This is the second in a series of articles related to nutrition during the treatment of paediatric cancer. The first article was an introduction and covered the general causes of malnutrition during treatment.

The focus on pre-conception nutrition and foetal health is important for women and men because optimal nutrition during pregnancy actually begins pre-conceptually, and developing foetuses depend solely on the transfer of nutrients from the bodies of the mothers carrying them¹.

nutrition in the womb encompasses not only maternal health history and nutrition, but also paternal nutrition and the health of sperm before conception

Gene expression can be promoted or altered by nutrients during pregnancy, childhood, and throughout the life-cycle. The importance of nutrition throughout the life-cycle which begins before conception cannot be refuted². Health professionals have recognized the effects of proper nutrition before conception on the health of the infant and its mother. However, “nutrition in the womb” encompasses not only maternal health history and nutrition, but also paternal nutrition and the health of sperm before conception.

Cancer involves the abnormal division and reproduction of cells that can spread throughout the body. It’s a disease characterized by abnormal cell growth and can occur in any organ. The genes lose control of cell-growth and cell-reproduction becomes unstructured and excessive, thus leading to development of a tumor. The precise etiology of cancer is not known, but heredity, viruses, environmental carcinogens, and possibly emotional stress contribute to its development³.

Although only approximately 5% to 10% of all cancers occur as a result of inherited genetic alterations, both parents are advised to avoid any form of exposure to carcinogenic compounds in their environment which could damage DNA or alter cell-division, in order to maintain optimum reproductive health and also give birth to a healthy child⁴.

Exposure of men and women to environmental chemicals, including pesticides, heavy metals, and organic solvents, is associated with an increased risk of producing a child with congenital anomalies⁵.

Some of the potential risk factors for the development of congenital anomalies in foetuses include;

• Alcohol: When a mother drinks alcohol, it enters the foetal bloodstream in the same concentration as it does the mother’s. Unfortunately, the foetus does not have the capacity to metabolize it as quickly as the mother, so it stays longer in the foetal blood than it does in the maternal blood, leading to gene-environment interactions which increase the risk of developing cancer later in life.
  For men, habitual alcohol consumption is associated with reduced sperm quality and changes in testosterone and sex hormone-binding globulin levels. Even only 5 drinks a week are associated with reduced sperm concentration and a general reduction in the percentage of sperm with normal morphology⁶. Abstinence is recommended.
• Cigarettes: Cigarette smoke increases the risk of; miscarriage, intra-uterine growth restriction, low birth-weight, pre-term delivery, and decreased semen quality. A father’s regular pre-conceptual smoking is associated with DNA damage to the sperm.
  Smoking also increases the risk that this child will have acute lymphoblastic leukemia, much as the absolute risk is still very low⁷. Cigarette smoke exposure includes active smoking, passive smoking, or both.
• Pesticides: Pesticides increase the risk of impaired foetal growth, increased the susceptibility to testicular and childhood cancers. The pesticides are applied in large quantities in agricultural, community, and household settings⁸.
• Maternal obesity: Maternal pre-pregnancy obesity is correlated with lower rates of conception, higher rates of congenital anomalies, and lower live-birth rates⁹. Obesity affects ovulation, oocyte development, embryo development, endometrial development, implantation, and pregnancy loss.
• Lead: Lead exposure increases risk to alterations in genomic methylation (whereby a methyl group is added onto the DNA strand without changing the sequence, but it changes the healthy regulation of gene-expression to a diseased one).
  Exposure occurs in battery manufacturing and recycling, smelting, car repair, welding, soldering, firearm and cleaning and shooting, in older homes where lead-based paints were used, water pipes, imported ceramics and pottery, herbal remedies, traditional cosmetics, hair dyes, contaminated soil, toys, and costume jewelry¹⁰.
• Malnutrition: Nutrient deficits during early pregnancy (iodine, vitamin B12, vitamin D, vitamin A, vitamin K, copper, zinc, folic acid, choline), increase the risk of impaired embryo development¹¹.
• Maternal medication: Substance exposure (including but not restricted to isotretinoin, phenytoin, carbamazepine, triamterene, trimethoprim, warfarin, and radioactive iodine), illicit recreational substances, and alcohol.
  Maternal medical conditions (diabetes, hypothyroidism, phenylketonuria), genetic alterations, infection during pregnancy (bacterial, parasitic, or viral¹²).

Studies have shown a positive correlation between the mother’s diet and the health of the baby at birth. It is also thought that the woman who consumed a nutritious diet before pregnancy is more apt to bear a healthy infant than one who did not. Exposure to environmental carcinogens increases the risk of alteration in the genetic make-up of the parents or the child, which invariably increases the risk of cancer development¹³. Knowing the carcinogens we are exposed to in our environment and avoiding them is paramount in the fight to reduce the cases of paediatric cancer.

Our next article in this series will cover nutrition during pregnancy.