nutrition and pregnancy

The information available on nutrition and supplementation is confusing and if often misleading, leaving the public immune or often misinterpreting information regarding nutrition and pregnancy. Here are a few points regarding the key issues, preconception,  during pregnancy and breastfeeding.

Weight and pregnancy

A healthy weight before and during pregnancy should be maintained. Before pregnancy the mother should have a BMI of between 18 and 25. Underweight mothers, mothers who carry out excessive exercise or have suffered amenhorrea ( >3 months of no period) in the past should be even more focused on maintaing a healthy weight, in order to prevent low birth rate and miscarrying the baby.  Obese people looking to become pregnant should also be considerate of their weight as a BMI >30 causes miscarrying and the implications associated with obesity, such as insulin resistant could put the baby at a genetic disposition to experience metabolic problems later in life.

Folic acid 

A supplement of 400mg a day is advised during pregnancy to prevent neural tube defects like spina bifida.  Food sources of folic acid can be found in: broccoli, kale, brussel sprouts, beans, legumes, and fortified foods such as cereals and marmite.
There is controversy over whether some foods should be regulatory fortified with high amounts of folic acid in them, yet the FSA has denied this fortification as folic acid as it can mask early signs of anaemia and vitamin B12 deficiency especially in the elderly causing neurological defects.

Vitamin D

Provided mainly from sunlight and absorbed by the epidermis layer in the skin, vitamin D is essential for the baby and their bones. A supplement of 10 mg per day should be advised particularly in people who are limited to sun exposure. Ethnic populations who are covered due to religion should also be aware of supplementation as they are more at risk due to reduced sunlight exposure.
Severe deficiency of vitamin D can lead to rickets,  decreased bone mineralisation, increase in fracture susceptibility,  and reduced bone size and mass.  "Healthy start" brand by the NHS provides the correct amount of vit D,C, and folic acid amounts.

Vitamin A

The amount of this vitamin should be limited. No more than 600 mg a day should be consumed in the diet or through supplementation ( always check other supplements do not contain any vitamin A). More than 800mg a day can be teratogenic. Vitamin A can be found in the diet in the form of carotenes and retinol. Foods containing high amounts should be avoided: pate, liver, kidneys. Excessive amounts can cause birth defects, such as a cleft lip and major heart defects.

Alcohol

If mothers are still going to drink during pregnancy, they should limit their consumption to one-two units twice a week.

Protein

There is no need in Western countries who consume a western diet, to increase protein intake, as the amount recommended is 60-85g which people already meet or exceed.

Smoking 

Smoking should be stopped during pregnancy, not only due to its 4,000 chemicals one cigarette contains but also due to the fact it restricts the oxygen flow to the baby making their heart work incredibly hard and faster potentially leading to death.

Fish

There is misleading messages on the NHS website and on various websites that may lead the pregnant women to avoid fish consumption completely. Yet research has said that the loss of nutrients from fish is far greater than the risk of harm from elements in the fish itself, so consumption of fish is still vital. Contamination from methyl-mercury is the main trace element of concern, therefore 1-2 portions of oil fish per week is advised, and no more than >3.3 ug/kg of body weight per week of fish like tuna, canned tuna, marlin, swordfish and shark should be consumed.
n-3 fatty acids from the fish (DPA,EPA,DHA) are essential fatty acid components of brain and retina cell membranes. Consumption of fish is particularly important in the third semester when there is a large increase in these membranes.  

Breastfeeding
breastfeeing should occur exclusively up to 6 months from the birth of the baby.
breastfeeding has many 

the sciencey bit...
a drop in estrogen and progesterone causes the primary milk let down in the breast of the mother and starts the process of the milk flow.
oxytocin and prolactin are regulated by a feedback loop, and cause the continual milk let down and the synthesis of milk. 
lactation provides all of the essential nutrients for the baby up to 6 months
the milk changes in the course of the six months providing different amounts of fat, nutrients and protein: colostrum - transitional milk - mature milk.
the milk also contains immune factors such as immune cells, antibodies and stem cells.
research has shown than 10% of early baby deaths can be prevented from breast feeding. 

Importance of breastfeeding
creates a bond between the mother and child
protection from early illness and diseases 
prevents eczema, asthma, childhood diabetes, chest infections
evidence suggests that breast feeding also prevents osteoporosis later in life 
it also aids weight loss if carried on for >6 months


Breastfeeding and HIV

HIV is mainly contracted through breastfeeding, this can be reduced by cessation of breastfeeding. Yet milk alternatives/formulas should be available with the correct amounts of vitamin and minerals. 
If breastfeeding is continued then antiretroviral therapy for both the mother and baby should be carried out.