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Is a well-balanced preconception diet enough?

Is a well-balanced preconception diet enough?

Preconception health and care are focused on nutrition and weight management to increase the chances of a healthy pregnancy. Preconception nutrition is an important part of the overall preparation for a healthy pregnancy irrespective of the gravidity. A healthy diet before conception reduces poor pregnancy risks and birth outcomes, A healthy diet before conception reduces poor pregnancy risks and birth outcomes including preterm birth, gestational diabetes, and hypertensive disorders of pregnancy.1,2,3 

The diet should include five food groups; grains, vegetables, fruits, dairy, and protein.4 Oils are not included in this group; however, nut oils, fish, olives, and avocados can be included in the diet in moderation.4 Apart from these elements, consensus guidelines recommend that pregnant women should consume around 200 mg of DHA per day to optimize pregnancy outcomes and improve fetal health.5 

Preconception nutrition 

Preconception nutritional status is affected by numerous variables including access to healthy food and dietary supplements, food preferences based on culture, income status, genetics, lifestyle, habits, diseases, or exposure to pollution.6,7 Many women don’t have a well-balanced diet and may have a poor nutritional status that does not meet the increased demands of pregnancy.8 Deficiencies of essential nutrients, as well as with obesity may have severe outcomes during pregnancy and for newborns. Deficiencies of essential nutrients, as well as with obesity may have severe outcomes during pregnancy and for newborns. These negative effects of deficiencies may also be augmented in women having pregnancies that are closely spaced since their nutritional reserves are depleted, resulting in neonatal deaths, stillbirths, low birth weight, and preterm births. On the other hand, being overweight and obese further increases the risk of maternal hypertensive disorders and gestational diabetes.2  

While many essential vitamins, minerals, amino acids, fatty acids, and other constituents can be absorbed from the regular diet, the physiological demands during preconception may necessitate additional micronutrient supplementation.9  

Several observational studies showed a strong association between health before pregnancy and maternal and infant outcomes. The consequences can extend across generations.7 

Essential nutrients during preconception 

Folic acid 

Folic acid is among the most essential nutrients needed during the preconception period, as it largely determines the proper development and growth of the fetus. All women of childbearing age need 400 micrograms (mcg) of folic acid each day.4,9 Different associations such as USPHS, AAP, ADA, ACOG, and AAFP recommend folic acid supplements in women of reproductive age during the preconception period to prevent neural tube defects in the offspring.9 Spina bifida is one of the most common birth defects observed with folic acid deficiency during pregnancy. It can lead to paralysis, incontinence, and in some cases intellectual disability.4

Women in the high-risk group (increased risk of NTDs or folic acid deficiency) are recommended 5 mg of folate per day during the preconception period and the first trimester of pregnancy. Included in this category are the following:9

  • Hispanic women 
  • Obese women 
  • Women suffering from Type 2 diabetes with poor glycaemic control 
  • Women with prior NTDs 
  • Women on antiepileptic medication for seizure control 

The first 28 days after conception is the period where most neural tube defects occur. Folic acid supplementation during this period can be very beneficial, however, many women don’t realize that they are pregnant in the first month. Hence the recommendation is to initiate folic acid during preconception and continue through pregnancy.4

Iron

Women of reproductive age are at increased risk of iron deficiency because of frequent pregnancies, menstrual blood loss, and poor diet. Women over the age of 18 need 18 milligrams (mg) of iron daily.4

Building the iron stores during preconception helps the mother to support the baby during pregnancy. Iron stores can be built by consuming good sources of iron regularly which include poultry, meats, fish, leafy greens of the cabbage family, legumes such as green peas, and whole-grain bread.4

Iron deficiency is the most common cause of anaemia in pregnancy. It is paramount that all women are screened for iron deficiency anaemia at preconception visits to improve perinatal outcomes.9

Calcium

Building healthy bones is an important process during preconception. The developing baby will need calcium, and in cases of deficiency in the pregnancy diet, the baby may draw calcium from the mother’s bones which can increase the mother’s risk of osteoporosis. The Institute of Medicine recommends 1000 mg/day of calcium for women who are 19-50 years old and 1300 mg/day for women who are younger than 19 years old. Having 3 servings of milk each day can provide around 1000 mg of calcium.9,10

Other nutrients

Multimicronutrient supplementations during preconception appear to be a promising strategy for reducing adverse pregnancy outcomes and achieving healthier birth outcomes through improved nutritional status.  

Vitamin D is essential for the health of pregnant women and infants.9 It is needed for the formation of the hormone calcitriol which in turn enables sufficient calcium absorption from the diet.10 Most experts agree that daily requirements may be closer to 1000 IU or higher.9 Women at risk for vitamin D deficiency include women not exposed to enough sunlight, those with lower dietary vitamin D intake (no dairy or lactose intolerant), and those wearing head coverings.9  

Iodine is required for thyroxine, and triiodothyronine production. Inadequate iodine consumption results in insufficient thyroid hormone production and a range of disorders including mental retardation, cretinism, stillbirth, abortion and increased neonatal and infant mortality, goitre, and hypothyroidism. Women of reproductive age with iodine deficiency should be counselled on the importance of having an adequate intake of 150 µg iodine during preconception.9  

Women of child-bearing age should attain good nutritional status before conception to minimize health risks to both mothers and infants. Women of child-bearing age should attain good nutritional status before conception to minimize health risks to both mothers and infants. Nutrition-specific interventions are essential in this preconception period due to the clinical association between poor maternal status and its consequences. While diet inadequacy and malnutrition are common in young women, certain micronutrient supplements in addition to a varied diet are recommended in preparing for a healthy pregnancy. 

References: 
  1. Adams KP, Adu‐Afarwuah S, Mridha MK, et al. The impact of maternal supplementation during pregnancy and the first 6 months postpartum on the growth status of the next child born after the intervention period: Follow‐up results from Bangladesh and Ghana. Maternal & child nutrition. 2020 Apr;16(2):e12927. 
  2. Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: nutritional risks and interventions. Reproductive health. 2014 Dec;11(3):1-5. 
  3. McKenna E, Hure A, Perkins A, et al. Dietary supplement use during preconception: The australian longitudinal study on women’s health. Nutrients. 2017 Oct;9(10):1119. 
  4. Nutrition Before Pregnancy. Available at:
    https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=… Accessed on 23 May 2022. 
  5. Coletta JM, Bell SJ, Roman AS. Omega-3 fatty acids and pregnancy. Reviews in obstetrics and gynaecology. 2010;3(4):163. 
  6. Gardiner P, Bickmore T, Yinusa-Nyahkoon L, et al. Using health information technology to engage African American women on nutrition and supplement use during the preconception period. Frontiers in endocrinology. 2021:1045. 
  7. Stephenson J, Heslehurst N, Hall J, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018 May 5;391(10132):1830-1841. 
  8. Goossens J, Beeckman D, Van Hecke A, Delbaere I, Verhaeghe S. Preconception lifestyle changes in women with planned pregnancies. Midwifery. 2018;56:112-120. doi:10.1016/j.midw.2017.10.004. 
  9. Gardiner PM, Nelson L, Shellhaas CS, et al. The clinical content of preconception care: nutrition and dietary supplements. American journal of obstetrics and gynecology. 2008 Dec 1;199(6):S345-56. 
  10. Calcium and Vitamin D: Important at Every Age. Available from:
    https://www.bones.nih.gov/sites/bones/files/pdfs/cal-vit-d-important-an…. Accessed on: 30/06/2022.