student

1. Joseph Kungu
Preconception Nutrition

2. Session objectives
By end of the session participants should be
able to;
 Describe what is preconception nutrition care
 Assess the importance of preconception care

3. What is preconception care?

4. Goal of preconception care
 The goal of preconception care is to reduce the risk of
adverse health effects for the woman, fetus, and infant
by optimizing the woman's health and knowledge
before planning and conceiving a pregnancy

5. Why preconception care
 Review Fetal Origins of Adult Disease hypothesis (aka
Barker Theory)
 Nutrition status at time of conception
 Most organs form 3-7 weeks after last menstrual
period (first 1-5 weeks of pregnancy)
 Many women do not know they are pregnant at that
point.

6. The preconception movement is based on the
realization that:
 Prenatal care starts too late to prevent many of
these poor pregnancy outcomes.
 Women who have higher levels of health before
pregnancy have healthier reproductive outcomes.
 Preconception guidance is based on findings that
many women enter pregnancy with suboptimal
nutrition intake

7. .
 One study of 249 pregnant women who reported for
their first prenatal visit found low dietary intakes of
vitamin E, folate, iron, and magnesium in the
preconception period and during pregnancy (Pinto et
al. 2009)

8. The placenta
 An organ that connects the developing fetus to the
uterine wall to allow nutrient uptake, waste
elimination, and gas exchange via the mother's blood
supply.
 The outer layer of the blastocyst becomes the outer
layer of the placenta

9. Fetal and placental malnutrition
 Maternal diabetes or obesity, can increase or decrease
levels of nutrient transporters in the placenta resulting
in overgrowth or restricted growth of the fetus.
 Impaired fetal growth clearly suggested that nutrient
supply to the fetus was impaired, and that the
placenta, the major conduit of nutrients to the fetus,
might also be compromised.

10. Organogenesis
 The formation and development of the organs of living
things.
 Embryology- The science of the development of an
embryo from the fertilization of the ovum to the fetus
stage

11.  Placental implantation begins 5 days after
fertilization and is complete by days 9-10.
–Before most women know they are pregnant.
 Most critical period for development of structural
anomalies is days 17-56 after fertilization
–Organogenesis begins just 3 days after the first missed
menses
–Before most women can get into prenatal care.
–The red bars on the next slide illustrate the critical
periods of structural development for many organs
–The yellow bars indicate the periods of functional
development .

12. Source: Modified from Keith Moore; The Developing Human: Clinical Oriented
Embryology, 3rd Ed, W.B. Saunders.Co.Philadelphia, PA . 1983

13. History of preconception care
 Usually in context of family planning or adolescent
reproductive health education
–International Conference of Primary Health care
–Safe Motherhood Conference (Kenya 1987)
–World Congress of Obstetrics & Gynecology (1988)
–Netherlands, London have pre-conception clinics

14. Nutrition-related “A” CDC Interventions
 Family planning/reproductive plans
 Weight Status (Under/Over)
 Nutrient intake
–Folate, Multi Vitamin, Calcium, iron, Iodine

15. 2 well known examples
 Folic acid supplementation at least 1 month before
pregnancy reduces the incidence of neural tube
defects.
 Adequate glucose control in a woman with diabetes
before conception and throughout pregnancy can
decrease maternal morbidity, spontaneous abortion,
fetal malformation, fetal macrosomia, intrauterine
fetal death, and neonatal morbidity.
Czeizel AE, Dudas I. 1992; Obstet Gynecol.
2005;105:675–85

16. Priming the Body for Pregnancy
 May also help with fertility
 Prevent early miscarriage
 Decrease fetal malformations
 Child’s sole source of nourishment

17. Priming the Male Body
 Fertility
 Healthy sperm development
 Sperm turnover every 30 days

18. Key components:
 Nutrition assessment
◦ Anthropometric data
◦ Dietary assessment
◦ Dietary supplement assessment
◦ Lab assessment
–Nutrition diagnosis
◦ Nutrition related problems or risk factors (obesity
eating disorders)

19. Cont…
Nutrition intervention
–Dietary goals
–Plan of action
 Begin to chart weight gain
 Food plan
 Supplement use
 Physical activity
 Monitor, Evaluate, Refer

20. Population indicators of infant health
 Infant mortality
 Birth weight
 Gestational age

21. Nutrition status

22. Vitamin A
Functions
–Normal fetal growth
–Visual function
–Reproduction
–Immunity
•Food sources
–Liver, whole milk, leafy greens, carrots, orange fruits and
vegetables
•Excess supplementation (not food) dangerous
–Miscarriage
–Birth defects

23. Folic acid
Clear scientific evidence
–Folic acid protective of neural tube during organogenesis
•Food sources
–Green leafy vegetables, fruits like oranges, cantaloupe
and bananas, legumes, milk, whole grains and organ
meats (such as chicken livers).
•Folate vs. Folic acid vs. “Bioavailable” Folate as
Metafolin is more bioavailable

24. Folic acid…
 Folic acid helps prevent birth defects of the brain and
spinal cord. It may also protect the pregnant woman
against cancer and stroke.
• Pregnant women should get 400-600 micrograms of
folic acid every day from food and supplements.
• Most prenatal vitamins contain 600–1,000 micrograms
of folic acid

25. Multivitamins
 Substantial evidence
–Greater benefit than harm in taking regular concentrated
supplements
–Reduce risk orofacial cleft, limb deficiencies, urinary
tract infections, cardiovascular defects, sub-par child
development
–Especially in women who drink alcohol, vegans, those
with limited resources, those who poorly absorb B12
–What could be the potential downside?

26. Choline
 425 mcg/day
 May reduce neural tube defects

27. Vitamin D
 Calcium absorption
 Bone mineralization
 Deficiency during pregnancy: rickets, fractures
 Optimal dose??

28. Calcium
 Calcium helps the nervous, muscular and circulatory
systems stay healthy.
 When a pregnant woman doesn't get enough calcium
from the foods she eats, the body takes the calcium
from her bones to give it to her growing baby.
 Having less calcium in the bones can cause serious
health conditions later in life, such as osteoporosis. In
osteoporosis, the bones thin, and the person is at
increased risk of bone breaks.

29. Iron
 Low iron store prior to pregnancy :
–Increased risk of iron deficiency during pregnancy
–Preterm delivery
–Low iron stores in baby
•Accretion of iron stores is more effective prior to
pregnancy

30. Essential fatty acids
 Chronic inflammation can lead to metabolic
syndrome, PCOs, etc…
–Omega 3’s mitigate effects of chronic
inflammation
–Other antioxidant nutrients too
 Structural component of cell membrane, central
nervous system, retinal cell membranes
 Possible longer gestation by 2 days with
supplementation.
 1g/day

31. Iodine
 Single most preventative cause of brain damage
 Necessary for thyroid function
 Deficiency:
 abortion,
 stillborn,
 mental retardation,
 cretinism, goiter,
 hypothyroidism
 220mcg or 290 mcg pregnant or lactating women

32. Preconception weight and BMI
 US Stats: 62% of women who can become pregnant are
overweight
 Overweight/Underweight affects fertility
 Also NTD, Stillbirth, Preterm, GDM, Macrosomia
 BMI between 19.8-26
 Complications:
–HTN,
-DM,
-C- section,
-Preterm

33. Eating disorders
 What are the risks?
 Is there difficulty conceiving?
 What can be done?

34. Diabetes
 Counsel on:
–Risk of malformation
–Effective contraception
–Nutritional counseling
–Insulin therapy
–Treat complications
–Assess medications