Scientific research shows that diet and lifestyle have a significant influence on the health of both a mother and her children, beginning even before conception takes place.
Malnutrition is often a problem in the developing world. However, an analysis of recent studies published in the journal Maternal and Childhood Nutrition1 this week shows that women, even in developed countries, may not be meeting the requirements of a healthy, nutritious diet, both before and during pregnancy.
This can have far-reaching effects on not only fertility, pregnancy and birth outcomes but also the long term health of both mother and child.
The vital role of nutrition in conception, pregnancy and health
Current findings show that the first 1,000 days of life, beginning at the point of conception up until two years of age are critical in the prevention of adult-onset disease2. Certain maternal conditions in the period leading up to conception, especially obesity and excessive weight gain in pregnancy have been linked to high birth weight, changes in glucose metabolism and obesity in children3. Later in life, this can lead to an elevated risk of developing cardiometabolic conditions such as diabetes, heart disease and stroke.
Growth rate in the first months of life also influences health in later life. The production of breastmilk is considered the gold standard for infant feeding. This is because breastmilk not only affects infant growth, but breastfeeding has significant benefits to lactating women's health. The health-related advantages afforded by breastfeeding include lowered cardiovascular risk and hip fracture incidences post-menopause, as well as protecting against breast and ovarian cancer4.
To ensure that women and their offspring remain healthy and are given the best possible health outcomes long term, adequate nutrition is essential.
Where women are falling short on nutrition
The recent analysis involved the examination of 18 observational studies that were conducted across ten countries to gain a broad perspective on the matter. The authors concluded that based on the evidence at hand, most women are not meeting the minimum requirements for a healthy diet.
In general, the women studied did not meet the dietary guidelines for the following both before conception and during pregnancy:
- Cereal grains
- Folate (vitamin B9)
In pregnant women:
- 91% did not meet the iron intake requirements
- 55% fell short of the calcium recommendations
- 55% also consumed a higher amount of fat than guidelines stipulate
All of which could have adverse effects on pregnancy, birth outcomes and the health of both women and their children.
It was noted, however, that older women with higher education levels, who were non-smokers adhered more closely to dietary guidelines both before and during pregnancy.
Numerous reasons influence why women don't always adhere to nutritional guidelines. These include5:
- Availability and affordability of food
- Personal beliefs and preferences
- Cultural beliefs and preferences
- Level of education
- Social factors
- Geographical and environmental factors
According to the study's corresponding author Cherie Caut, in addition to the above, the women may not be following the recommended dietary guidelines simply because they are not aware of them. She believes communities need better education and more information on healthy eating that highlights the links between diet and healthy pregnancy and birth.
Dietary guidelines for pregnant women and those planning to fall pregnant
Women's nutritional requirements differ significantly when they are pregnant. The widely accepted dietary guidelines are discussed below6,7. It is, however, vital to remember that these are generally directed towards women with single, uncomplicated pregnancies.
In instances where complications arise, for example, if a woman develops gestational diabetes, or when a woman is expecting twins, adjustments will need to be made. A nutritionist or registered dietitian can help pregnant women to ensure that they are getting adequate nutrition.
- Caloric intake: Energy requirements vary significantly from one person to another. A woman's age, BMI, and activity level all play a role in how much she needs to eat. During pregnancy, it is generally accepted that in the first trimester, a woman doesn't need to eat more calories than a non-pregnant woman. However, in the second and third trimester of pregnancy, the general recommendation is that women increase their caloric intake by 340 kcal and 452 kcal per day, respectively.
- Protein: General protein intake guidelines recommend [grams:46] of protein per day for non-pregnant women. Pregnant women are usually advised to consume [grams:60] per day.
- Carbohydrates: These should make up 45 – 64% of a woman's daily calories and include 6 to 9 servings of whole grains, which help to ensure adequate fibre intake. Whole grains are the 'whole' form of the plant's seed and include things like barley, brown rice, buckwheat, cracked wheat (bulgar), millet, oatmeal, popcorn, quinoa, sorghum, spelt, whole oats, whole-wheat bread, pasta or crackers. Consumption of sugar should be limited to [grams: 25] (i.e. five teaspoonfuls)
- Fat: Similar to non-pregnant women, pregnant women's fat intake should only account for 20-35% of their daily caloric intake. The choice of fats is vital, and omega 3's should be included in a woman's diet. The recommended amount of these is 200–300 mg/day which can be achieved by eating two [grams:150] to [grams:300] servings of fish twice a week, one of which should be a fatty fish (salmon, sardines etc.). For those who do not eat fish, omega 3's can be found in plants rich in linoleic acid and ground linseed and hemp are good options.
- Micronutrients: It is generally recommended that women take a daily prenatal multivitamin both before conception and throughout pregnancy. The difference between prenatal vitamins and regular multivitamins is the higher levels of folic acid, iron and vitamin D in pregnancy vitamins.
- Folic acid is a synthetic form of naturally occurring folate (vitamin B9). It is necessary to support the rapid cell growth, cell replication, cell division, and nucleotide synthesis that takes place as a foetus and the placenta develop during pregnancy. Scientific evidence shows that folic acid supplements (400-800μg daily) taken before conception can reduce the risk of neural tube defects in the foetus8. Neural tube defects result in conditions like spina bifida (where the baby's spine fails to develop correctly) or anencephaly (where a baby is born with an underdeveloped brain and incomplete skull. This condition is fatal, with 75% of infants with this condition being stillborn). Supplementation during pregnancy may be higher for some women.
- Iron: Iron supplements are generally recommended in pregnancy as women's iron needs almost double during this time. These supplements often contain vitamin C, which aids absorption.
Nutritional Guidelines for lactating women
A women's energy and dietary requirements also differ during lactation and breastfeeding. The following should be kept in mind:
- Caloric intake: It is estimated that breastfeeding women require 500 kcal/day more than they did before falling pregnant.
- Protein: An additional [grams:25] per day is recommended on top of the usual [grams:46] for non-pregnant women.
- Micronutrients: During breastfeeding, these requirements increase compared to pregnancy (except for vitamins D and K, calcium, fluoride, magnesium, and phosphorus). As such, women need to continue to take their prenatal vitamins while breastfeeding. A doctor may adjust supplement levels for vegetarians who often require additional calcium as a result of their diet.
These are just some of the considerations that women need to be aware of when preparing to conceive as well as during pregnancy. In cases where ensuring adequate nutritional intake is challenging due to a woman's chosen dietary habits, for example, being a vegetarian, consulting with a nutritionist is highly recommended.
1. Caut C, Leach M, Steel A. Dietary guideline adherence during preconception and pregnancy: A systematic review. Matern Child Nutr. 2019. doi:1111/mcn.12916
2. Marangoni F, Cetin I, Verduci E et al. Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document. Nutrients. 2016;8(10):629. doi:3390/nu8100629
3. Berti C, Cetin I, Agostoni C et al. Pregnancy and Infants’ Outcome: Nutritional and Metabolic Implications. Crit Rev Food Sci Nutr. 2014;56(1):82-91. doi:1080/10408398.2012.745477
4. For mothers: breastfeed your baby, if you can. World Cancer Research Fund. https://www.wcrf.org/dietandcancer/recommendations/breastfeed-your-baby. Published 2019. Accessed December 6, 2019.
5. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Health.gov. https://health.gov/dietaryguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf. Published 2015. Accessed December 4, 2019.
6. Kominiarek M, Rajan P. Nutrition Recommendations in Pregnancy and Lactation. Medical Clinics of North America. 2016;100(6):1199-1215. doi:1016/j.mcna.2016.06.004
7. Meija L, Rezeberga D. Proper Maternal Nutrition During Pregnancy Planning And Pregnancy: A Healthy Start In Life. 1st ed. Latvia: WHO Europe; 2017. http://www.euro.who.int/__data/assets/pdf_file/0003/337566/Maternal-nutrition-Eng.pdf?ua=1. Accessed December 4, 2019.
8. Pitkin R. Folate and neural tube defects. Am J Clin Nutr. 2007;85(1):285S-288S. doi:1093/ajcn/85.1.285s