Drawing Attention to Prenatal Nutrition: what you need to know

This interview was originally published in The Sherman Hub News in Lyndsay's column "Mom Talk: prenatal and parenting wellness." 

Eating well during pregnancy can make a lifetime of difference for both mother and baby. Food eaten by the pregnant person is broken down and absorbed into the bloodstream, and then passed to the fetus through the placenta and umbilical cord. The very start of a healthy body is the gestational period inside the womb.

There are basics that are quite commonly known: no shellfish, sushi or soft cheese, try not to eat too many sugary foods or drinks, do drink plenty water and eat lots of greens. There are plenty of misconceptions about nutrition during pregnancy and lots of misinformation. Unlike a pregnant woman’s primary prenatal health providers like an Obstetrician or Midwife, a Registered Dietitian (RD) is often overlooked. Yet for the health and well-being of the mother and baby, RDs are essential. According to Jacquie Reeds, MSc, RD, they are “the go-to source for nutrition information as the College of Dietitians of Ontario ensures that RDs provide only accurate information.”

“RDs can help in complex health situations where someone has multiple food allergies or health concerns, or can help with eating on a strict budget or even meal planning and basic
nutrition education. Everyone has different needs with regard to nutrition and it is the role of the RD to help address these needs.”

Jacquie Reeds is a local resident and mother of three - a five year old, three year old, and a four-week old. She has a Masters of Science and is a Registered Dietician. We did a ‘Question & Answer’ with Reeds to get some very important details about nutrition during pregnancy and its effect during pregnancy and afterward for mother’s and baby’s bodies (i.e. continued growth and sustenance for breastfeeding).

Q & A with a Registered Dietician

Q: How is pregnancy affected by nutrition?
A:  More  and  more  research  is  published   each  year  which  points  to  prenatal   (pregnancy)  nutrition  as  being  one  of   the  most  critical  factors  influencing   childhood  and  adult  health.  Certainly,   we  have  understood  for  quite  some   time  that  certain  nutrients  are  required   to  promote  healthy  fetal  growth   (ie.  Adequate  folic  acid  intake  pre-­ conception  and  in  the  first  12  weeks  of   pregnancy  has  been  shown  to  reduce   the  risk  of  neural  tube  defects).  It  seems   that  the  mother's  body  makes  fetal   growth  and  development  a  priority   in  that  the  required  nutrients  are   offered  up  to  the  developing  fetus  first;   however  if  nutrition  is  not  sufficient,   the  fetus  will  also  suffer.  One  of  the   most  well  known  examples  of  this  is  a   low  overall  nutritional  intake,  which   can  result  in  low  birth  weight.  All  in  all,   the  better  the  nutrition  of  the  mother,   the  better  the  outcome  for  both  infant   and  mother.

Q: In what ways does the pregnancy benefit from proper nutrition?
A:  Proper  nutrition  in  pregnancy  has   been  linked  with  a  number  of  benefits,   including  better  overall  health  for  the   infant  and  mother.  More  specifically,   proper  prenatal  nutrition  promotes   optimal  brain  and  bone  development,   better  birth  weights  (which  predict   better  overall  health  outcomes  for   baby),  and  a  better  prenatal  experience   for  the  mother.

Q: In what ways could it suffer? What foods/nutrients are most important and from what sources?
A: There  are  a  number  of  very   important  nutrients  in  pregnancy:     
Calcium  -­  sources  include  milk,  cheese,   yogurt,  fortified  soy/rice/cashew/ almond  (and  other  alternative)  milks/ beverages,  tofu,  almonds,  broccoli...   Calcium  is  important  for  bone   development  in  the  fetus,  and  as  many   have  heard,  the  mother's  calcium  status   can  suffer  at  the  expense  of  ensuring   adequate  calcium  delivery  to  the  fetus   (we  have  all  heard  about  women  with   many  children  suffering  from  poor   dental  health,  which  could  be  a  result   of  both  low  calcium  and  dental  care).  

Vitamin  D  -­  fortified  milks  (cow/rice/ almond/soy/cashew/etc),  salmon  ...   While  Health  Canada  recommends   the  same  amount  of  vitamin  D  for   adults  whether  they  are  pregnant   or  not,  it  is  important  for  calcium  
absorption  and  balance  and  thus  bone   development.  Most  prenatal  vitamins   provide  400  IU  of  vitamin  D;  however,   I  recommend  pregnant  women  also   take  an  additional  1000  IU  vitamin  D3   supplement  each  day.  

 Folic  Acid  -­  fresh  fruits  and  vegetables,   especially  oranges  and  leafy  greens.   Folic  acid  has  even  been  added  to   Canadian  grain  products  such  as   breads,  cereals  and  pasta.  Women  of   childbearing  age  are  encouraged  to  take   a  folic  acid  supplement  (1  mg)  every   day  to  help  promote  proper  neural   tube  development  in  the  event  that   they  become  pregnant.  In  some  cases,   a  physician  will  recommend  a  higher   dose,  such  as  5  mg  daily.   

Vitamin  B12  -­  milk  and  alternatives   and  related  products  (eg.  Cheeses,   yogurts,  etc.),  meat,  fish,  poultry,   fortified  soy  products,  eggs.  While   vitamin  B12  does  not  usually  receive  a   lot  of  attention  in  prenatal  nutrition   articles,  I  mention  it  because  high   intakes  of  folic  acid  can  hide  B12   deficiency.  It  is  also  worth  mentioning   because  it  is  important  for  nerve   health  and  development  and  because   B12  is  found  in  protein-­rich  foods   and  protein  is  important  for  growth   and  development.  Routine  prenatal   blood  work  does  not  include  a  check   on  vitamin  B12  status,  but  I  always   recommend  checking  serum  vitamin   B12  status,  and  if  levels  are  less   than  300  pmol/L,  I  recommend  a   supplement.  

 Iron  -­  meat,  fish,  poultry,  fortified   breakfast  cereals  and  soy  products,   legumes,  pumpkin  seeds,  ...   Iron  is  important  in  pregnancy  because   it  is  a  key  ingredient  in  red  blood   cells  which  are  being  mass  produced   to  provide  an  adequate  blood  supply   for  both  mother  and  baby.  Brain   development  is  also  aided  by  adequate   maternal  iron  intake.  This  is  why   most  prenatal  supplements  contain   approximately  27  mg  of  iron.   Serum  ferritin  is  supposed  to  be   checked  in  all  pregnant  women  to   ensure  adequacy  and  determine  if   there  is  a  need  for  additional  iron   supplementation.   
 
Omega-­3  Fatty  Acids  (specifically  EPA   &  DHA)  -­  Salmon,  mackerel,  rainbow   trout,  walnuts,  ...   EPA  and  DHA  are  required  for  brain   development;  however,  these  important   nutrients  are  not  always  discussed  with   pregnant  women.  In  general,  eating   fish  two  to  three  times  a  week  will   provide  enough  EPA  &  DHA.  Someprenatal  supplements  provide  EPA   and  DHA.  If  someone  is  looking  for  a   separate  supplement,  choose  one  with   1000  mg  of  combined  EPA  and  DHA.   For  those  looking  for  information   on  the  safety  of  a  variety  of  fish  in   pregnancy,  search  online  for:  A  Guide   To  Eating  Fish  For  Women,  Children   and  Families.

More and more research is published each year which points to prenatal (pregnancy) nutrition as being one of the most critical factors influencing childhood and adult health.

Q: In what way is nutrition important for the breastfeeding mom after the baby is born?
A:  Nutrition  in  the  breastfeeding   mother  is  nearly  as  important  as   prenatal  nutrition.    All  of  the  nutrients  important  in   pregnancy  are  also  important  for   lactation,  though  some  of  the  rationale   differs.  For  example,  while  iron   continues  to  be  important,  it  is  not   directly  for  the  infant's  sake.  There  is   not  much  iron  in  breast  milk;  however,   it  is  important  for  the  postpartum   mother  to  replenish  her  iron  stores  for   overall  health,  but  also  for  energy.  
 Vitamin  D  can  pass  into  breast  milk,   but  to  meet  the  infant's  needs,  the   mother  would  need  to  take  more  than   the  recommended  supplemental  dose,   which  cannot  be  widely  recommended.   Rather,  it  is  better  to  supplement  the   infant  directly  with  a  dropper-­style   liquid  vitamin  D  supplement.      Without  focusing  on  the  details  of   each  nutrient,  nursing  mothers  will   want  to  drink  plenty  of  fluids,  include   calcium-­rich  foods  throughout  the  day,   and  include  protein-­rich  foods  (meat/ fish/poultry/nuts/seeds/legumes/ tofu/eggs/etc.).

Q: What are some common misconceptions you've noticed when it comes to prenatal nutrition and eating?
A:  One  of  the  most  common   misconceptions  with  regard  to  prenatal   nutrition  is  the  notion  that  a  pregnant   woman  is  "eating  for  two."  Obviously   there  is  a  grain  of  truth  in  this;   however,  that  second  person  is  really   quite  small,  and  thus  overall  calorie   needs  do  not  increase  by  more  than   approximately  300  calories  per  day  in   a  singleton  pregnancy.  Realistically   for  those  who  have  adequate  access   to  food,  they  will  do  fine  if  they  eat   regularly  throughout  the  day  and  eat   health-­promoting  real  foods  (ie.  avoid   processed,  boxed  foods)  according  to   hunger  and  contentment  (satiety).    
   Interestingly,  the  general  consensus  is   that  a  breastfeeding  mother  has  greater   calorie  needs  than  a  pregnant  woman.   Again,  eating  based  on  individual   hunger  and  satiety  is  advised.   

Q: What are the best resources online and in the community to find out more about prenatal nutrition?
   A: Registered  Dietitians  (RDs)  are  the   go-­to  source  for  nutrition  information   as  the  College  of  Dietitians  of  Ontario   ensures  that  RDs  provide  only  accurate   information.  Hamilton  residents   whose  family  physicians  are  members   of  the  Hamilton  Family  Health  Team   (or  the  Stone  Church  or  McMaster   Family  Health  Teams)  have  OHIP-­ covered  access  to  RD  consultation   through  their  family  doctors'  offices.   There  are  also  RDs  available  to  North   End  residents  at  North  Hamilton   Community  Health  Centre.      At  any  time,  people  can  visit   eatrightontario.ca  to  access  nutrition   information  provided  by  Ontario  
RDs.  Eat  Right  Ontario  also  provides   free  email  or  phone  consultation  with   Ontario  RDs.
Hamilton  Public  Health  Services  is   another  trustworthy  source  of  nutrition   information,  as  they  too  employ  RDs.     
For  reliable  information  about   the  safety  of  food,  beverages  and   medication  in  pregnancy  and  while   breastfeeding,  access  Mother  Risk  -­  a   website  and  hotline  developed  by  Sick   Kids  in  Toronto.  
   There  are  other  people  and   professionals  in  the  community  who   may  be  knowledgeable  about  nutrition;   however,  be  critical  and  careful  if  they   are  not  trained  and  current  RDs.
  
Q: How can someone determine if a resource is accurate?
A:  Registered  Dietitians  are  required  to   share  only  evidence-­based  information.   Outside  of  seeking  out  RD  counsel,   people  should  use  their  own  critical   thinking  skills  to  determine  whether   or  not  they  should  trust  nutrition   information.  If  someone  is  unsure,  one   can  contact  EatRight  Ontario  online   or  by  phone  (1-­877-­510-­5102)  to  double-­ check.