|
||||||||||||
 |
||||||||||||
HEALTH PROFESSIONALS' GUIDE TO PRECONCEPTION CARE
(BOOKLET) Foresight realises that doctors have heavy demands upon their time, demands with little time to focus on only one aspect of healthcare such as pregnancy and study all the relevant research papers. With this In mind, Foresight has researched the important work on nutrition, alcohol, smoking, lead and other toxic metals, pesticides, food additives, G.U. infections, allergies, infestation and other hazards and their impact and effect on preconception and pregnancy. Foresight, together with its medical committee, has worked for over 15 years to put together a thoroughly researched scientific preconception programme for doctors to implement easily and practically to help their patients achieve and maintain a healthy pregnancy. By maximising the health of the parents and therefore by inference the quality of both the ova and sperm, it is possible to reduce and in most cases eliminate infertility, recurrent spontaneous abortions, premature births, low birth weight and birth defects. The recent introduction of folic acid to minimise neural tube defects is one example of research that has been known by Foresight for almost a decade. Most environmental hazards, including alcohol and smoking, are at their most dangerous at the earliest stages of pregnancy, when cell division is highest. So these substances need to be avoided before conception ie: when the woman chooses to be pregnant, not when she discovers she is. Also their effects on ovulation and spermatogenesis are well documented so again pre-conception care is vital. The Foresight video is available for sale or hire either to be used in teaching situations with the help of a health visitor, midwife, or practice nurse, or to loan to patients to give them a clearer picture of the programme. Authoritative reports are available or in the pipeline on genitourinary infections, food additives, lead and other toxic metals, zinc deficiency and manganese deficiency, smoking, alcohol and pesticides. All recommendations in this document are backed up by extensive research and full references are available in the respective reports. Other help or information, eg: more detailed information on nutrition or supplements can always be obtained from Foresight. A booklist of recommended reading is available plus posters, leaflets and a detailed booklet called 'Preparing for Pregnancy'. Results of the Foresight Programme Research by the University of Surrey on the Foresight Programme followed the progress of 367 couples. The women ranged in age from 22-45 years, the men from 25-59 years. By the end of the study 89% of the couples had given birth. The average gestational age was 38.5 weeks. 42% of the babies were males whose average eight was 7lb 4.5 oz (3299g) and 58% were females whose average weight was 7lb 2oz (2368g). There were no miscarriages, perinatal deaths or malformations. No baby was admitted to Special Care. Upon coming to Foresight 41% of couples had had no previous adverse reproduction history, but among these were the older couples. 37% had a history of infertility, 38% had a history of previous miscarriage, 11% had had a therapeutic abortion, 3% had suffered a stillbirth, 15% had had small for dates babies or low birth weight babies and 2% had had babies with a malformation. 70% of the mothers were primigravida; 30% multigravida having 1-3 children. 60% of the women drank alcohol, and 57% of them smoked. 90% of the men drank alcohol and 45% of them smoked. Approximately 2% admitted smoking cannabis mostly in the past. Of the couples coming to foresight with no history, 96% had given birth by the end of the study. The following problem groups had also given birth by the end of the study with these percentages:
No problems with any Foresight pregnancy. Setting Up A Preconception Clinic Logistically, there are a number of ways of setting up the clinic including:-
Couples and women who would benefit from this type of Preconception Programme
Clinical Protocol The objective of the Foresight Preconception Care Programme is to eliminate as far as possible all health problems in both partners that have been proven by research to cause or increase the likelihood of infertility, miscarriage, perinatal death, malformation, prematurity, low birth weight, mental retardation and / or compromised health in the forthcoming pregnancy and baby. This long term and preventative approach saves not only the emotional trauma that couples and women experience with infertility, miscarriage, malformation, etc.. There are also the financial savings for the health system in the alleviation of problems by intervention, surgery and after-care. These are incalculable. It has to be stressed that in order for this programme to work at its optimum, the advice needs to be given at least six months before the desired conception. In the case of recurrent spontaneous abortions, couples are advised to wait for six months before trying to conceive. Research has shown that it takes at least four months for effective changes to take place in both the man and the woman, after the initial two months during which time tests are made and results discussed. The supplementation programme is then recommended. Some couples need longer than others. This programme is for preconception and onwards. Research has shown this to produce healthier full term pregnancies with less nausea and fatigue, easier breastfeeding and healthier children, free from malformation and less prone to infection and / or hyperactivity. The Foresight programme focuses on a number of areas and each one will be discussed in detail:-
Also within each area, there is a 'Recommendations' section as well as suggestions for the relevant diagnostic tests that help to decide the best course of action. 1. Nutrition The inability to reproduce is one of the first signs of imperfect nutrition. This vital link between nutrition and fetal development has been demonstrated by a number of scientists. In animal studies, almost all the commonly seen birth defects (Spina bifida and other neural tube defects, heart defects, diaphragmatic hernia, urogenital anomalies, cleft palate, club foot, missing digits) can be reproduced or eliminated at will by manipulating the diet. The removal of even one essential nutrient during the crucial first trimester of pregnancy can produce a characteristic defect that can be seen in different species and in whole litters of young. In the same animals, the situation can be reversed in subsequent litters with replacement of the nutrient. Problems such as sterility, spontaneous abortion, premature birth and undersized young have been produced or eliminated at will by dietary intervention. Recommendations The emphasis should be on increasing the intake of fresh fruit and vegetables (the WHO guidelines are at least five pieces a day). The use of organically grown, unsprayed produce, additive-free foods and drink, free range eggs, fresh fish and organically reared meat and poultry should be strongly recommended. The benefits of regular meals, and the need to avoid unsupervised slimming regimes of under 2,000 calories per day cannot be too strongly emphasised. That serious health problems with the unborn child can be caused by deficiencies of vitamins, minerals and essential fatty acids should be made clear. 2. Tobacco, Alcohol, Street Drugs and Medication Smoking, alcohol and street drugs have been proven to have deleterious effects not only on fetal health and development but also on the condition of the sperm and ova during the period leading up to conception. Statistics have shown just how dramatic these effects are. The prematurity rate in mothers who smoke 30 cigarettes a day is 33% compared to only 6% in non-smoking mothers. Studies have found that smokers are more likely to have children with all types of congenital malformations, especially cleft palate, hare lip, squints, deafness and CNS abnormalities. Even when the mother does not smoke, if her partner smokes over 10 cigarettes a day, they are 2.5 times more likely to have a child with congenital malformations. Both smoking and alcohol have been found to reduce sperm counts and also produce damaged sperm in men who have otherwise no known problems. Recent work on Fetal Alcohol Syndrome (FAS) undertaken in America by Dr. Anne Streissguth has shown a 7 point deficit in IQ where the mother has taken just one alcoholic drink daily during pregnancy. It is now recognised that there are children who do not bear the physical characteristics of FAS but who have subtle mental or behavioural difficulties from being exposed to alcohol in the womb and are now identified as suffering from Fetal Alcohol Effects (FAE). Many forms of commonly used medications and over the counter drugs such as painkillers and laxatives are contraindicated during pregnancy. Attention to diet, deficiencies or allergic conditions can almost always eliminate the need for non-essential medication Recommendations Any medical drug taking should be reviewed in the light of the forthcoming pregnancy so that only absolutely essential medication, cleared as safe for use during pregnancy, is prescribed and the dangers of self-medication should be explained. 3. Food Additives Food additives include preservatives, colourings and artificial sweeteners. The food scientist is not only able to change the colour and flavour of foods but also to manufacture 'foods' from chemicals, for example, a raspberry flavour dessert may contain no raspberries. There are now 4,000 additives in use in the UK, though only about 350 of them appear on labels. Toxicological tests are used on food additives but these do not reveal all the adverse side effects and certain countries have more stringent testing procedures than others. For example, America has banned saccharin because of the risks involved and yet it is still freely available in this country. A day's intake of food and drink that contains food additives in their many forms gives a chemical cocktail of substances that have never been tested in combination. The effect on the fetus is at present unknown. Recommendations 4. Food Allergies and / or Malabsorption Couples may seek help because they suffer from a chronic health condition such as eczema, asthma, epilepsy, migraine, insomnia, depression, joint and / or back pain. They are anxious not to have to rely on prescribed drugs during pregnancy and in some cases they are also anxious not to pass the condition on to the baby. Very often these conditions can be resolved by allergy testing with the elimination of an offending food or other substance from the diet or environment. In other cases the condition may be the direct result of a vitamin or mineral deficiency., It is likely that resolving the allergy or supplementing the deficiency will prevent later illness in the baby. It should also eliminate or minimise the need for drugs, many of which are contraindicated for use during pregnancy. Some allergies, such as cow's milk allergy or intolerance to gluten grains may set up a malabsorption syndrome. This may be revealed by very low levels in the hair analysis. It is therefore necessary to pay very careful attention to advising an adequate diet and to the mineral levels. The pregnancy must then be postponed until these are at a satisfactory level. Many people have some degree of milk and / or wheat intolerance and it is now official that wheat and cow's milk are not recommended for babies until they are one year old. 5. Organophosphate Pesticides and other Hazardous Substances Organophosphate pesticides work by inactivating various enzyme systems in the organisms that ingest them. This effect on such a wide range of enzymes results in a large variety of conditions shown in studies of animals and humans who have been intentionally or accidentally exposed, including ataxia, brain dysfunction, irreversible delayed neurotoxicity, cardiovascular problems, memory loss, long-term change in brain function and death. Cattle exposed to pesticides have produced offspring with severe malformations. Great Ormond Street hospital are investigating the link between and organophosphate pesticide and CHARGE syndrome. Over-reliance on agrochemicals kills the organisms that live in the soil that break down the decaying matter into nutrients for the plants. The chemicals create imbalances that eventually erode the soil. This leads to a vicious circle, since farmers counteract lower productivity by more agrochemicals, further exhausting the soil. Recommendations It is important to ascertain whether the patients themselves are farmers and have direct exposure to these chemicals or whether they have a hobby such as gardening. They must avoid the use of insecticides during the critical time of pre-conception and pregnancy. Organic gardening should be recommended. Other areas to avoid are new carpets and furnishing fabrics (moth proofing, flame retarding), anti-lice shampoos, flea collars on pets and treatments for woodworm and dry rot, etc. Jobs may expose patients to chemicals of a different nature, such as hairdressing (a number of abnormalities have been seen), wood preserving, chemical engineering, etc. and there needs to be discussion of the risks involved and whether the exposure can be reduced or avoided for a short while. This is a list of substances known or suspected of harming male reproductive health:-
Occupations which come into contact with the above substances would
include artists, jewellers, electrical workers, auto-manufacturing
and repair workers, electronic and semiconductor workers, food workers,
general manufacturers, chemical workers, clothing textile and leather
workers, glass and pottery workers and hospital and health care professionals. 6. Drinking Water Much of the drinking water in the UK is contaminated with lead, copper, aluminium and more rarely, mercury and cadmium. Agrochemicals, nitrites and organophosphates can often be found in levels above those recommended by the EC and the WHO. The local water board will test the water on request and can say whether the water fits the EC guidelines. Recommendations 7. Mineral Analysis, Toxic Metals and Supplementation Much research from America and Australia has highlighted the dangers of mineral deficiencies in pregnancy. Sterility, abortion, stillbirth, infant deaths, many types of malformation, hyperactivity and lack of mental acuity have all be demonstrated to be attributable to mineral deficiencies and excessive levels of toxic metals. Hyperemesis, post-partum depression and lactation failure, also restlessness and failure to thrive in the baby, have all been linked to deficiencies of zinc, magnesium, vitamin B6 and essential fatty acids. Various agrochemicals are depleting the soil to the extent that even with a 'good' diet it is difficult to know how many nutrients we are actually absorbing. With many prospective parents living busy lives, they may not even be aware that they are not eating a 'good' diet. With this in mind, the necessity of supplementation becomes important especially in light of findings such as the preventative effect of the vitamin, folic acid. Recent research has demonstrated that hair mineral analysis gives a good overall guide to mineral status. Several laboratories have now spent many years perfecting their technology and currently test hair, blood, sweat, serum, red cells, white cells and urine. The hair gives and eight week history of the minerals taken up. Minerals below the reference range need to be supplemented to optimum levels. After the contraceptive pill, the copper IUD or superovulation-stimulating drugs (Clomid, etc.) the copper reading may be over-high and the zinc, and possibly also magnesium and manganese, may be too low. It is vital to adjust the levels before recommending the couple embark on a pregnancy. In the Foresight study undertaken by the University of Surrey, some of the most significant findings were that when a previous baby had been born with malformation, the mineral analysis of the placenta after birth reflected this in high levels of lead and cadmium and low levels of zinc, magnesium and / or manganese. More marked findings were seen among the men with fertility problems. Where the problem was a low sperm count, zinc was seen to be low and lead was high. A high proportion of malformed sperm related to low levels of zinc, selenium, calcium and potassium and high levels of lead and / or cadmium. Poor motility in sperm related to low levels of copper, zinc, calcium, magnesium and potassium. Mineral analysis in smokers and drinkers, showed cadmium levels to be raised and the iron and zinc levels to be depressed. With alcohol, iron and zinc were both markedly reduced. Lack of B12 and vitamin E have also been found to inhibit sperm development / motility in animal studies. Lead and cadmium pollution, both heavy toxic metals, has been linked in a number of studies to infertility, miscarriage, prematurity, low birth weight, perinatal death and malformation; also to stunted growth and to learning and co-ordination difficulties in older children. Raised mercury and aluminium have been correlated with placental insufficiency. Over-high copper has been found to cause prematurity in animal studies and research with placental tissue has correlated high copper / low zinc with small birth weight. Recommendations Magnesium is particularly important for muscle tone and deficiency can result in miscarriage. High copper levels coupled with low zinc and manganese can lead to miscarriage, malformation and premature birth. In most cases, Foresight has found that ovulation can be restored by optimising levels of zinc and other minerals with the B complex vitamins particularly B6 and also gamma-linolenic acid. Where the woman has not restarted ovulation a few months after the minerals have been optimised, one very small dose of Clomid can often be enough to restart ovulation. Poor sperm count, low motility and deformed sperm should be recognised as suboptimum and a hazard to fetal development. Strenuous efforts should be made to restore the man's basic health. It will be necessary to supplement deficiencies, cleanse toxic metals, treat infections and modify the man's lifestyle. Zinc, magnesium, manganese, vitamin B12 and vitamin E are said to be particularly beneficial for sperm development and magnesium and potassium are said to encourage motility. Vitamin C has been particularly useful in cases of sperm agglutination. Hot baths, tight clothing, smoking and alcohol are all highly disadvantageous to sperm health and should be discontinued. Cold water splashing on the genitals can increase sperm motility. Foresight provides a leaflet on male infertility. No 'blanket coverage' approach to mineral supplementation is certain to be adequate and the preferred approach must be to interpret hair and possibly, blood and sweat analyses and to treat specific deficiencies indicated by these. A sample programme may look like the following:-
The regime avoids the obvious dangers of giving a vitamin or mineral in isolation and helps to restore adequacy to the average British diet and minimise the likelihood of any essential nutrient being insufficiently supplied for fetal needs. In particular, the vitamin A content has been specifically formulated for safety during pregnancy and the dose falls within all the Government guidelines (below 5,000iu daily). It must be noted that vitamin A deficiency can be teratogenic, causing eye defects, even absence of eyes, genital anomalies, hydrocephalus and diaphragmatic hernia. Deficiency is very much more likely than toxicity, which has only been reported under very extreme circumstances in the USA. It is vital not to discourage women from taking sufficient vitamin A. Supplements that we find helpful include:-
Mercury comes from tinned tuna fish, water contaminated by factory effluent, some weed killers and some dental amalgams. Major dental work should be undertaken, where possible, before preconception and definitely avoided during pregnancy. Cadmium comes from cigarette smoking, active or passive, and some plumbing alloys. Cigarettes should be discontinued at least four months before the intended conception for both the man and woman. Aluminium comes from kitchen utensils, kettles, teapots. Spinach, rhubarb and apple take metal from the pan and more is taken if the water contains added fluoride. Tannin in tea combines with aluminium so teapots are particularly hazardous. Cooking in aluminium foil imparts aluminium to the food. Aluminium is used as an anti-caking agent in some foods and in milk substitutes and is found in some antacids. Aluminium kitchen ware should be replaced with stainless steel, enamel, glass, cast iron, etc. Copper is an essential mineral. However, too heavy contamination can cause levels to rise too far above the norm. Sources are drinking water from copper pipes in the areas where the water is soft and acid. Water drawn through an Ascot-type water hater may also contain large amounts. Kettles should not be filled from these. External contamination can come from henna hair dyes and swimming pools and this can confuse analysis so an uncontaminated hair sample needs to be tested. The contraceptive pill and the copper IUD cause levels of copper to rise in the body (For alternative contraception methods see section 8). Foresight supplies a leaflet on the avoidance of toxic metal contamination. The toxic metals (lead, aluminium, cadmium, mercury) can be reduced by a number of measures that include vitamin C: 2.5gms daily, zinc, manganese, magnesium, calcium and especially selenium. Garlic tablets can be helpful. Chromium is specific to cadmium cleansing, magnesium and selenium for cleansing aluminium, and copper can be decreased by large amounts of zinc, manganese and vitamin C. Foresight has formulated a vitamin C and garlic supplement as described previously specifically for lowering toxic metals. Foresight can supply hair mineral analysis forms and will formulate individual supplement programmes based on the results obtained. 8. Contraception The contraceptive pill has been shown to lower levels of zinc, manganese, vitamin A and a number of the B complex vitamins, especially pyridoxine (B6), and to raise copper levels. It may also lower magnesium. The copper IUD has been found to raise levels of copper and thus will lower levels of zinc and usually also manganese and selenium. Mineral testing and readjustment is usually necessary after the use of these forms of contraception. Recommendations The address of the nearest Natural Family Planning teacher and a book on NFP can be obtained from Mrs C.Norman, tel: 01222 754628 There are two electronic devices, one used for contraception and one for conception, which helps to make this method user-friendly and scientifically sound for all couples. For further information, contact Mrs C. Bridge, tel: 01306 882850. 9. Genito-urinary Infections Radical changes in sexual behaviour over the last few decades have resulted in a dramatic rise in the prevalence of sexually transmitted infections. Whilst the classical venereal diseases such as syphilis and gonorrhoea are in decline due to early detection and treatment, their place has been taken by a group of other infectious agents. In recent years, chlamydia trachomatis has become increasingly recognised a s a common human pathogen. In women it has been found to manifest as cervicitis, endometritis, acute salpingitis and pelvic inflammatory disease. It has also been found directly responsible for ectopic pregnancy, prematurity, perinatal mortality and spontaneous abortion. In addition, chlamydia trachomatis infection is directly implicated as one of the most common causes of infertility. In men, chlamydial infection is recognised as the leading cause of epididymitis and urethritis, as well as contributing to male infertility or subfertility. Chlamydia gives eye problems, pneumonia, gastroenteritis, otitis media and UTI in the babies. The spread of other infections which are also frequently sexually transmitted such as viruses and mycoplamas has also grown to near epidemic proportions. Maternal mycoplasma infections have been associated with a high incidence of spontaneous abortions and prematurity as well as neonatal morbidity and mortality. All types of genito-urinary infection are shown to contribute to infertility, miscarriage and premature birth. Recommendations
Test both partners, treat, re-test and re-treat if necessary.
A competent pathology department will culture samples and recommend specific anti-biotics. Homeopathy has been found to be effective in some cases and this can be confirmed by a re-test. Other specialist help may be required in this area. 10. Other Areas of Concern Electromagnetic Radiation (EMR) Avoiding the use of electric blankets, microwave ovens, sunbeds and if possible medical X-rays will cut down the exposure to EMR. VDUs should not be used in the three months before intended conception or during the first three months of pregnancy. After this they should not be used for more than four hours per day or for more than three to four hours and any one time. Using a filter screen may be helpful. Problems have been reported by people who live near high voltage power lines, nuclear power stations and reprocessing plants. Houses can be checked for natural radon and the National Radiological Protection Board will cope with any problems they may find (for help and information call 01235 831600 in the South of England and 01532 679041 in the North). Infestations Infestation of the intestines such as candida, thread worms or giardia lamblia are not rare. If there appears to be general malaise, irritable bowel syndrome, depression, fatigue, anal irritation and in some cases abdominal pain and if the levels of trace minerals in the hair do not rise with supplementation, then it is worth checking this out. Another pointer to infestation is travel to foreign countries such as the Middle East, the Far East and Africa. Conclusions It is worthwhile for all couples to do the full Foresight programme very thoroughly, as the rewards are huge in terms of general health education, normal healthy pregnancies and in perfectly formed, healthy, full-term babies. This foundation of health is then later reflected in the general well-being and intelligence of the children. The Foresight Association (which is a registered charity) can supply books, leaflets, posters, booklets and a video and can arrange symposia or informal meetings for lay groups or health professionals as needed. Research is ongoing and the work will be expanded and updated as new findings emerge from international studies. Courses on pre-conception care are available from the Raworth College, 20-22 South Street, Dorking, RH4 2HQ. tel:- 01306 742150. During the initial stages of implementing the Foresight programme, help and advice can be given in all the areas mentioned above.
APPENDIX
More:- Foresight Literature Summaries
|
