Wednesday, November 1, 2017

EXPERT ROUNDTABLE SESSION "ALL ABOUT FERTILITY AND PREGNANCY: TRUTHS & MYTHS"



I am mom of two boys and glad to have take time off to attend the expert roundtable session "All About Fertility and Pregnancy. Truths & Myths". This is good info for everyone, not just for mom's to be.

One of Malaysia’s leading nutrition companies, Shaklee Products (M) Sdn Bhd (‘Shaklee Malaysia’), has just held its 2nd Expert Roundtable Session themed “All About Fertility & Pregnancy: Truths & Myths”

This expert roundtable session saw expert panellists; Dr Sonhee Park, Senior Research Scientist in Research & Development of Shaklee Corporation, Dr Mathi Arasu Muthusamy, Fertility Specialist & Medical Director of Fertility Associates and Dr Nurzarina Abdul Rahman, Founder and Certified Lactation Counsellor of Gravidities Consultancy, discuss topics surrounding pre and postnatal nutrition, pregnancy, breastfeeding and fertility.

Dr Sonhee Park, Senior Research Scientist in Research & Development of Shaklee Corporation (USA) emphasised that deficiency in nutrients such as Vitamin B9 (folate) is highly prevalent in pregnancy and breastfeeding women and their infants. Deficiency in Vitamin B9 during pregnancy is associated with increased risk of birth defects and in B12, iodine, and iron with other common complications in infants and mothers.


Organised by one of Malaysia’s leading nutrition companies, Shaklee Products (M) Sdn Bhd (“Shaklee Malaysia”), the expert roundtable session themed “All About Fertility & Pregnancy: Truths & Myths” also saw other expert panellists, namely Dr Mathi Arasu Muthusamy, Fertility Specialist & Medical Director of Fertility Associates and Dr Nurzarina Abdul Rahman, Founder and Certified Lactation Counsellor of Gravidities Consultancy, discuss topics surrounding pregnancy, breastfeeding and fertility.


“Nutrition is key in all stages of life, especially in the reproductive years for women who plan on conceiving. As the saying goes, “a healthy mother makes a healthy baby.” While every mother wants the best for her children, nutrition plays a fundamental role in paving a conducive environment for fertility to take place (pre-conceptional), a healthy pregnancy (prenatal), and a sustainable motherhood journey especially during breastfeeding (postnatal),” said Park. Vitamin B9 deficiency during pregnancy has been found to increase the risk of birth defects, such as spina bifida and other serious and irreversible birth defects in the brain, spinal cords, and heart. Associated with the development of neurological and cognitive functions of the foetus and infant, B12 and iodine are also critical vitamin and mineral for expecting mothers to consume optimum levels. According to the Ministry of Health in Malaysia, expectant mothers are recommended to consume 600 mcg of folic acid, 4.5 mcg of B12, and 200 mcg of iodine per day.1


Docosahexaenoic acid (DHA) is a nutrient that will be transferred to the baby during both pregnancy and breastfeeding phases and is essential for brain, eye and nervous system development. However, since growing babies rely on their mothers for DHA supply, it is important for mothers to consume sufficient DHA. Calcium is another essential nutrient for baby’s bone and tooth formation. Calcium loss from mother’s bone will be increased to meet baby’s calcium needs if her diet is lacking in calcium. Hence, it is important to consume sufficient calcium during pregnancy and throughout the breastfeeding period for her own bone health and for baby’s strong bones and teeth. Thus, a careful dietary intake with these nutrients in mind is critical for both the mother and the baby.


Fundamentals of Prenatal & Postnatal Nutrition

Nutrition exerts an important influence on pregnancy outcomes.2 Over the years, multiple research have pointed out the value of nutrition interventions to help women achieve adequate diet for a normal, stable pregnancy.


Essential nutrition in the prenatal and postnatal stages contributes to several factors namely:
· Reduce the risk of anaemia in the mother
· Reduce risk of birth defects of the offspring
· Restore nutrient loss during lactation period (postnatal)
· Facilitate weight management for better health (postpartum)


Accordingly, essential nutrients such as calcium, iron, iodine, zinc, B12, and folate are some of the “must-haves” throughout the different stages of motherhood.3 Daily consumption of key nutrients, such as folic acid, several months before the conception and during the early stages of pregnancy has been proven to reduce the risk of birth defects, such as neural tube defects.4 “While it is ideal to obtain key nutrients through healthy eating habits, the quality of some nutrients may be compromised or the quantity may be inadequate from the foods that we consume routinely. In this case, iron is one nutrient that is not easily obtained through food, especially if one is a vegetarian or vegan,” Park explained.


A long-term multiple dietary supplement study5 conducted by the University of California, Berkeley among 1056 participants across three sample groups – long term non-dietary supplement users, single supplement users and multiple Shaklee supplement users has also revealed that users who consumed highly bioavailable dietary supplements were found to have improved health as compared to non-users. Bioavailability is a term used to describe the proportion of a nutrient that is absorbed from the diet and is used for regular body functions.


Nutrients, such as iodine, improves fertility and foetal mental development and is known to prevent miscarriages and premature births. Iron is essential for DNA synthesis as well as haemoglobin production, the protein in red blood cells which helps carry oxygen to body’s cells. Anaemia may occur when the haemoglobin level is low in the blood due to iron deficiency. In Malaysia, it is estimated that 38% of pregnant women suffer from anaemia according to a survey by the World Health Organization6.


A strong calcium foundation prepares the pregnant and lactating mother to reduce osteoporosis risk in the later stage of her life because the need for calcium increases during this stage to support baby’s growth. Along with calcium, Vitamin D is essential to facilitate calcium absorption, preventing Rickets in babies and children.


Myths & Truths of Breastfeeding

At the roundtable session, certified lactation counsellor, Dr Nurzarina Abdul Rahman said, “While breastfeeding is perceived to take place naturally for women, most women who failed to breastfeed have a common misconception that they are simply not fated to lactate. There is still room to raise awareness amongst mothers, especially new mothers on the many contributing factors that leads to a successful breastfeeding journey.” The nutrition requirements for breastfeeding are similar to those for pregnancy. However, a breastfeeding woman is recommended an intake of extra 500 kcal of nutrient rich foods per day compared to the pregnancy stage.7


“One of the more common myths encountered include the misconception that frequent nursing would lead to poor milk production. In reality, the mother’s supply of milk is dependent on the demand. This means that the more milk the baby drinks, the mother’s body will be able to produce a higher level of breastmilk. Indeed, breastmilk is a mother’s gift to her child and is designed to provide the necessary nutrients for the baby as long as required. It is important for mothers to look into their diet, eating habits to ensure that the vital nutrients are received adequately during the lactation period”, added Dr Nurzarina. The World Health Organization (WHO)’s recommended period for breastfeeding recommended that mothers should commit to a minimum of 6 months “exclusive breastfeeding” in which the baby only consumes breastmilk and is encouraged to continue to breastfeed (non-exclusive) up to two years of age and beyond.8


Fertility & Infertility

According to the National Population and Family Development Board in Malaysia (LPPKN), it was revealed that the fertility rates in Malaysia has declined rapidly since the early eighties. It is projected to decline to 1.79 in 2030.9 Couples who successfully complete the pregnancy journey may also be faced with further burdening situations if the child is born with major birth defects.


“In Malaysia, we observed that couples prefer to start their families at a later age, more commonly in their 30’s or 40’s. In general, a typical fertile couple aged 25 years will have a 20% chance of successful conception each month. However, as women age, the percentage is expected to fall to 17% at the age of 35 years and down to 10% at the age of 40”, said Dr Mathi Arasu Muthusamy, Fertility Specialist & Medical Director of Fertility Associates.


Successful conception is dependent on various factors. Lifestyle habits during the reproductive years, maintaining a healthy weight, dietary intake and adequate exercise are elements that contributes to preparing a conducive environment for conception.


During the media session, Ms Helen Lam, President of Shaklee Malaysia said, “In today’s hectic lifestyle, it is important that the women and mothers in our families pay close attention to their health. The journey of motherhood should be threaded carefully to reduce risks of pregnancy complications and other negative factors after childbirth. As such, we look forward to putting in place health and wellness-focused programmes for women and mothers to empower our Malaysian women the relevant knowledge on nutrition as well as dispel myths about conception. Equally, men should also shoulder the responsibility of staying healthy.”

The expert roundtable session marks the continuity of Shaklee Malaysia’s wellness education campaign, “Live Well, Be Well”. More key health and wellness-focused community activities and programmes are targeted to be rolled out. Distributors and the public at large can expect thematic ongoing activities and educational workshops during this campaign period via their Facebook page at facebook.com/shakleeproductsmalaysia or website at www.shaklee.com.my


(From left to right) Dr Mathi Arasu Muthusamy, Fertility Specialist & Medical Director of Fertility Associates; Dr Sonhee Park, Senior Research Scientist in Research & Development of Shaklee Corporation; Dr Nurzarina Abdul Rahman, Founder and Certified Lactation Counsellor of Gravidities Consultancy




Being a mom of two boys myself, I had breastfeeding my sons experienced, my eldest son breastfeed for 3 and half years and youngest son for only 11 months. Now my sons are 11 years old and 6 years old. Eldest son has got mix feeding with milk powder and breastfeeding milk until he's 4 month old that when I was pumping milk one day and decided to try to breastfeeding him directly, it's success that I didn't give up hope on direct breastfeeding and continue to breastfeeding him til 3 and half years old. I have ectopic pregnancy before both my sons, my right fallopian tube has been remove due to heavy bleeding during ectopic pregnancy. Sharing is caring, I have experienced before on the nipple confusion myth 8, yeah and it took time for me to exclusive breastfeeding again with my eldest son. Just sharing with you my past breastfeeding experienced of my sons. 


Dispelling Breastfeeding Myths by Dr Nurzarina Abdul Rahman

What were some of the ‘old wives’ tales’ that you may have heard when a relative or your friend has decided to embark on the breastfeeding journey? Misconceptions and myths over breastfeeding have prevailed for many generations.


Here are some of the 10 COMMON MYTHS ON BREASTFEEDING

Myth 1: Breastfeeding will come naturally
True, breastfeeding is natural and normal. However, it does not mean it will be an easy process. Thus, it is important for first-time mothers to learn the correct and incorrect ways to breastfeed your baby...such as baby positioning, latching and feeding cues.


Myth 2: Never wake a sleeping baby!
False. New born babies may not wake often enough on their own. It is important to bear in mind that breastfeeding is on demand. Mothers need to recognise the feeding cues and nurse babies according to their cues, and not watching the time. Do not be afraid to wake your baby in the first couple of weeks until he/she has reached the ideal baby weight!


Myth 3: Breastfeeding is nature’s birth control
True. Breastfeeding suppresses a woman's fertility in the early months after delivery. Known as Lactational Amenorrhea Method (LAM), women can safely rely on breastfeeding as a natural birth control method. A women can use LAM if her menstrual period has not returned since delivery, she is breastfeeding her baby on demand and not feeding other foods or liquids regularly, and her baby is less than six months old.


Myth 4: Frequent nursing leads to poor milk production
False. Frequent nursing increases the production of breastmilk. The more milk is used up, the more milk will be produced.


Myth 5: Mothers should avoid breastfeeding when ill
False. Unless a symptom of a more serious condition, common illnesses such as a cold, sore throat, flu, fever or mastitis should not stop the mother from breastfeeding. The breast milk will not transmit
illness to baby, but it does have antibodies in it that are specific to the mother’s illness. This help prevent baby from getting sick. However, if medication is required, mothers are advised to consult their doctor for one that is also safe for the baby.


Myth 6: Engorged breasts would mean sufficient milk supply
False. Engorgement is actually not the norm when it comes to breastfeeding, this is a sign that the body is producing too much milk and is not emptied entirely. Mothers who breastfeed frequently enough would not have to experience engorgement at all.


Myth 7: My baby cries all the time, am I not producing enough milk for my baby?
False. There are many factors why a baby would cry relentlessly, such as infrequent feeding, poor latch-on technique or other basic needs such as uncomfortable due to dirty diapers, too sleepy or simply need to be burp. The Dunstan Baby Language would be a recommended guide for first-time mothers to understand the different types of cries your baby may be signalling you for.


Myth 8: Nipple confusion due to bottle feeding or use of pacifier at an early age
Yes, breastfeeding and bottle feeding are completely different in terms of opening the mouth, tongue movement and suckling technique. Milk flows from a bottle so easily that baby does not have to suck “correctly” to get milk. One alternative is cup feeding, placing a small cup by the baby’s lips and tilting it so they can lap at the milk at their own pace if breastfeeding is not possible at that time. However, do seek professional guidance for the cup method if you must, for safety reasons.


Myth 9: I must stop breastfeeding when I am pregnant
Untrue. It is safe to breastfeed when pregnant unless there are serious complications or if it leads to premature labour. In fact, some mothers tandem breastfeeding their younger and older child while pregnant. Just ensure that mothers have enough nutritional intake to support themselves and your children. Mothers may consult obstetrician about breastfeeding during pregnancy if they have any doubts.



Myth 10: Breastmilk quality will decline after six months
False. The composition of human milk changes to meet the changing needs of the baby as it matures which may cause it look or feel different. Ensure a healthy dietary intake, and try to meet most of your nutritional requirements.

References :
1. World Alliance For Breastfeeding Action. http://www.waba.org.my/
2. Lawrence RM & Lawrence RA. Given the Benefits of Breastfeeding, what Contraindications Exist? Pediatric Clinics of North America 2001 (February); 48(1): 235-51.
3. http://americanpregnancy.org/breastfeeding/breastfeeding-while-pregnant/
 4. https://www.askdrsears.com/topics/feeding-eating/breastfeeding/common-problems/nipple-confusion

About Dr Nurzarina Abdul Rahman Founder and Certified Lactation Counsellor of Gravidities Consultancy A mother of five herself, Dr Nurzarina is a former senior medical lecturer turned passionate parenting educator. She is a true believer of attachment parenting and is a certified Lactation Counsellor, HypnoBirthing Educator, Dunstan Baby Language Teacher, and International Association of Infant Massage Instructor.

The Fine Lines between Fertility & Infertility in Malaysia by Dr Mathi Arasu Muthusamy

The National Population and Family Development Board in Malaysia (LPPKN) revealed that the fertility rates in Malaysia has declined rapidly since the early eighties. It is projected to decline to 1.79 in 2030.1


What are some of the factors that cause infertility?

Infertility Factors
· About 30% cases of infertility in Malaysia can be attributed to female fertility issues, 30% male infertility issues and about 20% a result where both partners are infertile
· Age is an important factor in the fine lines of fertility vs infertility
· As women age, their chances of becoming pregnant significantly drops
· Low quality sperms in the male partner


Trending in Malaysia
· It is observed that Malaysian couples are getting married much later in life with the average age of marriage being 30 years and above due to factors such as postgraduate studies, travel, career or finance
· More women try to conceive at a later age in their mid-30s or 40s. As a result, an increasing number of couples are faced with infertility
· The estimated ratio of fertility – A typical fertile couple aged 25 will have a 20% chance of getting pregnant each month. As women age, this falls to 17% at the age of 35 and down to 10% at the age of 40
· Hence, women over 35 years of age should wait no longer than six months of trying before seeking help from a fertility specialist


Overcoming Social Stigma
· Infertility is often “assumed” as a woman’s problem.
· Couples are too afraid to seek help and admit that they face fertility challenges. More often than not, couples wait too long to seek medical help (women age 35 years and above)

· Only women seek medical help. This would result in failing to diagnose the real causes of infertility at an earlier stage especially in cases where infertility is a result from both partners


Fertility Screening
· Fertility screening is similar to having a health screen. For both men and women there are a range of tests that can help check their fertility to help them plan for their future
· Screening tests for women help to predict a woman’s biological clock and fertility chances.
· ‘Ovarian Reserve’ test measures the number of egg follicles developing at a particular time. Testing of ovarian reserve involves doing a blood test for the hormones FSH and estradiol between day 2 and day 4 of the cycle, a pelvic ultrasound and/or performing a blood test for Anti Mullerian Hormone (AMH) that can be done anytime of the month
· Semen Analysis looks at the number of sperm, shape and ability to move.
· Antibodies in sperm can reduce or stop sperm fertilising an egg and reduce movement in the woman’s cervical mucus. ‘SperMar’ is a test in which sperm with antibodies bind to tiny plastic beads. More than 40% binding is generally considered significant, although lower levels may be important after vasectomy or vasectomy reversal

Increasing Fertility Chances via Lifestyle Modification

For Men…
· Maintain an optimal Body Mass Index (BMI)
o Keep active, obese men have sperm counts on average 22% lower when compared to their slimmer counterparts. The recommended BMI would be below 28
· Avoid Smoking/Alcohol
o Smoking and alcohol can affect sperm quality and fertility
· Keep it Cool
o Men in sedentary jobs can have poorer quality sperm because their testes are more prone to heating up. Keep your laptop off your lap!
· Healthy Diet
o Eat a diet with lots of healthy antioxidants. Foods rich in antioxidants can reduce the damage that chemicals called free radicals can have on sperm. Antioxidants are found in fresh vegetables, fruit, nuts, seeds, green tea and dark chocolates.



For Women…

· Maintain an optimal Body Mass Index (BMI)
o Pregnancy in overweight women is associated with problems such as diabetes and high blood pressure. The recommended BMI would be between 20-25
· Folic Acid Supplements
o Take folic acid supplements when trying to get pregnant and up to 12 weeks into the pregnancy.
o Folic acid can help reduce the chances of spina bifida by up to 92%. Other minerals and supplements may also be useful
· Use Iodised Salt
o Iodine is necessary for foetal brain development
· Get Vaccinated
o Ensure you have had immunisation shots for rubella/chicken pox. Rubella can damage unborn babies.


About Dr Mathi Arasu Muthusamy Fertility Specialist & Medical Director of Fertility Associates A Fertility Specialist and Medical Director of Fertility Associates, Dr Mathi Arasu and a team of staff provide a full range of fertility treatments for their patients. Dr Arasu has served in various hospitals in Malaysia under the Ministry of Health and currently has a private obstetrics and general gynaecology practice at Pantai Hospital in Cheras.


(From left to right) Dr Sonhee Park, Senior Research Scientist in Research & Development of Shaklee Corporation; Ms Helen Lam, President of Shaklee Malaysia, Dr Nurzarina Abdul Rahman, Founder and Certified Lactation Counsellor of Gravidities Consultancy; Dr Mathi Arasu Muthusamy, Fertility Specialist & Medical Director of Fertility Associates




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