Pregnancy nutrition: Are there long-term health consequences?

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Recently, researchers of 36 institutions from the United States, the European Union and Australia collaborated on the “Early Nutrition Research Project” to review the impact and long-term health outcomes of pre-pregnancy, pregnancy and post-pregnancy nutrition along with the diet of infants and children. Furthermore, they updated the recommendations for optimized nutrition for affluent populations1.

The food and nutrition before, during and after pregnancy may not seem to have long-term health benefits to most. However, it bears the greatest significance in the health of not only the mother but also the child at reducing the risk of non-communicable diseases, such as diabetes, obesity and cardiovascular disease2.

International Federation of Gynecology and Obstetrics (FIGO) recommends the adoption of various healthy dietary habits from early childhood and adolescence to aid in healthy pregnancy. These include physical activity and exercise, modification of diet and lifestyle, weight loss and normal BMI, restraint from alcohol, tobacco and recreational drugs, screening of chronic diseases, and supplementation of folic acid and other supplements (iron, calcium, vitamin B12 and D, zinc, iodine, polyunsaturated fatty acids), as required3.

A systemic review involving 12 RCTs conducted on 2713 pregnant women concluded that pregnant women with normal BMI had reduced chances of gestational weight gain (mean difference -1.25 kg; 95% CI: -2.39 to -0.11 in 446 women) after antenatal dietary and lifestyle modification4.

The energy intake in the first, second and third trimester should be increased by 85, 285, 475 kcal/day, respectively unless there are multiple pregnancies, high physical activity and malabsorption/infection, in which case the energy intake should be increased further3. Since physical activity tends to be reduced in the third trimester; the dietary intake should be increased by not more than 10% in the third trimester as compared to preconception needs5.

There is still a lack of global consensus on optimal gestational weight gain; however, it is widely accepted that extreme gestational weight gain leads to retention of weight after pregnancy that increases the risk of unfavorable health consequences including hypertension, diabetes and stillbirth in subsequent pregnancies6,7. Thus, the quality of pregnancy food, which is rich in critical nutrients, is more important than the quantity of food.

Pregnancy nutrition should be rich in micronutrients, such as folic acid, iron, vitamin D, B12, A and iodine along with their supplementation in nutrient-deficient pregnant women1,3.

Food consisting of green leafy vegetables, legumes, cabbage, tomatoes, oranges, and whole-grain products are rich in dietary folate; however, additional supplementation of folic acid (at least 400 ug/day) is advised before pregnancy and continued until the first trimester. Folic acid is associated with reduced risk of serious birth defects (especially neural tube defects)8,9.

Vitamin B12 deficiency leads to sub-optimal pregnancy, stunted fetal growth and brain development. Vitamin D is vital for maternal calcium homeostasis and fetal bone development. Its total intake should be in the range of 1000-2000 IU/day. Deficiency of vitamin D is associated with childhood rickets, newborn osteopenia, low birth weight, decreased bone density, neonatal hypocalcemia and cardiac failure risk11-15.

On the other hand, breastfeeding is vital to the health of an infant and it is considered the best nutrition for an infant. It is also emphasized by WHO, which recommends exclusive breastfeeding for <6 months old infants and the introduction of complementary foods in >6 months old children. Some studies reported that childhood adiposity is associated with early introduction (<15 weeks) of complementary foods16.

Pregnant women need to avoid eating for two, rather have a healthy weight and a balanced diet that is supplemented with all critical nutrients before, during and after pregnancy are recommended for long-term health benefits for both mother and her child.

References

  1. Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, de Waard M, Brands B, Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM; EarlyNutrition Project Systematic Review Group. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The EarlyNutrition Project Recommendations. Annuals of Nutrition and Metabolism. 2019;74(2):93-106.
  2. Koletzko B, Brands B, Grote V, Kirchberg FF, Prell C, Rzehak P, Uhl O, Weber M; Early Nutrition Programming Project. Long-term Health Impact of Early Nutrition: The Power of Programming. Annuals of Nutrition and Metabolism. 2017;70(3):161-169.
  3. Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, Ma RC, McAuliffe FM, Maleta K, Purandare CN, Yajnik CS, Rushwan H, Morris JL. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”. International Journal of Gynaecology and Obstetrics. 2015;131 Suppl4:S213-53.
  4. O’Brien CM, Grivell RM, Dodd JM. Systematic review of antenatal dietary and lifestyle interventions in women with a normal body mass index. ActaObstetricia et Gynecologica Scandinavica. 2016;95(3):259–269.
  5. Koletzko B, Bauer CP, Bung P, Cremer M, Flothkötter M, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Rasenack R, Schäfer T, Vetter K, Wahn U, Weissenborn A, Wöckel A. German national consensus recommendations on nutrition and lifestyle in pregnancy by the ‘Healthy Start – Young Family Network’. Annals of Nutrition and Metabolism. 2013; 63(4):311-22.
  6. Scott C, Andersen CT, Valdez N, Mardones F, Nohr EA, Poston L, Loetscher KC, Abrams B. No global consensus: a cross-sectional survey of maternal weight policies. BMC Pregnancy Childbirth. 2014; 14:167.
  7. Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S, Gillman MW. Preconceptional and maternal obesity: epidemiology and health consequences. The Diabetes and Endocrinology. 2016;4(12):1025-1036.
  8. Chitayat D, Matsui D, Amitai Y, Kennedy D, Vohra S, Rieder M, Koren G. Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update. Journal of Clinical Pharmacology. 2016;56(2):170-175.
  9. De-Regil LM, Pena-Rosas JP, Fernandez-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Systematic Review. 2015;(12):CD007950.
  10. Koletzko B, Boey CC, Campoy C, Carlson SE, Chang N, Guillermo-Tuazon MA, Joshi S, Prell C, Quak SH, Sjarif DR, Su Y, Supapannachart S, Yamashiro Y, Osendarp SJ. Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an early nutrition academy workshop. Annals of Nutrition and Metabolism. 2014; 65(1):49-80.
  11. Godfrey KM, Costello PM, Lillycrop KA. The developmental environment, epigenetic biomarkers and long-term health. Journal of Developmental Origins of Health and Disease. 2015;6(5):399–406.
  12. Bischoff-Ferrari HA. Vitamin D: role in pregnancy and early childhood. Annals of Nutrition and Metabolism. 2011; 59(1):17-21.