What is Preconception care?
Preconception care (otherwise known as pre-pregnancy care), involves education and guidance to help you make purposeful and healthful choices in the months prior to conception. Preconception care is a fabulous initial step for both partners in planning for a healthy pregnancy.
What are the Benefits of Preconception care?
While it is well recognized that health and behavioural choices of both partners in the 3- 6 months leading up to pregnancy directly affect the health of the developing baby, research is also showing that the impact of dietary patterns even three years prior to conception may influence both maternal and fetal health (1). Hence the importance of optimizing parental health prior to conception – this sets the foundation for the child’s health throughout their lifetime. Now – don’t panic if you haven’t been eating only wild-caught fish, kale and quinoa for 3 years before pregnancy. Most of us haven’t! Do the best you can with the time and resources you have.
Preconception care with a Naturopathic Doctor
As a fertility and pregnancy – focused Naturopathic Doctor, I often work with individuals and couples before they begin their fertility journey. This means, whether you are planning to try to conceive tomorrow, or in the next 6-12 months, my care starts now. Naturopathic Doctors are in a prime position to educate our patients on preventative health care measures; including the impact of our lifestyle choices on prenatal health.
How is Preconception health evaluated?
A preconception workup with a Naturopath includes evaluating nutritional status, stress levels, hormone levels, as well as environmental and medical risk factors that influence reproductive health and the health of a future pregnancy.
The goal of preconception care is to understand your current state of health, promote optimal wellness through lifestyle medicine, and identify and treat any risk factors for pregnancy.
Preconception care starts with a thorough evaluation for both partners; reviewing past medical history and family history, running and reviewing appropriate lab tests, and taking that information to identify any necessary changes to diet or lifestyle.
What happens in an Initial appointment with a Naturopathic Doctor at Oona?
The initial appointment with our Naturopathic Doctors at Oona involves a detailed intake and subsequent recommendations or testing to evaluate the following:
- Nutrition and micronutrient status
- Sleep, stress, and nervous system function
- Hormone levels, ovarian reserve, sperm parameters
- Glycemic control
- Environmental exposures
- Familial or genetic risk factors
- Medical risk factors for pregnancy: such as elevated blood sugar, blood pressure, or obesity
What does a Preconception care plan include?
Individualized recommendations can then be tailored to each future parent in accordance with their unique goals and needs. Recommendations to support the following concerns are commonly discussed in a Naturopathic consultation:
- Address any underlying health concerns, such as fatigue, stress, or poor digestion
- Nutritional counselling
- Supplement recommendations
- Exercise goals
- Antioxidant support to enhance fertility
- Optimizing blood sugar management and weight
- Addressing hormone imbalances
- Mood or sleep support
- Identify and mitigate toxin exposures
- Acupuncture or other stress management techniques
For patients with ovaries, it will also involve:
- Menstrual cycle and ovulation tracking and support
- Egg quality support
For patients with sperm, it will also involve:
- Assessment for behaviours, exposures or risk factors that impact sperm quantity, quality, motility or DNA
- Support for sperm quality
At Oona, your care with our Naturopaths and extensive team of practitioners extends beyond the preconception window and continues throughout pregnancy to postnatal and pediatric care.
What are some common preconception health concerns?
Pre-existing health conditions and genetic risk factors
Certain health conditions, including high blood pressure, endocrine conditions such as PCOS, hypothyroidism or diabetes, autoimmune conditions and other chronic conditions may increase risks in pregnancy. Certain genetic risk factors should also be considered. Actively managing any of these risk factors during the preconception period and as well as in pregnancy is imperative.
Lifestyle factors
Lifestyle factors including sleep, stress and exposures all play a role in preconception health. Care and counseling should be in place around reducing factors that are problematic such as caffeine, alcohol, smoking and recreational drug use.
Addressing Infertility
Infertility or subfertility are very common – and affect at least 1 in 6 Canadian couples. Working to identify any hormone imbalances and other factors that impact fertility is highly advantageous to support a shorter time to pregnancy.
Typically, fertility investigations will start once a couple has been trying unsuccessfully for one full year, if they are under the age of 35, or after 6 months if they are over the age of 35. With our Naturopathic Preconception program at Oona, fertility assessment and investigations are addressed sooner.
What Lifestyle changes improve Preconception health?
Exercise
Regular physical activity contributes to overall good health, decreasing our risk of chronic diseases such as high blood pressure, heart disease, type 2 diabetes, osteoporosis and certain types of cancer (5). Setting an exercise goal for both partners of at least 150 minutes per week of moderate physical activity has clearly documented benefits for impacting the time to achieve pregnancy, as well as pregnancy health.
Blood sugar control
Proper blood control is necessary for your overall health and the health of your pregnancy. Particularly for individuals with a strong family history of diabetes, or with insulin resistance, or a hormonal predisposition, such as in PCOS, active management of blood sugar levels prior to conception is necessary.
Mental health
Supporting mental health should be an integral part of preconception care. Our team of practitioners at Oona includes a dedicated Mental health support team. Particularly for individuals who have struggled with mood or anxiety disorders in the past, addressing these issues prior to pregnancy can lead to the best outcomes for postnatal wellness.
How can Diet support Preconception health?
Maintaining healthy dietary patterns up to three years prior to pregnancy can support the best prenatal outcomes (1). The emphasis should be on maintaining a whole foods diet, with an abundant intake of vegetables and fruits, lean sources of protein such as lean meats, eggs, and beans, healthy fats such as nuts, seeds, olive oil and fish, and high-quality carbohydrates such as whole grains, to best support pregnancy. Caffeine, sugar, salt, processed foods and red meat should be limited (4, 5). A Mediterranean diet pattern during pregnancy has been associated with lower incidence of gestational diabetes and better glycemic control throughout pregnancy (6). In the first trimester, energy requirements differ very little from pre-pregnancy intake, and the focus should be on quality of food choices and ensuring critical micronutrients (4). Although this can vary for individuals, standard suggestions during pregnancy would be to increase energy intake by about 85 calories per day in the first trimester, then by 285 calories per day in second trimester, and 475 calories per day in the third trimester (8). From the second trimester and forward, the need for protein increases to 1.1 g/kg per day (7).
The role of Folate
All individuals considering pregnancy within the next 3 months should begin supplementation with folate; as well as including folate-rich foods, such as leafy greens, in their daily diet. Folate helps to support egg and sperm quality, and is needed for cell growth, especially in the very early weeks of pregnancy – the embryonic stage. When started prior to conception, folate supplementation reduces the risk of neural tube defects in infants (5).
Although folic acid is the common form of this vitamin included in many prenatal supplements, folic acid is inactive in the body until it is converted to 5-methyltetrahydrofolate (5-MTHF) (2). Other critical nutrients to include in the diet during the preconception period include adequate intakes of calcium, iron and vitamin D (5).
Final thoughts
Preconception care encourages the best state of health for both partners prior to pregnancy. Naturopathic doctors are in an exceptional position to address preconception health care with their patients – empowering them to take an active role in the current state of health, which impacts not only their immediate wellness, but also the future health of their child. Given that the health of the parents prior to conception establishes the foundation for a child’s lifelong health, preconception care is preventative medicine. Our dedicated team at Oona looks forward to supporting you in this model of proactive care.
About Dr. Erica Nikiforuk, BSc, ND, RAc
Dr. Erica Nikiforuk is a Naturopathic Doctor and Registered Acupuncturist with a focus on fertility, pregnancy and pediatric health. She has dedicated her practice to improving the health of current and future parents; thereby impacting generations to come.
You can read more about Dr. Erica here: https://oonacares.com/staff/erica-nikiforuk/
References
- Stephenson J, Heslehurst N, Hall J, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health [published correction appears in Lancet. 2018 May 5;391(10132):1774]. Lancet. 2018;391(10132):1830-1841.
- Ferrazzi E, Tiso G, Di Martino D. Folic acid versus 5- methyl tetrahydrofolate supplementation in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:312-319.
- Servy EJ, Jacquesson-Fournols L, Cohen M, Menezo YJR. MTHFR isoform carriers. 5-MTHF (5-methyl tetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. J Assist Reprod Genet. 2018;35(8):1431-1435. doi:10.1007/s10815-018-1225-2
- Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, de Waard M, Brands B, Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM; EarlyNutrition Project Systematic Review Group. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. Ann Nutr Metab. 2019;74(2):93-106.
- Government of Canada (2021, April 26). Chapter 2. Preconception Care. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-2.html
- Karamanos B, Thanopoulou A, Anastasiou E, et al. Relation of the Mediterranean diet with the incidence of gestational diabetes. Eur J Clin Nutr. 2014;68:8–13.
- Lowensohn RI, Stadler DD, Naze C. Current Concepts of Maternal Nutrition. Obstet Gynecol Surv. 2016 Aug;71(7):413-26.
- Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, et al. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”. Int J Gynaecol Obstet. 2015;131(Suppl 4):S213–53.
