preventing obesity during pregnancy

Nutrition and other lifestyle factors during several early periods in the lifecycle—just before conception, the months spent in utero, and the months after birth—can have profound effects on an individual’s weight at birth, during childhood, and on into adulthood. These are also potentially optimal times for intervention, for two reasons: Women may be more receptive to making lifestyle changes as they prepare to get pregnant and when they are pregnant to increase the likelihood of having a healthy baby. And after giving birth, many women are willing to make substantial changes to raise a healthy infant. Here are five key messages for women of childbearing age that could help improve their health and the health of their children, and limit the current epidemic of obesity:

  • -Strive for a healthy weight before pregnancy : Being overweight prior to falling pregnant can increase the risk of bigger baby pre disposed to obesity later on in life.
  • -Don’t smoke during pregnancy : Moms that smoke during pregnancy have a higher risk of having an underweight for age baby. However babies born low birth weight are actually at a greater risk of obesity than Babies born a healthy average weight for age.
  • -Aim for a reasonable weight gain during pregnancy : Excessive weight gain and inadequate weight gain during pregnancy ca both predispose your bay to unhealthy weight gain later in life.
  • -Breastfeed (preferably without other liquids for 4–6 months and some breastfeeding for at least 12 months) : This has sown to be protective against later onset obesity in that breastfed babies ad especially demand breastfed babies learn how to self regulate very early on. Food self regulation or intuitive eating is the best way to bring about healthy eating habits and correct weight gain later in life.
  • -Ensure infants get adequate sleep during the first few years of life : Adequate sleep is linked to better feeding habits and improved development and thus gross motor development is improved.
pregnancy-nutrition

So what would a pregnant mom eat?

Scientists have discovered that women who diet while they are pregnant could be putting their unborn children at risk of becoming obese during childhood.

It is believed that less nutrition entering the womb sends signals to the baby’s developing fat cells. It causes a chemical imbalance that can trigger weight problems in later life.

While this sounds like a contradiction, it actually makes sense and it is yet another example of how the body works and the care that needs to be taken when dieting.

Diets While Pregnant

Pregnant women often try and cut down on their fat intake in order to remain fit and healthy during pregnancy and to try and limit the amount of weight they put on.

However, it’s actually essential for mums-to-be to gain a certain amount of weight over and above that of the baby. Whilst the baby does account for some pregnancy weight gain, most of it is actually from other elements such as the placenta, amniotic fluid, fat reserves and the extra blood in circulation around the body.

As a rough guide, most women put on 8-12kg during their pregnancy and, although it sounds like a lot, a large proportion of this is shed in the delivery room.

shutterstock_64805905Eating Healthily

There’s a fine line between eating healthily and actually going on a diet. Whilst it’s obviously very important to eat a healthy, balanced diet when pregnant, it is also equally important to provide the right environment for the baby to develop.

A pregnant woman requires a greater number of daily calories – fat being an important component – so dieting while pregnant is not advisable on any level. The body is experiencing such a change in its chemical and hormonal make-up that it would be crazy for a woman to disrupt the balance by embarking on a diet at this stage in her life.

Eating for Two

The old phrase, ‘I’m eating for two’, used to cover a multitude of sins with regards to excess consumption but we’re now far more aware of nutrition and health, particularly when it comes to foetal development. Whilst there’s no need to literally double the daily food intake, most women find that they do need to eat more than usual.

Future Eating Habits

The food consumed during pregnancy can have a direct impact on the future eating habits of the unborn child, so although dieting is out, junk food should be limited. Research has shown that babies get a taste for certain foods while in the womb and a propensity for processed foods with a high fat and sugar content could be just as detrimental to future health problems as a lack of nutrients.

Today my friend and colleague, Lily Nichols, a fellow registered dietitian and certified diabetes educator, shares her insight on carbohydrate-restricted diets during pregnancy. This is a controversial topic that I believe deserves more attention and investigation, which Lily does brilliantly in the following article.

Is It Safe to Go Low Carb During Pregnancy?

With the wide adoption of low-carbohydrate diets, many people question if they are safe during pregnancy. While quite a few women use a lower carbohydrate diet to conceive (since they are especially useful for women struggling with infertility), most medical professionals discourage women from continuing this diet during pregnancy. I find it ironic that if you tell your doctor that you plan to eat low carb during pregnancy, they’ll say it’s unsafe, but if you say you plan to eat a diet based on fresh vegetables, meat, fish, eggs, dairy, nuts, seeds, and a little fruit, they’ll encourage you to stay the course. The controversy over the safety of low carbohydrate diets in pregnancy stems primarily from misconceptions around ketosis. It’s incorrect, but widely accepted, that ketosis during pregnancy is harmful to a developing baby.

When I first dove into the research, I was shocked to find that studies on healthy, non-diabetic pregnant women (eating a “regular” diet) show a marked elevation in ketones after a 12-18 hour fast, which is akin to eating dinner at 8pm and having breakfast at 8am (or skipping breakfast entirely).What’s more interesting is that pregnancy actually seems to favor a state of ketosis. Compared to non-pregnant women, blood ketone concentrations are about 3-fold higher in healthy pregnant women after an overnight fast. And in late pregnancy, metabolism shifts to a state of catabolism, making ketosis even more frequent.  Knowing this, I would expect that every pregnant woman experiences ketosis at some point during her pregnancy (particularly if she experiences nausea or food aversions!).

I find it hard to believe that our bodies would perpetuate a state of ketosis if it was truly harmful to a baby, but I continued my research into the topic. The majority of studies on ketosis are actually looking at diabetic ketoacidosis (DKA) or starvation ketosis, not nutritional ketosis (induced by eating a low amount of carbohydrates).

First, let me state that diabetic ketoacidosis is an extremely dangerous phenomenon, pregnant or not, that occurs in people with insulin dependent diabetes. This is classically due to skipping insulin shots, incorrectly dosing insulin, or taking inadequate insulin to cover unexpected elevations in blood sugar. Unlike nutritional ketosis or starvation ketosis, DKA is accompanied by unnaturally high levels of ketones from complete insulin deprivation and blood sugar levels at least three times higher than normal, which profoundly and dangerously alters the acid-base balance in the body. The blood sugar levels seen with DKA are themselves teratogenic (can cause birth defects), so this state should obviously be avoided by pregnant women. Some studies have suggested the metabolic effects of diabetic ketoacidosis may harm fetal brain development

However, to assume that all ketosis is harmful to a developing baby is illogical. For example, nutritional ketosis (the type of low level ketosis sometimes experienced on a low carbohydrate diet) is accompanied by normal blood sugar levels, blood ketones at very low levels (in general, thirty-fold less than what’s seen in diabetic ketoacidosis), and normal acid-base balance in the blood. So if a woman eats a lower carbohydrate diet during pregnancy, she might experience ketosis from time to time, but it’s not anywhere close to ketone levels induced by DKA in a pregnant woman with uncontrolled diabetes. Even if a woman tests positive for urinary ketones, it’s highly unlikely her blood ketone levels will be elevated. Studies on pregnant women who test positive for urine ketones rarely have detectable levels in the blood.

Despite all the medical warnings about ketones “harming the fetus”, it turns out the fetal brain actually gets approximately 30% of its energy from ketones.In fact, ketones are used by the growing fetus to synthesize a variety of essential cerebral lipids, which perhaps helps explain why ketosis is more common in the third trimester. And get this: Ketones are so important for fetal development, that researchers believe the fetus manufactures its own ketones. Umbilical venous blood samples (fetal blood supply) indicate significantly higher ketone concentrations compared to maternal levels in healthy pregnant women in their second and third trimesters.

So although the fetus requires glucose for growth, it also requires ketones. Either fuel provided in excess is harmful to the developing fetus, but as long as a mom is consuming enough calories and maintaining normal blood sugar levels, the baby will get just the right mix.

Given all of this information, I’ve changed my stance on the recommended carbohydrate levels for pregnant women and believe that it is safe to go low carb during pregnancy – at least lower than the arbitrary “minimum” of 175g per day suggested by most dietitians.

Now before you cut out all carbs, know that there are a variety of carbohydrate foods that pregnant women should continue to eat, including vegetables, fruit, nuts, seeds, and if they are tolerated, dairy and legumes. Eating fewer carbohydrates generally means women will eat less refined grains, junk foods, and added sugars, leaving more room for nutrient-dense foods that provide a growing baby with essential nutrients.