Pregnancy is probably the one time in a woman’s life when she is bombarded by more “old wives’ tales” and other doubtful advice than at any other period. Conflicting dietary admonitions characterise the advice pregnant women receive from their girlfriends, female relatives, midwives, mothers, grandmothers and popular magazines. No wonder modern women are confused about what they should eat to ensure that they and their developing baby are healthy.
‘The first 1,000 days’
Recently researchers have also been giving a great deal of attention to the lifestyles and diets of women of childbearing age before conception, and have coined the phrase “the first 1,000 days”, which encompass a child’s life from preconception to approximately the age of 2. These 1,000 days include the period of 9 months of pregnancy when the baby is dependent on the mother for all its needs.
According to paediatric experts, these 1,000 days can determine a child’s entire life. Dietary factors such as exposure to toxins and malnutrition, overweight and underweight, breastfeeding and weaning foods, combined with a variety of other factors are crucial to giving your baby the best chance in life.
Factors that influence pregnancy outcomes
According to Prof Kelly Tappenden, Editor-in-Chief of the Journal of Enteral and Parenteral Nutrition and an Endowed Professor at the University of Illinois, so many important developments take place during the first three months of pregnancy, that women planning to conceive should take into account the so-called “periconception maternal factors”, which can have important effects on their baby’s development in the womb.
The following factors have been identified as having negative effects on the success of pregnancies:
- Extreme underweight or overweight. This maternal factor can complicate your baby’s development and is nowadays probably one the most important factors because such a large percentage of our female population is overweight or obese. On the other hand, many teenagers who fall pregnant are seriously underweight and malnourished.
- The nutritional status of both the mother and the father is important. For a healthy baby both parents need to be well nourished and consume a balanced diet which is not overloaded with alcohol and stimulants such as caffeine.
- Environmental toxins in our water supply, air and food are a constant threat to healthy cell replication. Toxins are also found in e.g. medications and cigarette smoke, and at work or during leisure activities.
- Folic acid plays a very important part in preventing neural tube defects. Unfortunately the folic acid levels in staple foods have been declining steadily as global soils become depleted. This is why the two staple foods in South Africa, namely maize meal and wheat flour are fortified with folic acid and 7 other important nutrients, including iron (see below). Since the introduction of fortification of our staples, one of the most significant improvements in the nutrient intake of women has been folic acid and this is reflected in a decrease in the number of babies suffering from neural tube defects reported at birth. Before fortification with folic acid, the incidence of neural tube defects in South Africa was 14.1 per 10,000 births, and after introduction of folate fortification this rate has dropped to 9.8 per 10,000 births, a 31% reduction.
- Deficiencies of vitamin B12 and iron in pregnant women can also have a major effect on pregnancy outcomes. Both these nutrients prevent different type of anaemia in the mother, which in turn can prevent poor oxygen transport to the foetus. Vitamin B12 and bioavailable iron are found in meat and liver, egg yolk and whole grain foods. The high levels of iron in plants like spinach are unfortunately unavailable because they are bound to compounds called oxalates which make them insoluble.
- Excessive caffeine intake in the perinatal period from coffee, tea and caffeinated energy drinks can have a negative effect on conception. Studies have shown that having more than 300 mg of caffeine a day before conception can increase the risk of spontaneous abortion by 30%.
Healthy pre-pregnancy weight
What is a “healthy pre-pregnancy weight?” This is probably one of the most popular questions among mothers-to-be.
Because the pre-pregnancy body mass index (BMI) is “an independent predictor of many adverse outcomes of pregnancy”, the best scenario is for women to have a normal BMI before they fall pregnant (i.e. BMI = 18-25). With nearly 70% of the female population in South Africa suffering from overweight or obesity, this requirement is going to be hard to achieve. On the other hand, many of our young mothers are chronically underweight with BMIs below 18.
In 2009, the Institute of Medicine in the USA published the following table to guide weight gain based on prepregnancy BMI:
These recommendations will probably upset the “eat for two” brigade. For example, there is no recommendation for weight gain per week for the first trimester! This does not mean that you should starve yourself and your baby for those exceptionally important first three months, but it does mean that there is no need to imagine that because you are pregnant you suddenly need to gorge yourself, develop cravings for fatty food (many cravings are “all in the mind” anyway), or stop eating a healthy, balanced diet with a moderate energy content.
Next week we will continue with the critical subject of what pregnant mothers need to know about their diets to achieve the best results for themselves and their babies.
- Tappenden KA (2015). Eating for Two. Best Practices for Maternal Nutrition. Paper presented at the Nutritional Solutions CNE Event, 16 April 2015, Johannesburg.
- Institute of Medicine (2009). Report Brief: Weight gain during pregnancy: Reexamining the Guidelines. May 2009.
Image: Eating well during pregnancy from Shutterstock