Bump to Baby - Nutritional Support During Pregnancy
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Bump to Baby - Nutritional Support During Pregnancy
By Raihane Palagi
1 month ago
Being pregnant is an exciting time with nine months of planning your future life as a mother and the expansion of your family. During those special months, your body goes through significant anatomical and physiological changes in order to grow and nurture your baby. Your nutrition not only influences your own health, but it also has a significant effect on the short and long term health of your baby.
However, making sense of all the conflicting information can be stressful and yet another chore on your long pregnancy to-do list. In this blog, we will be taking you through the various changes that pregnancy entails and how best to support your body and baby.
What to eat during pregnancy
Contrary to popular belief, pregnant women do not need to ‘eat for two’. Energy requirements do not change in the first six months of pregnancy, and the calorie requirements only increase by 200 calories a day in the last trimester,[i] which is only equivalent to about two apples!
However, youdo need to increase your intake of micronutrients (vitamins and minerals) to meet the requirements of both mother and baby. The best way to achieve this is by eating a diet rich in fresh vegetables and fruit, complex carbohydrates, nuts and seeds, and good protein sources like eggs, grass-fed and organic meat, and a conservative amount of wild oily fish. If there is one time where eating organic is particularly important, it is during pregnancy.
Eating organic foods helps to reduce your baby’s exposure to harmful pesticides and other solvents. If cost is a concern, you can use the ‘Clean Fifteen, Dirty Dozen’ list put together by the Pesticide Action Network to help you buy organic in an affordable way.
It is essential to be aware that diets high in refined sugar and processed foods can lead to excess weight gain, which can increase the risk of developing gestational diabetes, hypertension, and can lead to complications during labour and delivery.
While your baby will benefit from a healthy supply of all vitamins, vitamin B9 – also known as folic acid or folate – is of particular importance. This essential vitamin plays a key role during the first 12 weeks of pregnancy, when the brain and spinal cord are rapidly developing. Supplementing with folate can prevent up to 70% cases of neural tube defects, notably spina bifida[ii], and may be protective against Down’s syndrome[iii], cleft lip and palate,[iv][v] and autism.[vi]
Methylfolate is a more bioavailable form of folate andis more effective than folic acid at improving your folate status.[vii],[viii],[ix]Methyfolate also supports a vital biochemical process called methylation, which is crucial for the creation of new cells and foetal development as well as the health of mum (e.g. mood, immunity) Compromised methylation is associated with infertility, neural tube defects, recurrent miscarriage,[x],[xi] and preeclampsia.[xii]
Include plenty of folate-rich foods in your daily meals: green leafy vegetables such as cabbage, kale, spinach, cavolo nero, broccoli, brussel sprouts, peas, chickpeas. Raw or lightly steamed since folate is a water-soluble nutrient which is easily lost in cooking water and denatured by high cooking temperatures.
During pregnancy, blood volume expands by 35%-50%, with additional iron required for the development of the baby’s organs and formation of red blood cells. Iron deficiency is very common during this time, usually due to inadequate intake from food (especially if following a vegan or vegetarian diet) and low iron stores at the onset of pregnancy (e.g. if a woman previously had heavy periods). So make sure you eat plenty of iron-rich foods and choose a multinutrient with good iron levels.
Iron sources include: lamb, beef, beans, lentils, nuts, and green leafy vegetables.When consuming plant based (non-heme) sources of iron, combine them with foods high in vitamin C to improve iron absorption, such as broccoli, red peppers, and citrus.
Iodine regulates the function of the thyroid gland, which is important for the neurological development of the baby, before and after birth.[xiii] Iodine deficiency in pregnant women is associated with lower IQ scores and cognitive deficits in their children.[xiv]
Iodine sources include: seaweed, eggs, and dairy products.
Looking after your vitamin D status during your pregnancy is also crucial. Maternal vitamin D status is associated with the development of allergic diseases, autoimmune diseases, and infectious diseases in their offspring.[xv] An intake of up to 4000iu daily of vitamin D increases your chance of reaching full term pregnancy and reduces the likelihood of pre-eclampsia and neonatal hypocalcemia.[xvi]
A study analysed levels of vitamin D of 1,200 women before and during pregnancy and found that sufficient levels of vitamin D before conception was associated with a reduced risk of miscarriage.[xvii]
It is a good idea to test your vitamin D before you plan a pregnancy, through your GP or private laboratories. A Nutritional Therapist will be able to guide you on the right dosage to get you at an optimal level. If not possible, 1000iu is a helpful therapeutic maintenance dose.
Essential fatty acids (EFAs) play a vital role in your baby’s brain development. There are two types of EFA – omega-3 and -6. While omega-6 is widespread in the Western diet (e.g. in grains, vegetable oils), omega-3 is often depleted in many individuals’ diets as it is found in nuts and seeds, such as flaxseeds and walnuts as alpha-linolenic acid (ALA) and in oily fish like salmon, mackerel and tuna as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which are less commonly consumed.
EPA and DHA support neural,[xviii] psychomotor,[xix] and retinal development,[xx] and visual acuity[xxi] in the foetus. They also reduce the risk of miscarriages related to poor uterine blood flow.[xxii]
However, while the omega-3 in fish oils are hugely beneficial, eating lots of oily fish is not advised during pregnancy. Farmed oily fish contain mercury and PCBs, which can have detrimental effects on your baby’s nervous system.[xxiii] Therefore, it is a good idea to take a high quality, purified fish oil supplement instead alongside a conservative dietary intake of fish.
During foetal development, large amounts of choline are needed to support the rapid cell division, growth, and development of the brain. Choline can reduce the risk of neural tube defects.[xxiv]
Animal products are rich sources of choline, including beef, eggs, chicken, and fish. Nuts, legumes, and cruciferous vegetables are relatively good sources as well, however those on a vegan/vegetarian diet should particularly make sure to consume a multinutrient containing choline.
Vegans and vegetarians
If you are vegan or vegetarian, supplement with an algae-based omega-3 oil to ensure you get enough EPA and DHA. Choose a vegan multinutrient with sufficient levels of iron, vitamin B12, and choline to help prevent deficiencies and ensure you have a healthy and balanced plant-based diet (seek the advice of a private Registered Nutritional Therapist for tailored advice).
Being pregnant is a special time, but it brings a set of challenges too. Optimum preconception care through a good diet, lifestyle, and appropriate supplementation is important to ensure excellent baseline levels of nutrients for both you and baby. By adopting a healthy lifestyle and taking a pregnancy multinutrient while trying to conceive, you can give yourself the best chance of enjoying the experience, and give your baby the best start in life.
[iii] Patterson. Folate metabolism and the risk of Down syndrome. Nutrition 2005;21:698-704
[iv] Kelly et al Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study. Br J Gen Pract. 2012;62:466 – 72.
[v] Houston. Taking folic acid at start of pregnancy seems to lower risk of cleft lip and palate. BMJ. 2012 Jul 5;345:e4614
[vi] Fruen et al. Folic Acid Intake During Early Pregnancy Associated With Reduced Risk of Autism in Offspring Biochem J 1990;270(1):119-123
[vii] Hekmatdoost A, et al. Methyltetrahydrofolate vs Folic Acid Supplementation in Idiopathic Recurrent Miscarriage with Respect to Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms: A Randomized Controlled Trial. Matsuo K, ed. PLoS ONE. 2015;10(12):e0143569.
[viii] Lamers et al. Red blood cell folate concentrations increase more after supplementation with [6S]-5-methyltetrahydrofolate than with folic acid in women of childbearing age. Am J Clin Nutr. 2006 (84): 156-61.
[ix] Prinz-Langenohl et al. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C,T polymorphism of methylenetetrahydrofolate reductase. British Journal of Pharmacology. 2009 (158) 2014-2021.
[x] Chen H, Yang X, Lu M. Methylenetetrahydrofolate reductase gene polymorphisms and recurrent pregnancy loss in China: a systematic review and meta-analysis. Arch Gynecol Obstet. 2016 Feb;293(2):283-90.
[xi] Zhu L. Polymorphisms in the methylene tetrahydrofolate reductase and methionine synthase reductase genes and their correlation with unexplained recurrent spontaneous abortion susceptibility. Genet Mol Res. 2015 Jul 28;14(3):8500-8.
[xiii] Bath SC. The effect of Iodine deficiency during pregnancy on child development. Proc Nutr Soc. 2019; 78(2): 150-160.
[xiv] Klein RZ et al. Relation of severity of maternal hypothyroidism to cognitive development of offspring. J Med Screen 2001; 8: 18-20.
[xv] Erkkola et al Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children. Clin Exp Allergy. 2009 ;39(6)
[xvi] Hollis et al. Vitamin D Supplementation during pregnancy; Double-blind, Randomised Clinical Trial of Safety and Effectiveness. Journal of Bone and Mineral Research. 2011; 26 (10): 2341-57.
[xvii] Mumford et al. Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss: a prospective cohort study. The Lancet Diabetes & Endocrinology. 2018;6(9);725-732
[xviii] Oken et al. Fish consumption, methylmercury and child neurodevelopment.Curr Opin Pediatr. 2008; 20: 178-83.
[xix] Jensen et al. Effects of n-3 fatty acids during pregnancy and lactation. Am J Clin Nutr. 2006; 83 (6 suppl): 1452S–7S.
[xx] Birch et al. The DIAMOND (DHA intake and measurement of neural development) study: A double-masked, randomized controlled clinical trial of the maturation of infant visual acuity as a function of the dietary level of docosahexaenoic acid. Am J ClinNutr. 2010; 91 (4): 848-59.
[xxi] Campoy et al. Omega 3 fatty acids on child growth, visual acuity and neurodevelopment. Br J Nutr. 2012; 107 (Suppl 2): S85-106.
[xxii] Lazzarin et al. Low-dose aspirin and omega-3 fatty acids improve uterine arTtery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion. Fertil Steril. 2009; 92 (1): 296-300.
[xxiii] Murata et al. Effects of methylmercury on neurodevelopment in Japanese children in relation to the Madeiran study. Int Arch Occup Environ Health. 2004;77(8):571-9.
[xxiv] Shaw GM et al. Choline and risk of neural tube defects in a folate-fortified population. Epidemiology. 2009;20(5):714-719.
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