tag:theconversation.com,2011:/africa/topics/pregnancy-diets-5398/articlesPregnancy diets – The Conversation2018-05-02T10:45:26Ztag:theconversation.com,2011:article/953022018-05-02T10:45:26Z2018-05-02T10:45:26ZFolic acid in pregnancy – MTHFR gene explains why the benefits may differ<figure><img src="https://images.theconversation.com/files/216250/original/file-20180425-175061-ym28c4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUyNDY3Mjc0NCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfNzA3NzgwNjU2IiwiayI6InBob3RvLzcwNzc4MDY1Ni9odWdlLmpwZyIsIm0iOjEsImQiOiJzaHV0dGVyc3RvY2stbWVkaWEifSwiUkIvdzFuRldmNTE3eXZ0bi9ZNXhTZjBDY0xVIl0%2Fshutterstock_707780656.jpg&pi=33421636&m=707780656&src=7ltlrj4qNOP6w7AIm96RSg-1-0">Shutterstock</a></span></figcaption></figure><p>It’s generally recommended that <a href="https://www.nhs.uk/chq/pages/913.aspx?categoryid=54">all women should take folic acid</a>, both while they’re trying to get pregnant and during the <a href="https://theconversation.com/five-ways-to-boost-your-nutrition-before-pregnancy-76352">first 12 weeks of pregnancy</a>. This is because folic acid is considered to be very important for the development of a healthy foetus.</p>
<p>But recently, it has been claimed this “one-size-fits-all” approach may be wrong and that some pregnant women may benefit more from <a href="http://www.foxnews.com/health/2014/07/27/should-skip-prenatal-vitamins-with-folic-acid.html">alternatives to folic acid</a>. Specifically, it has been found that forms of a certain gene that vary among people, may affect how the body utilises folic acid.</p>
<p>The terms “folic acid” and “folate” are often used interchangeably to describe Vitamin B9, but they are not exactly the same. Folate is often called the natural form of vitamin B9, which is found in dark green vegetables, including broccoli and spinach and dried legumes. Folic acid is the synthetic form of vitamin B9, found in supplements and also added to processed, or “fortified,” foods. </p>
<p>By eating foods that are high in folate regularly, most people should be able to get the necessary amount (200 mcg a day). For some people though, more than this recommended amount of folate is necessary.</p>
<p>It is known that folate or folic acid is very important for the development of a healthy foetus. This is why all pregnant women and women trying for a baby are advised to take double this amount (400 mcg a day) – or even more in certain cases, to help prevent the risk of birth defects in unborn babies.</p>
<p>It would be almost impossible to get this much folate just from natural sources. That’s why folic acid is often prescribed to pregnant women in the form of supplements. </p>
<p>It is also the reason why <a href="https://www.theguardian.com/society/2018/jan/31/folic-acid-new-research-is-a-game-changer-in-push-to-fortify-british-foods">folic acid is added to grains</a> (this process is called fortification) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257747/">in many countries</a>. Recently, there has been a push to make it <a href="https://theconversation.com/heres-why-the-uk-should-fortify-flour-with-folic-acid-88354">mandatory in the UK as well</a>.</p>
<h2>Understanding the science</h2>
<p>People differ in how much folate they need and receive in their diet, and this can be corrected with supplements. But people also differ in how much folate or folic acid they need for their health – based on the activity of “the MTHFR gene”. </p>
<p>To understand why this matters, first of all we need to know a bit more about the science of how our bodies work. There are 20,000 genes in the human genome. Each of these genes provides instructions in the form of a DNA sequence for making a specific protein. Proteins play various important roles in our body: from building our cells through to making our brain function.</p>
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<img alt="" src="https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Foods high in folate.</span>
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<p>One of these genes – the MTHFR gene – provides the instructions for making the protein methylenetetrahydrofolate reductase. This protein is a key player in the complex process of converting folic acid (or folate) that we receive with foods into methylfolate, the form that our body can use. </p>
<p>The MTHFR gene is responsible for how much methylfolate is produced in the body. Our body needs methylfolate for a proper metabolism. If there is not enough methylfolate in the body, it leads to many serious health problems. </p>
<h2>MTHFR explained</h2>
<p>All people have two copies of the MTHFR gene – one copy is inherited from the mother and another copy is inherited from the father. Each copy of the gene can be normal or can have a defect – a change in DNA sequence that affects how much protein this gene can produce.</p>
<p>These defects are called mutations. The common mutation in the MTHFR gene is a single change in DNA sequence that reduces the activity of the protein produced. About 10-15% of people have both copies of the gene affected by this mutation.</p>
<p>These people have very low activity of the MTHFR protein in the body. This results into a highly reduced ability of the body to convert folic acid into a usable form and can lead to accumulation of the amino acid homocysteine – which is toxic to the body.</p>
<p>The MTHFR gene mutation has been found to be one of the factors that puts people at an <a href="https://link.springer.com/article/10.1007%2Fs10549-010-0783-5">increased risk of cancer</a>, <a href="https://www.sciencedirect.com/science/article/pii/S0378111913012869">cardiovascular disease</a>, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121147">infertility</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-2982.2007.01400.x">migraine</a>, and <a href="https://academic.oup.com/qjmed/article/90/2/111/1612940">foetal development problems</a>. It has also been found to increase the risk of depression, <a href="https://www.sciencedirect.com/science/article/pii/S0889159110005799">schizophrenia</a> and <a href="https://link.springer.com/article/10.1007%2Fs12035-016-9722-8">dementia</a>. </p>
<h2>To supplement or not</h2>
<p>A diet rich in folate is said to be particularly important for those with the mutation in the MTHFR gene. People with a mutation in the gene may be affected more if they do not receive enough folate with foods. </p>
<p>It has been shown that <a href="https://www.sciencedirect.com/science/article/pii/S0140673611608726">people with this mutation</a> are affected more in Asia than in countries that use grain fortification with folic acid – such as the US, Australia, and New Zealand. But more studies are needed to prove whether alterations in diet and use of folate supplements can be sufficient to overcome negative health effects caused by the MTHFR gene mutations.</p>
<p>Caution is also needed with high-dose supplementation of folic acid in pregnant women with different forms of the MTHFR gene as very high intake of folate may have unintended negative effects on their offspring – particularly on early brain development, as demonstrated by <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/1919923">recent human</a> and <a href="https://academic.oup.com/hmg/article/26/5/888/2856406">animal studies</a>. But ultimately, future studies are critical to determine a safe upper limit for all people – and pregnant women particularly – who have different genetic profiles.</p>
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<img alt="" src="https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of a series tied to Medicine made for you, a series by The Anthill podcast on the future of healthcare and how it could soon get a lot more personal. <a href="https://theconversation.com/uk/topics/medicine-made-for-you-82269">Read more here</a>.</em></p><img src="https://counter.theconversation.com/content/95302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darya Gaysina does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Folic acid in pregnancy – and the gene which explains why the benefits may differ.Darya Gaysina, Senior Lecturer in Psychology, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/835872017-10-06T14:35:03Z2017-10-06T14:35:03ZComplex guidelines on eating fish when pregnant mean that mothers – and babies – are missing out<figure><img src="https://images.theconversation.com/files/188211/original/file-20170929-19823-15ndn8i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/her-husband-returned-fishing-trip-brought-293226974?src=3FOSkGUbzXn27Ckv5zRz7A-3-24">Shutter stock</a></span></figcaption></figure><p>As soon as women find out they’re pregnant, they are overwhelmed with information about what they can – or more likely can’t – <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/pages/foods-to-avoid-pregnant.aspx">eat and drink</a>. Off the menu go soft cheeses, partially cooked eggs, raw meat, pâté, liver, caffeine, alcohol. It’s a lot to remember. </p>
<p>But the advice on eating fish when pregnant is the by far the most complex. Does it need to be so complicated? What is the actual evidence of the risks and benefits of eating fish for a mother-to-be?</p>
<p>The UK Food Standards Agency, through <a href="http://www.nhs.uk/chq/Pages/should-pregnant-and-breastfeeding-women-avoid-some-types-of-fish.aspx?CategoryID=54">NHS Choices</a>, gives advice to pregnant and breastfeeding women, as well as women planning to become pregnant. It focuses on the consumption of mercury and chemicals known as polychlorinated biphenyls (PCBs) and dioxins in fish and seafood. </p>
<p>The guidelines for women planning to become pregnant and pregnant women include three fish to avoid completely. These are the predatory species, marlin, shark and swordfish. There is also information on limiting intake of other fish, such as fresh and canned tuna. </p>
<p>The guidelines for women who are breastfeeding differ slightly. For them, predatory fish are allowed once a week and there is no limit on canned tuna. </p>
<p>Crucially, the guidance also includes a recommendation to eat at least two portions of fish a week, at least one of which should be oily – important advice that is mentioned only in passing on the <a href="http://www.nhs.uk/chq/Pages/should-pregnant-and-breastfeeding-women-avoid-some-types-of-fish.aspx?CategoryID=54">NHS Choices web page</a>.</p>
<p>It all adds up to a complicated set of advice. To be able to follow it, women are required to distinguish correctly between different species of fish. They need to be able to identify oily fish and to keep a weekly tally of the number of portions of different species they have eaten. </p>
<h2>Mercury exposure and child development</h2>
<p>There is growing evidence of benefits to the health and development of the baby if women eat fish while pregnant, despite the mercury content. In the UK, a study in which pregnant women were recruited and their children followed up for many years (the Avon Longitudinal Study of Parents and Children <a href="http://www.bristol.ac.uk/alspac/">ALSPAC</a>) showed that eating fish makes only a <a href="https://ehp.niehs.nih.gov/1206115/">small contribution</a> to blood levels of mercury during pregnancy. </p>
<p>Eating two to three portions of fish a week had beneficial effects on measurements of child development, suggesting that limiting fish intake might actually be harmful. For instance, there was no effect of eating fish on the chances of the <a href="http://www.sciencedirect.com/science/article/pii/S1438463916300463?via%3Dihub">baby being pre-term or born with a low birthweight</a>. In fact, birthweight was lower in the babies of women who did not eat fish during pregnancy. Other measurements of later child development, such as <a href="http://www.sciencedirect.com/science/article/pii/S0161813X1630170X?via%3Dihub">child behaviour</a>, <a href="http://www.sciencedirect.com/science/article/pii/S0161813X1630016X?via%3Dihub">social, motor and communication skills</a>, and <a href="http://www.sciencedirect.com/science/article/pii/S1438463917302079?via%3Dihub">IQ</a> also showed no link with the women’s blood mercury levels during pregnancy. </p>
<p>Similar results have been found in the <a href="http://ajcn.nutrition.org/content/101/3/530.long">Seychelles Development Study</a>, where women eat fish every day and are likely to have higher mercury levels than in the UK.</p>
<h2>Antenatal nutrition</h2>
<p>The beneficial effects of eating fish on the baby’s development are probably due to the <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/low-fish-intake-is-associated-with-low-blood-concentrations-of-vitamin-d-choline-and-n3-dha-in-pregnant-women/572BA17F475B62332AB4CBE23B76FB01">nutrients provided by fish</a> – particularly vitamin D, iodine, selenium and omega-3 fatty acids – which could protect against any potentially harmful effects of mercury. </p>
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<img alt="" src="https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188214/original/file-20170929-23041-1ffcfq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pregnant pause.</span>
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<p>Women who give up eating fish during pregnancy are probably missing out on these positive effects.</p>
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Read more:
<a href="https://theconversation.com/health-risks-of-light-drinking-in-pregnancy-confirms-that-abstention-is-the-safest-approach-83753">Health risks of light drinking in pregnancy confirms that abstention is the safest approach</a>
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<p>In the face of the confusing and complicated guidelines, it is likely that many women simply give up eating fish altogether. This is certainly <a href="http://ajcn.nutrition.org/content/92/5/1234.full.pdf+html">the case in the US</a> in the face of <a href="https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm">equally complex national information</a>. There is no doubt that women in the UK who are of child-bearing age (16-49 years old) eat considerably <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/310995/NDNS_Y1_to_4_UK_report.pdf">less than the recommended minimum two portions of fish a week</a>.</p>
<h2>Better advice</h2>
<p>There is clearly a danger that the message to eat at least two portions of fish per week during pregnancy and breastfeeding is being lost in the complex guidelines. Simplification would help to resolve this.</p>
<p>Firstly, the recommendation to eat at least two portions of fish per week, at least one of which should be oily, should be the main headline message.
Second, the advice on fish to avoid, limit and eat freely should be removed. Third, the guidelines should apply equally to pregnant women, those planning to become pregnant and those who are breastfeeding.</p>
<p>These simple changes to the guidelines would help women get the maximum benefit from eating fish, whether the’re pregnant, planning to be pregnant, or breastfeeding. And they would ensure the very best future for their children.</p><img src="https://counter.theconversation.com/content/83587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Taylor receives funding from the Wellcome Trust (Career Re-entry Fellowship, grant ref: 104077/Z/14/Z).</span></em></p>It really should be consumed at least twice a week.Caroline Taylor, Research Fellow, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/618812016-07-13T12:18:19Z2016-07-13T12:18:19ZSocial media is putting pregnant women under pressure to look perfect<figure><img src="https://images.theconversation.com/files/130416/original/image-20160713-12377-1fsyd6z.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's no such thing as a perfect pregnancy body.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/bed-bedroom-photo-baby-69097/">www.pexels.com/Josh Willink</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>There is no doubt that social media and its instant availability has changed the way we engage with the outside world. As the popularity and <a href="http://www.reuters.com/article/us-facebook-newsfeed-influence-idUSKCN0ZF1P2">influence of sites such as Facebook</a> continue to grow, few can argue that these are not among the most important tools for social contact in the modern world. </p>
<p>At any time of life, whatever we may experience, social media has become a platform to reach out to others going through the same thing. Pregnant women, for example, can reach out to other expectant mothers who are <a href="https://www.facebook.com/groups/965670403444322/">due to give birth around the same time</a> as them, and track each others’ progress, problems and proud moments, providing support along the way.</p>
<p>However, there is a downside to this constant, carefully selected communication. High levels of Facebook use have been linked to increased <a href="http://www.sciencedirect.com/science/article/pii/S0747563212003172">depression, anxiety and poor life satisfaction</a>, with those who use it a lot finding their <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055162">mood decreases afterwards</a>. </p>
<p>It’s very easy to see why this is the case: Facebook isn’t reality; it’s made up of usually carefully constructed highlights of people’s lives. Posts are all about the latest parties, purchases and happy relationships, and less about sitting home alone on a Friday night in your pyjamas. Even if deep down we realise Facebook is a false presentation of the world our peers live in, the risk of making negative self-comparisons is still high. </p>
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<p>One of the biggest negative impacts of Facebook is the <a href="https://www.strath.ac.uk/research/subjects/psychology/socialmediapicturesmayleadtonegativebodyimages/">increase in body image dissatisfaction</a>, as users compare themselves to the literally billions of perfect photos of celebrities and our peers available to us with just a few clicks. Some might argue that these photos have always been available through traditional media, but social sharing sites make them more accessible. More than ten million photographs are uploaded onto Facebook <a href="https://causal.unc.edu/files/2011/08/Naimi2014BigDataRevolutionReview.pdf">worldwide every hour</a>, offering an immediate availability of new images that far surpasses that found in any magazine.</p>
<p>The issue of course is that many of these photos aren’t real. We are viewing images that are carefully selected, posed, filtered or altered in some way: Photoshop is no longer confined to magazines or professional websites, with a simple app, a person can rapidly change their image to become their own ideal.</p>
<p>Poor body image is not a good thing at the best of times: it can lead to low self esteem, damage relationships and increase the risk of poor health. Though often assumed to be a problem for mostly teens and young women, body image dissatisfaction can be a <a href="https://www.theguardian.com/society/2012/jun/10/body-image-elderly-hidden-illness">problem for women of all ages</a> – even during pregnancy.</p>
<p>Pregnancy is of course a time of big changes to the body. Add to the growing stomach, sickness, heartburn and sore breasts and it’s no surprise that it is an uncomfortable time in a woman’s life. But while pregnancy was once viewed as an excuse to “eat for two” – which, incidentally, wasn’t a good thing either – growing numbers of pregnant women are now trying to limit the amount of weight they gain in a bid to get the “perfect” body.</p>
<p>In a recent study exploring pregnancy body image, we found that over half of the 269 women we surveyed had <a href="http://www.sciencedirect.com/science/article/pii/S0266613816301073">concerns about what their pregnant body</a> looked like, how much weight they had gained and what their body would look like afterwards. Only a third “loved” how they looked or felt confident about their pregnant body; the rest worried about their changing shape and felt they were gaining too much weight. </p>
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<p>Potentially this trend could be caused by lots of factors, but our frequent and carefully constructed use of social media isn’t helping. Our research found that the more pregnant women used Facebook, the greater their body dissatisfaction, and the more likely they were to try and limit how much weight they gained. Directly, two thirds of women who used Facebook stated that they compared their body negatively to other pregnant women and celebrities using it, and that seeing photos of other pregnant women increased their dissatisfaction with their body. </p>
<p>The frequency of this dissatisfaction and attempt to limit weight gain is of concern for both the physical health and well-being of mum and baby during pregnancy. Gaining too little weight increases the risk of <a href="http://www.nature.com/ijo/journal/v30/n3/abs/0803184a.html">low birth weight, premature birth and even miscarriage</a>, and is associated with <a href="http://hpq.sagepub.com/content/20/4/413.short">a drop in self esteem</a> in itself. Research has also shown that when mums have poor body image during pregnancy they are also <a href="http://www.sciencedirect.com/science/article/pii/S0266613814001715">less likely to breastfeed</a> which can further increase the risk of health issues for mum and baby. </p>
<p>Deep down most people know that we only put our best photos on Facebook and many use apps to alter their photos, but this isn’t always clear. Pregnant women are increasingly feeling the pressure to conform to a slender ideal at a time when weight gain and body changes are not only normal but part of helping their baby grow and develop. </p>
<p>Womens’ changing shape during pregnancy and what this represents is something to be treasured. Forget “eating for two”, the world needs to realise that women are living for two and that the true beauty in this lies in the stretch marks, wobbly bits and swollen ankles - whether that looks “good” on social media or not.</p><img src="https://counter.theconversation.com/content/61881/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>
Amy Brown has previously received funding from the Economic and Social Research Council for her work exploring infant feeding</span></em></p>Women are no longer eating for two – or one, for that matter.Amy Brown, Associate Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/459142015-08-13T10:11:43Z2015-08-13T10:11:43ZA simple daily pregnancy pill could boost population IQ and save the NHS money<figure><img src="https://images.theconversation.com/files/91571/original/image-20150812-18096-6czfnu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bottoms up</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>An estimated <a href="http://www.ncbi.nlm.nih.gov/pubmed/22892867">1.9 billion people</a> are at risk of iodine deficiency, a medical condition that can stunt your brain power. <a href="http://www.thyroid.org/iodine-deficiency/">Iodine deficiency</a> – which can be avoided by eating seafood, cereal and cow’s milk (due to iodine in cattle feed) – doesn’t just affect the developing world. Up to <a href="http://www.ign.org/cm_data/2012_Li_Teh_changing_epidemiology_of_iodine_deficiency_NatRevEnd.pdf">one-third of children</a> in Europe are thought to need more iodine in their diets.</p>
<p>Because of this, some argue that we should add iodine to salt or provide it in pill-form to pregnant and breast-feeding women, who need even more of it than everyone else. But would the benefits really be worth the cost?</p>
<p>Iodine is a micronutrient that is essential for the thyroid to produce hormones that are crucial for normal brain and neurological development. If you don’t get enough iodine when you’re a child it can result in intellectual disability. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/21640375">recent national survey</a> demonstrated mild to moderate iodine deficiency in the UK and <a href="http://www.ncbi.nlm.nih.gov/pubmed/23706508">important observational evidence</a> has linked mild to moderate iodine deficiency to lower IQ scores in UK school children.</p>
<h2>Pregnant women need more</h2>
<p>Pregnant and breast-feeding women in particular need higher levels of iodine because they produce more thyroid hormones, transfer more iodine to their foetus and in breastmilk, and lose more through urination. Yet an estimated <a href="http://bit.ly/1IFB2Mk">two-thirds of pregnant women</a> in Europe don’t consume enough and <a href="http://www.ncbi.nlm.nih.gov/pubmed/25663363">regional surveys have confirmed</a> mild to moderate iodine deficiency in UK pregnant women.</p>
<p>This is why the <a href="http://www.who.int/nutrition/publications/micronutrients/iodine_deficiency/9789241595827/en/">World Health Organisation</a> advocates adding iodine to salt. However, European households are cutting the amount of salt they add to food (in the UK salt added to food represents <a href="http://www.ncbi.nlm.nih.gov/pubmed/24172290">only about 15%</a> of all salt consumed).</p>
<p>An alternative solution is to give pregnant women iodine tablets. Indeed, many prenatal vitamin-mineral supplements already contain iodine. Yet there is no current UK guidance recommending iodine supplementation in pregnancy and the NHS-prescribed “Healthy Start” vitamins do not contain the nutrient.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/91572/original/image-20150812-18104-1pri0xv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Thyroid gland.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>My colleagues and I recently examined how the costs of giving women iodine pills during pregnancy weighed against the benefits. We carried out a systematic review of the available evidence and then used that to build a mathematical model that calculated how much iodine pregnancy supplements would boost children’s IQ ratings and the money this would save. </p>
<p><a href="http://bit.ly/1Elohm4">We found</a> that giving iodine to pregnant women could potentially boost the IQ of their children by an average of 1.22 points. This might not seem very much on an individual basis, but across the whole population it would significantly raise the intellectual ability of a large number of children with special needs. Because these children’s additional needs would be reduced, the policy would save the NHS an average of £199 per pregnant woman. Wider societal savings – such as better educational achievement leading to higher incomes in later life – were even higher, at about £4,476 per woman.</p>
<p>There are risks to iodine supplementation, namely <a href="http://www.ncbi.nlm.nih.gov/pubmed/20172475">thyroid dysfunction</a>. However, we calculated the cost of this problem would need to be more than £91,000 per woman affected to cancel out the overall benefits.</p>
<h2>Study limits</h2>
<p>It is important to realise that the predictions are only as reliable as the studies that contributed data. We did not investigate whether iodine supplements in pregnancy boost a child’s IQ ourselves but assumed the fact based on previous observational research. While there is <a href="http://bit.ly/1TsBS1P">compelling evidence</a> that iodine supplementation improves child IQ in areas of severe iodine deficiency, there is currently no trial evidence for mild-to-moderate deficient populations. However, we took a conservative approach to estimating the benefits and overestimated the potential harms, meaning the IQ and cost gains may be even greater than predicted.</p>
<p>Iodine tablets do have their drawbacks. Pregnancy supplements <a href="http://www.ncbi.nlm.nih.gov/pubmed/15918932">often do not reach</a> poorer, less educated women (unlike adding nutrients to salt). And as most women only become aware they are pregnant several months after conception, they are unlikely to take tablets during <a href="http://www.ncbi.nlm.nih.gov/pubmed/23062035">the early stages</a> when the developing fetal brain is especially vulnerable.</p>
<p>Overall, our study has to be considered alongside other research but it provides compelling evidence that iodine supplementation for pregnant women in the UK is potentially cost saving. And, importantly, it has implications for the 1.9 billion people in the 32 countries with iodine deficiency worldwide.</p><img src="https://counter.theconversation.com/content/45914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristien Boelaert does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research into iodine tablets suggests the case for giving them to all pregnant women is compelling.Kristien Boelaert, Reader in Endocrinology, School of Clinical and Experimental Medicine, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/288512015-04-08T04:36:31Z2015-04-08T04:36:31ZExplainer: what is placenta?<figure><img src="https://images.theconversation.com/files/77271/original/image-20150408-26476-1iomi3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The placenta plays a critical role in pregnancy, fetal development and health throughout life</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/remysharp/6196105213">Remy Sharp/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>An incredibly complex and important organ in its own right, the placenta is only found in mammals. And how it functions has the potential to have profound effects on the lifelong health of the developing foetus. </p>
<p>The placenta exists solely during pregnancy, and plays a crucial role in nurturing and protecting the foetus throughout gestation. It’s connected to the foetus via the umbilical cord and attached to the wall of the womb, allowing for essential exchanges of nutrients, gases and waste with the mother’s circulation. </p>
<p>Placenta is composed of maternal and foetal parts, which are known as the basal and chorionic plates, respectively. Nutrients are exchanged through the maternal blood entering the foetal section, but maternal and foetal blood don’t actually mingle; they’re separated by arteries and capillaries. </p>
<p>Interestingly, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20004469">the placenta has a gender</a> matching that of the foetus, indicated with the presence of either XX or XY sex chromosomes. But placental sex is not used to test fetal gender as that would require invasive surgical tests and add unnecessary risk to the pregnancy. </p>
<h2>In the beginning</h2>
<p>The placenta begins developing once the embryo is implanted into the wall of the uterus. During the nine months of pregnancy, it increases in size and performs several vital functions. It regulates the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25009498">exchange of nutrients</a> for foetal growth and development, the exchange of gases including oxygen and carbon dioxide, and hormone secretion. </p>
<p>It also protects the foetus from toxins and infections as well as the <a href="http://www.ncbi.nlm.nih.gov/pubmed/24581729">mother’s immune system</a>, which would otherwise regard it as a foreign invader. This is a critical aspect of placental physiology; if the mother’s immune system rejects the foetus, it will spontaneously abort.</p>
<p>In order to prepare the developing foetus for the world it will inhabit after pregnancy, the placenta is very sensitive to the mother’s environment. It’s able to adjust its functions in response to external cues, such as the mother’s diet or environmental pollutants, which can then alter foetal development. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77277/original/image-20150408-26515-5ut8qi.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The placenta begins developing once the embryo is implanted into the wall of the uterus.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/louisewoodcock/5151401966">Louise Woodcock/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25222554">Maternal diet</a> plays a major role in foetal development; studies show eating a balanced diet of fruit, vegetables, and lean meat <a href="http://www.ncbi.nlm.nih.gov/pubmed/25551251">helps reach a good birth weight</a>. But <a href="http://www.ncbi.nlm.nih.gov/pubmed/19221603">exposure to pollutants</a>, such as car exhaust fumes, can have a negative impact and may increase the risk of the child developing asthma. </p>
<p>Permanent changes to the developing foetus’s physiology during development is known as foetal <a href="http://www.ncbi.nlm.nih.gov/pubmed/11978056">programming</a>. And variations in the development of organs and systems within the foetus may increase lifetime susceptibility to <a href="http://www.ncbi.nlm.nih.gov/pubmed/25724893">cancer</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24817102">heart disease</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/12750609">allergies</a> and other diseases. </p>
<p>The mechanisms underlying these susceptibilities are incredibly complex and we’re only now beginning to understand them. One of them is <a href="http://www.ncbi.nlm.nih.gov/pubmed/24835110">epigenetics</a>, which changes foetal gene expression, altering the physiology and functioning of the foetus throughout life.</p>
<h2>What can go wrong</h2>
<p>Placental disorders can cause <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1997.tb18405.x/abstract">serious health complications</a> during pregnancy for both the foetus and mother. They can result in abnormal foetal development, growth restriction, malformations, miscarriage or stillbirth, and may even <a href="http://www.ajog.org/article/0002-9378(93)90043-I/abstract">endanger the mother’s life</a>.</p>
<p>Because the placenta keeps forming throughout pregnancy, <a href="http://www.ncbi.nlm.nih.gov/pubmed/17007686">abnormalities</a> in its structure and implantation into the uterine wall can happen at any time. <a href="http://www.ncbi.nlm.nih.gov/pubmed/24836826">Placental abruption</a>, for instance, occurs in approximately one in a 100 pregnancies. Abruption is either the partial or full detachment of the placenta from the uterine wall. And it can deprive the foetus of oxygen and nutrients, potentially leading to preterm birth or stillbirth. </p>
<p>One of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25750742">most common disorders</a> of pregnancy is <a href="http://www.ncbi.nlm.nih.gov/pubmed/25767405">pre-eclampsia</a>, which occurs in 3% to 7% of all pregnancies; it’s the leading cause of maternal health complication and death. Characterised by high blood pressure and protein in the urine, pre-eclampsia can lead to permanent vascular and metabolic damage in the mother. </p>
<p>The exact cause of the disorder is unknown, but it’s thought several factors including poor diet, high body fat, a history of high blood pressure and genetics may all play a role. Abnormal placental development and function is thought to be another major contributing factor.</p>
<p>If left untreated, pre-eclampsia can develop into <a href="http://www.ajog.org/article/0002-9378(90)91176-D/abstract?cc=y">eclampsia</a>, which is characterised by cerebral fluid build-up and seizures. Once the placenta is removed, pre-eclampsia and eclampsia end. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77273/original/image-20150408-26476-7i15dd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Out of the several thousand mammalian species, humans are among only a handful that don’t regularly consume the placenta.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/kom_bo/3179203175/in/photostream/">Kom bo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The placenta can become infected by bacteria, viruses or <a href="http://trstmh.oxfordjournals.org/content/77/2/232.short">parasites</a> which can lead to abnormal foetal development, preterm birth or foetal death. This occurs mostly in developing countries such as Africa, where <a href="http://www.placentajournal.org/article/S0143-4004(03)00307-2/abstract">the malaria parasite</a> contributes to 100,000 deaths annually as a result of severe foetal growth restriction.</p>
<p>Finally, cancer of the placenta, known as choriocarcinoma, occurs in approximately one in 20,000 to 40,000 pregnancies. This cancer usually spreads to lungs and while it can be life-threatening, the cure rate is over 90%. It’s very responsive to <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1438.2002.01125.x/full">chemotherapy</a>, which is given after the baby is born.</p>
<h2>Cultural significance</h2>
<p>The placenta has little cultural value in Western countries; it’s often unrecognised by parents as being fundamental for a healthy and successful pregnancy. So, it’s usually discarded after childbirth. </p>
<p>But some other cultures hold great respect for this uniquely temporary organ, and have the mother eat it, in a practice known as <a href="http://www.bbc.com/news/uk-england-27307476">human placentophagy</a>. According to traditional <a href="http://www.natureofbirth.com.au/placenta-bar.html">Chinese medicine</a>, for instance, the placenta is thought to rejuvenate the body after childbirth. </p>
<p>This practice has recently become more popular in Western culture but remains highly controversial, mostly due to the cannabalistic nature of the act. There are few <a href="http://www.tandfonline.com/doi/abs/10.1080/03670244.2012.719356#.VSST__mUeE4">scientific studies</a> examining the benefits of placentophagy, but it’s worth noting that out of the several thousand mammalian species, humans are among only a handful that don’t regularly consume the placenta.</p>
<p>Different cultures hold a <a href="http://catalogue.nla.gov.au/Search/Home?lookfor=isn%3A%229023233662%22">variety of beliefs</a> about the placenta. Indonesian and Malaysian cultures consider the placenta to be a sibling of the newborn, for instance. And, in China, it’s thought to be its first and finest clothing. They all have a deep reverence and appreciation for the placenta and its ceremonial role in the birthing event. </p>
<p>The placenta plays a critical role in pregnancy, foetal development and health throughout life. It may only be a temporary organ, but plays some of the most important roles in sustaining early life.</p><img src="https://counter.theconversation.com/content/28851/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Astrud Tuck receives funding from the Channel 7 Children's Research Foundation.</span></em></p>An incredibly complex and important organ in its own right, the placenta is only found in mammals. And how it functions has the potential to have profound effects on the lifelong health of the developing foetus.Astrud Tuck, Postdoctoral Research Fellow in Reproductive Health, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/387242015-04-02T03:33:34Z2015-04-02T03:33:34ZDon’t judge pregnant women, give them good nutrition advice<figure><img src="https://images.theconversation.com/files/76730/original/image-20150401-21711-37ijm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adequate nutrition in utero is key to lifelong health.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/yourdon/2771648417">Ed Yourdon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>At no other point in life is good nutrition more important than while the foetus is developing. But women in Australia often don’t receive adequate reliable information about how to ensure what they eat is best for both themselves and their developing baby.</p>
<p>Early nutrition is the key to lifelong health. The “developmental origins of adult disease” hypothesis first proposed by <a href="http://www.ncbi.nlm.nih.gov/pubmed/2871345">David Barker</a> in the late 1980s drew attention to the role of intrauterine nutrition on the later health of the child. The Barker hypothesis states inadequate nutrition results in permanent changes in the foetus’ physiology and metabolism. These adaptations, it’s thought, equip the foetus for postnatal life in an environment of nutritional deficit. </p>
<p>So, low birth weight (but not pre-term) babies, who are later exposed to excess – as is the case of most economically developed societies – are more prone to developing diabetes, hypertension and heart disease in adulthood. </p>
<p>But eating too much during pregnancy is not recommended either. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25497183">Maternal obesity</a> is also associated with the risk of chronic disease in the offspring. </p>
<h2>Medicalisation of pregnancy</h2>
<p>But advances in scientific knowledge like this one have sadly meant pregnancy has moved from being considered a natural life stage to a state that requires medical management, with strong parameters around <a href="http://www.tandfonline.com/doi/abs/10.1080/09581596.2012.657612#.VRNNv_lWxBk">risk reduction</a>. This shift has been accompanied by <a href="http://www.tandfonline.com/doi/abs/10.1080/13698575.2011.624179#.VRNOpPlWxBk">societal judgement</a> that considers women responsible for the poor health of their children. </p>
<p>Popular media perpetuates this with headlines such as “<a href="http://www.heraldsun.com.au/news/victoria/obese-pregnant-women-risking-babies-health/story-fni0fit3-1226805348710">Obese pregnant women risking babies’ health”</a>. And then there are non scientifically-trained celebrities, who nonetheless get to air their opinions. Consider chef <a href="http://www.aww.com.au/diet-health/diet-and-nutrition/2014/10/expert-dismisses-pete-evans-claims-that-modern-diet-causes-autism/">Pete Evans</a> who attributes autism to maternal diets, even when the diets comply with relevant guidelines. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76731/original/image-20150401-21707-1cnp6o0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s plenty of pressure on women to do all the ‘right things’ during pregnancy to have a healthy child.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/staipale/2281431583">Sami Taipale/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>All this places pressure on women to do all the “right things” during pregnancy to have a healthy child. It also results in women feeling judged about their decisions and becoming extremely <a href="http://www.tandfonline.com/doi/abs/10.1080/13698575.2011.624179#.VRNOpPlWxBk">risk averse</a>. </p>
<h2>Mixed messages</h2>
<p>You’d think all this pressure stems from the fact that women receive lots of good nutrition-related advice during pregnancy so they can make informed decisions and limit risk. But this is not the case. Pregnant women receive conflicting information about nutrition, and are often confused by the <a href="http://www.ncbi.nlm.nih.gov/pubmed/24748213">mixed messages</a> they get from health-care providers, the media and the internet. </p>
<p>Fish and seafood, for instance, are good sources of several nutrients, including protein, omega 3 polyunsaturated fatty acids and iodine, all of which are important for <a href="http://www.ncbi.nlm.nih.gov/pubmed/25793632">foetal development</a>. <a href="http://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55_australian_dietary_guidelines.pdf">Australian dietary guidelines</a> say: </p>
<blockquote>
<p>maternal consumption of fish during pregnancy is likely to have a number of health benefits for women and their children. </p>
</blockquote>
<p>But research shows many women may be <a href="http://onlinelibrary.wiley.com/doi/10.1111/1747-0080.12112/abstract">avoiding fish and seafood</a> during pregnancy because of concerns related to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131842/">food safety and the detrimental effects of mercury</a>. Although both can be eaten as long as they have been well cooked and served hot, and when <a href="http://www.foodauthority.nsw.gov.au/consumers/life-events-and-food/pregnancy#.VRNW_PlWxBl">larger species (shark, marlin, swordfish) are limited</a>, women report avoiding these foods altogether. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76840/original/image-20150401-31287-1vihfzj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advice about fish and seafood is one example of how women are not getting the right guidance about what to eat during pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/villify/13677277283">IamNotUnique/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Much of the educational material given out in antenatal clinics emphasise the risks of fish and seafood consumption also, without highlighting their <a href="http://www.ncbi.nlm.nih.gov/pubmed/23549329">nutritional benefits</a>. This is just one example of the kind of coupling of risk aversion and limited advice that work together to promote less than ideal nutritional outcomes in pregnancy. </p>
<h2>The right way forward</h2>
<p>All in all, the causes of poor nutrition in the preconception and pregnancy stages are complex and multifactorial. They may be related to poor education and low income, inadequate access to proper health care, and a general lack of awareness about nutritional requirements. To address it, we need an approach that encompasses both individual education and “upstream” public health initiatives.</p>
<p>In Australia, pregnant women are not routinely referred to allied health professionals such as dietitians, which means it’s often left to midwives to provide them with nutrition-related advice. But <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1747-0080.2007.00177.x/abstract">midwifery degrees</a> are <a href="http://www.biomedcentral.com/1471-2393/12/102">not required to include</a> nutritional content, so <a href="http://www.womenandbirth.org/article/S1871-5192%2813%2900034-6/abstract">midwives are clearly ill-equipped</a> for this task. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25196454">General practitioners</a>, who are often the first point of call for women when they get pregnant, and who may continue caring for them throughout their pregnancies in shared-care models, are also failing to provide essential nutrition information. </p>
<p>If we’re going to help pregnant women ensure they’re eating right for themselves and their babies, we will need to start by educating health professionals who they encounter throughout their pregnancies to provide clear nutritional advice. This guidance should address myths about food risks and emphasise trustworthy sources of information. And whatever else they do, it’s vital our messages aren’t about blaming soon-to-be mothers.</p><img src="https://counter.theconversation.com/content/38724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pregnant women get all kinds of advice but reliable, evidence-based information on what they should eat for their good health as well as that of their developing child is often sorely missing.Karen Charlton, Associate Professor, School of Medicine, University of WollongongCatherine Lucas, Accredited Practising Dietitian and PhD Candidate (School of Medicine), University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/303562014-10-20T03:33:21Z2014-10-20T03:33:21ZHealth Check: what to eat and avoid during pregnancy<figure><img src="https://images.theconversation.com/files/62177/original/f66bhj7t-1413763373.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women find it difficult to strike the right balance between nutrition and safety.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mcgraths/3656184801">Sean McGrath/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>As soon as women announce “I’m having a baby!”, the congratulations are quickly followed by long lists of dos and don'ts about food. Try ginger for morning sickness. Avoid soft cheese because of <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Food_poisoning_listeria">listeria</a>. Eat more meat to boost your iron. Eat this fish – but not that one, because of <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mercury_in_fish">mercury</a>. </p>
<p>Pregnant women are understandably confused. So, how do you strike the balance between nutrition and safety, when so many things are off the menu? </p>
<p>During pregnancy, women need to consume a variety of different foods and need more of the main pregnancy nutrients: protein, folate, calcium, iron, zinc, iodine, and fibre. Here’s a quick guide to the best sources.</p>
<p><strong>Protein</strong>: lean meat, chicken, seafood, dairy products, legumes, nuts, eggs</p>
<p><strong>Folate</strong>: fortified bread and breakfast cereal, green leafy vegetables, legumes, seeds, chicken, eggs, oranges</p>
<p><strong>Calcium</strong>: dairy foods, fortified soy milks, green leafy vegetables, nuts, seeds, canned fish with bones </p>
<p><strong>Iron</strong>: red meat, fortified cereals, egg yolks, green leafy vegetables, legumes, nuts </p>
<p><strong>Zinc</strong>: meat, eggs, seafood, nuts, tofu, miso, legumes, wheat germ, wholegrain foods</p>
<p><strong>Iodine</strong>: canned salmon and tuna, other fish, oysters, bread fortified with iodine </p>
<p><strong>Fibre</strong>: wholemeal and wholegrain breads and high fibre cereals, oats, vegetables and fruit with the skin on.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62178/original/8nptrq58-1413763872.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">National dietary guidelines recommend pregnant women consume five serves of vegetables and legumes per day.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ginnerobot/3168342551">Ginny/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>We have recently shown that a <a href="http://www.ncbi.nlm.nih.gov/pubmed/23222964">moderate intake of protein</a> (18-20% of a total energy intake) allows pregnant women to eat the best range of foods across all the healthy core groups in the <a href="http://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">Australian Guide to Healthy Eating</a>, while optimising vitamin and mineral intakes. </p>
<p>Interestingly, the protein to carbohydrate ratio was <a href="http://www.ncbi.nlm.nih.gov/pubmed/23034964">related to the amount of muscle and fat tissue</a> in the developing baby. While more research is needed, it may contribute to the risk of developing diabetes in the future. </p>
<h2>How much?</h2>
<p>The <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55h_healthy_eating_during_pregnancy.pdf">Australian dietary guidelines</a> advise pregnant women to consume the following number of servings from the five core food groups each day.</p>
<p><strong>Vegetables and legumes/beans: five servings</strong>. One serve = 75g or 100-350kJ, for example, half a cup cooked green or orange vegetables, one cup of raw salad vegetables, half a medium potato, one tomato.</p>
<p><strong>Fruit: two servings</strong>. One serve = 150g or 350kJ, for example, one medium piece (apple, banana, orange), two small pieces (apricots, kiwi fruit), one cup diced or canned fruit.</p>
<p><strong>Grain (cereal) foods, mostly wholegrain or high-fibre varieties: eight-and-a-half servings</strong>. One serve = 500kJ, for example, one slice of bread, half a cup of cooked rice, pasta or porridge, one-quarter of a cup muesli, three crispbreads.</p>
<p><strong>Lean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes and beans</strong>: three-and-a-half servings. One serve = 500-600kJ, for example, 65g cooked lean meat, 80g cooked lean poultry, 100g cooked fish, two eggs, 170g tofu, 30g nuts, one cup of cooked beans.</p>
<p><strong>Milk, yoghurt, cheese or alternatives, mostly reduced fat: two-and-a-half servings</strong>. One serve = 500-600kJ, for example, 250ml milk, 200g yoghurt, two slices (40g) of cheese.</p>
<h2>Morning (noon and night) sickness</h2>
<p>Nausea and vomiting affects about <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635459/">three in four</a> pregnancies. While the data on <a href="http://www.ncbi.nlm.nih.gov/pubmed/23863612">fetal risks associated with drug treatment</a> are controversial, non-drug approaches are a good place to start. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=874&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=874&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=874&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1098&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1098&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62179/original/8dsr37zx-1413764017.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1098&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating small snacks rather than big meals can help alleviate morning sickness.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-59031802/stock-photo-pregnant-woman-and-her-pet-looking-for-food-in-the-fridge.html?src=tKpId9RMBPSRI2u42J5O6g-1-42">Michael Pettigrew/Shutterstock</a></span>
</figcaption>
</figure>
<p>Limit exposure to food odours by having foods that do not smell as much during cooking or by reducing cooking time, with stir-frys or a BBQ cooked outdoors. </p>
<p>Nausea can be worse in the presence of hunger, so avoid an empty stomach by having small, frequent meals and snacks comprised of foods that you can tolerate and don’t have much smell, such as fruit or nuts, or raisin bread or sandwiches, or yoghurt. Very cold drinks can help with the nausea and prevent dehydration.</p>
<p>You could try ginger as a ginger tablet, cold ginger beer or ginger cordial. While only some evidence supports the use of <a href="http://www.ncbi.nlm.nih.gov/pubmed/20824863">ginger and/or vitamin B6 supplements</a> to relieve nausea of pregnancy, they’re unlikely to cause harm. </p>
<h2>Mercury and fish</h2>
<p>Fish and seafood are important sources of protein and minerals. They are low in saturated fat and are a major source of omega-3 fatty acids. </p>
<p>During pregnancy, omega-3s play an important role in the baby’s developing central nervous system, the brain and retina in eyes. Research shows that maternal <a href="http://www.ncbi.nlm.nih.gov/pubmed/24468708">omega-3 fatty acid consumption during pregnancy</a> reduces the risk of preterm birth, and increases the length of gestation and therefore birth weight.* </p>
<p>Deficiency of omega-3s is associated with irreversible visual and behaviours deficits in children, as well as an increased risk of depression, <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pregnancy_-_pre-eclampsia">pre-eclampsia</a> and <a href="http://americanpregnancy.org/pregnancy-complications/pregnancy-induced-hypertension/">pregnancy hypertension</a> in the mother. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62183/original/wtz2xrqj-1413765055.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pregnant women eat less fish than is recommended.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-202450903/stock-photo-grilled-fish-with-lemon-and-spices.html?src=pp-same_artist-203204449--grbwE4bD-oigIXtvtBPGw-3">Shaiith/Shutterstock</a></span>
</figcaption>
</figure>
<p>Population surveys in the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17307104">United Kingdom</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12907111">United States</a> show that pregnant women don’t eat enough fish and therefore omega-3s, partly due to fears about adverse effects of mercury and other toxins (such as <a href="http://www.npi.gov.au/resource/polychlorinated-biphenyls-pcbs">polychlorinated biphenyls</a>). </p>
<p>We have shown that <a href="http://onlinelibrary.wiley.com/doi/10.1111/1747-0080.12112/abstract">pregnant women in Australia</a> also eat less fish than is recommended. But when we estimated what their weekly exposure to mercury would be from eating two to three serves a week, it was well below the targets. Pregnant women in Australia <a href="http://www.foodstandards.gov.au/consumer/chemicals/mercury/pages/default.aspx">can safely eat fish</a>.</p>
<h2>Listeria risk</h2>
<p>Due to changes in the immune system during pregnancy, women are more susceptible to food poisoning. But by avoiding all foods that carry a risk for harbouring listeria, women are <a href="http://www.ncbi.nlm.nih.gov/pubmed/22397868">consuming</a> fewer nutrients. </p>
<p>You don’t have to go without. For every item on the “no” list, there are a number of alternatives: </p>
<p>Avoid <strong>pre-packaged cold meats</strong>. This includes deli meats and sandwich bars. Instead, choose freshly cooked seafood one to two times per week and/or canned fish up to four times a week. Choose home-cooked meat instead and make it into homemade sandwiches. </p>
<p>Avoid <strong>ready-to-eat pre-cooked chicken pieces</strong>, especially if cold. Instead, choose home-cooked chicken or hot take-away whole chicken or large pieces – but eat it immediately. </p>
<p>Avoid <strong>raw and chilled seafood</strong> including oysters, sashimi or sushi, smoked salmon, ready-to-eat peeled prawns, prawn cocktails, sandwich fillings, and prawn salads. Don’t eat shark (flake) or billfish (swordfish, broadbill and marlin). Limit orange roughy (deep sea perch) or catfish to once per week. Instead choose other fish species, including canned salmon and tuna two to three times a week.</p>
<p>Avoid <strong>salads (fruit and vegetables) that are pre-prepared or pre-packaged</strong> or from salad bars or smorgasbords. Instead, choose freshly prepared homemade salads (with leafy greens or other salad vegetables), fresh fruit, or canned or frozen fruits and vegetables. </p>
<p>Avoid <strong>soft, semi-soft and surface-ripened cheeses</strong> such as brie, Camembert, ricotta, feta and blue cheese. Instead, choose hard cheeses such as Cheddar or tasty, processed cheese, cheese spreads, or plain cottage cheese if packaged by the manufacturer. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62181/original/f8hh4265-1413764465.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Opt for hard cheeses to reduce the risk of listeria food poisoning.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-196898183/stock-photo-cheese-plate-with-gouda-leerdammer-edamer-hard-and-swiss-cheese.html?src=M22H8DSsSWJlvZnIcemFzw-1-41">Markus Mainka/Shutterstock</a></span>
</figcaption>
</figure>
<p>Avoid <strong>soft serve ice cream</strong> and unpasteurised dairy products such as raw goat’s milk. Instead choose packaged frozen ice cream and pasteurised dairy products such as milk, yoghurt, custard and dairy desserts. </p>
<p>Listeria can live in lower temperatures, so take extra care with foods served cold, and avoid buffets and smorgasbords altogether. Cooking, however, kills listeria but the food needs to be heated until steam rises. And remember to always wash your hands before handling food or starting to prepare foods. </p>
<h2>Constipation</h2>
<p>Up to 40% of pregnant women develop <a href="http://www.ncbi.nlm.nih.gov/pubmed/11405974">constipation</a>. This is caused by rising levels of progesterone and oestrogen, and the relaxation of muscles of the bowel. Low fluid and fibre intakes can also play a role. </p>
<p>Mild constipation can be self-treated by increasing high-fibre foods, including soluble (oats, lentils, dried peas and beans, psyllium) and insoluble (wholemeal and wholegrain breads and cereals, wheat bran, vegetables and fruit) fibres. To counter constipation in pregnancy aim for 25 to 28 grams of fibre per day, drink plenty of water (1.5 to two litres per day) and exercise regularly. </p>
<p>Some oral iron supplements can cause constipation. If medication is required, only use what your doctor prescribes as not all laxatives are safe during pregnancy. </p>
<h2>Multivitamins</h2>
<p>Women <a href="http://theconversation.com/mondays-medical-myth-take-a-vitamin-a-day-for-better-health-8482">planning or in early pregnancy</a> are likely to need a folic acid supplement to reduce the risk of the baby having a <a href="http://www.cdc.gov/features/folicacidbenefits/">neural-tube defect</a>, and iodine for the developing brain and nervous system.</p>
<p>Multivitamin supplements may be recommended when there is a fairly high chance of not meeting nutrient needs from food. This is more likely for pregnant adolescents, vegetarians, those on pre-existing special diets, individuals with drug, tobacco and alcohol addictions, or obese pregnant women on medically restricted diets to limit weight gain.</p>
<p>Pregnancy is an important time to focus on what you eat. The food-based recommendations in the Australian Dietary Guidelines will help you enjoy a variety of foods while getting the best mix of nutrients important at this time.</p>
<p><em>* This article originally said omega-3 fatty acid consumption during pregnancy was associated with increased birth weight and improve brain development in the child. This has been updated to better reflect the evidence.</em></p><img src="https://counter.theconversation.com/content/30356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins receives or has received funding from NHMRC, ARC, Hunter Medical researcg Institute, The University of Newcastle, Meat and Livestock Australia.</span></em></p><p class="fine-print"><em><span>Michelle Blumfield does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As soon as women announce “I’m having a baby!”, the congratulations are quickly followed by long lists of dos and don'ts about food. Try ginger for morning sickness. Avoid soft cheese because of listeria…Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleMichelle Blumfield, Postdoctoral researcher, Priority Research Centre in Physical Activity and Nutrition, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/263342014-05-20T04:52:44Z2014-05-20T04:52:44ZHow your parents’ diet before your birth impacts your health<figure><img src="https://images.theconversation.com/files/48118/original/y323q2yb-1399601619.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What parents eat before conceiving a child affects their baby's DNA expression. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hndrk/1864566210/sizes/l">hndrk/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Chromosomes and genes contain the blueprint for your physical characteristics. But your parents’ health and diet before you were conceived can also affect how your genes are expressed – and impact your long-term health. </p>
<p>There’s a good explanation for this. </p>
<p>What’s known as the “periconception period” covers the final stages of egg and sperm growth, fertilisation and embryo development before implantation into the uterus. During this time, the overall health of the egg, sperm and embryos are highly susceptible to changes in the environment. </p>
<p>Both under-nutrition (through deliberate calorie restriction) and over-nutrition (through diets high in calories, fats and sugars) in parents during this time can have major impacts on fertility and the long-term health of children.</p>
<h2>The impact of under-nutrition</h2>
<p>A recent study published in <a href="http://www.nature.com/ncomms/2014/140429/ncomms4746/full/ncomms4746.html">Nature Communications</a> provides a good illustration of how this works. It described how mothers’ seasonal dietary changes prior to conception affected epigenetic changes in their children. </p>
<p>The study was done in rural Gambia, where there are two distinct seasons – the rainy “hungry season” (low nutrition, protein and energy diets) and the dry “harvest season” (abundant energy supply). </p>
<p>Children conceived during the hungry period were shown to have higher levels of epigenetic changes compared to children conceived during the harvest period. This corresponds with children conceived during the hungry season having lower birth weights and being small for their gestation age. </p>
<p>Under-nutrition prior to conception and increased rates of low birth-weight babies are also prevalent in <a href="http://icmr.nic.in/ijmr/2009/november/1120.pdf">India</a>, where pregnant women are three times more likely to deliver small babies compared to other countries. But these babies are classed as “thin-fat” because while they have lower birth weights, they have similar amounts of fat (from skin-fold tests) as Western babies. </p>
<p>These children are at higher risk of developing <a href="http://www.nature.com/ijo/journal/v27/n2/full/802219a.html">insulin resistance</a> (Type 2 diabetes) and other health problems as adults.</p>
<h2>Changes to DNA expression</h2>
<p>Your parents’ health before conception can also affect your weight as an adult. A <a href="http://press.endocrine.org/doi/abs/10.1210/en.2007-1273?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">study in mice</a>, for instance, has shown that when two-cell embryos from diabetic mothers are transferred into mothers without diabetes, development is still negatively affected. These embryos have higher rates of congenital and growth abnormalities compared to offspring from mothers with normal glucose levels. </p>
<p>In terms of fathers’ roles, <a href="http://www.fasebj.org/content/27/10/4226.long">obese mice</a> that were fed high-fat diets before conception had children and grandchildren with increased fat levels.</p>
<p>But if DNA itself is not being altered, how are these changes being inherited? During the periconception period, egg and sperm DNA undergo changes in their structure, namely epigenetics modifications, that are highly sensitive to environmental changes.</p>
<p>Epigenetic modifications alter the way genes are expressed without changing the DNA sequence. It’s similar to wrapping a present in a parcel. If you use tissue paper and sticky tape, it will be easier to access than if it is wrapped in gaffer tape. </p>
<p>Epigenetic modifications, like the wrapping of a present, change access to genes. They act as an on/off switch without altering the DNA sequence. </p>
<h2>Multi-generational effects</h2>
<p>In general terms, the main epigenetic modifications are DNA methylation (where methyl is added to certain spots) and modifications in the histone (changes to the scaffolding through which DNA is stored). Such modifications are stable in normal cells, but following fertilisation, a mother’s health can dramatically affect the methylation and histone state of the embryo. </p>
<p>Both methylation and histone modifications are affected by diet, environmental chemicals, drugs and ageing. And when they’re induced by poor diet, these changes can have multi-generational effects (as shown in the study of mice on high-fat diets). </p>
<p>Under-nutrition in Gambian mothers increased DNA methylation in their babies, while high fat diets in male mice decreased DNA methylation in their sperm and children. </p>
<p>The link between macronutrient (the types of food we need in large amounts such as protein, fat and carbohydrates) intake prior to conception and the health outcomes of babies is well known. But the impact of poor diet before pregnancy in both mothers and fathers is becoming increasingly important as we learn more about its impact on development and subsequent health. </p>
<p>If you’re planning to start a family soon, remember the long-term health of your child (and potentially your grandchildren) is set before conception and make sure you’re eating a well-balanced diet. </p><img src="https://counter.theconversation.com/content/26334/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melanie McDowall receives funding from the Australian Research Council Centre of Excellence for Nanoscale BioPhotonics (CNBP).</span></em></p>Chromosomes and genes contain the blueprint for your physical characteristics. But your parents’ health and diet before you were conceived can also affect how your genes are expressed – and impact your…Mel McDowall, Researcher, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/149962013-06-18T20:41:12Z2013-06-18T20:41:12ZLack of dietary iodine threatens brain development in children<figure><img src="https://images.theconversation.com/files/25760/original/fwzxzz4b-1371538418.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnant and breast-feeding women have iodine needs that are 50% higher than the general population.</span> <span class="attribution"><span class="source">Teza Harinaivo Ramiandrisoa</span></span></figcaption></figure><p>Iodine is naturally present in a range of food, especially seaweed and fish. So it may seem odd that the people of an island nation (most of whom live along its vast coastline) are not getting enough of this vital mineral.</p>
<p>Insufficient iodine causes a range of problems including hypothyroidism (which can also be caused by too much of the mineral), high cholesterol, lethargy, fatigue and depression. But its most insidious impact is on brain development, and therefore, on children.</p>
<p><a href="http://www.nutritionj.com/content/12/1/32">Research recently completed in Adelaide</a> shows that our primary attempt to address iodine shortage (by requiring the use of iodised salt in bread) is failing to provide pregnant women with enough of the mineral. </p>
<p>This is just the latest in a growing body of recent research that should act as a public health wake-up call about our need for adequate iodine, especially during pregnancy, breast-feeding and childhood. </p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/23633204">prospective study from Tasmania</a> has shown that children of mothers with mild iodine deficiency during pregnancy have reduced educational outcomes by the time they are eight or nine (decreased NAPLAN performance of up to 10%). </p>
<p>And a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60436-5/abstract">similar study from the United Kingdom</a>, published in the Lancet, has provided convincing evidence that mild maternal iodine deficiency results in decreased IQ in children by the age of eight.</p>
<h2>Growth and development</h2>
<p><a href="http://www.who.int/nutrition/publications/micronutrients/iodine_deficiency/9789241595827/en/">Iodine deficiency</a> is considered by the World Health Organization to be “the single most important preventable cause of brain damage” worldwide. </p>
<p>But Australia’s public health programs have a primary focus on the prevention of excessive weight and obesity in children. They don’t address micronutrient deficiencies and other nutrition issues. </p>
<p>In its most drastic forms, <a href="http://www.ceecis.org/iodine/04a_consequences/02_int/chapt_on_i_brain.pdf">severe iodine deficiency</a> in pregnancy results in cretinism and mental retardation. <a href="http://apjcn.nhri.org.tw/server/apjcn/Volume14/vol14.1/fullArticles/Quian.pdf">Studies in China</a> indicate that iodine deficiency results in a population-level loss of intelligence in children up to the magnitude of about 13 IQ points.</p>
<p>Iodine is essential for human growth and development, as the thyroid gland depends on it for the production of hormones. These hormones play an essential role in regulating your metabolism.</p>
<p>Programs to address iodine deficiency were first introduced in Australia in the 1950s. These included the introduction of iodised salt and supplementation through medical practitioners. But they were stopped when communities were considered to be iodine sufficient in the 1980s.</p>
<p>Until the early 1990s, iodine was supplied to Australians mainly via milk through the use of iodised cleaning agents in the dairy industry. But then the cleaning agents changed and iodine deficiency returned.</p>
<p>A <a href="https://www.mja.com.au/journal/2006/184/4/are-australian-children-iodine-deficient-results-australian-national-iodine">national study</a> of schoolchildren published in 2006 identified mild to moderate iodine deficiency in some states. To address this, a mandatory iodisation was started in Australia and New Zealand in late 2009. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/25759/original/xtg6d7w6-1371538000.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Iodine deficiency can lead to hypothyroidism.</span>
<span class="attribution"><span class="source">Wen-Yan King</span></span>
</figcaption>
</figure>
<p>All bread-making flour, except organic breads, were to contain iodine. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23682893">Early reports</a> have shown improvements in children since introduction of fortification. This is good news, but clearly not enough for prospective mothers. </p>
<p>Pregnant and breast-feeding women have iodine needs that are 50% higher than the general population. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23541517">Our survey of pregnant women</a> three years after iodine was added to bread also found that they would be unable to obtain adequate iodine from their diets, even when it included fortified bread.</p>
<h2>A balancing act</h2>
<p>Authorities needed to balance the iodine requirements of children with avoiding excess intake across the population before fortifying food with iodine. This dilemma led the <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/new45_literature_review.pdf">National Health and Medical Research Council</a> to recommend iodine supplementation of 150 ug/day for pregnant and breast-feeding women.</p>
<p>But four in ten women are <a href="http://www.ncbi.nlm.nih.gov/pubmed/23541517">still not taking</a> recommended iodine supplements during their pregnancy. Breast-feeding women are also generally <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2011.00791.x/abstract">iodine deficient</a> unless they are taking supplements.</p>
<p>Women have been poorly informed about the importance of iodine for development of their baby. <a href="http://www.mdpi.com/2072-6643/4/9/1317">Our research shows</a> they perceive the nutritional advice provided by their doctors to be insufficient.</p>
<p>In May 2013, updated <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/13DFC2A40EEE9BAACA2574C700213A36/$File/ANC_Guidelines_Mod1_v32.pdf">clinical guidelines on antenatal care</a> were published by the Department of Health and Ageing. They recommend nutritional supplementation of 150 ug iodine every day throughout pregnancy. </p>
<p>New models of antenatal care will be required to implement these guidelines. Government actions could include:
- provision of free nutritional supplements to women during pregnancy, under the Pharmaceutical Benefits Scheme,
- improved information about optimal dietary and supplemental iodine intakes for women of reproductive age and
- better training of health professionals on the need for adequate iodine intakes.</p>
<p>Iodine deficiency during pregnancy appears to have been overlooked as a preventable cause of developmental delay in young children. Even subtle cognitive changes may affect school attainment, examination grades, and employment opportunities further down the track. </p>
<p>At the population level, a one-point increase in a nation’s average IQ <a href="http://ideas.repec.org/p/wpa/wuwpdc/0507005.html">has been associated</a> with a persistent 0.11% annual increase in gross domestic product per capita. </p>
<p>Pregnant and breast-feeding women need to know about the importance of iodine supplements so that their children are not disadvantaged.</p><img src="https://counter.theconversation.com/content/14996/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Yeatman is President of the Public Health Association of Australia, and she chairs the Consumer and Public Health Dialogue of FSANZ.</span></em></p><p class="fine-print"><em><span>Karen Charlton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Iodine is naturally present in a range of food, especially seaweed and fish. So it may seem odd that the people of an island nation (most of whom live along its vast coastline) are not getting enough of…Heather Yeatman, Associate Professor in School of Health Sciences, University of WollongongKaren Charlton, Associate Professor in School of Health Sciences , University of WollongongLicensed as Creative Commons – attribution, no derivatives.