When eat­ing for two puts mother and baby at risk

In many cases, it seems that di­etary ad­vice and its im­por­tance is be­ing ig­nored, or mis­un­der­stood by women

The Irish Times - Tuesday - Health - - Health | Pregnancy - Sean Duke

Three-quar­ters of preg­nant women in Ire­land are be­com­ing over­weight by eat­ing too much of the wrong kind of foods, which are lack­ing in essen­tial vi­ta­min D, fo­late and iron in the mis­taken be­lief that they need to be “eat­ing for two”.

This puts mother and baby at in­creased risk of di­a­betes, stroke and heart dis­ease, ac­cord­ing to Fiona McAuliffe, pro­fes­sor of ob­stet­rics and gy­nae­col­ogy at the Na­tional Ma­ter­nity Hos­pi­tal, Holles Street. The stakes are high for both mother and baby as if a mother is over­weight in preg­nancy it can put both at in­creased risk of life­long obe­sity, di­a­betes, stroke and high blood pres­sure.

“A lot of women are eat­ing too much in preg­nancy, I think that is an im­por­tant mes­sage,” said Prof McAuliffe. “We have an in­crease in obe­sity and over­weight in the pop­u­la­tion, and preg­nancy is a par­tic­u­lar risk fac­tor. Women who have had chil­dren are usu­ally heav­ier than women who haven’t, and that’s be­cause if they have put on over­weight in preg­nancy they don’t lose it, they start the next preg­nancy heav­ier, and so they put on more weight over each preg­nancy.”

Re­search

There is strong sci­en­tific ev­i­dence from re­search groups around the world that a mother’s diet leads to what is called “foetal pro­gram­ming”. This refers to how the mother’s in­take of su­gars, for ex­am­ple, can im­pact on the baby’s ap­petite for sugar in the womb and later life, rais­ing the bar for what sat­is­fies them. The more sugar a mother has in her diet, the more a baby will crave su­gars.

But, by the same to­ken, foetal pro­gram­ming can be a good thing as it pro­vides moth­ers with the op­por­tu­nity to put their baby, and them­selves, on a healthy di­etary tra­jec­tory for life, which can lead to all kinds of health ben­e­fits. The NMH of­fers di­etary ad­vice to preg­nant women, but, in many cases, it seems this ad­vice, and its im­por­tance is be­ing ig­nored, or mis­un­der­stood by some women.

One study at the NMH, called the Rolo study, where women were ad­vised to move towards a low gly­caemic in­dex diet, sug­gested why di­etary ad­vice was not heeded by a sig­nif­i­cant num­ber of preg­nant women. The study found that those moth­ers who had un­der­gone third-level ed­u­ca­tion were far more likely to change their diet ac­cord­ing to ad­vice from their doc­tor or a di­eti­cian. This ef­fect was the same whether the ed­u­cated women lived in an area de­fined as ad­van­taged or dis­ad­van­taged and the re­verse was true for women with no third-level ed­u­ca­tion.

Vi­ta­min D

Ire­land lies on the 53rd par­al­lel north, sit­u­ated as far north as the south­ern part of Alaska, so it’s not a sur­prise that we don’t get enough sun­light here. This is rel­e­vant and im­por­tant for preg­nant women be­cause sun­light is re­quired to pro­duce vi­ta­min D in the skin, par­tic­u­larly in the win­ter months.

The al­ter­na­tive is to get vi­ta­min D in the diet, but the main source is oily fish, which is not a ma­jor con­stituent of many peo­ple’s diet here. This means that the blood lev­els of preg­nant women are of­ten low in vi­ta­min D, which is im­por­tant be­cause vi­ta­min D is re­quired to en­sure that mother and baby de­velop strong bones. There is also re­search in­di­cat­ing that the baby’s of preg­nant women with a diet low in vi­ta­min D are more likely to be over­weight at the age of two.

In the last 10 years in Ire­land there has been an in­crease in rick­ets, a con­di­tion which was last seen here, on any scale, back in the 1920s and 30s. This is be­cause of the ar­rival of new pop­u­la­tions of darker skinned women that are not tak­ing in sun­light be­cause their skin is cov­ered for cul­tural rea­sons. These women, and all women in Ire­land, are ad­vised to take a five-mi­cro­gram vi­ta­min D sup­ple­ment ev­ery day, while in the UK the rec­om­men­da­tion is 10 mi­cro­grams.

Fo­late

The main source of fo­late is folic acid in veg­eta­bles and many peo­ple, in­clud­ing preg­nant women, have a diet lack­ing in folic acid. The baby’s spine de­vel­ops very early in preg­nancy, and its de­vel­op­ment is com­plete of­ten around the same time a woman finds out that she is preg­nant. If, at that time, the woman doesn’t have suf­fi­cient fo­late in her diet, her baby is at in­creased risk from spina bi­fida. This means that it is im­por­tant to plan a preg­nant and to start on a diet which in­cludes suf­fi­cient folic acid at least three months be­fore be­com­ing preg­nant.

It is ex­tremely hard to get suf­fi­cient fo­late from a diet, as it would re­quire a woman to lit­er­ally eat­ing bucket loads of broc­coli or spinach each day to get the 400 mi­cro­grams re­quired. A di­etary sup­ple­ment is the way to go here, and this should be taken daily through the first three months of the preg­nancy.

Iron

As the baby grows, the mother’s blood vol­ume must in­crease by two or 2.5 litres, and mak­ing all of that ex­tra blood will drain her iron re­serves. Also, mum has to make a pla­centa, which also drains her avail­able iron. An­other fac­tor is breast feed­ing, and given that the World Health Or­gan­i­sa­tion rec­om­mend that the mother breast­feeds for six months, this also puts de­mands on her iron.

It is highly un­likely that the mother will be able to get the amount of iron she re­quires from diet alone, as again, it would re­quire a big in­crease in her in­take of red meat, the pri­mary source or iron, as well as darker poul­try meats, and sal­mon and oily fish. The sim­ple an­swer here is in di­etary sup­ple­ments of iron, but there are some di­etary strate­gies that can help to make up the de­fi­ciency too.

“There are two types of iron, the one that comes in your meat and the one that comes in things like your veg; that’s your non-heme iron,” said Eileen O’Brien, clin­i­cal nu­tri­tion­ist and PhD can­di­date at the NMH. “If you take that with vi­ta­min C it in­creases its ab­sorp­tion and it is eas­ier then to take it and to use it in the body. If you had your Weetabix in the morn­ing, which is for­ti­fied with iron, have it with some or­anges, berries, fruits, to give that Vit C that will help to ab­sorb that as well,” O’Brien said.

Snacks

Preg­nant women are less likely to sit down to a for­mal meal as preg­nancy pro­gresses, and snacks be­come more at­trac­tive as the womb gets larger. There are a range of healthy snacks such as oak cakes, an ap­ple, banana, oat bis­cuits, a slice of toast with peanut but­ter, a hand­ful of nuts or seeds and whole­grain crack­ers. These should be taken in con­junc­tion with plenty of wa­ter, par­tic­u­larly towards the lat­ter end of preg­nancy when con­sti­pa­tion can be­come an is­sue.

“We are not en­cour­ag­ing preg­nant women who feel hun­gry to not eat,” said Prof McAuliffe. “They should eat reg­u­larly, but the main prob­lem is that they are eat­ing too much. They think they are eat­ing for two, but they are not re­ally.”

In the last 10 years in Ire­land there has been an in­crease in rick­ets, a con­di­tion which was last seen here, on any scale, back in the 1920s and 30s

We have an in­crease in obe­sity and over­weight in the pop­u­la­tion, and preg­nancy is a par­tic­u­lar risk fac­tor

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