Sakshi Chopra, MBBS DGO DNB (Gynaecologist)
A healthy pregnancy starts before conception. To have a healthy baby, it’s best for both partners to improve their lifestyles before planning the pregnancy. In this blog, we review major nutritional factors which can influence the pregnancy outcomes and maternal and child health.
- Recent research shows that maternal nutrition prior to and during pregnancy, and nutrition during early childhood can have strong programming effects on the health and function of the child in later parts of life. So, it is better to start the journey of pregnancy with optimum health and adequate nutritional reserves to avoid potential negative effects.
- Nutrition in pregnancy not only affects brain growth and development, it also impacts long term cognitive function, behaviour, immunity and risk of allergy or autoimmune diseases, and bone health. It also influences the risk of developing childhood obesity, diabetes, and cardiovascular diseases such as heart attacks and stroke later in life.
Poor pregnancy outcomes can, therefore, be avoided by modifying such risk factors during the pre-conception period.
Here are some tips:
- Vaccination: Women should ensure their vaccination status of rubella and hepatitis B is up to date.
- Manage diagnosed medical conditions: Medical conditions like thyroid disorders, diabetes, hypertension should be adequately corrected.
- Maintain adequate nutritional intake: Try to eat a balanced and nutritious diet. Ensure enough intake of Iron and Folate (Vit B10). Note that prenatal vitamins (especially folic acid) can be started one month prior to the conception as it can significantly reduce the risk of neural tube defects in your child.
- Manage body weight: Extremes of body weight can follow a U-shaped curve on the health of mother and the baby. Being underweight is associated with poor fetal growth, pregnancy loss, preterm delivery, gastroschisis while being overweight is associated with development of medical complications in pregnancy, miscarriage, stillbirth and high birth weight deliveries.
- Begin a healthy and active lifestyle: Include regular exercise to achieve normal BMI and avoid smoking, alcohol and drug use. See our blog on exercise during pregnancy and post-partum!
The genetic relationship between maternal nutrition and child’s health
The basis for embryonic and fetal development is already set prior to conception, and it is subsequently modulated by nutritional lifestyle choices throughout during pregnancy. This is known today as the developmental origins of health and disease, or the metabolic programming hypothesis. Therefore the exposures and experiences of the parents can induce epigenetic modulations to the genetic material contained in oocytes and in sperms well in the fertilized egg. For example, the composition of the oviductal and seminal fluids is influenced by prenatal nutrition, metabolism, and inflammation. These findings are what forms the basis of epigenetics!
How to improve your nutritional status?
- Choose nutrient dense foods such as vegetables, fruits, beans, peas, unsalted nuts and seeds, fat free and low fat dairy products as well as lean meats and poultry.
- Avoid refined sugars, saturated fats and refined starches as much as possible. The total daily intake of added sugars and saturated fats should not exceed 5 to 10% of daily consumed calories.
- Try to achieve a diet comprising of the following proportions of the macronutrients: Carbohydrate– 55%, Fat -15-30%, and Protein- 10-15%
- Here are some specific recommendations:
| RECOMMENDATION | LEVEL OF INTAKE |
| Fruits and vegetables | At least 5 *80g portions/day (400g) |
| Oily fish | At least 1 portion/week (140g) |
| Fat | 35% food energy (maximum) |
| Saturated fat | 11% food energy (maximum) |
| Non-starch polysaccharide | An average intake of 18g/day |
| Alcohol | No more than 2-3 units/day. Women planning pregnancy should drink no more than 1-2 units twice per week. |
| Salt (NaCl) | Maximum of 6 g /day (2.4g Sodium/day) |
| Caffeine | 200 mg /day |
Energy requirement during pregnancy should be increased by 10% or 250 kcal/day. Weight gain during pregnancy is 10-16 kg (22-35 lbs) for women with normal BMI. Typically, no weight gain occurs in the first trimester and real gain begins in the second and third trimester. The diet composition should again include carbohydrates, proteins and fats in the amounts discussed above.
Research has shown that the risk of delivering LBW (low birth weight) infants was significantly reduced when women took multi-micronutient supplements before birth, compared with women who just took Iron- Folate supplements. These findings highlight the influence of nutrition during pregnancy. However, the phase before pregnancy is a critical time period that is often overlooked. Improving knowledge of good nutrition, lifestyle and food safety practices at this point in time is not only a good opportunity to improve women’s health in general but also beneficial in pregnancy and for the health of the next generation.
References –
1. Davies MJ (2006) Evidence for effects of weight on reproduction in women. Reproductive Biomedicine Online 12(5), 552-61.
2. SACN (Scientific Advisory Committee On nutrition) (2008) The Nutritional Wellbeing of the British Population. The Stationary Office: London.
3. Shah PS and Ohlsson A (2009) Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis. Canadian Medical Association Journal 180 (12), E99-108.
4. Dietz PM, Callaghan WM, Cogswell ME et al. (2006) Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery. Epidemiology 17, 170-177.
5. Lam PK, Torfs CP & Brand RJ (1999) A low pregnancy body mass index is a risk factor for an offspring with gastroschisis. Epidemiology 10, 717-721.
6. Roseboom TJ, van der Meulen JH, Ravelli AC et al. (2001) Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview. Molecular and cellular endocrinology 185,93-98.