Mom's diet during pregnancy

Parents have enormous influence over what their children eat.  In the early years, children eat only what they are given.  As time goes on, they begin to make their own food choices; largely shaped by parents.  It turns out that the influence (specifically from mom) may begin much earlier than initially thought.

Children may actually have their flavors sculpted while still inside the womb!   This is an idea that has been spread through folklore from one generation to the next.  But a new study in Current Diabetes Reports seems to confirm this idea.

The concept is called "prenatal flavor learning."  The study found that:

"the flavors of the foods in the maternal diet are found in the amniotic fluid swallowed by the fetus, with the fetus developing a preference for those flavors that is shown to persist in infancy."

In other words, the baby could taste what Mom tasted and preferred those tastes even as an infant.  I especially appreciate another line from the authors,

"This is an empowering concept for a pregnant woman."

It shows that developing a child's taste for healthy foods begins with Mom when she is pregnant.  It certainly continues after birth as the parents model healthy eating and behavior.

Mom's healthy pregnancy diet has a dual benefit.  It provides bountiful nourishment to the developing child and programs his/her taste buds to continue that healthy trend after birth.

Pregnancy- Essential Fats

Many people have heard of omega 3 fatty acids.  We see these advertised on infant formula, supermarket eggs and more.  Food manufacturers have begun fortifying many foods with this essential fat as it plays crucial roles in heart health, brain health, and in reducing inflammation.  You can easily find a bottle of fish oil (or an actual fish) in any supermarket.  Omega 3's are among the best researched nutritional supplement available and in our generally fish-deprived culture, a good supplement for most of us to take.

Omega 3s are especially important for the pregnant woman.  Supplementing with omega 3 fatty acids is a great idea, but women of child-bearing years should pay attention long before they get pregnant.  Experts believe that women consuming a traditional Western diet do not consume sufficient amounts of omega 3s to nourish the developing child. 

In late pregnancy, many women consuming contemporary Western diets may not be able to meet the fetal demand for n-3 long chain polyunsaturated fatty acids (LCPUFAs) from the diet alone.  Annu Rev Nutr 2010 Aug 21; 30: 237-55

In fact, much of the omega 3 available to the growing baby comes from Mom's fat tissue.  As Mom consumes omega 3 fatty acids, some are immediately utilized and other are stored in her fat tissue.   This becomes available to the growing baby throughout pregnancy and especially in the latter months.  The baby then utilizes some and stores some in his fat.  He will use these fats during the first few months of life. 

Omega 3 supplements should be a part of every woman's prenatal care.  Just as you would take a good prenatal vitamin with sufficient folate, omega 3s should also be included.

Metabolic Syndrome- Fetal Origins

There's no doubt that many of our lifestyle habits and dietary patterns powerfully influence our health; often, adversely.  Metabolic syndrome is a combination of many "famous" risk factors.  This includes hypertension, insulin resistance, dyslipidemia, promthrombotic state, abdominal obesity and a few others.  The American Heart Association has a great web page explaining metabolic syndrome.

Most health professionals acknowledge that metabolic syndrome is a consequence of poor lifestyle decisions and can be prevented by following common sense health principles.  But like many diseases, scientists are studying the origins and pathogenesis of metabolic syndrome.  As it turns out, the 'seeds' of metabolic syndrome may actually be sown during embryonic development. 

This paper states that "nutritional, hormonal, and metabolic environment afforded by the mother may permanently program differentiating target tissues of the offspring toward the development of metabolic syndrome/PCOS phenotype in adult life."

Stated differently, this simply means that a pregnant woman's health habits, including her diet, have the potential to radically affect her baby's health even as an adult!  This is something I've written about before.  It shows that the 9 months of intrauterine development may be the most important months of a human being's life.  If you didn't get a chance to read it yet, check out this piece from TIME magazine a few weeks ago.  It does a great job in discussing the most important months of your life.

Over 50 million Americans are affected by metabolic syndrome.  Wouldn't it be great if we could cut that number in half in a single generation?  Pregnant women, please take care of yourself. 

Pregnancy and Nutrition

Pregnancy is a time when women should pay extra attention to quality nutrition.  But an article in the Journal of the American Dietetic Association suggests that this may not be as easy as it sounds.  The article specifically highlights choline, a member of the B vitamin family.

Choline, like so many other nutrients, has many roles in the body.  One of the most famous roles is acting as a substrate to make acetylcholine, an important neurotransmitter.  It is also vital for cell signaling and maintaining the integrity of the cell membrane.  Choline is found in food often as phosphatidylcholine (aka lecithin).  Phosphatidylcholine is present in egg yolks, meat products, soy, brussel sprouts, broccoli, beef liver and more.  

During pregnancy, a great amount of choline is concentrated in the growing baby.  By the time he is born, his blood choline concentration is 3 times higher than Mom's!  Clearly, pregnancy is a critical time for choline availability.  Taken to an extreme, choline deficits can lead to neural tube defects in the embryo as well as cognitive impairment.  

According to Dr. Caudill, the author of the article being referenced here, "the majority of pregnant (and presumably lactating) women are not achieving the target intake levels and that certain common genetic variants may increase requirements for choline beyond current recommendations."

Ideas like this show us we have a long way to go if we want to truly provide comprehensive prenatal care.

Vitamin D and Pregnancy

Another paper on the significance of vitamin D has recently been published.  In it, the authors report,

"low maternal levels of 25 hydroxyvitamin D are associated with adverse outcomes for both mother and fetus in pregnancy as well as the neonate and child."

Further, low vitamin D seems to be linked with "infertility, preeclampsia, gestational diabetes and an increased rate of caesarean section."

Clearly, it is very important for pregnant women to maintain healthy vitamin D levels.  The general recommendation for most people is to maintain serum 25-OH D levels above 55 ng/mL.  The absolute bottom threshold seems to be around 33ng/mL but greater than 55 is generally believed to be a more optimal range.  

The authors of this study admit that whether low vitamin D causes problems during pregnancy or is simply associated with them is unclear.  However, they also acknowledge that there are plausible physiological mechanisms that could explain how low vitamin D would cause the issues.

With 3/4 of American deficient in vitamin D, it appears that we need to pay special attention to pregnant mothers.

Infants and Vitamin D

The American Academy of Pediatrics increased their vitamin D recommendations for infants in late 2008.  A recent report in Pediatrics takes a look at how we're doing. The answer is; bad.  The vast majority of infants still do not get adequate amounts of vitamin D.

Pregnant moms should make sure their vitamin D levels are on the high end of normal.  Mom should make sure her vitamin D levels are high while she is nursing her infant.  And infants should also be given supplemental vitamin D.

Maternal Diet and Chronic Disease

A recent review article was published in the Journal of Nutrition.  In it, the authors state, "Micronutrient status in fetal and early life may alter metabolism, vasculature, and organ growth and function, leading to increased risk of cardiometabolic disorders, adiposity, altered kidney function, and, ultimately, to type 2 diabetes and cardiovascular diseases."

This means mom's nutrient deficits have potential to create long term harm in the child.  By now, this kind of research shouldn't be surprising.

Up until recently, most prenatal nutrition recommendations were relatively boiler-plate.  Get enough folic acid to prevent neural tube defects and take a fish oil capsule.  Some advised women to avoid fish due to mercury contamination and many experts even spend the effort to figure out how much coffee women can "get away with" without long term negative effects.

But rather than thinking about how "not to hurt" the developing child, it is time we focus on providing him/her the best chance for long term health and wellness.

Will Your Child Develop Metabolic Syndrome?

Metabolic syndrome is a major problem in the United States.  It is marked by insulin resistance, inflammation, dyslipidemia, hypertension and a number of other variables.  Within the past 10 years, the prevalence has risen dramatically among adolescents.  Over 45% of adolescents have at least 1 risk factor for metabolic syndrome and with overweight and obesity on the rise, this number is likely rise.

A recent study in Diabetes Care found that hyperinsulinemia in pregnant women predicted an increase in overweight and metabolic syndrome in the offspring!  

Other researchers propose that changes in the nutritional environment of the pregnant mother may lead to "a long term re-setting of cellular energy homeostasis, most probably via epigenetic modification of genes involved in a number of key regulatory pathways."  In other words, the genes themselves may not change but mom may profoundly influence the expression of the child's genes.  This doesn't suggest that the health of the child is now predetermined.  But it does tell us that your child has now been, "dealt a bad hand."  Nat Rev Endocrinol 2009 Nov;5(11):604-10. Epub 2009 Sep 29.

"Eating for two" should take on a different light now.  The abuse of chocolate cake and twinkies will forever affect your child. 

More on Respiratory Health

Here's another piece that reinforces the ideas presented in the previous post.  In this study, researchers found that low birth weight predicts decreased lung health in adults.  The report reviews 627 adults born in Beijing between 1948-1954.  While the researchers are cautious to draw conclusions, they acknowledge the possible role of fetal programming secondary to poor maternal nutrition.

Asthma and fetal programming

The prenatal environment is very important.  That's a bit of an understatement.  It is absolutely instrumental in programming the health of your child for the rest of his/her life. Although I highlighted vitamin D, B12 and probiotics in my previous posts, we have to keep the larger picture in mind.  There is no single 'magic' nutrient that will optimize your child's health.  Here's a great article that talks about prenatal care in the context of asthma. 

"A large body of evidence shows that the intrauterine and early childhood environments are crucial for development of diabetes and coronary heart disease, and asthma has been increasingly included in a similar category of diseases "programmed" in utero."

The authors present evidence for breastfeeding, vitamin D consumption, essential fats, probiotics and more.  But we must acknowledge that that intrauterine environment that Mom provides during pregnancy is subject to influence from many variables.  Deciphering the "influence of diet" alone is quite difficult.  But even with those difficulties, there is enormous promise in elucidating this influence.

"Diet could modulate epigenetics, intestinal microbiota, physiological development, airway remodeling, and immune maturation – factors highly relevant to the etiology of asthma."

If we understand there is power behind a healthy diet in determining the child's risk of asthma, diabetes and heart disease, could the same be true of many other diseases?  It is likely.

Where does that leave a pregnant Mom?  Moms, you have a huge influence over your child's lifelong health.  These next two years set the tone for the rest of his life.  These years... you don't get back.

Probiotics

Do probiotics help prevent eczema in high risk infants?  In a recent study, 112 pregnant women with a family history of allergic disease were assessed and some were given probiotics during late pregnancy and 6 months after delivery.  Infant of mothers in the placebo group had nearly twice incidence of eczema.  In other words, probiotics seem to help prevention of eczema.  The authors conclude,  

"Prenatal and postnatal supplementation with a mixture of B. bifidum BGN4, B. lactis AD011, and L. acidophilus AD031 is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life."

If you are pregnant, it may be wise to take probiotics in addition to maintaining a health diet.

Mom's Vitamin B12

A November 2009 paper explored the relationship between maternal nutrition and the child's health.  The authors state, "low maternal vitamin B12 status predicted increased adiposity and insulin resistance in the children."  This is noteworthy because adiposity (being fat) and insulin resistance are very common among kids.

Another study looked at maternal vitamin B12 and cognitive function in kids. The researchers examined pregnant women's vitamin B12 levels and assessed cognitive performance many years later; when the children were age 9.  The children born to mothers with the lowest vitamin B12 levels had the worst performance on assessments of cognitive function.  The authors suggest that "vitamin B₁₂ status during intrauterine growth could influence different aspects of brain growth and neurocognitive development." 

It is becoming clear that maternal nutrition profoundly affects fetal development.  

Mom's Vitamin D and Multiple Sclerosis

A new report finds that when Mom has a high intake of vitamin D early in pregnancy, the child has up to a 45% reduced risk of developing multiple sclerosis later in life.  By now, this kind of news is becoming common.  Mom's health has the potential to 'mark' genes for expression later in life.  We all know that genes don't change.  But Mom's diet has a profound ability to place markers along the genes (kind of like flags) to tell the body whether or not to turn on those genes.

Another study found that higher vitamin D intake during pregnancy reduced the risk of childhood asthma and allergic rhinitis.  

Some authorities suspect that low vitamin D levels negatively influence the development of the child's brain and immune system.

"Vitamin D deficiency during pregnancy may, therefore, not only impair maternal skeletal preservation and fetal skeletal formation but also be vital to the fetal "imprinting" that may affect chronic disease susceptibility soon after birth as well as later in life." Med Hypotheses 2010 Jan;74(1):71-5. Epub 2009 Aug 18.

Rethinking prenatal care

When most people think about prenatal care, we consider the obvious; stop drinking, quit smoking, eat better and take folic acid.  We've known for a very long time that folic acid helps prevent neural tube defects early on during the pregnancy.  Outside of that, medical opinion has recently evolved to include the significance of maternal intake of omega 3 fats for healthy brain development.  Most professionals recommend a general prenatal multivitamin as well.  We're going to head into a series that covers a few topics beyond the usual recommendations.

Mom's health is very important for the baby.  I know that we all know that.  But let's dig a little deeper so we start to understand the real significance of Mom's health and how far-reaching the consequences of poor health are.  Most Mom's and their doctors have as their goal; full-term pregnancy with safe delivery.  No complications during pregnancy (gestational diabetes, preeclampsia etc.) and a healthy baby with a good APGAR score.

Those are great outcome measures.  There's nothing wrong with these goals.  Quite the opposite- these goals should be a major priority and a measuring stick of success.  But is it beyond reason to hope for more? Can we actually have a goal of optimizing the neuroendocrine immune system to reduce the risk of chronic disease later in life?  The answer is yes.  But the only way to do this is by appreciating the integration of body systems.

Let's start with one paper.

"...prenatal stress (i.e. stress experienced by the pregnant mother with impact on the fetal ontogeny) has programming effects on the hypothalamic-pituitary-adrenocortical axis, brain neurotransmitter systems and cognitive abilities of the offspring"

To appreciate the significance, we need to understand the role of the hypothalamic-pituitary adrenal axis and the result of a compromise in that system.  To state it simply; Mom's stress can interfere with the child's brain development, hormone activity, neurotransmitter levels and ability to think.   These are not traditional "birth defects".  But it happens.

How many American woman have high levels of uncontrolled stress?  Do they have babies? Even with all 10 fingers and all 10 toes, have those babies been "dealt a bad hand"?  We'll continue to explore this topic.