Importance of a healthy food pattern during pregnancy
High food quality, together with adequate macro- and micronutrient intake in pregnancy, is crucial for the health status of the mother and child. Recent findings suggest that it could also be beneficial or harmful in the context of the well-being of the whole future population. According to the developmental origins of health and disease hypothesis, most conditions that occur in adulthood originate in fetal life. Moreover, some epigenetic events, modified inter alia by diet, impact more than one generation. Still, the recommendations in most countries are neither popularized nor very detailed. While it seems to be important to direct diet trends towards a healthier lifestyle, the methods of preventing specific disorders like diabetes or asthma are not yet established and require further investigation.
Composition of the maternal diet—quality
Specific recommendations exist for different types of nutrients in pregnancy. They differ in some points according to both the eating tradition and nutrition status of the population. WHO antenatal standards paper provides 39 recommendations related to 5 types of interventions. The healthy eating and physically active style of life is promoted to prevent excessive gestational weight gain (GWG). In the undernourished population, balanced energy and protein intake are recommended to prevent LBW, SGA, and stillbirths. Doses of iron and folate supplementation are given with possible daily or intermittent routine. Supplementation of vitamin A is suggested to be restricted only to areas where vitamin A deficiency is a substantial public health problem. Recommendation of calcium supplementation is limited to population with low-calcium intake. Vitamin B6, zinc, multi-nutrient supplements and vitamin D supplementation are not advocated as routine procedure. Avoiding of caffeine is suggested for women with high consumption. Canadian consensus highlights the need of the uptake of nutrient-dense and energy-appropriate food with moderate increase of energy intake during pregnancy. Concern is given to GWG, adequate folate, iron, choline, omega-3 fatty acid and iodine input, as well as avoiding or limiting specific food which contains bacteria or methyl mercury and alcohol. German National Consensus is quite detailed in different aspects of diet in pregnancy. In the first paragraph, the difference between slightly increase of energy needs in comparison to a much greater increase of vitamin and minerals is highlighted. According to these requirements, nutrient-dense food eating, regular meals and regular exercises together with moderate GWG are recommended. The specific concerns exist for obese pregnant women for whom the standards of care and weight lose still are not well established, vegetarian nutrition with possible supplementation of iron and DHA and vegan where specific medical counselling is required due to diet deficiency of many nutrients .Italian Consensus differs a little in the points according to energy input and protein intake during pregnancy, where specific amounts are recommended in the particular periods. The emphasis is put on the protein and fat composition, iron supplementation, as well as iodine and calcium adequate provision.
Both the quantity and the composition of protein are important in the context of diet quality. In a rat model, protein deficiency in pregnancy results in decreased birth weight, decreased heart weight, increased heart rate and increased systolic blood pressure .In general, animal protein is of higher quality than vegetable protein, suggesting that meat should be the main source of protein in pregnancy, but mixing different types of vegetables increases the quality of plant protein substantially.
Nevertheless, it should also be considered that specific types of plant diets, such as vegetarian and vegan diets, are associated with microelement and mineral deficiencies and unfavorable pregnancy outcomes. In this context, a vegetarian diet can result in vitamin B12 and iron deficiency, as well as low birth weight, whereas a vegan diet can lead to inadequate intake of DHA, zinc and iron, as well as an increased risk of preeclampsia and inadequate brain development. However, still a well-balanced ovo-lactose vegetarian diet usually enables good nutrient status in pregnancy, when supplemented with vitamin D, folic acid, iodine, iron, vitamin B12 and zinc, and, in cases of a fish-free diet, with DHA.
In contrast, consumption of red meat, which was recently revealed to be associated with cancer risk, raises some concerns over pregnancy and protein requirements, but till now, there are no any evidence that this diet can negatively impact child’s health.
Fat in the diet of pregnant woman is important mainly in context of fatty acid composition, mainly that of DHA and eicosatetraenoic acid (EPA). Omega-3 fatty acids are beneficial for brain development and proper functioning of the retina. In many studies, maternal serum DHA concentration has been associated with neuronal development and plasticity, receptor-mediated signaling, membrane fluidity and the formation of second messengers. This type of fatty acid also impacts modulation of inflammation by affecting Toll-like receptors (TLRs), related to adequate response to bacteria and other microorganisms. DHA also plays a role as a precursor of the anti-inflammatory lipid mediator RvD, which prevents the formation of proinflammatory arachidonic acid products, thus indicating the anti-inflammatory function of these molecules.
Carbohydrates are an essential component of a healthy diet. However, increased caloric intake associated with increased fat and carbohydrate consumption with adequate protein has been associated with neonatal adiposity, which is obviously unfavorable .Additionally, a preconception diet rich in saturated fat, carbohydrates and take-away food has been associated with poor asthma control during pregnancy, thus affecting child well-being .Moreover, changing the maternal eating pattern by decreasing carbohydrate load and increasing physical activity could impact the inflammation status associated with obesity in pregnant women .Similarly, modifying the protein/carbohydrate ratio can decrease the expected GWG.
Gestational weight gain
According to US epidemiological data, 69% of the population is overweight and 35% is obese. This change in prevalence is related to changes in lifestyle, but some prenatal events are also important. Gestational weight gain GWG has been shown to be a predictor of pregnancy complications and future health problems in the child .GWG is strongly associated with birth weight and values exceeding 4000 g are associated with a 2-fold greater risk of obesity later in life. Excess intake of calories during pregnancy has been associated with miscarriage, diabetes and preeclampsia in mothers and obesity and type 2 diabetes in children. This diabetic effect seems to be transgenerational. The mechanism is possibly related to placental gene-expression changes
Surprisingly, opposite effect was described by Barker and colleagues who observed that nutritional insufficiency in the fetal period reflected by LBW or SGA is also related to glucose intolerance, diabetes, hypertension and coronary disease later in life .These observations are the basis of the so-called thirsty phenotype hypothesis, which reflects the changes in the metabolism as it increases efficiency.
In Lina’s and Dina’s we do our best to assure the pregnant lady is getting the right diet plan with the right organized amount of meals , so the process of weight gain will be manageable during the 9 months , at the same time providing all fresh nutrients needed for her and the baby .
1. Alwan N, Hamamy H. Maternal iron status in pregnancy and long-term health outcomes in the offspring. J Pediatr Genet. 2015; 4:111–123. doi: 10.1055/s-0035-1556742
2. Amer MG, Mohamed NM, Shaalan AAM (2017) Gestational protein restriction: study of the probable effects on cardiac muscle structure and function in adult rats. Histol Histopathol 11883. 10.14670/HH-11-883
3. Barker DJ. Fetal growth and adult disease. Br J Obstet Gynaecol. 1992; 99:275–276. doi: 10.1111/j.1471-0528. 1992.tb13719.