states that USA has 4.3 deaths per 1000 live births each year.
Infant mortality- the odds that a newborn will live past its first month is one of the most important measures of a country’s quality of life.
An article in USA Today, states that USA has 4.3 deaths per 1000 live births each year.
According to a recent study, published in journal PLoS Medicine, USA ranks 41st among 193 nations. Two decades ago, it ranked 28th.
But actually, the mortality rate is improving and the situation is not really worse in USA than before.
PRECONCEPTION HEALTH CARE AND NUTRITION
Fish and shellfish
2.To ensure that all US women of childbearing age receive preconception care services(screening, counseling and interventions) that will enable them to enter pregnancy in optimal health.
3. To reduce risks indicated by a prior adverse pregnancy outcome through interventions in the interconception period that can prevent or minimize health problems for a mother and her future children.
4. To reduce the disparities in adverse pregnancy outcomes
PCOS (Polycystic Ovary Syndrome) Epilepsy
Smoking (preterm birth, lowbirth wt)
STD(associated with ectopic pregnancy, infertility, chronic pelvic pain)
PKU(Phenylketonuria- Mothers should adhere to low phenylalanine diet before conception and throughout the pregnancy)
The quality of the diet during pregnancy has a profound impact on fetal and maternal outcomes.
DRI for macronutrients during pregnancy
αlinolenic acid (Omega 3)—1.4 g/d
linoleic acid (Omega 6) --- 13 g/d
EPA and DHA (long-chain omega 3 FA)canbe synthezied from linoleic and α-linolenic acid.
- vegetable oils (canola oil, flaxseed oil, soyabean oil)
- fish oil and
- fatty fish
- seeds and
- vegetable oils (corn oil, soyabean and safflower)
- moderate protein intake is optimal during pregnancy
Certain Minerals and Vitamins are of significant importance in pregnancy. Some of the key micronutrients are Mg, Fe, Folate, VitD, B vitamins.
Deficiency: abnormal prenatal development and pregnancy outcome.
Inhibitors : phytates and polyphenols
Mg- 400-360mg/d (14-50yrs)
Folate – 600µg/d ( “ ) (to avoid NTD)
Vit D - 15µg/d ( “ )
Thiamin – 1.4 mg/d ( “ )
Riboflavin – 1.4mg/d ( “ )
Niacin – 18mg/d ( “ )
Biotin – 30µg/d ( “ )
Pantothenic acid – 6mg/d( “ )
Vit B 6 – 1.9mg/d ( “ )
Vit B 12 – 2.6µg/d ( “ )
Fe – 27mg/d ( “ )more Fe is needed for developing fetus and placenta and ↑ in bld volume.
Functions- energy production, synthesis of nucleic acid, proteins, ion transport across membranes, cell signaling, bone structural integrity.
- effective in controlling eclampsia, preeclampsia, arrhythmia, severe asthma, migraine
Deficiency- chronic diseases
Food sources – green leafy vegetables, nuts, legumes,whole grains
Functions- O2 transport and storage, e-transport, energy metabolism and DNA sysnthesis.
Food Sources: Heme Fe (readily absorbed) Meat, poultry, fish.
Non-hemeFe – legumes (requires additional Vit C, organic acids to enhance absorption)
Good sources of Fe – Beef, lentils, beans, bran cereal, raisins
Deficiency -- anemia
Inhibitors of Non-hemeFe – phytates, polyphenols and soyproteins
Functions- nucleic acid and amino acid metabolism
- interacts with B 6 and B12
Deficiency – low birth wt, premature birth, neural tube defects(NTD),
↑ homocysteine levels (predictor of poor preg outcomes)
Folic acid – supplements and fortified foods. Folic acid is 100% absorbed
Folate – (only partially absorbed) asparagus, spinach, lentils, broccoli, orange juice.
Functions- essential for skeletal health, efficient utilization of Ca, BP regulation, insulin secretion, immunity, cell differentiation
Food sources – fortified with Vit D – dairy products, cereals, orange juice
Function – participate in many metabolic pathways including energy metabolism
Deficiency- leads to hypomethylation of DNA and altered gene expression
- homocysteinemia and poor pregnancy outcome
- Homocysteine may cause oxidative stress and susequent placental ischemia
- ↑ free radical O2,↓nitrous oxide leading to endothelial dysfunction
- homocysteine is thrombogenic
Higher risk of GDM (gestational diabetes Mellitus)
Preeclampsia (high blood pressure and protein in the urine develop in the late 2nd and 3rd trimester) (may result in inadequate placental bld supply)
Macrosomia (aka large for gestational age-LGA) may result in
C- section and
Neonatal hypoglycemia (low glucose level)
- due to assisted reproductive technologies (ART)
New borns conceived through ART are at higher risk for
- low birth weight (2500g and less)
- perinatal mortality
Women who conceive through ART are more likely to develop
- preeclampsia (↑ in BP)
- preterm birth (<37 weeks)
- Nausea and vomitting(current dietary recommendation to reduce the symptom is to take multivitamin in preconception period, supplementation with Vit B6, eating ginger as nonpharmacolgic option)
- Heart burn
- Ptyalism (excessive secretion of saliva. Dietary alterations include chewing gum and restriciting fluids)
- Constipation (DRI for fiber intake during pregnancy is 28g/day and increase in fluid intake)
- Diarrhea (may be due to food borne infections and irritable bowel syndrome. Acute diarrhea may lead to severe dehydration and result in loss of important electrolytes)
- anorexia nervosa
- Bulimia nervosa
- menstrual dysfunction
- low bone density
- sexual dysfunction
- preterm delivery or low birth weight
- delayed fetal growth
- contain traces of mercury.(avoid large fish)
FDA and EPA recommends that
- pregnant women
- Women of childbearing age,
- young children
consume 12 oz of fish /week that are lower in mercury
- Shrimp, canned tuna, salmon, pollock, catfish
- caused by Listeriamonocytogenes ( a gram+ve bacterium)
People at risk
- pregnant women (septicemia, meningitis, encephalitis, cervical infections)
- adults with weak immune system
- persistent fever
The onset time to gastrointestinal symptoms is probably greater than 12 hrs
- Hot dogs/ luncheon meats (deli)
- soft cheese (feta, brie, camembert, blue cheese, roquefort, queso fresco unless the label says made with pasturized milk
- unpasteurized milk, eggs, juice
- refrigerated pates or meat spreads
- refrigerated smoked seafood
What is it?
A problem in women when the ovaries grow many small cysts. The cysts are not harmful but cause hormonal imbalance which is associated with
The hormone levels get out of balance. (there are several causes for the changes in the hormone levels). Normally, the ovaries make tiny amount of androgens(male sex hormone), but, in PCOS, they make more amounts
In 2010, Barry et al demonstrated hyperandrogenism in utero environment in PCOS pregnancies. But, Anderson et al (2010) demonstrated decreased intrauterine androgen levels and large for gestational age in the offspring of women with PCOS.
Design: Prospective case-control study
Participants: Thirty- nine women with PCOS and 31 control women and their infants .
Objectives: To determine whether the infants of women with PCOS have increased intrauterine androgen levels or reduced birth weight.
Outcome Measures: Birth weight and mixed cord blood testosterone (T), androstenedione (A), dehydroepiandrosterone, 17-hydroxyprogesterone, estradiol (E2) and dihydrotestosterone levels were measured
Result: There was a significant ↑in the prevelance of LGA infants in PCOS group. Cord blood E2 and A levels were lower (P<0.05). Testosterone to E2 ratios did not differ in female PCOS vs control offspring. There was no difference in E2 and A levels in the male PCOS vs control offspring. There was no difference in 17-hydroxygrogesterone or other androgen levels in either male or female PCOS offspring vs respective control group
Conclusions: Offspring of women with PCOS were more likely to be LGA. Female offspring of PCOS have lower cord blood A levels and lower E2 levels. The study demonstrated decreased fetal or placental production of steriods.
1. Improving infant mortality in the US and Worldwide.American Academy of Pediatrics. Updated onSept 1st2011
http://www.healthnewsdigest.com/news/Children_s_Health_200/Improving_Infant_Mortality_in_the_U_S_and_Worldwide.shtml. Retrived on Sep1st.
2. http://theweek.com/article/index/218803/infant-mortality-why-does-america-lag-behind . Accessed onSept 1st.
3. http://www.getting-pregnant.com/preconception-nutrition.html. Accessed on Sept 1st.
4. Johnson K, Postner SF, Biermann J, Cordero JF, AtrashHK, Parker CS, Boulet S, Curtis MG. Recommendations to improve preconception health and health care---United States. A report of the CDC. MMWR.2006;55(RR06):1-23.
5. Lamy C. Neurological disorders in pregnancy.J Neurol Neurosurg Psychiatry .2005;76:299
6. http://www.nlm.nih.gov/medlineplus/ency/article/000898.htm. accessed on Sept 2nd 2011.
7. Chu SY, Callaghan WM, Kim C, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30:2070-2076.
8. http://www.nlm.nih.gov/medlineplus/ency/article/002251.htm. Accessed on Sept 2nd 2011.
9. http://www.nlm.nih.gov/medlineplus/ency/article/007306.htm. Accessed on Sept 2nd 2011.
10. Chan RL,OlshanAF,Savitz DA, et al. Maternal influences on nausea and vomiting in early pregnancy. Matern.Child Health J. 2009.
11.http://www.iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/New%20Material/5DRI%20Values%20SummaryTables%2014.pdf. Accessed on Sept 2nd 2011.
12. Environmental Protection Agency. Fish Advisories. What you need to know about Mercury in fish and shellfish. http://www.epa.gov/fishadvisories/advice. Accessed on Sept 2nd 2011.
13. Barry JA, Kay AR, Navartnarajah R, Iqbal S, et al. Umbilical vein testosterone in female infants born to mothers with polycystic ovary syndrome is elevated to male levels. J ObstetGynaecol. 2010;Vol. 30:5:444
14. Samour PQ, King K. Pediatric Nutrition, Fourth Edition. Jones and Bartlett Learning, LLC. Sudbury, MA 2012.
15. Langley-Evans SC, Lilley C, McMullen S. Maternal Protein restriction and fetal growth: Lack of evidence of a role for homocysteine in fetal programming. Br j Nutr. 2006;96:578-86.
16.Gardiner PM, Nelson L, Shellhass CS, et al. The clinical content of preconception care: Nutrition and dietary supplements. Am j Obstet Gynecol. 2008; 199(6 Suppl2):S345-356.
17. Jeanes YM, Barr S, Smith K, Hart KH. Dietary management of women with polycystic ovary syndrome in the United Kingdoms: the role of dietitians. J Hum Nutr Diet. 2009;22:551-558.
18. Hawthorne G. Metformin use and diabetic pregnancy-has its time come? Diabet Med. 2006;23:223-7
19. Cuco G et al. Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. Eur j ClinNutr. 2006;60:364-371.