Preconception care: What is it?

What is preconception care?

Simply put, preconception care is a holistic and individualized approach to optimizing the health and wellness of all those involved in conceiving a child.

1 + 1 ≠ 3

This definition might seem weirdly phrased, however, today with the advancements in reproductive technology, 1 + 1 no longer equals 3. There can be many individuals involved in creating a new life such as egg and sperm donors and surrogates.

Male infertility is a women’s health issue

The phrasing of this sentence is also important for a second reason. Unfortunately, “[w]ith the development of assisted reproductive technology (ART), the treatment burden for male and unexplained infertility has fallen mainly on women. […] A diagnosis of male infertility rarely includes an assessment of internal sperm components […]”_¹

Instead, the couple struggling with male fertility factors, are often recommended to undergo one of the following treatments: intrauterine insemination (IUI), in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

These procedures are very invasive for women and they often required frequent intramuscular injections. These medications can produce significant adverse effects like mood swings and weight gain.

It’s important to remember that these procedures occur even when the fertility issue lies 100% with the male partner. The treatment burden of male fertility issues falls solely on the female partner.

Unfortunately, I have seen this pattern time and time again in my clinical practice. The male fertility factor is ignored in the sense that it receives no further assessment to determine a possible root cause and no recommendations are made to help improve their fertility. In addition, when it comes to heterosexual couples, I often only see and treat the female partner. Guys, your health matters too!

Preconception care is for everyone

Lastly, preconception care is not only for those with perceived or true fertility/conception issues like recurring pregnancy loss, endometriosis, low sperm count and motility. Preconception care is for EVERYONE looking to conceive regardless of marital status, sexual orientation, gender or method of conception (e.g. IUI, IVF, ICSI or natural).

In this post, we will be discussing what preconception care may involve.

What does preconception care involve?

When preparing for pregnancy/conception it’s important to assess and optimize the following aspects of your health (ideally with a trusted healthcare provider).

1. Diet
2. Lifestyle
3. Relationship(s)
4. Pre-existing conditions and health concerns
5. Micronutrient levels
6. Hormonal & seminal health
7. Toxic burden

Before we move on to further discuss each category it is important that I reiterate that preconception care is holistic and individualized. What does that mean exactly? Well, it means that each individual or couple will have a unique preconception care plan that addresses their specific concerns, health history and goals.

For example, Pam who struggles with Hashimoto’s disease and has a history of pregnancy loss would have a different preconception plan than Kelly who was diagnosed with PCOS as a teenager, does not have a regular period and will be undergoing IVF with donor sperm. Jim who has a high-stress job, poor nutrition and insomnia would have a different preconception plan than Ryan who is overweight, has sleep apnea, low testosterone and sperm count.

Diet

These days most people understand the importance of a healthy diet. It can be quite intuitive to change our diet once we become pregnant, but what about the months leading to conception.

Addressing our diet before we become pregnant can positively impact the quality of our eggs and sperm. It takes up to 3 months for the nutrients in our diet and prenatal vitamins to impact our eggs and sperm. Therefore, optimizing our diet before pregnancy could potentially decrease the time to conception (how long it takes to get pregnant once you actively start trying).

Once pregnant there is an increased demand for all of our nutrients, for example, iron, DHA, and vitamin D. It is, therefore, important to increase our nutrient stores prior to pregnancy in order to prevent any nutritional deficiencies. Iron-deficiency anemia is common among pregnant women even when taking a prenatal multivitamin. It can be difficult to increase our iron stores during pregnancy with oral iron supplementation without causing significant adverse effects like constipation.

Consider this time as an oppertunity to assess and optimise your current diet and dietary patterns in preparation for the demands of pregnancy and parenthood. In other words, now is the time to learn to cook foods you enjoy; to figure out a meal planning system that works for you; and to adopt healthy eating patterns.

Lifestyle

The preconception phase is also an ideal time to establish healthy lifestyle behaviours that you enjoy and that are beneficial to you! For example, you can focus on :

• Self-care routine(s) – whatever that means for you.
• Establishing morning or nighttime routines to help you start or end your day on the right foot.
• Prioritizing sleep – Check out my mini blog series on sleep.
• Increasing your time spent in nature.
• Adding a date night.
• Practicing mindfulness/mediation.
• Increasing your level of physical activity – See the 2019 Canadian Guideline for Physical Activity throughout Pregnancy

Establishing a few key healthy lifestyle practices prior to pregnancy can really help us to better cope with the demands of life. Check out The Healthy Habits Challenge for some inspiration and guidance.

Relationships

Deciding to become parents can be extremely exciting for a couple. Unfortunately, for some this journey can become quite stressful. One rarely starts the journey to parenthood with the expectation that their relationship might be challenged at any or every step of the way.

From clinical experience, I find there is very little emphasis placed on fortifying one’s relationship before pregnancy. In their book “And Baby Makes Three: The Six-Step Plan for Preserving Marital Intimacy and Rekindling Romance After Baby Arrives”, John Gottman PH.D. and Julie Schwartz Gottman PH.D. wrote the following:

“Our research study found that after the first baby was born, relationship satisfaction dropped significantly for two-thirds of the couples. Conflict within the relationship and hostility towards each other dramatically increased. They found themselves fighting much more. Their emotional intimacy deteriorated. They became bewildered and exhausted. Not surprisingly, their passion, sex and romance plummeted.” ²

Couple goals

There are many great couple’s therapists as well as many online resources. I highly recommend following The Gottman Institute on Instagram or checking the resources on their website. They also have a podcast called Small Things Often and you can subscribe to their email list called the Marriage Minute.

I strongly believe that it’s never too early or a waste of time to re-prioritize your relationship.  After all “[t]he greatest gift you can give your baby is a happy and strong relationship between the two of you.”²

Pre-exhisting conditions

Naturopathic medicine is a holistic medicine, which is a form of healing that considers the whole person — body, mind, and spirit.

Therefore it shouldn’t come as a surprise that preconception care encompasses more than just boosting your reproductive health. We look at your whole being. 

It’s important when entering pregnancy that major health concerns have been addressed as much as possible in both partners. The stress and lack of sleep that can come with trying to conceive, pregnancy, delivery and postpartum recovery can exacerbate pre-existing conditions. 

Not only that but pre-existing conditions can make getting pregnant, staying pregnant, labour & delivery and postpartum recovery more difficult.

Micronutrient levels

As mentioned earlier there is an increased demand for nutrients during pregnancy and that includes vitamins and minerals. Unfortunately, many individuals are low or deficient in key nutrients before becoming pregnant.

The most common nutritional deficiencies that I encounter in clinical practice are low vitamin D and iron/ferritin.

Most people in the northern hemisphere are either low or deficient in vitamin D regardless of skin pigmentation. A 2017 study suggested that “[i]nsufficient maternal 25(OH)D during pregnancy may increase the risk of MS in offspring.”³

Deficiencies in iron can lead to iron-deficiency anemia, which can not only adversely impact mom’s health (increased risk of preeclampsia, postpartum hemorrhage etc.) but if left untreated it can also negatively impact baby’s health. 

Low birth weight is one possible outcome associated with iron-deficiency anemia during pregnancy.⁴ There is emerging evidence indicating that low birth weight may predispose children to develop cardiovascular disease, type 2 diabetes, and metabolic syndrome in adulthood.⁵

Your health history and diet typically dictate which vitamins and minerals should be tested for deficiencies. For example, those with heavy menstrual bleeding and/or a diet low in animal protein should be tested for iron-deficiency anemia.

Hormonal and seminal health

Testing the reproductive hormones (e.g. estrogen, progesterone, prolactin, total testosterone, FSH and LH) or doing a semen analysis is not necessary for all individuals and couples. However, testing could be of benefit to those :

• Who have menstrual issues such as:
  • Heavy periods or no periods.
  • Severe cramping and/or PMS.
  • Endometriosis or adenomyosis.
  • Polycystic ovarian syndrome (PCOS).
  • Polyps and/or fibroids.
• With thyroid issues (hypothyroidism, Hashimoto’s disease) or a history of thyroid issues.
• Who struggle with symptoms of low testosterone such as:
  • Reduced sex drive
  • Reduced erectile function.
  • Loss of body hair.
  • Less beard growth.
  • Loss of lean muscle mass.
  • Feeling very tired all the time (fatigue).
  • Obesity (being overweight).
  • Symptoms of depression.
• Who are struggling to conceive.
• With a history of pregnancy loss.

Toxic burden

“In a [2005] study spearheaded by the Environmental Working Group (EWG) in collaboration with Commonweal, researchers at two major laboratories found an average of 200 industrial chemicals and pollutants in umbilical cord blood from 10 babies born in August and September of 2004 in U.S. hospitals. Tests revealed a total of 287 chemicals in the group. The umbilical cord blood of these 10 children, collected by Red Cross after the cord was cut, harbored pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage.”⁶

Stay calm and focus on what you control

It can feel quite disempowering, frustrating, and even overwhelming to discover that our babies are being exposed to these harmful chemical agents even before they are born. However, we must remember to focus on the things that we can change within our immediate environment.

For example, we might not be able to change overnight how the government regulates body products or pesticide use but we can choose safer body products and organic foods.

It’s a journey not a destination

When it comes to making your environment a healthier and safer place, I always tell my patients that this is a lifelong journey. It is not expected or recommended that you throw out all your current makeup & cleaning products; replace all your plastic containers with glass containers; or only consume organic foods overnight.

I like to promote a more moderate approach. For example, when you finish a cleaning product look for a better option whether it is a product you buy in the store or one you make at home. When you are looking for a new lip balm take the time to look-up a few brands that advocate for clean beauty. The EWG has a great database for beauty products call EWG Skin Deep. The David Suzuki Foundation also has information concerning “The Dirty Dozen” cosmetic chemicals to avoid.

Regarding food, it might not always be feasible to eat organic and that’s okay. Consider buying more fresh organic produce during the summer when prices are a bit cheaper and frozen during the winter. Or maybe it is more important for you to consume organic animal products (meat, dairy, honey & eggs) instead of organic produce. Some use the EWG’s Clean Fifteen and Dirty Dozen to help them decide what they should consider buying organic. The EWG updates these lists every year.

The take away

Preconception care is a holistic and individualized approach to optimizing the health and wellness of all those involved in conceiving a child. As a result, everyone’s preconception plan will be a bit different.

A preconception plan may involve the assessment and optimization of your diet, lifestyle, hormones, relationship(s), health condition(s) and concerns, vitamin and mineral levels, and toxic burden.

References

1. Turner, K. A., Rambhatla, A., Schon, S., Agarwal, A., Krawetz, S. A., Dupree, J. M., & Avidor-Reiss, T. (2020). Male Infertility is a Women’s Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed. In Cells (Vol. 9, Issue 4). NLM (Medline). https://doi.org/10.3390/cells9040990
2. Gottman, J. M., & Schwartz Gottman, J. (2007). And Baby Makes Three: The Six-Step Plan for Preserving Marital Intimacy and Rekindling Romance After Baby Arrives (1st ed.). Three Rivers Press.
3. Munger, K. L., Åivo, J., Hongell, K., Soilu-Hänninen, M., Surcel, H. M., & Ascherio, A. (2016). Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish Maternity Cohort. JAMA Neurology, 73(5), 515–519. https://doi.org/10.1001/jamaneurol.2015.4800
4. Abu-Ouf, N. M., & Jan, M. M. (2015). The impact of maternal iron deficiency and iron deficiency anemia on child’s health. Saudi Medical Journal, 36(2), 146–149. https://doi.org/10.15537/smj.2015.2.10289
5. Smith, C. J., Ryckman, K. K., Barnabei, V. M., Howard, B. V., Isasi, C. R., Sarto, G. E., Tom, S. E., Van Horn, L. V., Wallace, R. B., & Robinson, J. G. (2016). The impact of birth weight on cardiovascular disease risk in the Women’s Health Initiative. Nutrition, Metabolism and Cardiovascular Diseases, 26(3), 239–245. https://doi.org/10.1016/j.numecd.2015.10.015
6. Body Burden: The Pollution in Newborns | EWG. (n.d.). Retrieved January 21, 2021, from https://www.ewg.org/research/body-burden-pollution-newborns
7. Davenport, M. H., Ruchat, S. M., Mottola, M. F., Davies, G. A., Poitras, V. J., Gray, C. E., Garcia, A. J., Barrowman, N., Adamo, K. B., Duggan, M., Barakat, R., Chilibeck, P., Fleming, K., Forte, M., Korolnek, J., Nagpal, T., Slater, L. G., Stirling, D., & Zehr, L. (2018). 2019 Canadian Guideline for Physical Activity Throughout Pregnancy: Methodology. In Journal of Obstetrics and Gynaecology Canada (Vol. 40, Issue 11, pp. 1468–1483). https://doi.org/10.1016/j.jogc.2018.09.004