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Pre-conception nutrition is a vital part of preparing for pregnancy. If you’re planning to start a family or add to yours, then it’s time you focused on your diet.

There are many health factors that affect a woman's fertility and it's imperative to be in good health to conceive easily. At times weight issues and hormonal imbalances (due to conditions such as PCOS and endometriosis) can affect your chances of conceiving.

But the good news is that the right diet can greatly improve them.

Another reason why women should be careful about what they eat is that their diet prior to conception affects their baby’s health. Start making healthy changes three months to a year prior to your plans to conceive by following the right dietary guidelines. This ensures that your body is ready for childbearing and that the fetus develops optimally.

Here's what you need to keep in mind.

1) Maintain healthy body weight

Your pre-pregnancy body weight directly influences your baby's birth weight. Studies show that underweight women are more likely to give birth to small babies, even though they gain the same amount of weight during pregnancy as normal weight women.

In addition, women with a Body Mass Index (BMI) in the healthy range have an increased chance of conceiving easily. In contrast, women who are underweight (BMI below 18.5) or obese (BMI over 30) may have abnormal sex hormone levels and ovulation cycles, which may adversely impact their fertility.

An appropriate amount of weight loss or weight gain can remedy the situation by helping restore sex hormone levels to a more normal level, subsequently assisting in conception.

Overweight or obese pregnant women are at higher risk for pregnancy complications such as gestational diabetes, emergency caesarean procedures, miscarriage, blood clots, pre-eclampsia and maternal death. A baby born to an obese mother is also at higher risk of fetal death, stillbirth, congenital abnormality and subsequent obesity.

For women who are planning for a child, it's important to achieve a healthy body weight before conception; it's not advised to diet or restrict calories during pregnancy. This is because insufficient energy and nutrient intake may have negative effects on the development and health of the fetus.

2) Add folic acid to your diet

Folic acid is a B vitamin most necessary during the first 28 days after conception when the most vital spinal and neural tube development occurs in the fetus. Unfortunately, many women do not realise they are pregnant before 28 days.

Therefore, it is recommended that women of reproductive age consume at least 400 micrograms (0.4 milligrams) of folic acid or folate daily, before and during the first 12 weeks of pregnancy. A low maternal folate status in the early stage of pregnancy has been associated with a higher risk of infant neural tube defects (NTD).

NTDs are a group of serious birth defects that affect the developing nervous system. The most common neural tube defect is spina bifida, in which the vertebrae of the spine do not fuse together properly, causing the spinal cord to be exposed. This can lead to varying degrees of paralysis, incontinence, and, sometimes, intellectual disability.

There is an increased risk of NTDs if there is maternal diabetes or a family history of NTDs. In these cases, a higher dose of folic acid may be required. If anti-epileptic medication is being taken, a higher dose of folic acid may also be required.

The vitamin can be obtained naturally from the following food sources: dark green, leafy vegetables such as spinach, kale, and romaine lettuce; citrus fruits such as orange, grapefruit and lemon; beetroot; nuts; legumes such as lentils and beans; whole grains such as brown rice, whole wheat bread, and oats; fortified breads and breakfast cereals.

3) Consume iron regularly

Some women may have low iron intake before becoming pregnant and so are at risk of developing iron deficiency anaemia. If they get pregnant in this state, it can increase the risk of the baby having a low birth weight and developing iron deficiency anaemia during the first few months of life.

Therefore a higher priority needs to be given to iron intake to help ensure that women who are entering pregnancy already have the stores they need.

Research also shows that an iron-rich diet may lower the risk of ovulatory infertility.

Dietary iron can be obtained naturally from meat, eggs, beans, pumpkin seeds, nuts, dark green vegetables and fortified foods (such as some breakfast cereals).

Consuming vitamin C rich foods at the same time as consuming iron rich foods helps the body to better absorb the iron in the digestive tract. So, try having lemon, bell peppers, berries, orange, grapefruit or 150ml of unsweetened orange juice at the same time as a meal containing iron.

In contrast, it's recommended not to consume tea or coffee around the same time as iron-rich meals. Tea and coffee contain chemical compounds called tannins which bind with dietary iron in the digestive tract and inhibit its absorption by as much as 60%.

4) Limit your caffeine intake

Caffeine is an adenosine receptor antagonist that may influence fertility by affecting ovulation, menstrual characteristics and sperm quality.

Research has shown that greater than 250 milligrams of caffeine per day may significantly reduce fertility. Caffeine also hinders the body’s ability to absorb iron and calcium.

Therefore, it is important to wean yourself off caffeine if your consumption is high. Consume no more than 250 milligrams of caffeine (roughly 2 cups of coffee) per day.

Caffeine is present in coffee and tea, soft drinks, energy drinks, chocolate, some cold and flu medicines.

On average, a cup of coffee contains 100-140 mg, a cup of tea 75 mg, a can of regular or diet soft drink 40 mg, and a 50g bar of chocolate 15 mg. Herbal tea, decaf tea and decaf coffees contain negligible amounts of caffeine.

5) Adopt an overall healthy, balanced diet

According to a 2007 study at Harvard, women who closely followed the ‘fertility diet’ had a 66% reduced risk of ovulatory infertility (when a woman doesn't ovulate at all or ovulates irregularly or infrequently) and a 27% lower risk of infertility from other causes when compared to women who did not follow the diet as closely.

Women following the ‘fertility diet’ chose to consume less trans fat and more monounsaturated fat (from foods such as avocados, nuts, seeds and olive oil), less animal protein sources of protein and more vegetable protein sources, more high-fiber, low-glycemic index carbohydrate-rich foods, more vegetarian iron sources and fewer meat sources of iron, multivitamins, high-fat dairy instead of low-fat dairy.

Overall, the fertility diet is similar to general recommendations for a healthy, balanced diet. In practice, this means adopting a dietary pattern that has a lot of variety and is based on whole grains, plenty of vegetables and fruits, moderate amounts of beef, mutton, chicken, fish and other protein sources (such as eggs, lentils and beans) and moderate amounts of dairy products. Fatty and sugary foods and beverages should be consumed in very limited amounts.

This article was originally published on 28 September, 2018.