Pre-conception health care planning is great, in that when there is time to optimize the health of both parents, the health of the baby is optimized too. I have worked quite a bit with families in this area, especially parents of kids who have had a range of health challenges, who wanted to make sure they were as healthy as possible before having more children. There is some lab testing for pre-conception health care that can help determine particular areas that can be worked on ahead of time.
The mom-to-be is going to be the primary focus of most of the testing as she will be housing the baby, but it is also great to look at certain things in the Dad to ensure the healthiest sperm possible.
Following are some of the areas that I test –
While genetic testing and counseling for genetically-linked disorders such as Down’s syndrome is not new, there is now a different and unique type of genetic testing called Nutrigenomics.
This new and sophisticated genetic testing assesses defects in the enzyme systems that drive methylation pathways. Methylation pathways are vital biochemical pathways within our cells that have many roles. They can turn genes on and off, affect detoxification of heavy metals and other chemicals, enhance the production of neurotransmitters (the brain chemicals that affect our moods and emotions such as serotonin), and affect our body’s ability to deal with chronic viral infections. Mutations in these pathways can influence susceptibility to Downs syndrome, autism etc. The MTHFR and COMT mutations are among the primary mutations addressed.
How can supplements help a genetic defect? If it is chromosomal can we really make a difference? The answer is yes. Depending upon the genetic profile it is possible to adjust supplementation to bypass and compensate for these mutations.
One example of this supplementation with folate and neural tube defects. It is well accepted that using folate during pregnancy helps to decrease the risk of neural tube defects. This is not changing the DNA but having an effect on the process none-the-less, and the results are well proven. However, if a person’s genetic profile showed that they have a mutation in the pathways relating to folate, and cannot use folate, supplementation will be worthless. That person may need 5-methyl THF (a different form of folate) to bypass the mutation in their folate pathway. Only then would the protective benefit of folate be provided.
At the current time this can be done by either saliva or blood work.
Jumping ahead a step, it is also important to test your newborn to find out their particular susceptibilities. Supplementing these deficits may prevent many health problems later on. If the methylation cycle is working properly from day one it should help with myelination of nerve cells, immune regulation, the ability to make new DNA and RNA that is needed for growing cells. Viruses can bind heavy metals, so if we can prevent the buildup of chronic virus (methylation is needed to silence viruses), then we can also prevent accumulating stores of toxic heavy metals.
Hormone and metabolic testing
There are many factors that influence the hormonal milieu within a man or woman’s body. Most people do not realize that any kind of stress of the body can throw out the delicate balance and give rise to problems. Such stressors include mental/ emotional stress, poor nutritional status, inflammation within the body, infections such as parasites, and chronic pain. These stressors place undue strain on the adrenal glands, which are the stress management centers of our body. The adrenal glands produce cortisol, our “stress hormone”, as well as estrogens, progesterone, DHEA and testosterone. It follows then that anything that affects the adrenal glands is going to affect our output of reproductive hormones. Subsequently, testing adrenal health through a simple saliva test and addressing underlying stressors on the body is the starting point in addressing imbalances in male and female hormones. In anticipation of conception, this becomes crucial, as testosterone plays a role in the sperm production of the male, and progesterone is needed for maintaining pregnancy in the female. If estrogen and progesterone are depleted, or not being produced in adequate amounts at the appropriate time in the cycle, achieving conception and maintaining a viable pregnancy will be very difficult. It is thought that many first trimester miscarriages are due to insufficient progesterone levels, which can either reflect insufficient ovarian output and/or insufficient adrenal output. I also look at markers such as anti-mullerian hormone as a gauge of a woman’s egg reserve.
Metabolic testing is done to ascertain the level of stress on the body. A urine sample can provide information on how well protein is being broken down in the body, whether there is an excessive level of oxidative stress, and how the liver is functioning in regards to its detoxification capacity. If any of these markers are outside normal range, we have to dig deeper to find the source of stress on the body.
Blood chemistry testing
There are many general markers of health that must be checked. An expanded chemistry panel checks blood counts (ruling out anemia and immune dysfunction), liver and kidney function and mineral levels. I also tend to screen for gluten intolerance with anti-transglutaminase and anti-gliadin antibodies, blood sugar dysregulation with fasting insulin, glucose and amylase, and candida (yeast) overgrowth with the metabolite d-arabinitol (this can be assessed by a urine test too). A full thyroid screen is included with TSH, free T3, reverse T3 and free T4, as well as checking RA factor and ANA, common markers of auto-immune disease.
Testing for GI infections and food allergies
Food allergies lead to inflammation within the digestive tract, which in turn produces inflammatory chemicals that move through the blood stream to the rest of the body. Food allergies can also promote auto-immune processes. If is essential to evaluate both parents for food allergies and tailor their nutrition program accordingly.
My personal belief is that parents would be better off adhering to a gluten, dairy and soy free diet for several months prior to conceiving, and during pregnancy and breastfeeding. These food groups are known to be pro-inflammatory in nature, and are common allergens. They are also problematic for children on the autistic-spectrum, so avoiding early exposure to them can only be beneficial for a developing baby.
Infections in the digestive tract can also create problems throughout the entire body. H. pylori is a very common bacterial infection that affects the stomach, while several parasites such as Cryptosporidium parvum and Entamoeba histolytica can take up residence in the intestines. Not everyone is symptomatic with these infections, so it is prudent to run stool tests and treat accordingly. Sometimes antibiotics are used to eradicate such infections, so being able to do that well ahead of conception, and then recolonize the good flora, is important. Candidiasis, a yeast overgrowth in the gut, is also very common, but rarely exists in isolation. An overgrowth of candida points to some other infection as the primary issue.
Heavy metal testing
There are several different ways to test for heavy metal toxicity. A baseline test measuring metals in the hair is an ok place to start. If mercury and other metals measure low in the hair, it does not necessarily mean that there are no metals in the body – worse, it means the metals are being trapped and not excreted as we would like!! The hair test is a reflection of circulating metals in the blood over the six weeks prior. If metals are sequestered in the tissues, the hair test measurement will be low.
The more effective way of testing heavy metals is a “provoked” urine test, sometimes also called a “challenge” test. In this test, an oral chelating agent is given (a chelating agent is any agent that is used to bind metals and help them be excreted from the body), and urine collected for 8 hours afterwards. This enables us to see how much mercury, lead etc was excreted when it was provoked by the chelating agent.
Testing for mold and chemical toxicity
Depending on history and prior exposures, antibody testing for molds and chemicals may be advised. Antibody tests look for an immune cell reaction to that particular substance. For example, if antibodies (immune cells in the blood) to molds are elevated, we can see that mold has become a toxic substance for that individual. At that point a thorough evaluation of the home must be undertaken to rule out continued exposure, and anti-fungal treatments initiated. A urine test measuring mycotoxins may be warranted too.
Certain other tests can be run to rule out conditions that might make conception difficult. Chlamydia, for example, is a silent venereal disease prevalent in men and women that can be contracted through sexual contact, and can contribute to infertility. An anti-sperm antibody test shows if a woman’s immune system is attacking her partner’s sperm. I also think a general micronutrient panel is advisable, to see if there are any vitamins, minerals and antioxidants that are deficient.
Running a panel of testing prior to starting trying to get pregnant is a helpful way to maximize the chances of a healthy pregnancy, and a healthy child. The more time that can be dedicated to this the better – I think six months prior is a good time frame to look at – bearing in mind though that if heavy metals come up as an issue, it might take longer than that to safely detox them from the body. In that case I’d prefer to see a mother finishing chelation therapy approximately six months prior to conceiving.