1. Summary: Diet plays a critical role in before, during and after pregnancy. PCOS and Gestational Diabetes are both effected by diet and weight status. Being in good health and at a healthy weight will increase your chances of conception. Pre-existing conditions as in PCOS can limit a women's ability to get pregnant at all in her lifetime. PCOCS is genetically passed and the risk of developing it through the generations double each time it passed through a family line. PCOS cause higher testosterone levels in the body which can result in increased chances of infertility. Being overweight while pregnant increases your chances of developing gestational diabetes. Gestational diabetes can result in developing type II diabetes after the baby is born if not well controlled during pregnancy Weight status prior to conception may play a large role in fertility Weight status prior to pregnancy can have long-standing affects on the mother and the fetus Clinical Applications: As healthcare professionals, it is important as Dietitians to educate women on how their health may affect their fertility and pregnancy. It is important to discuss the following with women of childbearing age: Importance of incorporating a healthy and well-rounded diet before pregnancy Incorporation of exercise into daily activities Education on how much weight gain is needed according to pre-pregnancy weight How lifestyle factors may lead to development of serious complications during pregnancy to the mother and child Education on how to meet the recommended intake levels of the most important vitamins & minerals before and during pregnancy Folic Acid: Increased needs during pregnancy Deficiency may lead to Neural Tube Defects (NTDs) DRI: 400mcg Iron: May affect ovulation prior to conception Iron deficiency before pregnancy can increase risk for: iron deficiency anemia in mothers, preterm birth rates and can cause low iron stores in the child DRI: 27 mg/day during pregnancy Calcium: Necessary for bone integrity and skeletal development of the fetus Important in the production of breast milk DRI: 1000 mg/day Polycystic Ovarian Syndrome: PCOS is one of the most common hormonal endocrine disorders in women. It is characterized by multiple cysts on ovaries in a “string of pearls” pattern. This hormonal imbalance may also cause insulin resistance. Both signs may be indicators of PCOS. Cannot be diagnosed by one test alone Known as the “Silent Killer” Increases risks for Insulin Resistance, Type II Diabetes, High Cholesterol, High Blood Pressure and Heart Disease 5-10% of women of childbearing age are affected by PCOS PCOS is responsible for 70% of infertility issues in women who have problems ovulating 50% increased risk for daughters to have PCOS of mothers who have PCOS A pregnant women with PCOS has a higher risk of developing gestational diabetes because PCOS can cause insulin resistance in the body. Weight Status: Weight gain is essential to ensure that the mother is meeting the increased energy requirement needed to support her and her fetus, but excessive or inadequate weight gain may lead to complications. Undernutrition: Lowers the chances that a woman may become pregnant May cause an imbalance in growth rates, resulting in a smaller fetus in comparison to the placenta 5 Fetal growth will be sacrificed to maintain health and function of the placenta 5 Excess gestational weight gain (GWG): Higher risk of cesarean section births & birth defects 2 May increase other health risks such as gestational diabetes, hypertension, preeclampsia, neural tube defects, neonatal hypoglycemia, and failure to initiate breast- feeding 4 Gestational Diabetes: Higher pre-pregnancy BMIs correlate with an increased likelihood of maternal development of Gestational Diabetes Mellitus (GDM) 7 Affects 1.1-25.5% of women in US  risk for gestational HTN & preecclampsia, PCOS later in life  risk of obesity & glucose intolerance in child  risk of birth defects in child  risk of developing DM2 after pregnancy Overall healthy lifestyle lowers risk, even if the mother is overweight Introduction: Diet plays a critical role both before and during pregnancy. Not only does diet affect maternal health, but it affects fetal health as well. Implementing a proper diet about 3 months to a year prior to conception may improve fertility in women who are planning on getting pregnant. It is also important to implement a healthy diet during a women’s child bearing age, in case an unplanned pregnancy occurs. Regardless of whether or not a pregnancy is planned, good eating habits are important so that those habits are continued throughout pregnancy. Pre-existing health complications, such as polycystic ovarian syndrome (PCOS) should be under control prior to pregnancy so the neither the health of the mother or fetus is compromised during pregnancy. While pregnant, it is important for women to meet her increased caloric needs to support her and the growing fetus, however there is a fine line between meeting needs and over consumption. Over consumption throughout pregnancy may increase risks for both short term and long term health risks. Some of these risks include obesity, diabetes, cardiovascular disease, and dyslipidemia. During pregnancy, women are especially at risk for developing Gestational Diabetes, which may lead to the development of type II Diabetes in both the mother and the fetus. Weight may also contribute to congenital abnormalities in the fetus if not controlled prior to pregnancy. 1 It is critical that women are leading a healthy lifestyle before they become pregnant in order to minimize the risk of complications that may affect mother and baby. Research Findings: Poor nutrition may stunt embryo growth and development, and the embryo may experience periods of hypo- and hyperglycemia Undernutrition may alter the relationship between glucose and insulin and growth hormone and insulin-like growth factors may be altered in the fetus. Physiological variables, like insulin sensitivity and basal metabolic rate may influence GWG, along with psychosocial factors including depression, self- esteem, anxiety and stress. Even variables such as race, education level, age, and level of food security have been weakly correlated to risks for GWG, according to an an article published in 2013. 4 About 50% of women with gestational HTN diagnosed before 30 weeks’ develop preeclampsia, GHTN + proteinuria 1 Low-glycemic, high fiber diet reduced the risk for GDM by about half 1 Women who consume high-glycemic foods double the risk of their fetus developing a Neural Tube Defect (NTD) 1 In some countries, inadequate pre-pregnancy weight and inadequate caloric intake during pregnancy are the major contributors to intrauterine growth retardation (IUGR). In more developed countries, smoking is the leading factor in developing a fetus with an IUGR, while low pre-pregnancy weight and low caloric intake follow. 6 The pearl sized cysts on ovaries are fluid filled and often contain immature eggs 8 The insulin resistance caused by PCOS causes the ovaries to produce more testosterone resulting in hormonal imbalances 7 PCOS is currently genetic and each female family member after has about a 50% higher chance of having PCOS 9 PCOS currently has no cure 9 Pre-Conception Nutrition & Associated Health Complications Jordan Kowalczewski & Liane Cesare IOM 2009: TOTAL AND RATE OF WEIGHT GAIN Total weight gainRate of weight gain in 2 nd /3 rd trimester Pre-Pregnancy BMIRange (lbs)Mean (range) in lbs/week Underweight (<18.5 kg/m 2 )28-401 (1.3) Normal weight (18.5-24.9 kg/m 2 )25-351 (0.8-1) Overweight (25.0-29.9 kg/m 2 )15-250.6 (0.5-0.7) Obese ( >30.0 kg/m 2 )11-200.5 (0.4-0.6)

2. IOM 2009: TOTAL AND RATE OF WEIGHT GAIN Total weight gainRate of weight gain in 2 nd /3 rd trimester Pre-Pregnancy BMIRange (lbs)Mean (range) in lbs/week Underweight (<18.5 kg/m 2 )28-401 (1.3) Normal weight (18.5-24.9 kg/m 2 )25-351 (0.8-1) Overweight (25.0-29.9 kg/m 2 )15-250.6 (0.5-0.7) Obese ( >30.0 kg/m 2 )11-200.5 (0.4-0.6)