Never too soon to plan for pregnancy

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The process of life creation is one of nature’s great wonders, none more so than in the creation of new humans. This process seemingly unhindered for thousands of years has produced a global expansion in population numbers of billions. Today 384,701 people will be born and 156,936 people will die, resulting in a net gain of 227,765 humans (give or take a few thousand). This year 140 million babies will be born and 57 million people will die and with each new life comes opportunity and risk.

Geography, social standing, education, parents and peers all have a role to play in the health and safety of the baby, with long term implications for their ability to function and thrive.

One of the interventional areas open to you in your typical clinical care is that of preconception health, of which nutrition and nutritional status plays an important role. The preconception period it has been suggested in a new paper should be redefined according to (1) the biological perspective—days to weeks before embryo development, (2) the individual perspective—a conscious intention to conceive, typically weeks to months before pregnancy occurs, and (3) the public health perspective—longer periods of months or years to address preconception risk factors, such as diet and obesity. In effect significantly extending the previously recognised 12-week preconception.

The preconception period presents a period of special opportunity for intervention; the rationale is based on life course epidemiology, developmental (embryo) programming around the time of conception, maternal motivation, and disappointment with modest or ineffective interventions starting in pregnancy.

Adolescence (a period of frequent conception) might represent a particularly sensitive period as unhealthy life-style behaviour—e.g., smoking, poor diet, and eating disorders—often originate in the teenage years. These preconception risk factors can set patterns that have a cumulative effect on the health of the baby all the way througth into adulthood and for future generations, as shown by mounting evidence of the long-term effects of poor maternal nutrition and obesity for the child. So say the authors of a recent Lancet Series.

During work undertaken for the series the researchers assessed the nutrition of 509 women aged between 18 and 42, thus approximately of a reproductive age, as recorded by the UK National Diet and Nutrition Survey. Their findings concluded that 96 per cent of the women have iron and folate dietary intakes that are less than ideal when preparing for pregnancy.

A typical diet in high-income countries, characterised by a high intake of red meat, refined grains, refined sugars, and high-fat dairy, is also lacking in several important nutrients (including magnesium, iodine, calcium, and vitamin D. Their analysis in the UK showed that many women of reproductive age will not be nutritionally prepared for pregnancy, since they do not meet even the lower reference nutrient intake (RNI) amounts, which applies especially to young women and mineral intake. 77% of women aged 18–25 years had dietary intakes below RNI daily recommendations for iodine and 96% of women of reproductive age had intake of iron and folate below daily recommendations for pregnancy. Of specific concern is that adequate folate concentration in pregnancy (red blood cell folate concentration above 906 nmol/L) for prevention of neural tube defects is hard to achieve through diet alone.

In the UK and Australia, more than nine out of ten young women reported consuming fewer than five fruit and vegetable portions daily, in effect failing to comply with the public health message promulgated through the best efforts of government agencies. As the diet of a young child is determined largely by the mother, this aspect has important implications for future child health.

The authors of the first part in the series explore a number of confounding factors that also play into risks of health, but qualified their view on micronutrient status by saying: Although every effort should be made to correct micronutrient deficiencies in women once pregnant, there is a growing consensus that the greatest gain will be achieved through a life-course approach or continuum of improved nutrition in children, adolescents, and young women contemplating pregnancy.

Therefore, if you are considering, or clients or family members are considering or planning for pregnancy, the evidence suggests that significant changes to lifestyle, food and supplementation will confer greater advantage to the health of the child and parent than waiting until pregnant to make the changes. Are you advising your prospective mothers accordingly?

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