August 13, 2018
(working title)
Maternal Nutrition in Preparation for Pregnancy
Maternal health is critical to the growth and development of a newborn. When a mother is balanced nutritionally, the likelihood of a healthy newborn physically and mentally is high. The modern era has added a host of scientific evidence to support these beliefs.
Let's look at the development of infants as it relates to maternal health. In the Journal Pediatrics from April 2017, a team of doctors wrote a lengthy supplement
called the Research gaps at the intersection of pediatric neurodevelopment, nutrition, and inflammation in low resource settings. (Raiten et. al. 2017) This review is comprehensive and goes through reams of data on what happens when a mother is deprived of macro- and micro- nutrients.
The results are simple to discern. When we deprive a mother of critical nutrients the child will suffer neruo-developmental and inflammatory diseases.
"Accumulating data from animal and human studies indicate that the prenatal environment plays a significant role in shaping children's neurocognitive development. Clinical, epidemiologic, and basic science research suggests that two experiences relatively common in pregnancy - an unhealthy maternal diet and psychosocial distress - significantly affect children's future neurodevelopment." (Osterholm et. al. 2013)
Let's look at some indivdual data. Maternal malnutrition is highly associated with worse infant outcomes globally. In the British Medical Journal, Dr. Neovius looked at 1.2 million live births and found that "Risks of any major congenital malformation increased with maternal overweight and increasing severity of obesity." By definition, these mothers are calorically overloaded but nutritionally deprived.(Neovius et. al. 2017) The problem of maternal obesity while pregnant is at epidemic proportions. In 2014, according to CDC statistics, more than 50% of pregnant women were overweight or obese. (Gregory E. et. al. 2016)
How about the other side of the weighted scale? Maternal depression and undernutrition is associated with poorer neurological outcomes in offspring and there are critical times where this risk increases. The first trimester is especially important. (Jensen et. al. 2013) (Nelson et. al. 2010)
The mechanisms underpinning these poor outcomes in children are likely related to the thousands of biochemical and epigenetic pathways that are negatively affected by micronutrient and macronutrient supplies. These mothers are getting the wrong types of macronutrients with increased volumes of inflammatory refined carbohydrates and processed fats as oils and modern corn fed farmed animals. While these consumed foods are calorically dense, they are frequently poor in nourishment.
There is a sweet spot for optimal childrearing and delivery. It is not overweight or conversely underweight, but it also requires adequate micronutrients.
The vast majority of the globe battles undernutrition as it relates to pregnancy. The United States and Europe are unfortunately battling overweight and frank obesity.
In an obese individual, fat is deposited in large volumes through the chronic exposure to excess calories, obesogenic chemicals and host genetics. The excessive consumption of refined carbohydrates as sugar laden beverages and foods gets stored by the human liver and fat cells around the organs and body. These fat stores are metabolically active producing hormones, immune cells and protein signals that can affect a pregnancy.
The negative effects of the excessive metabolically active fat cells are maternal hypertension, diabetes, premature delivery, spontaneous abortions, still birth, failure to progress delivery, blood clots and infections. (Schulkin et. al. 2008)
How about the risks of maternal obesity on the newborn?
Compared with offspring of normal weight mothers the risk of any major congenital malformation among the offspring is significantly greater. The frequency of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers. (Neovius et. al. 2017)
Aside from just calories needed, micronutrients including vitamins and minerals are necessary for proper cellular function for mom and baby and can be unfortunately low in both over and underweight mothers. (Berger et. al. 2014)
The research is clear that maternal insufficiencies of iron, zinc, choline, folic acid, B12 and many other micronutrients are each independently associated with disease risk especially where it relates to neuro-cognition. For example, Dr. Steven Zeisel and his group out of the local research campus in Kannapolis, NC have published many papers on the effects of maternal choline on newborns (Zeisel 2006).
A highly consumed poor quality American fast food and heavily processed diet is missing the basic nutrients for an optimal outcome. The fetal brain is growing rapidly with over 100,000 new cells per minute at its peak. (Lancet Executive Summary 2013) If a mother consumes a calorie rich and nutrient poor diet during critical periods of brain development, especially the first trimester, the outcome is suboptimal or worse.
Over the next few sections, we are going to look at the maternal microbiome, macro and micronutrients individually and then prenatal supplements.
Eat healthily for your newborn,
Dr. M
See the Pediatrics picture on neurodevelopment at this link
Pediatrics Research Gaps Summary Article
J of Child Psychology and Psychiatry Osterholm Article
British Medical Journal Neovius Article
CDC Statistics Gregory Article
The British Journal of Psych Jensen Article
Child Development Nelson Article
PLOSone Berger Article
Annual Review in Nutrition Zesiel Article
Lancet Maternal and Child Nutrition Article
Reviews in Obstetrics and Gynecology Schulkin Article
