Nutrition and pregnancy

Pregnant woman eating fruit.

Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception (probably several months before) as well as throughout pregnancy and breast feeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life.

An inadequate or excessive amount of some nutrients may cause malformations or medical problems in the fetus, and neurological disorders and handicaps are a risk that is run by mothers who are malnourished.[1] 23.8% of babies worldwide are estimated to be born with lower than optimal weights at birth due to lack of proper nutrition.[2] Personal habits such as smoking, alcohol, caffeine, using certain medications and street drugs can negatively and irreversibly affect the development of the baby, which happens in the early stages of pregnancy.[3]

Caffeine is sometimes assumed to cause harm to the unborn baby but there is not enough evidence so say if this is true.[4] A recent review showed that more research is needed to show whether caffeine intake effects birth weight, preterm births, gestational diabetes and other outcomes.[5]

Nutrition before pregnancy

Beneficial pre-pregnancy nutrients

As with most diets, there are chances of over-supplementing, however, as general advice, both state and medical recommendations are that mothers follow instructions listed on particular vitamin packaging as to the correct or recommended daily allowance (RDA). Daily prenatal use of iron substantially improves birth weight, potentially reducing the risk of Low birth weight.[6]

Nutrition during pregnancy

During the early stages of pregnancy, since the placenta is not yet formed, there is no mechanism to protect the embryo from the deficiencies which may be inherent in the mother's circulation. Thus, it is critical that an adequate amount of nutrients and energy is consumed.

Multiple micronutrient supplements taken with iron and folic acid can improve birth outcomes for women in low income countries.[15] These supplements reduce numbers of low birth weight babies, small for gestational age babies and stillbirths in women who may not have many micronutrients in their usual diets.[16] Undernourished women can benefit from having dietary education sessions and, balanced energy and protein supplements.[17]

A review showed that dietary education increased the mother’s protein intake and helped the baby grow more inside the womb.[18] The balanced protein and energy supplement lowered risk of stillbirth and small babies and increased weight gain for both the mother and baby.[19] Although more research is needed into the longer term effects on the mothers’ and infants’ health, the short term effects look promising.[20]

Supplementing one's diet with foods rich in folic acid, such as oranges and dark green leafy vegetables, helps to prevent neural tube birth defects in the fetus. In addition, prenatal vitamins typically contain increased amounts of folic acid, iodine, iron, vitamin A, vitamin D, zinc, and calcium over the amounts found in standard multi-vitamins.[21]

Zinc supplements have reduced preterm births by around 14% mainly in low income countries.[22] No other benefits were seen4. The World Health Organisation does not routinely recommend zinc supplementation for pregnant women because there is not enough good quality evidence.[23]

For women with low calcium diets, taking calcium supplementation can reduce their risk of preeclampsia.[24] It has also been suggested that calcium can reduce numbers of births that happen before the 37th week of pregnancy (preterm birth).[25] However a more recent review looking into other benefits of calcium supplementation did not find any improvement in numbers of preterm or low birth weight babies.[26] There is not enough good quality to research to suggest best doses and timing of calcium supplementation.[27]

Pregnant women are advised to pay attention to the foods they eat during pregnancy, such as soft cheese and certain fish, in order to reduce the risk of exposure to substances or bacteria that may be harmful to the developing fetus. This can include food pathogens and toxic food components, alcohol, and dietary supplements such as vitamin A and potentially harmful pathogens such as listeria, toxoplasmosis, and salmonella.[28] Dietary vitamin A is obtained in two forms which contain the preformed vitamin (retinol), that can be found in some animal products such as liver and fish liver oils, and as a vitamin A precursor in the form of carotene, which can be found in many fruits and vegetables.[28] Intake of large amounts or, conversely, a deficiency, of retinol has been linked to birth defects and abnormalities.[29] It is noted that a 100 g serving of liver may contain a large amount of retinol, so it is best that it is not eaten daily during pregnancy. Excessive amounts of alcohol have been proven to cause fetal alcohol syndrome. The World Health Organization recommends that alcohol should be avoided entirely during pregnancy, given the relatively unknown effects of even small amounts of alcohol during pregnancy.[30]

Folic acid

Folic acid, which is the synthetic form of the vitamin folate, is critical both in pre-and peri-conception.[28] Deficiencies in folic acid may cause neural tube defects; women who had 0.4 mg of folic acid in their systems due to supplementing 3 months before childbirth significantly reduced the risk of NTD within the fetus.[31] The development of every human cell is dependent on an adequate supply of folic acid. Folic acid governs the synthesis of the precursors of DNA, which is the nucleic acid that gives each cell life and character. Folic acid deficiency results in defective cellular growth and the effects are most obvious on those tissues which grow most rapidly.[32]

Water

During pregnancy, one's mass increases by about 12 kg.[33] Most of this added weight (6 to 9 L) is water[33] because the plasma volume increases, 85% of the placenta is water[34] and the fetus itself is 70-90% water. This means that hydration is an important aspect of nutrition throughout pregnancy. The European Food Safety Authority recommends an increase of 300 mL per day compared to the normal intake for non-pregnant women, taking the total adequate water intake (from food and fluids) to 2,300 mL, or approximately 1,850 mL/ day from fluids alone[35]

Nutrition after pregnancy

Proper nutrition is important after delivery to help the mother recover, and to provide enough food energy and nutrients for a woman to breastfeed her child. Women having serum ferritin less than 70 µg/L may need iron supplements to prevent iron deficiency anaemia during pregnancy and postpartum.[36][37]

During lactation, water intake may need to be increased. Human milk is made of 88% water, and the IOM recommends that breastfeeding women increase their water intake by about 300 mL/day to a total volume of 3000 mL/day (from food and drink); approximately 2,400 mL/day from fluids.[38]

See also

References

  1. ↑ Barasi EM (2003). Human Nutrition - A Health Perspective. London: Arnold. ISBN 0-340-81025-4.
  2. ↑ "WHO | 10 facts on nutrition". World Health Organization. 2011-03-15. Retrieved 2011-08-07.
  3. ↑ Laura Riley. Stephanie Karpinske, ed. Pregnancy: The Ultimate Week-by-Week Pregnancy Guide. Meredith Books. pp. 21–22. ISBN 0-696-22221-3.
  4. ↑ Jahanfar, S; Jaafar, SH (9 June 2015). "Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcomes.". The Cochrane database of systematic reviews 6: CD006965. PMID 26058966.
  5. ↑ Jahanfar, S; Jaafar, SH (9 June 2015). "Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcomes.". The Cochrane database of systematic reviews 6: CD006965. PMID 26058966.
  6. ↑ Haider, BA, Olofin, I, Wang, M; et al. (2013). "Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis". British Medical Journal 21: f3443. doi:10.1136/bmj.f3443.
  7. ↑ Schaefer, Christof (2001). Drugs During Pregnancy and Lactation: Handbook of Prescription Drugs and Comparative Risk Assessment. Gulf Professional Publishing. ISBN 9780444507631. Retrieved 2015-05-13.
  8. ↑ Shils, Maurice Edward; Shike, Moshe (2006). Modern Nutrition in Health and Disease. Lippincott Williams & Wilkins. ISBN 9780781741330. Retrieved 2015-05-13.
  9. ↑ Aghajafari, Fariba; Nagulesapillai, Tharsiya; Ronksley, Paul E.; Tough, Suzanne C.; O'Beirne, Maeve; Rabi, Doreen M. (2013). "Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies". BMJ (Clinical research ed.) 346: f1169. doi:10.1136/bmj.f1169. ISSN 1756-1833. PMID 23533188. Retrieved 2015-05-12.
  10. ↑ Briggs, Gerald G.; Freeman, Roger K.; Yaffe, Sumner J. (2011). Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Lippincott Williams & Wilkins. ISBN 9781608317080. Retrieved 2015-05-13.
  11. ↑ Imhoff-Kunsch, Beth; Briggs, Virginia; Goldenberg, Tamar; Ramakrishnan, Usha (Jul 2012). "Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic review". Paediatric and Perinatal Epidemiology. 26 Suppl 1: 91–107. doi:10.1111/j.1365-3016.2012.01292.x. ISSN 1365-3016. PMID 22742604. Retrieved 2015-05-12.
  12. ↑ Jensen, Craig L. (Jun 2006). "Effects of n-3 fatty acids during pregnancy and lactation". The American Journal of Clinical Nutrition 83 (6 Suppl): 1452S–1457S. ISSN 0002-9165. PMID 16841854. Retrieved 2015-05-12.
  13. ↑ Murkoff, Heidi (May 20, 2010). "Foods that make you fertile". Everyday Health. Retrieved 2010-11-30.
  14. ↑ Peña-Rosas, Juan Pablo; De-Regil, Luz Maria; Dowswell, Therese; Viteri, Fernando E. (2012). "Daily oral iron supplementation during pregnancy". The Cochrane Database of Systematic Reviews 12: CD004736. doi:10.1002/14651858.CD004736.pub4. ISSN 1469-493X. PMC 4233117. PMID 23235616. Retrieved 2015-05-12.
  15. ↑ Haider, BA; Bhutta, ZA (1 November 2015). "Multiple-micronutrient supplementation for women during pregnancy.". The Cochrane database of systematic reviews 11: CD004905. PMID 26522344.
  16. ↑ Haider, BA; Bhutta, ZA (1 November 2015). "Multiple-micronutrient supplementation for women during pregnancy.". The Cochrane database of systematic reviews 11: CD004905. PMID 26522344.
  17. ↑ Ota, E; Hori, H; Mori, R; Tobe-Gai, R; Farrar, D (2 June 2015). "Antenatal dietary education and supplementation to increase energy and protein intake.". The Cochrane database of systematic reviews 6: CD000032. PMID 26031211.
  18. ↑ Ota, E; Hori, H; Mori, R; Tobe-Gai, R; Farrar, D (2 June 2015). "Antenatal dietary education and supplementation to increase energy and protein intake.". The Cochrane database of systematic reviews 6: CD000032. PMID 26031211.
  19. ↑ Ota, E; Hori, H; Mori, R; Tobe-Gai, R; Farrar, D (2 June 2015). "Antenatal dietary education and supplementation to increase energy and protein intake.". The Cochrane database of systematic reviews 6: CD000032. PMID 26031211.
  20. ↑ Ota, E; Hori, H; Mori, R; Tobe-Gai, R; Farrar, D (2 June 2015). "Antenatal dietary education and supplementation to increase energy and protein intake.". The Cochrane database of systematic reviews 6: CD000032. PMID 26031211.
  21. ↑ Laura Riley (2006-02-02). Stephanie Karpinske, ed. Pregnancy: The Ultimate Week-by-Week Pregnancy Guide. Meredith Books. pp. 21–22. ISBN 0-696-22221-3.
  22. ↑ Ota, E; Mori, R; Middleton, P; Tobe-Gai, R; Mahomed, K; Miyazaki, C; Bhutta, ZA (2 February 2015). "Zinc supplementation for improving pregnancy and infant outcome.". The Cochrane database of systematic reviews 2: CD000230. PMID 25927101.
  23. ↑ "Zinc supplementation during pregnancy". World Health Organization. Retrieved 22 April 2016.
  24. ↑ Hofmeyr, GJ; Lawrie, TA; Atallah, AN; Duley, L; Torloni, MR (24 June 2014). "Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.". The Cochrane database of systematic reviews 6: CD001059. PMID 24960615.
  25. ↑ Hofmeyr, GJ; Lawrie, TA; Atallah, AN; Duley, L; Torloni, MR (24 June 2014). "Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.". The Cochrane database of systematic reviews 6: CD001059. PMID 24960615.
  26. ↑ Buppasiri, P; Lumbiganon, P; Thinkhamrop, J; Ngamjarus, C; Laopaiboon, M; Medley, N (25 February 2015). "Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes.". The Cochrane database of systematic reviews 2: CD007079. PMID 25922862.
  27. ↑ Buppasiri, P; Lumbiganon, P; Thinkhamrop, J; Ngamjarus, C; Laopaiboon, M; Medley, N (25 February 2015). "Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes.". The Cochrane database of systematic reviews 2: CD007079. PMID 25922862.
  28. 1 2 3 Williamson CS (2006). "Nutrition in pregnancy". British Nutrition Foundation 31: 28–59. doi:10.1111/j.1467-3010.2006.00541.x.
  29. ↑ "Vitamin A (retinol)". Drugs and Supplements. Mayo Clinic. November 1, 2013. Retrieved May 17, 2015.
  30. ↑ "Framework for alcohol policy in the WHO European Region" (PDF). World Health Organisation.
  31. ↑ "Recommendations | Folic Acid | NCBDDD | CDC". www.cdc.gov. Retrieved 2015-05-13.
  32. ↑ Hibbard BM (August 1964). "The role of folic acid in pregnancy". BJOG 71 (4): 529–42. doi:10.1111/j.1471-0528.1964.tb04317.x.
  33. 1 2 Institute of Medicine (IOM). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press, 2004.
  34. ↑ Beall MH, van den Wijngaard JPHM, van Gemert MJC, Ross MG (2007). "Amniotic Fluid Water Dynamics". Placenta 28: 816–23. doi:10.1016/j.placenta.2006.11.009.
  35. ↑ EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010). "Scientific Opinion on Dietary reference values for water". EFSA Journal 8: 1459–1507. doi:10.2903/j.efsa.2010.1459.
  36. ↑ Milman N, Byg KE, Bergholt T, Eriksen L, Hvas AM (2006). "Body iron and individual iron prophylaxis in pregnancy--should the iron dose be adjusted according to serum ferritin?". Ann. Hematol. 85 (9): 567–73. doi:10.1007/s00277-006-0141-1. PMID 16733739.
  37. ↑ Sethi V, Kapil U (2004). "Iodine deficiency and development of brain". Indian J Pediatr 71 (4): 325–9. doi:10.1007/BF02724099. PMID 15107513.
  38. ↑ Dietary References Intakes:Water, Potassium, Sodium, Chloride, and Sulfate. Released February 11, 2014. https://iom.nationalacademies.org/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx

Further reading

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