Health around the time of conception, once a neglected topic, is now a focus of increasing interest, reflected in numerous recent reports from national and international health agencies. Few observational studies show strong links between health before pregnancy and maternal and child health outcomes during & post pregnancy, with consequences that can extend across generations.
Women need access to preventive and clinical care during their reproductive years for their own wellbeing and for children they may have. This includes attention to dietary adequacy, healthy weight and any medical nutrition therapy and preventive nutrition needs. This brief addresses both public health and clinical aspects of preconception and interconception health for women.
Preconception care can improve the chances of getting pregnant, having a healthy pregnancy, and a healthy baby. If you are planning for pregnancy, talk to your doctor about your preconception health. Preconception care should begin at least three months before you get pregnant. But some women need more time to get their bodies ready for pregnancy. Be sure to discuss your partner’s health too.
Discuss with your physician about:
- Family planning
- Starting folic acid.
- Vaccines and screenings you may need, such as a Pap test and screenings for sexually transmitted infections (STIs), including HIV.
- Managing health problems, such as diabetes, high blood pressure, thyroid issues, obesity, depression, eating disorders, and asthma. Find out how pregnancy may affect, or be affected by, health problems you have.
- Talk about mental health & stress factors
- Medicines you use, including over-the-counter, herbal, and prescription drugs and supplements.
- Ways to improve your overall health
- How to avoid illness like frequent fever, cough, cold, stomach upset etc.
- Health problems that run in your or your partner’s family.
Why preconception nutritional status is important?
At the time of conception, maternal nutritional status is an important determinant of embryonic and fetal growth. Placental and fetal growth is most vulnerable to maternal nutrition status during the pre-implantation period and the period of rapid placental development, which occurs during the first few weeks of development typically before pregnancy has been confirmed. Most organs form 3-7 weeks after the last menstrual period and any teratogenic effects may occur by this time.
Evidence is emerging that a mother’s diet and lifestyle influence the long-term health of her children. Recent research suggests that inadequate levels of maternal nutrients during the crucial period of fetal development may lead to reprogramming within the fetal tissues that predisposes the infant to chronic illnesses in adulthood.
A woman’s nutritional status is influenced by numerous variables including genetics, environment, lifestyle habits, the presence of disease or physiological stressors, and drug-toxicant exposures.
Preconception nutrition research has shown that food and healthy nutrition are tied to fertility health in both women and men. Additionally, there are substances that can hinder fertility.
The Nutritional Rule for Preconception
Maintaining a diet composed of whole grains, lean meat, omega 3 rich foods, colorful fruits, vegetables, and dairy products should provide you with the recommended dietary allowance of nutrients for proper reproductive functioning.
Nutrients that can benefit both:
A nutrient that contributes to semen and testosterone production in men, and ovulation and fertility in women. There are several studies that indicate that deficiencies in zinc affect both male and female fertility. Maintaining the recommended dietary allowance of zinc (15mg/day) can help keep your reproductive system functioning well. Oysters, Lean meat, and poultry are excellent sources of zinc. Baked beans, chickpeas, and nuts (such as pine nuts, peanuts, cashews and almonds) also vegetarian sources of zinc.
Iodine is necessary for the production of thyroid hormones, thyroxine, and triiodothyronine, and it must be provided in the diet. Inadequate iodine intake leads to inadequate thyroid hormone production and to a spectrum of disorders such as iodine deficiency disorders including abortion, stillbirth, mental retardation, cretinism, increased neonatal and infant mortality, goiter, and hypothyroidism. Iodine is readily transferred to the fetus, and the fetal thyroid concentrates iodine and synthesizes thyroid hormones by 10-12 weeks’ gestation. Iodine deficiency in pregnancy negatively affects the normal maturation of the developing fetal central nervous system, particularly myelination, and is responsible for cognitive impairment, permanent mental retardation, and in its most severe form, cretinism. Sufficient dietary iodine throughout the life cycle, especially during the preconception period, can minimize the risk of iodine deficiency during critical, early fetal development. Daily dietary iodine intake of 150µg during preconception and at least 200µg when pregnant. Adding a small amount of iodine in the form of potassium iodate or potassium iodide to dietary salt is highly effective. Salt iodization is also recommended. Sea foods & dairy products are excellent source of Iodine.
Omega 3 Fatty Acid
It has long been known to promote fertility, especially in men. The long-chained DHA fatty acids have been found in high concentrations in sperm, suggesting that the DHA molecules are important for viability, maturity. In addition, studies have found that higher levels of omega-3s correlate with improved sperm morphology and motility. Besides the benefits for the sperm, it also appears to be helpful for female fertility issues. Several studies concluded that a lifelong consumption of a diet rich in omega-3 fatty acids could prolong reproductive function to an advanced maternal age. The researchers also found that a short-term treatment of omega-3 fatty acids could help improve egg (oocyte) quality. Sea fishes (salmon, anchovies, sardine, oyester) , nuts & seeds (walnuts, flax & chia seeds) are excellent sources of omega 3 fatty acids.
Adequate vitamin A is essential for proper visual functioning, fetal growth, reproduction, immunity, and epithelial tissue integrity. Since vitamin A is lipid soluble, it crosses the placenta easily and has a long half-life. Although normal fetal development requires sufficient vitamin A intake, it also appears to be protective in pregnant women with human immunodeficiency virus/acquired immunodeficiency syndrome. There is growing evidence in developing countries that vitamin A may protect against maternal morbidity. Orange & yellow colored vegetables & fruits are most richest sources of vitamin A. Other good sources are animal liver, eggs, sweet potato, and dark green leafy vegetables.
Vitamin D is a lipid-soluble vitamin, important in the metabolism of calcium and phosphorus. It promotes calcium absorption and bone mineralization. It is one of the essential elements for ensuring health of pregnant women and their infants. Deficiency of Vitamin D during pregnancy is reflected in lower maternal weight gain, disturbed skeletal homeostasis in the infant; and in extreme situations reduced bone mineralization, rickets, and fractures. For women with vitamin D deficiency, education on vitamin D in the diet and supplementation should be a part of preconception care. Women at risk for vitamin D deficiency include women who are not exposed to enough sunlight and whose dietary vitamin D intake is low (no dairy & egg or lactose intolerance).
Calcium is essential for bone development and maintenance throughout life and in pregnancy. During pregnancy, the growing fetus receives its total nourishment from maternal sources. The dynamic balance between skeletal calcium storage and fetal nutritional needs can affect the maternal calcium equilibrium adversely. Therefore, if adequate calcium is not part of the maternal diet, bone can be degraded as calcium is taken from the maternal skeleton. Studies indicate that increases in calcium intake during pregnancy improve maternal bone health of mother and neonate. Higher birth weight babies, a reduced risk of preterm delivery, and lower infant blood pressure have all been linked with a high calcium intake during pregnancy. It is important to ask and advise dietary calcium consumption (milk & milk products) and calcium supplementation to maintain women’s overall calcium requirement during preconception
Iron deficiency is the most common nutritional deficiency worldwide and is the most common cause of anemia in pregnancy. Reproductive-aged women are at risk of iron deficiency because of blood loss from menstruation, poor diet, and frequent pregnancies. Potential fetal complications secondary to anemia include spontaneous prematurity and intrauterine growth retardation. Several studies showed an association between preconception maternal anemia status and adverse pregnancy outcomes. Anemia attributed to iron deficiency is significantly associated with decreased birth weight. It is recommended that all women should be screened at a preconception visit for iron deficiency anemia for the purpose of improving perinatal outcomes. Prior to conception and during pregnancy, women should eat iron-rich foods (lean meat, poultry, and iron fortified cereals, green leafy vegetables). The iron recommendation of child-bearing aged women is to eat foods high in hemeiron and/or consume iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin C–rich foods. Foods that inhibits iron absorption, such as whole-grain cereals, dairy items, legumes, tea, and coffee should be consumed separately from iron-fortified foods. Calcium is known micro nutrient which inhibits iron absorption, if taken with iron fortified foods.
The recommendation for women of childbearing age is to obtain 400 micrograms (0.4 milligrams) of folate or folic acid each day. This B vitamin helps reduce a baby’s risk of neural tube birth defects such as spina bifida. If your family has a history of neural tube defects, your doctor may increase your daily intake of Folic acid. This vitamin may be obtained naturally through leafy, dark green vegetables (i.e. spinach, kale, broccoli), citrus fruits, nuts, legumes, whole grains, and fortified bread and cereals. These foods can be supplemented with a prenatal vitamin.
Vitamin C is a water-soluble vitamin. This vitamin gets flushed out of your system, hence it needs to be replenished on a daily basis. This immunity-boosting vitamin not only promotes iron absorption, it also helps to improve the hormonal balance of the body. The presence of ascorbic acid helps in regulating the ovarian function and menstrual cycle. It even helps in increasing the level of progesterone in the body, which is directly related to improving the uterine health by thickening the uterine lining. The chances of conception are more in women who include vitamin C supplements in their daily diet than women who do not take any Vitamin C supplements. For men, it helps improve sperm health and motility. Consuming Vitamin C is known to improve sperm health and protect sperm DNA in men. The improved sperm quality thus reduces the chances of chromosomal defects and miscarriages. Sometimes oxidative damage may occur in the sperms due to the exposure to free radicals. In such cases, Vitamin C may help in protecting the sperms against free radical damage. This vitamin not only aids the sperm quality but also improves sperm mobility. Vitamin C is abundantly available in all type of colorful fresh fruits and vegetables.
Essential Fatty Acids
The Essential Fatty Acids (EFA) and Docosa-Hexaenoic Acid (DHA) are important structural components of cell membranes, the central nervous system, and retinal cell membrane structure. Several studies have shown an association between maternal dietary intake of EFA during pregnancy and visual and cognitive development, sleep patterns, and motor activity in infants. During the preconception period, women should be encouraged to eat a diet rich in EFAs including omega 3 and omega 6 fatty acids. Essential fatty acids are found in foods such as oily fish, flax seeds, walnuts, and vegetables oils.
Learn more about: Nutrition during Pregnancy
Lifestyle and changes of habits during preconception for couples
During preconception period, it is important for both men and women to maintain certain lifestyle
|Maintain healthy body weight / BMI||Being Over weight or Under weight|
|Homemade Soup, Citrus fruits juice, milk, buttermilk||Alcohol Consumption, carbonated beverages, caffeinated products|
|Light tea / light coffee 150 ml (max)||Smoking, Tobacco chewing|
|Exercise, yoga and meditation||Stress and Depression|
|Healthy balanced diet||Binge eating, Junk foods|
|Whole grains, complex carbs (B vitamin rich)||Refined cereals & carbs|
|Consumption of lean meat, egg & lentils||Processed meat & ready to eat foods|
|Antioxidant rich fruits & vegetables (colorful)||Calorie rich fruits and starchy vegetables|
|Proper sleep cycle (7-8 hours/day)||Insomnia / Disturbed sleep pattern|
|Regular menstrual cycle||Irregular menstrual cycle|
- For men, ensuring enough zinc and antioxidant in the daily diet can help produce healthier and larger supplies of sperm.
- Occupational and environmental factors such as exposure to heat, heavy metals, pesticides should be addressed because they may impair sperm health.
- A BMI less than 19 and more than 28 can impair fertility for both men and women.
- Losing 10-15% body weight can increase the fertility among women.
- Caffeine can harm the initial stage of developing baby; the recommended amounts are less than 200 mg/day.
- Alcohol and recreational drugs are known teratogen during pregnancy; their use may reduce the fertility and should be eliminated among couples who are actively trying to conceive.
- Smoking during pregnancy limits the oxygen available for the developing baby. Smoking can decrease fertility among men and women, and ideally should be stopped prior to conception.
Recommended blood tests for preconception for women
- Thyroid level
- Blood sugar level
- Iron & hemoglobin level
- Vitamin D
- Any viral infections (HIV, Hepatitis B & C, Rubella)
A pre-conception goal is thus a must to help mothers attain wellness and ensure better health of the unborn baby.
Wishing you all a very healthy planning and pregnancy!
For a healthy pre-pregnancy diet plan, meet your nutritionist today!
Want to consult a Nutritionist? Book Video Consultation Online with the best Nutritionist in India.
Watch video on Healthy Diet during Preconception Phase