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Preparing for a Healthy Pregnancy: Nutritional Advice

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By Victoria Maizes, M.D.

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Joyously, you’re considering having a baby. What could be more natural?  Women become pregnant every day, often unintentionally.  Still, many women struggle to conceive and the modern world has a host of unhealthy factors to contend with during that process.  I believe it is vital to learn ways to improve both your fertility and health of your unborn child; nutrition, moderate exercise, maintaining a normal weight and managing stress are all important, as are adopting practical strategies to reduce environmental toxins.

A healthy diet is critical to women and men seeking to conceive.  Multiple studies support that it makes it easier to conceive[1]; the fetal origins hypothesis suggests it will also enhance your child’s health.  I recommend a whole food diet, rich in vegetables and fruits, abundant in omega 3 fatty acids (choosing low-mercury fish such as wild salmon and sardines), eggs, and vegetable sources of protein.  The diet should be low in processed foods, meat, and rapidly digesting, high-glycemic index carbohydrates. The Mediterranean diet is one such whole-food diet and in two recent studies – one of women trying to conceive naturally and another in those using IVF - it was associated with a 40% reduced the risk of infertility. [2],[3]

Many women avoid fish entirely due to the 2004 FDA/EPA warning.   In it, pregnant women, and women who might become pregnant, were advised to eat no more than 12 ounces per week of seafood, to entirely avoid eating shark, swordfish, king mackerel, and tilefish and to limit albacore tuna to 6 ounces or less per week.  These big, predatory fish have large amounts of mercury that can be neurotoxic to a developing fetus.  In response to the warning, however, many women have cut out fish entirely.  In fact, the National Health and Nutrition Examination Survey showed that 90 percent of women are consuming less than the FDA-recommended amount of fish. 

The problem with not eating fish at all is that it is the best source of omega 3 in our diets. Omega 3 fatty acids are essential because our bodies cannot synthesize them, so we must consume them in foods.  The Avon Longitudinal Study of Parents and children, which began in 1991, showed that babies whose mothers avoided fish tended to have lower verbal IQs.[4]  The ideal fish to eat is low in mercury and high in omega 3’s such as wild Alaskan salmon, sardines, herring and trout. 

Rather than fish, it’s our soda consumption we need to watch out for.  Two studies show a linear relationship; the more soda consumed, the longer the time to conceive.[5],[6] Sodas are a form of high glycemic index carbohydrates; these carbs were also found to interfere with fertility in the Nurse’s Health Study (NHS).[7] 

Beware of breakfast cereals with flour or sugar as the first ingredient.  Even if it says whole-wheat flour, all flours are rapidly metabolized into blood sugar leading to spikes of insulin with subsequent inflammation, and a corresponding reduction of fertility.

We also need to avoid trans fats. While they are gradually being removed from the American diet, a significant amount persists in products that use partially hydrogenated oils; the NHS revealed that trans fats increase the risk of ovulatory infertility by 73%.[8]  

Our food and beverages are the primary way we absorb environmental toxins into our bodies.  Shockingly, the average baby at birth has more than 200 chemicals in their bodies.[9]  These environmental chemicals may increase a child’s risk of ADHD, autism, diabetes, and heart disease.  While frightening, careful lifestyle changes will reduce your baby’s exposure to environmental toxins. 

I recommend choosing organic when possible.  It is the best way to reduce pesticide exposure and genetically modified organisms (GMO). When the cost is prohibitive, choosing from the least contaminated vegetables and fruits on the Environmental Working Group (EWG) list is a smart alternative. The EWG has calculated that you can reduce your pesticide exposure by 92% when you eat from the clean fifteen rather than the dirty dozen. 

Many resources are now available to guide you to safer choices and practices. The EWG website (www.ewg.org) addresses food, water, cosmetics, and cleaning products.  Companies using cans with liners free of Bisphenol A (BPA) can be found at www.treehugger.com.  Rather than feeling overwhelmed, adopt a few doable environmental strategies around your food, water, food storage containers, personal care, and cleaning products. 

When you avoid environmental chemicals you can significantly reduce your body burden of many of these toxins.  Studies show, for example, that when children are fed organic food, they dramatically reduce the amount of pesticides in their bodies in five days.[10]  In just 3 days, adults can lower levels of BPA by two thirds, when they avoid canned food and plastic containers.[11] 

Choose multivitamins and supplements with care.  Because this is a relatively unregulated industry, it is important to read labels carefully.  You will want your preconception multivitamin to contain folic acid 400-600 mcg, iron 18 mg, and iodine 150 mcg among its various ingredients.  Since 2011, three different studies have revealed an association between the use of folic acid prior to conception and about a 40% reduced risk of autism.[12],[13],[14]  Prenatal multivitamins also reduce the risk of neural tube, heart, and other birth defects[15]; they make it easier to conceive and less likely that you will miscarry.[16] 

I also recommend that women consider supplementing with an Omega 3 fatty acid supplement.  These essential fats are scarce in the American diet and critical to the developing fetus’ nervous system. Look for a molecularly distilled fish oil product with both DHA (300-400 mg) and EPA (500-600 mg) and take it with your largest meal of the day.

Subfertile men benefit from taking multivitamins as well.  A 2011 meta-analysis of 34 studies found that men who supplemented were four times as likely to impregnate their partner and five times as likely to have a live birth.[17]  And one study showed that men who supplemented with omega 3s (EPA 1.1 g + DHA 700 mg) had better sperm counts and morphology.[18]

Changing lifestyle habits is challenging for most of us.  In my practice, I have found that there is no more motivated time, than when couples are considering pregnancy and the formation of a new life.  Consider the support you need and ask for it.  Some of us do better working with a partner.  Others ask friends or family to keep us accountable.  In whichever way you proceed, I wish you the blessing of fertility and the joys of parenthood.

Victoria Maizes MD is the executive director of the University of Arizona Center for Integrative Medicine and a Professor of Medicine and Public Health.  Her newest book Be Fruitful: The Essential Guide to Maximizing Fertility and Giving Birth to a Healthy Child is available on amazon.  For more information visit her website victoriamaizesmd.com or follow her on twitter @vmaizes. 

[1]Chavarro JE. Rich-Edwards JW. Rosner BA. Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology. 110(5):1050-8, 2007 Nov.

 [2] Toledo Estefania, Cristina Lopez-del Burgo, Alvaro Ruiz-Zambrana et al Dietary patterns and difficulty conceiving: a nested case–control study Fertility and Sterility, Vol 96, No.5, November 2011, 1149-1153

[3] Vujkovic M, de Vries JH, Lindemans J, Macklon NS, van der Spek PJ, Steegers EA, et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril 2010;94:2096–101.

[4] Hibbeln JR. Davis JM. Steer C. Emmett P. Rogers I. Williams C. Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet. 2007 Feb 17;369(9561):578-85

[6] Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology. 2009;20:374–381.

[7] Chavarro JE. et al.  A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. European J of Clin Nutrition. 63(1):78-86, 2009 Jan.

[8] Chavarro JE. et al. Dietary fatty acid intakes and the risk of ovulatory infertility. American Journal of Clinical Nutrition. 85(1):231-7, 2007

[9] Peter Fimrite, “Chemicals, Pollutants Found in Newborns,” San Francisco Chronicle, December 3, 2009

 [10] Chensheng Lu, Kathryn Toepel, Rene Irish, et al., “Organic Diets Significantly Lower Children’s Dietary Exposure to Organophosphorus Pesticides,” Environmental Health Perspectives 114, no. 2 (February 2006): 260–63

[11] R. A. Rudel, J. M. Gray, C. L. Engel, et al., “Food Packaging and Bisphenol A and Bis(2-Ethyhexyl) Phthalate Exposure: Findings from a Dietary Intervention,” Environmental Health Perspectives 119, no. 7 (2010): 914–920

[12] Schmidt, Rebecca J. et al. Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism. Epidemiology: Vol 22 (4);476-485, July 2011.

[13] Roth, Christine MSc et al. Folic Acid Supplements in Pregnancy and Severe Language Delay in Children. JAMA. 306(14):1566-1573, October 12, 2011.

[14] Surén P, Roth C, Bresnahan M, Haugen M, Hornig M, Hirtz D, Lie KK, Lipkin WI, Magnus P, Reichborn-Kjennerud T, Schjølberg S, Davey Smith G, Øyen AS, Susser E, Stoltenberg C.  Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children.  JAMA. 2013 Feb 13;309(6):570-7.

[15] Y. I. Goh, E. Bollano, T. R. Einarson, and G. Koren, “Prenatal Multivitamin Supplementation and Rates of Congenital Anomalies: A Meta-analysis,” Journal of Obstetrical Gynaecology Canada 28, no. 8 (2006): 680–89.

[16] Chavarro JE. Rich-Edwards JW. Rosner BA. Willett WC.  Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility.  Fertility & Sterility. 89(3):668-76, 2008 Mar.

[17] Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2011, Issue 1.

[18] Safarinejad MR. Effect of omega-3 PUFA supplementation in infertile men with idiopathic oligoasthenoteratospermia.  Andrologia 2011;43:38  47. 

 

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