Maternal and neonatal health outcomes are significantly influenced by nutrient availability throughout preconception, pregnancy and lactation. Inadequate nutrition during preconception and pregnancy poses significant risks to the foetus, including impaired development, preterm birth and low birth weight.6 The first 1,000 days of life, starting from conception, offer a critical window of plasticity, and therefore, opportunity. Maternal nutrient levels and overall health have a significant impact on the health and genetic expression of generations to come; thereby setting up the infant with the greatest potential for lifelong health. This relies on having a foundation of micronutrients, omega-3 essential fatty acids and a healthy gut microbiome.
Pregnancy is a critical time during which DNA methylation can shape neonatal health outcomes by helping regulate healthy gestational development and genetic expression.7 Inadequate methylation is a contributing factor in many disease states; however nutrients that act as methyl donors can promote healthy methylation.8 Adequate consumption of choline provides 60% of the body’s methyl groups9 by serving as a precursor for S-adenosylmethionine (SAMe) production, the universal methyl donor in the body.10 Genetic polymorphisms associated with impaired methylation have been linked to the accumulation of homocysteine,11 which is associated with adverse outcomes in pregnancy, including preeclampsia,12 miscarriage,13 and neural tube defects (NTDs) and poor brain development.14 Ensuring an adequate supply of methylating nutrients including choline, vitamins B6 and B12, and folic acid before and during pregnancy supports methylation and health outcomes. [NB: These nutrients are best prescribed by a qualified Naturopath to ensure quality and applicability in each case]
Gestational neurodevelopment is highly sensitive to nutritional status. Nutrient availability, high levels of oxidative stress and poor glycaemic control may also elevate the risk of NTDs,15 and interestingly, lutein can help reduce incidence via its antioxidant mechanisms, in combination with folate.16 Further, choline, and vitamins B6 and B12 have been demonstrated to lower the risk of NTDs in pregnancy when combined with adequate folic acid.17 Shown to reduce incidence by a significant 50% to 75%18; a large body of evidence supports the use of folic acid in lowering NTD risk, while the effectiveness of 5-methyltetrohydrofolate (5-MTHF) has not been extensively evaluated for this indication.19 5-MTHF can directly enter the methylation cycle,20 and may therefore be better utilised by individuals with an impaired ability to convert folic acid (e.g. those with MTHFR mutations).21 Our Naturopath is able to prescribe the proper form of folate to ensure superior bioavailability, while also providing protection against this serious condition.
Choline is an often-deficient essential nutrient utilised by the developing brain, as it is a precursor of acetylcholine,22 a key neurotransmitter that regulates neuronal proliferation, differentiation, migration, maturation and plasticity, as well as synapse formation.23 Additionally, human data indicates lutein comprises 59% of total brain carotenoids, and is found in high concentration within the infant nervous system, particularly in the occipital cortex and hippocampus; involved in learning and memory.24 Lutein supports intracellular communication within neurons, exerts neuroprotective properties, and enhances brain metabolism and growth in neonates.25 Providing these important nutrients can help support neural growth and healthy brain development.
NUTRITIONAL SUPPORT FOR MOTHER AND CHILD
Pregnant women require a varied diet and nutrient intake to allow for increased needs during pregnancy, and for the development and growth of a healthy baby.26 Providing key nutrients lays a solid nutritional foundation for a healthy pregnancy and most importantly, a healthy child. Many nutrients have multiple mechanisms of action and support various aspects of health, including:
- Thyroid Health: Iodine supports maternal thyroid function during pregnancy and lactation due to its role in the production of thyroid hormones, free thyroxine (T4) and triiodothyronine (T3).27 Demand for iodine is increased during pregnancy, as the foetus is reliant on maternal T4. Considering T4 is directly responsible for baby’s cellular metabolism, neuronal migration and myelination during development,28,29,30,31 ensuring adequate iodine intake is essential.
- Anaemia Prevention: One of the most common complaints in pregnancy is fatigue, which is associated with nutritional deficiency in pregnancy. Iron plays an important role in energy production as it transports oxygen via haemoglobin between mother and baby.32 Prenatal iron intake has been shown to improve neurological outcomes in children, highlighting the importance of maternal iron adequacy.33 Only some forms of iron are absorbed quickly and taken into the enterocyte more efficiently;34 because of this can help prevent iron deficiency anaemia in pregnant women and reduce the risk of negative health outcomes in infants.35
- Bone Health: Skeletal health in neonates is dependent on the availability of key nutrients during foetal development and the neonatal period. Adequate maternal levels of vitamin D are vital for offspring bone development.36 Vitamin K is also a key factor required for the formation of the neonatal skeleton; it promotes bone growth, prevents tissue calcification and limits calcium reabsorption from bone.37 Lastly, manganese is an essential cofactor in bone formation38 due to its role in the synthesis of chondroitin sulfate,39 and aids skeletal development by supporting the structural growth of bone tissue.
- Morning Sickness: Vitamin B6 administered within the first trimester of pregnancy has been shown to improve symptom severity. In a randomized, controlled trial, vitamin B6 was shown to be as effective as ginger and more efficacious than placebo in reducing the severity of morning sickness using a validated screening tool.40
ESSENTIAL FATTY ACIDS
Studies associate higher intakes of omega-3 essential fatty acids during pregnancy with improved foetal growth and development during gestation.41 Docosahexaenoic acid (DHA) in particular plays a key role during foetal and infantile brain development acting on multiple levels including membrane biogenesis, gene expression, protection against oxidative stress and neurotransmission conduction.42 DHA also supports the development of brain structure, contributing 30% to 40% of the total long chain polyunsaturated fatty acids within grey matter of the cerebral cortex.43 Additionally, DHA is involved in processes that support neuronal health44 including the regulation of neuronal apoptosis, and neuroprotection and repair.45 Clean and pure fish oil containing 600 mg/d DHA taken from 20 weeks’ gestation to birth improved infant growth and development, resulting in improved birth outcomes.46 Fish oil was also shown to improve foetal cardiac autonomic control and newborn neurobehaviour.47
The maternal microbiome is instrumental in the development of the infant microbiome, with the transfer of organisms affecting a wide range of organ systems beyond the gastrointestinal tract. Probiotic supplementation during pregnancy may beneficially influence both the maternal and infant gastrointestinal microbiota, and impact clinical outcomes. For example, if the mother supplements with specific strains of probiotics during pregnancy and lactation, the risk of allergy based conditions such as eczema,49 and behavioural based diagnoses including attention deficit disorder (ADHD)50 in children can be reduced. At True Medicine we use only high grade practitioner-only probiotics.
LAYING THE FOUNDATIONS FOR A HEALTHIER LIFE
Specific nutrients can help to offset the risk of dietary insufficiency related to inadequate nutrient intake during pregnancy. Creating a solid foundation of nutrients, omega 3 essential fatty acids (especially DHA) and a healthy gut microbiome is essential for preconception and pregnancy care to ensure the best possible health for both mother and the child.
Contact us at True Medicine for assistance in starting, or adding to, your family.
Source: Courtesy of Metagenics
6 Gernand AD, Schulze KJ, Stewart CP, West Jr KP, Christian P. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat Rev Endocrinol. 2016 May;12(5):274.
7 Zeisel SH. Choline: critical role during fetal development and dietary requirements in adults. Annu Rev Nutr. 2006;26:229-50.
8 Mahmoud AM, Ali MM. Methyl donor micronutrients that modify DNA methylation and cancer outcome. Nutrients. 2019 Mar 13;11(3). pii: E608 doi: 10.3390/nu11030608.
9 Niculescu MD, Zeisel SH. Diet, methyl donors and DNA methylation: interactions between dietary folate, methionine and choline. J Nutr. 2002 Aug 1;132(8):2333S-5S.
10 Zeisel SH. Choline: critical role during fetal development and dietary requirements in adults. Annu Rev Nutr. 2006;26:229-50.
11 Mahmoud AM, Ali MM. Methyl donor micronutrients that modify DNA methylation and cancer outcome. Nutrients. 2019 Mar 13;11(3). pii: E608. doi: 10.3390/nu11030608.
12 Wadhwani NS, Patil VV, Mehendale SS, Wagh GN, Gupte SA, Joshi SR. Increased homocysteine levels exist in women with preeclampsia from early pregnancy. J Matern Fetal Neonatal Med. 2016 Aug 17;29(16):2719-25.
13 Nelen WL, Blom HJ, Steegers EA, den Heijer M, Eskes TK. Hyperhomocysteinemia and recurrent early pregnancy loss: a meta-analysis. Fert Stert. 2000 Dec 1;74(6):1196-9.
14 Mahmoud AM, Ali MM. Methyl donor micronutrients that modify DNA methylation and cancer outcome. Nutrients. 2019 Mar 13;11(3). pii: E608 doi: 10.3390/nu11030608.
15 Carmichael SL, Yang W, Shaw GM. Periconceptional nutrient intakes and risks of neural tube defects in California. Birth Defects Res A Clin Mol Teratol. 2010 Aug;88(8):670-8 doi: 10.1002/bdra.20675.
16 Carmichael SL, Yang W, Shaw GM. Periconceptional nutrient intakes and risks of neural tube defects in California. Birth Defects Res A Clin Mol Teratol. 2010 Aug;88(8):670-8 doi: 10.1002/bdra.20675.
17 Petersen JM, Parker SE, Crider KS, Tinker SC, Mitchell AA, Werler MM. One-carbon cofactor intake and risk of neural tube defects among women who meet folic acid recommendations: a multicenter case-control study. Am J Epidemiol. 2019 Feb 19.pii:kwz040 doi: 10.1093/aje/kwz040.
21 Servy EJ, Jacquesson-Fournols L, Cohen M, Menezo YJR. MTHFR isoform carriers. 5-MTHF (5-methyl tetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. J Assist Reprod Genet. 2018 Aug;35(8):1431-1435 doi:10.1007/s10815-018-1225-2.
23 Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. 2018 Apr;32(4):2172-2180 doi: 10.1096/fj.201700692RR.
29 Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. Iodine [Internet]. Canberra (ACT): Australian Government. 2017 September [cited 2017 Dec 21]. Available from: https://www.nrv.gov.au/nutrients/iodine.
33 Iglesias L, Canals J, Arija V. Effects of prenatal iron status on child neurodevelopment and behavior: a systematic review. Crit Rev Food Sci Nutr. 2018 Jul 3;58(10):1604-1614 doi: 10.1080/10408398.2016.1274285.
34 Milman N, Jønsson L, Dyre P, Pedersen PL, Larsen LG. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med. 2014 Mar;42(2):197-206 doi: 10.1515/jpm-2013-0153.
35 Milman N, Jønsson L, Dyre P, Pedersen PL, Larsen LG. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial. J Perinat Med. 2014 Mar;42(2):197-206 doi: 10.1515/jpm-2013-0153.
36 Karras SN, Fakhoury H, Muscogiuri G, Grant WB, van den Ouweland JM, Colao AM, et al. Maternal vitamin D levels during pregnancy and neonatal health: evidence to date and clinical implications. Ther Adv Musculoskelet Dis. 2016 Aug;8(4):124-35 doi: 10.1177/1759720X16656810.
38 National Health and Medical Research Council. Manganese [Internet]. Canberra (ACT): Australian Government. September 2017. Cited: December 21st 2017. Available from: https://www.nrv.gov.au/nutrients/manganese.
40 Sharifzadeh F, Kashanian M, Koohpayehzadeh J, Rezaian F, Sheikhansari N, Eshraghi N. A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP). J Matern Fetal Neonatal Med. 2018 Oct;31(19):2509-2514 doi: 10.1080/14767058.2017.1344965.
42 Innis SM, Hansen JW. Plasma fatty acid responses, metabolic effects, and safety of microalgal and fungal oils rich in arachidonic and docosahexaenoic acids in healthy adults. Am J Clin Nutr. 1996 Aug;64(2):159-67.
43 McNamara RK, Able J, Jandacek R, Rider T, Tso P, Eliassen JC, et al. Docosahexaenoic acid supplementation increases prefrontal cortex activation during sustained attention in healthy boys: a placebo-controlled, dose-ranging, functional magnetic resonance imaging study. Amer J Clin Nutr. 2010 Apr;91(4):1060-7.
47 Gustafson KM, Carlson SE, Colombo J, Yeh HW, Shaddy DJ, Li S, et al. Effects of docosahexaenoic acid supplementation during pregnancy on fetal heart rate and variability: A randomized clinical trial. Prostaglandins Leukot Essent Fatty Acids. 2013 May;88(5):331-8.
48 Martins DA, Custódio L, Barreira L, Pereira H, Ben-Hamadou R, Varela J, et al. KM. Alternative sources of n-3 long-chain polyunsaturated fatty acids in marine microalgae. Mar Drugs. 2013 Jun 27;11(7):2259-81. doi:10.3390/md11072259.
49 Rautava S, Kalliomäki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol. 2002 Jan;109(1):119-21.