Preconception Planning: Enhancing Healthier Baby Outcomes
Shannon Sinsheimer, ND
Preconception planning is often recommended to couples who have an interest in optimizing their fertility, conception, pregnancy, baby’s development, and lifelong health and wellness of their children. However, not all couples seek or have the timing option to engage in preconception care. Unfortunately, the health and wellness of the upcoming generations is compromised as a result, primarily from environmental exposures and the downstream effects caused by them. This author seeks to make a case that all practitioners who have a patient population in the fertile years should consider implementing preconception care options and discussions as part of their routine health intake, considering the potential ramifications for those couples not receiving preconception care.
A Case for Preconception Planning
In 2004, the Environmental Working Group (EWG) conducted a landmark study indicating that environmental and industrial toxins do, in fact, cross the placental barrier.1 The study revealed a total of 287 industrial toxins present in cord blood in 10 babies from various parts of the country. Now, 15 years later, there are many published studies indicating that fetal exposure to environmental and industrial chemicals compromises development.2 There are also countless studies demonstrating the current environment’s disruptive effects on female and male reproductive hormone systems and structures.3 It can be deduced, and has been studied to a degree, that environmental toxins can alter human development in the preconception and post-conception stages.
Preconception planning is thus a health necessity for any couple in the family planning stage. Importantly, though, approximately 50% of pregnancies are unplanned,4 which suggests there is no targeted health optimization prior to pregnancy for 1 out of every 2 babies. Medical practices with a patient population of ages 16-50 years might thus consider that preconception planning is an unintended portion of their patient health intake and optimization plan. For practices with a focus on fertility, child wellness, female or male hormonal health, pregnancy, and midwifery, the addition of preconception planning is vital to generational health and wellness. The current pediatric population is experiencing a rise in childhood cancers,5 asthma,6 allergies,7 behavioral disorders,8 and emotional challenges,9 which as a group are probably related to a combination of environmental exposures, nutritional subclinical deficiencies and gross deficiencies, and hormonal imbalances. Implementing a multi-focus preconception optimization health plan for male and female counterparts in medical practices with a patient population in their fertile years serves to optimize the total health and wellness of all future generations as well as partially limit epigenetic, nutritional, and environment-driven disease.
Detoxification & Exposure Reduction
Preconception planning should begin 6 to 12 months prior to conception. The beginning of any preconception plan starts with a structured detoxification plan for both males and females. It can take time to reduce the accumulation of body toxicants and to reduce their effects on the physical system, hormonal system, and nutritional status. Toxic load can increase in the system following a detoxification protocol; therefore, adequate time should be allowed for optimal elimination. Because toxicants cross the placental barrier, a detox program is recommended at least 3 months – preferably 6-12 months – prior to planned conception. There are a multitude of products that assist in reducing environmental toxin body burden. A structured detox is based on the assumption that all males and females have had environmental exposures that may affect development and wellness. At some point following a general detox, testing for specific body toxicants might be considered in order to repeat a detox in a more targeted manner.
Following and during a structured detoxification plan, it is critical to educate your patients about ways to reduce future toxic exposures. This includes specific advice regarding food choices; the benefits of organic produce and pasture-fed animal proteins; household products; common home exposures such as volatile organic compounds (VOCs), flame retardants, mattress and pillow toxicants, make-up, sunscreen, and body care products; and workplace exposures. In addition to education and elimination, assist patients in implementing active exposure reducers, such as air filters, household plants, and removal of Wi-Fi devices from bodily contact and sleep exposure. The goals are 1) to reduce environmental toxicants that cause health disruption during fetal development, can cause hormonal disruptions that limit fertility, and can negatively affect development; 2) to optimize a physical environment where nutritional optimization is possible; and 3) to create a future house and lifestyle that maximizes the physical and neural development of baby and child.
Nutritional Testing & Optimization
Optimizing human development via nutrition should begin in the preconception period. Prior to fetal development, egg and sperm development is dependent on key nutrients and sound nutritional choices. Mature eggs and sperm both take approximately 3 months to develop from immature structures; thus, the health of the housing body predicts the health of the egg and sperm 3 months prior to full development. Enhancing nutritional choices 3 months or more prior to conception will enhance sperm and egg quality. Limiting trans fatty acids, high-fructose corn syrup, and processed foods, in addition to eating fresh, organic produce, specifically 4 cups per day of green leafy veggies, pasture-fed animal proteins, and plant-based proteins including omega fatty acids such as nuts and seeds, can improve sperm and egg quality. Based on these improvements, a diet rich in nutrients will in turn enhance fetal development.
Nutritional testing can provide patients with specific directions for optimizing nutritional status. A comprehensive nutritional profile that examines multiple nutritional elements, preferably 6-12 months prior to conception, allows patients to prioritize specific nutrient enhancement and improve the health of the gestational carrier and sperm and egg quality. If testing is conducted sufficiently in advance of conception, re-testing also remains an option to assess nutritional standing.
Both male and female fertility has declined largely due to environmental factors, suboptimal body mass index,10 lack of exercise,11 and environmental challenges.12 Preconception planning to reduce risk factors is primarily about eliminating and removing disruptive agents and implementing health-building and restorative factors. Detoxification improves fertility because removing exogenous estrogens can restore a more natural hormonal balance. And improving nutrition can increase substrates needed for hormonal balance, hormone communication, and structural integrity.
To further enhance fertility, the addition of herbal agents aimed at supporting pelvic circulation, ovarian stimulation, and hormone balancing should be considered. For females, effective herbal combinations might include Rhodiola rosea (rhodiola), Leonorus (motherwort), Angelica sinensis (dong quai), Lepidium meyenii (maca) root, Medicago sativa (alfalfa), red raspberry leaf, Vitex agnus-castus (chaste tree berry), and Tribulus terrestris. For males, consider a combination of maca, tribulus, ginseng, Serenoa repens (saw palmetto), and rhodiola. Of course, there are many routes for improving fertility, but reducing environmental endocrine disruptors, improving nutritional status, and balancing hormones with herbal remedies are powerful methods with proven benefits.
Preconception planning can sound like a specialized and niche medical interest; however, consider that each patient in his or her fertile years is a potential preconception patient, whether intending to be or not. Future generations are built upon the preconception health and wellness of the birth parents. The beginnings of a child start not with conception but with the health brought to create conception. Regardless of the specialty or niche medical interest of a medical practice, keep in mind that the potential for each patient to conceive in the fertile years is an important part of any health and wellness intake and optimization plan.
- Environmental Working Group. Body Burden: The Pollution in Newborns. July 14, 2005. EWG Web site. https://www.ewg.org/research/body-burden-pollution-newborns. Accessed December 30, 2018.
- Arora M, Reichenberg A, Willfors C, et al. Fetal and postnatal metal dysregulation in autism. Nat Commun. 2017;8:15493.
- Rehman S, Usman Z, Rehman S, et al. Endocrine disrupting chemicals and impact on male reproductive health. Transl Androl Urol. 2018;7(3):490-503.
- S. Department of Health and Human Services: Office on Women’s Health. Unplanned pregnancy. Last updated June 6, 2018. Available at: https://www.womenshealth.gov/pregnancy/you-get-pregnant/unplanned-pregnancy. Accessed December 30, 2018.
- Miller A, Goodman B, Bhargava HD. Childhood Cancer Rates Are Rising. Why? October 20, 2016. WebMD Web site. https://tinyurl.com/ybewllux. Accessed January 4, 2018.
- Centers for Disease Control and Prevention. Asthma Facts. July 2013. CDC Web site. https://www.cdc.gov/asthma/pdfs/asthma_facts_program_grantees.pdf. Accessed January 7, 2019.
- Reinberg S. Childhood Food Allergies on the Rise. 2008. MedicineNet Web site. https://www.medicinenet.com/script/main/art.asp?articlekey=94115. Accessed January 7, 2019.
- Centers for Disease Control and Prevention. Attention-Deficit / Hyperactivity Disorder (ADHD). Data & Statistics. Last updated September 21, 2018. CDC Web site. https://www.cdc.gov/ncbddd/adhd/data.html. Accessed January 7, 2019.
- Centers for Disease Control and Prevention. Data and Statistics on Children’s Mental Health. Last reviewed December 20, 2018. CDC Web site. https://www.cdc.gov/childrensmentalhealth/data.html. Accessed January 8, 2019.
- Boyles S. Study Shows Obesity Connected to Fertility Problems in Ovulating Women. December 11, 2007. WebMD Web site. https://www.webmd.com/infertility-and-reproduction/news/20071211/obesity-linked-to-infertility-in-women#1. Accessed January 7, 2019.
- Nordqvist C. Infertility in men and women. Last updated January 4, 2018. MedicalNewsToday Web site. https://www.medicalnewstoday.com/articles/165748.php. Accessed January 7, 2019.
- National Institute of Child Health and Human Development. What lifestyle and environmental factors may be involved with infertility in females and males? Last reviewed January 31, 2017. NICHD Web site. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/lifestyle. Accessed January 7, 2019.
Shannon Sinsheimer, ND, is a naturopathic doctor serving as founder, medical director, and practitioner at Optimal Health Center in Palm Desert, CA. Dr Sinsheimer is a 2006 NCNM graduate and specializes in preconception health and fertility. After becoming a participant in her own preconception program to create 2 healthy children, she is more determined than ever that each parent-to-be has the opportunity to become their healthiest self, prior to conception. In her spare time, Dr Sinsheimer can be found exploring the outdoors with her family or taking them on travel adventures.