Nutrition for Pregnant & Breastfeeding Women

Caring for two takes it out of your body. During pregnancy and breastfeeding, women’s nutritional requirements increase dramatically to cope with extra demand. There is also considerable variation in the types of nutrients required by mother and child during this exciting period. Foetal development can be less that optimal if certain nutrients are not available during specific sensitive windows of development [1], or if drugs or alcohol are consumed in significant amounts. Accordingly, pregnant women should aim to enjoy a balanced diet which includes food from each of the following groups on a daily basis: dairy products, fruit, vegetables, fish, meat, eggs, fat and carbohydrates. Maintaining a diet during pregnancy that draws from each of these nutritional groups should allow women to obtain all the nutrients they require to promote healthy child development. In addition, the nutrients below are particularly important.

Iodine

Women’s iodine requirements are significantly increased during pregnancy because mothers synthesise approximately 50% more iodine-containing thyroid hormone, some of which is transferred to the foetus. [1] Renal losses of iodine are also increased. [2] Iodine is found in high levels in seafood, particularly shellfish. Studies have shown that in areas of the world where seafood does not feature regularly in the diet, maternal iodine deficiency can negatively effect foetal and childhood cognitive developing, lowering children’s IQ by an average of 12 points. [1, 3]

The time frame during which inadequate amounts of iodine in the maternal diet may impact adversely upon foetal development is relatively large. While providing adequate iodine in mid-late pregnancy can improve infant cognitive development, greater benefits are seen when iodine is consumed at appropriate levels before or during early pregnancy. [1, 3]

The most common method of ensuring pregnant mothers receive dietary iodine is universal salt iodisation. However, if access to iodised salt is not available, the World Health Organisation recommends that iodine supplements be taken. [1, 4]

Omega-3 Fatty Acids

Omega-3 polyunsaturated fatty acids are considered to be essential fatty acids – they are required for human health, but cannot be manufactured by the body. It is therefore necessary to obtain these acids from food, with fish (particularly fatty fish such as salmon, tuna, herring and mackerel) providing an excellent source.

There are three key types of omega-3 fatty acids that are used by the human body: alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

DHA and EPA are particularly important during pregnancy and breastfeeding because they are the primary omega-3 fatty acids required for foetal brain development. [1] As is typical for human cells, the internal structures of the most common type of brain cell (neuron) are contained within a fluid mosaic, phospholipid bilayer membrane. The phospholipid bilayer is polarised. The head of each phospholipid molecule is hydrophilic (water-loving), while the phospholipid tail is hydrophobic (water-hating). Not only does this relative difference in electron charges enable the double-membrane to maintain its structure and coherence – it is just fluid enough to allow certain proteins and substances to pass into and out of the cell’s internal environment. (See Figure 1)

Each cell contains a number of receptors, proteins, and enzymes within its phospholipidmembrane. Depending on the particular conditions of the moment, more fluid membranes readily remodel themselves in order to bind with different receptors and enzymes. The positioning of lipids, cholesterols, receptors and other proteins contained within the membrane can be rapidly reorganised to optimise cellular function. That is, the more readily cellular membranes can remodel themselves to suit their environment, the better they will work.

The omega-3 polyunsaturated fatty acids DHA and EPA are both attached to larger phospholipid molecules in the cellular bilayer via esther chemical bonds. Saturated, monounsaturated (omega-9) and polyunsaturated (omega-6 and omega-3) fatty acids all interact within the phospholipid bilayer, with membrane fluidity being determined by the net outcome of all electron densities. Carbon-carbon double bonds have a relatively high electron density, and therefore impart a higher level of fluidity to the membrane. DHA (6 double bonds) and EPA (5 double bonds) are the most highly fluidising of all major membrane fatty acids. Therefore, the greater the amount of DHA and EPA contained within a membrane, the greater its fluidity and dynamic properties.[5] Ultimately, the more omega-3 fatty acids consumed by a mother during pregnancy, the more EPA and DHA that can be incorporated into the developing infants’ brain cells, thereby promoting optimal cognitive function.

The window within which most dietary DHA and EPA may be transferred into infant brains to optimise cognitive development spans from mid-pregnancy into the first year of life. [1, 6] However, omega-3 fatty acids are most rapidly accumulated in the infant brain during the last trimester of pregnancy and the first year of life. [1] It is therefore particularly important for pregnant and breastfeeding women to ensure they are obtaining adequate amounts of omega-3 during this period by incorporating more fish into their diet and seeking reputable omega-3 supplements.


Choline and Folate

As nutrients, choline and folate are metabolically interrelated. Folates are important for energy production, and are essential cofactors in a number of key biochemical reactions. [1] Choline is involved in cell membrane synthesis, methylation and the biosynthesis of several neurotransmitters. [1, 7]

Folate has been proven to significantly reduce the likelihood of children being born with neural tube defects (such as spina bifida) when obtained in adequate amounts by pregnant mothers. [8] Indeed, rates of neural tube birth defects fell by 26% in the US following the introduction of cereal grains that were enriched with 140μg folic acid per 100g of grain. [1] While the effects of choline during pregnancy are less well understood than those of folate, it is known that inadequate amounts of choline in the maternal diet may also result in the disruption of normal foetal neural tube closure. [1, 9] Animal studies [10] have also shown that mothers who consume extra choline give birth to offspring that perform better on memory tests, indicating that choline’s beneficial effects on neurogenesis and neural optimisation are significant. [1]

All prenatal vitamin supplements are now fortified with folic acid, as are many commercially available breads and juices. Expectant mothers should also seek to include choline-rich foods such as eggs and liver in their diets, or seek to obtain adequate amounts of choline from supplementation.

Iron

Pregnant mothers also require more iron that usual in order to produce the additional blood required to supply nutrition to the placenta and embryo. Good dietary sources of iron include lean red meat, lamb’s fry, green vegetables such as spinach and broccoli, muesli and wholemeal bread.

Iron is more easily absorbed if taken in conjunction with vitamin C, either in the form of a supplement or contain within citrus fruit (such as orange or pineapple) or juice. Additionally, excessive amounts of caffeine can interfere with the body’s ability to absorb iron.

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