09A. Preconception Counseling: A Critical Window for the Health Promotion of Children

Focus Areas: Integrative Approaches to Care, Pediatrics Modern women are taught to ignore their biological clocks and proceed with their careers, the larger media message promising that fertility is possible at advanced ages with a bit of help from reproductive technologies. This can be a false promise. Men, too, are now known to have increased risks of fathering children with schizophrenia or autism after the age of 40. The fetal origins hypothesis posits that the environment of the womb has a profound effect on a human being, greatly increasing, or helping to prevent, a myriad of diseases. To maximally benefit, health-promotion activities must begin prior to conception. This session will describe the risks to fertility and health, the most common routes of exposure, and strategies to minimize risks. Dr Maizes will discuss how to reduce exposure to the thousands of environmental chemicals currently in use, many of which are endocrine disruptors. The known consequences to the fetus include increased risk of autism, leukemia, cancer, and cardiovascular disease. She will review the impact of the standard American diet, which reduces fertility and increases obesity in children, as well as evidence for whole-food diets and various macronutrients for increased fertility. She will discuss the physiological effect of stress on the hypothalamus and pituitary glands. Finally, she will address micronutrients that have been proven to reduce the risk of neural tube and heart defects and that are associated with lower levels of autism. Despite universal support from the AAFP, AAP, and ACOG, the majority of women of childbearing age in the United States are not taking a multivitamin. In this interactive session, Dr Maizes will present the evidence for integrative approaches that can optimize fertility as well as increase the likelihood of having a healthy child.