THE average Irish woman is overweight beginning her pregnancy and postnatal weight retention can place many women at risk of obesity in the long-term.
That’s according to Louise O’Mahony of the dietetic department in Cork University Maternity Hospital (CUMH), who, along with colleague Linda Culliney, the National Maternity Hospital, The Rotunda and The Coombe, last week released new pregnancy nutrition guidelines to help women at this important time of their lives.
These updated guidelines are designed for healthcare professionals to share with women, as Louise says mums-to-be are motivated to make positive changes in their lives.
“Nutrition at the time of conception and during pregnancy impacts immediate and long term maternal and infant health.
“A pregnant woman’s nutrition influences not only her own health but also the growth and development of her baby, and forms the foundation for a child’s life-long health,” said Louise.
“Pregnancy is the ideal opportunity to help women to achieve a balanced nutritional intake, when motivation levels are high. Supporting our women to achieve the best nutritional intake possible before, during and after pregnancy may have lasting effects for the woman’s own health and that of her whole family into the future,” she said.
The guidelines, updated from 2013, among other things, advise pregnant women to abstain completely from alcohol and then for at least the first month of breastfeeding until supply is established.
“The very occasional glass of wine is unlikely to do any harm but it is safer to avoid completely,” she said.
They also give clarity on caffeine.
“We would commonly see women taking high amounts of caffeine in pregnancy. High intakes of caffeine can increase the risk of miscarriage so pregnant women should take maximum two to four cups tea or two cups instant coffee or one filtered coffee per day.
“Women should also include intake of chocolate, cola, energy drinks, etc, in their total caffeine count.
“Lactating women are advised to limit caffeinated drinks to no more than 2-3 cups daily. Infants do not make the enzymes required to breakdown caffeine until approximately three months of age so babies taking excessive caffeine via breastmilk may have poor sleep and become irritable,” she advised.
Another common issue Louise and her colleagues see is women not starting their folic acid supplementation before pregnancy.
“All women of reproductive age are advised to consume 400g of folic acid per day as a supplement. An individual folic acid supplement or a pre-pregnancy/ pregnancy multivitamin will provide this.
“Folic acid in pregnancy helps prevents conditions such as spina bifida and other neural tube defects (NTDs). Folic acid is most important in the months before becoming pregnant and the first 12 weeks of pregnancy but often women won’t start their folic acid until their booking assessment at the hospital which is usually past the important window of opportunity.
“We also commonly see obese women that are not prescribed a high dose of folic acid in pregnancy — due to increased risk these women should be on high dose (5mg) of folic acid which they will need to get a prescription for from their GP,” she said.
Eating for two, while a cliché, is another issue they deal with. The weight gain for an average woman with a single pregnancy and a healthy BMI going into pregnancy is approximately 12kg (or 26lbs).
Louise said women need to think more about quality than quantity.
“On average, a woman only needs approximately 500 calories more in the third trimester of pregnancy and these calories should generally be coming from nutrient dense foods that help provide all the extra demands on the mother’s reserves, e.g. from fruit or dairy.
“Gaining too much or too little weight in pregnancy can increase the risks for both the baby and the mother. It is not uncommon for us to see women in pregnancy who may have gained more weight than recommended and yet are malnourished because their energy is coming from food sources that are not nutritionally rich,” she said.
On the flip side, weight loss is generally not recommended during pregnancy, so it is best for overweight women to lose their excess weight well before conception. Severe dieting around the time of conception is discouraged, as this may have adverse effects on the embryo.
Fertility is also decreased in both females and males who are significantly underweight or overweight so addressing concerns before trying to conceive is ideal.
Ideally women who are underweight, overweight or obese should be seen for pre-pregnancy dietary counselling in the community, Louise says.
“There is a fantastic, free community dietetic service available in Cork that most GPs can refer into, so women that are concerned before pregnancy should seek out a referral from their GP into this service.”
Cravings are definitely something they see a lot of: “Generally, I would say to a woman that unless it is a high risk food she is craving, then there is no harm in indulging occasionally in pregnancy, but consistently overindulging can lead to excess weight gain in pregnancy which in turn places the woman and her baby at higher risk of complications e.g. gestational diabetes, pre- eclampsia and large for gestational age babies.”
Exercise during pregnancy is something the guidelines encourage.
“Women with uncomplicated pregnancies should partake in at least 150 minutes per week of moderate-intensity aerobic activity, spread throughout the week. Pregnant women who were inactive before pregnancy should follow a more gradual progression of exercise, with 10 minute bouts of moderate intensity continuous exercise building up to a total of 150 minutes per week.”
After giving birth, breastfeeding has been associated with losing weight and may also decrease the likelihood of future obesity for the baby, she said.
“It may also help decrease a woman’s risk for breast and ovarian cancers as well as cardiovascular disease in later life.
“Women should be supported to achieve breastfeeding and can take advantage of the breastfeeding support services offered both within the maternity hospital and in the community during and after pregnancy. Women should again be advised to choose foods with a high nutrient density and quality after their baby is born, particularly if they choose to breastfeed,” Louise advised.
While that might all seem like a lot of do’s and don’ts, Louise insisted they don’t want to cause any women undue anxiety with pregnancy.
“We just want to help to make sure we optimise outcomes for mum and baby.”