When eating for two puts mother and baby at risk

Three-quarters of pregnant women in Ireland are becoming overweight by eating too much of the wrong kind of foods, which are lacking in essential vitamin D, folate and iron in the mistaken belief that they need to be "eating for two".

This puts mother and baby at increased risk of diabetes, stroke and heart disease, according to Fiona McAuliffe, professor of obstetrics and gynaecology at the National Maternity Hospital, Holles Street. The stakes are high for both mother and baby as if a mother is overweight in pregnancy it can put both at increased risk of lifelong obesity, diabetes, stroke and high blood pressure.

Women who have had children are usually heavier than women who haven't

“A lot of women are eating too much in pregnancy, I think that is an important message,” said Prof McAuliffe. “We have an increase in obesity and overweight in the population, and pregnancy is a particular risk factor. Women who have had children are usually heavier than women who haven’t, and that’s because if they have put on overweight in pregnancy they don’t lose it, they start the next pregnancy heavier, and so they put on more weight over each pregnancy.”

There is strong scientific evidence from research groups around the world that a mother’s diet leads to what is called “foetal programming”. This refers to how the mother’s intake of sugars, for example, can impact on the baby’s appetite for sugar in the womb and later life, raising the bar for what satisfies them. The more sugar a mother has in her diet, the more a baby will crave sugars.

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But, by the same token, foetal programming can be a good thing as it provides mothers with the opportunity to put their baby, and themselves, on a healthy dietary trajectory for life, which can lead to all kinds of health benefits. The NMH offers dietary advice to pregnant women, but, in many cases, it seems this advice, and its importance is being ignored, or misunderstood by some women.

The study found that those mothers who had undergone third-level education were far more likely to change their diet

One study at the NMH, called the Rolo study, where women were advised to move towards a low glycaemic index diet, suggested why dietary advice was not heeded by a significant number of pregnant women. The study found that those mothers who had undergone third-level education were far more likely to change their diet according to advice from their doctor or a dietician. This effect was the same whether the educated women lived in an area defined as advantaged or disadvantaged and the reverse was true for women with no third-level education.

Ireland lies on the 53rd parallel north, situated as far north as the southern part of Alaska, so it's not a surprise that we don't get enough sunlight here. This is relevant and important for pregnant women because sunlight is required to produce vitamin D in the skin, particularly in the winter months.

The alternative is to get vitamin D in the diet, but the main source is oily fish, which is not a major constituent of many people’s diet here. This means that the blood levels of pregnant women are often low in vitamin D, which is important because vitamin D is required to ensure that mother and baby develop strong bones. There is also research indicating that the baby’s of pregnant women with a diet low in vitamin D are more likely to be overweight at the age of two.

These women, and all women in Ireland, are advised to take a five-microgram vitamin D supplement every day

In the last 10 years in Ireland there has been an increase in rickets, a condition which was last seen here, on any scale, back in the 1920s and 30s. This is because of the arrival of new populations of darker skinned women that are not taking in sunlight because their skin is covered for cultural reasons. These women, and all women in Ireland, are advised to take a five-microgram vitamin D supplement every day, while in the UK the recommendation is 10 micrograms.

The main source of folate is folic acid in vegetables and many people, including pregnant women, have a diet lacking in folic acid. The baby’s spine develops very early in pregnancy, and its development is complete often around the same time a woman finds out that she is pregnant. If, at that time, the woman doesn’t have sufficient folate in her diet, her baby is at increased risk from spina bifida. This means that it is important to plan a pregnant and to start on a diet which includes sufficient folic acid at least three months before becoming pregnant.

It is extremely hard to get sufficient folate from a diet, as it would require a woman to literally eating bucket loads of broccoli or spinach each day to get the 400 micrograms required. A dietary supplement is the way to go here, and this should be taken daily through the first three months of the pregnancy.

As the baby grows, the mother's blood volume must increase by two or 2.5 litres, and making all of that extra blood will drain her iron reserves. Also, mum has to make a placenta, which also drains her available iron. Another factor is breast feeding, and given that the World Health Organisation recommend that the mother breastfeeds for six months, this also puts demands on her iron.

It is highly unlikely that the mother will be able to get the amount of iron she requires from diet alone, as again, it would require a big increase in her intake of red meat, the primary source or iron, as well as darker poultry meats, and salmon and oily fish. The simple answer here is in dietary supplements of iron, but there are some dietary strategies that can help to make up the deficiency too.

Pregnant women are less likely to sit down to a formal meal as pregnancy progresses

“There are two types of iron, the one that comes in your meat and the one that comes in things like your veg; that’s your non-heme iron,” said Eileen O’Brien, clinical nutritionist and PhD candidate at the NMH. “If you take that with vitamin C it increases its absorption and it is easier then to take it and to use it in the body. If you had your Weetabix in the morning, which is fortified with iron, have it with some oranges, berries, fruits, to give that Vit C that will help to absorb that as well,” O’Brien said.

Pregnant women are less likely to sit down to a formal meal as pregnancy progresses, and snacks become more attractive as the womb gets larger. There are a range of healthy snacks such as oak cakes, an apple, banana, oat biscuits, a slice of toast with peanut butter, a handful of nuts or seeds and wholegrain crackers. These should be taken in conjunction with plenty of water, particularly towards the latter end of pregnancy when constipation can become an issue.

“We are not encouraging pregnant women who feel hungry to not eat,” said Prof McAuliffe. “They should eat regularly, but the main problem is that they are eating too much. They think they are eating for two, but they are not really.”