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Running head: EFFECT OF NUTRITION ON PREGNANCY

Eating for Two? The Effect of Nutrition on Pregnancy and Methodology to Ameliorate

Misconceptions and Inequities Worldwide Regarding Pregnancy

Rachel R. Rockecharlie

Glen Allen High School

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Introduction

In today’s high-paced, always changing world, increasingly more people—and women,

especially—struggle to combat and ameliorate anemia, caffeine addictions, and the opioid

epidemic. Hence, it is more important than ever to take preemptive healthcare measures when it

comes to pregnancy. Women must make every effort in an attempt to create the best possible

outcomes for their pregnancies, thus meaning that healthy habits and pre-pregnancy planning are

essential. Healthful nutrition prior to and during pregnancy serves to counter the myriad other

forces working against a woman during pregnancy. Given that weight gain goals for pregnancy

are based in “pre-pregnancy weight, height, age, and usual eating patterns”, no detail or choice

should be left to chance (International Food Information Council, 2009). Of course, since this is

an issue not limited to the United States but rather universal among all nations, it is of utmost

necessity to examine how and to what extent nutrition affects pregnancy. From the development

of childhood allergies to other problematic fetal defects, maternal nutrition is a key player in the

neurological and physical development of a young child. In addition, misconceptions regarding

best practices during pregnancy continue to run rampant despite efforts to quell inaccurate

beliefs. Erroneous views regarding issues such as cravings during pregnancy and food intake of

mothers as it relates to the child’s food preferences must be dispelled through proper education

and good practice. Doctors and healthcare professionals play a key role in this patient education,

and continued and increased education opportunities are crucial to increasing the likelihood of

proper nutrition. Thus, in order to best explain the impact of nutrition on pregnancy, a complete

examination of all factors that relate to pregnancy must be discussed. That said, the impact of

nutrition on pregnancy must not be underestimated, and it is essential to subdue misconceptions

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on this issue in an effort to increase knowledge and understanding of the basics of healthy living

so as to ensure that pregnancies occur with minimal risk for all involved.

Basic Nutrition

In order to assure that a pregnant woman is eating properly, an analysis of basic nutrition

serves to set a foundation upon which all additional information can be added. There are five

basic food groups: grains, fruits, vegetables, dairy, and protein (American College of

Obstetricians and Gynecologists, 2017). Altogether, these food groups contribute to the overall

health of an individual. Combined with the fat, carbohydrates, fiber, and other nutrients that

exist within these foods, it is possible for one to maintain a healthy, well-rounded diet. Although

some people assume fat is bad, this belief is inaccurate in considering that fats play a vital role in

the functioning of the immune system as well as the clotting of blood (American College of

Obstetricians and Gynecologists, 2017). Registered Dietician and PhD Lisa Brown recently

authored an article in which she discusses the necessity of analyzing a woman’s health not only

during pregnancy and in isolation, but rather in the “larger context of the mother’s overall

health” (Brown, 2011). Additionally, research conducted by the International Food Information

Council and in concurrence with Brown’s findings underscores the idea that pregnancy is not

about “eating for two”; instead, only three hundred additional calories a day are recommended

for a typical woman who consumes approximately two thousand calories a day prior to

pregnancy (2009). That said, the fifteen percent caloric increase should primarily be comprised

of nutrient dense foods, meaning foods that are low in calories but rich in vitamins and other

nutrients. Furthermore, the analysis of a woman’s pre-pregnancy Body Mass Index—BMI—

provides a highly accurate estimation of how much weight a woman may gain during pregnancy.

Because BMI takes into account a woman’s body fat in relation to her height and weight, it is
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much more useful than mere height and weight measurements (International Food Information

Council, 2009).

Of course, while it may be easy to enumerate and explain the basics of nutrition,

following certain meal plans is a bit more complex. There are a variety of meals that are healthy

for a pregnant woman to eat, but a wholesome diet will often consist of a few key factors.

Breakfast, for example, must include a substantial amount of protein in order to increase energy

levels and provide a strong basis upon which to start the day (Authority Nutrition, 2017). Eggs

with a banana and peanut butter suffice for this suggestion. Lunch should consist of a

combination of healthy fats, fruits and vegetables, and whole grains. Hence, a meal that includes

a sandwich made with turkey, avocado, and spinach on whole-wheat bread coupled with a

serving of berries and roasted chickpeas effectively checks all of these boxes. Dinner should be

similar to lunch in terms of the nutrients it provides, but there should be a focus on protein and

dairy; a meal of salmon with spinach and lentils combined with a dessert of vanilla Greek yogurt

and chocolate chips represents an ideal meal (Authority Nutrition, 2017).

Vitamins and Supplements

As more research becomes available on the benefits of consuming various vitamins,

minerals, and other supplements, there is an increasing emphasis on the importance of prenatal

vitamins. Globally, women are deficient in iron and folate, both of which are important in a

pregnancy. The majority of foods contain nonheme iron, which is difficult for the body to

absorb and thus explains why many people are unaware of their deficiencies (Cox & Phelan,

2008). Contrastingly, heme iron, found in certain types of meats, is easier to absorb and is thus

recommended for women who are planning to become or are pregnant (Cox & Phelan, 2008).

Recognizing deficiencies in iron is crucial to ensuring the health of mother and baby during a
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pregnancy; extreme iron deficiencies result in anemia, which can lead to preeclampsia for the

mother and low birth weight for the baby, among other complications (Milman, Paszkowski,

Cetin, & Castelo-Branco, 2016). Additionally, the World Health Organization, in agreeance

with Cox and Phelan, recently acknowledged that a “folate deficiency in pregnancy is

[especially] common” (Milman, Paszkowski, Cetin, & Castelo-Branco, 2016). Folate is the

nutrient that is found naturally in foods; that said, folic acid, the “synthetic form [of folate] used

in supplements”, is an excellent substitute for women lacking in this nutrient (International Food

Information Council, 2009). Particularly during the first four weeks of pregnancy, folate and

folic acid play formative roles in the development of the central nervous system, as they work to

prevent and decrease neural tube defects in fetuses (Brown, 2011).

That said, there are a multitude of other important nutrients that can come in the form of

vitamins. Docosahexaenoic acid—colloquially known as DHA—is an “omega-3 fatty acid that

is important for babies’ brain and eye development” (International Food Information Council,

2009). DHA is easily accessible through vitamins, and prenatal vitamins especially make access

to DHA very easy. Likewise, Vitamin D is essential for the health of a mother and baby. Not

only does it regulate “the amount of calcium and phosphate in the body”, but also it decreases the

likelihood of abnormal bone growth, factures, or rickets in babies when and after they are born

(NHS, 2017).

Often overlooked, probiotics are essential to any pregnant woman’s health. Because the

immune system is suppressed during pregnancy, “taking immune-boosting probiotics” becomes

the key to staying healthy (Bajaj, 2014). In terms of the relation of probiotics to the baby, the

intake of such a supplement by the mother can assist in building up a bacteria culture to which
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the baby will be exposed, thereby having a lifelong impact on the baby’s “immunity and health”

(Bajaj, 2014).

With all of the aforementioned information in mind, it is worth considering whether or

not the typical prenatal vitamin provides the necessary vitamins and supplements that a woman

may be lacking. Although almost every woman could benefit from taking a prenatal vitamin,

there is a specific target group of individuals who benefit most. Women who have higher needs

than normal are most encouraged to take these vitamins. These needs may include HIV, a

pregnancy of multiples, chronic disease, and certain blood disorders (Baby Center, 2016). Folic

acid and iron are most commonly found in prenatal vitamins, whereas nutrient needs such as

calcium must be met elsewhere. Still, the consumption of prenatal vitamins prior to pregnancy

allows a woman to build up an adequate supply of nutrients so as to ensure that when she

conceives, the baby will have enough nutrients to thrive (Brown, 2011). Folic acid, for example,

is most important during the early weeks of pregnancy; therefore, it is during this time and

immediately before that the vitamins are especially meaningful. By taking preemptive measures

and using caution and care when planning for pregnancy, it is possible to avoid many dangerous,

frightening situations that may arise from poor planning or unhealthy addictions.

Drugs and Alcohol

Increasingly, research on nutrition during pregnancy has focused on drugs and alcohol.

That said, many women do not realize that caffeine is a drug; although moderate caffeine

consumption is acceptable during pregnancy, any amount above 300 milligrams is pushing the

boundaries of what is known about the effects of this drug on mother and baby (International

Food Information Council, 2009). Additionally, since “alcohol can pass freely through the

placenta” it is dangerous to consume any quantity of this substance (Brown, 2011). Not only can
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alcohol consumption during pregnancy lead to preterm birth and low birth weight, but also, more

commonly, it is associated with Fetal Alcohol Syndrome, characterized by mental retardation

and skeletal and cardiac malformations. Delving deeper, recent research compiled by professor

of nursing Amy Levi indicates that more than twenty percent of pregnant women have used

“illicit drugs, including opiates such as heroin and illegally obtained prescription painkillers”

(2014). Clearly, this epidemic and its far-reaching effects do not spare pregnant women, and

with the rise of the opiate crisis has come increased complications with pregnancies. Although

“opiates are not teratogens in humans”, they still carry significant risks, including spontaneous

abortion, fetal demise, preterm birth, and more (Levi, 2014). Additionally, heroin passes through

the placenta and to the fetus within one hour of use, hence leading to a toxic build-up of this

substance in the amniotic fluid as well as changes to the chemical makeup of the placenta (Levi,

2014). Although methadone is the “first-line treatment of opioid addiction in pregnancy” in

many countries, this drug, like buprenorphine—another option for the management of opiate

addiction—does not come without its own dangers (Levi, 2014). Nonetheless, the recommended

time frame for weaning a woman off of opioids starts in the first trimester; the later into the

pregnancy it begins, the higher the risk of premature labor or fetal death. With that information

in mind, there should be a significant increase in the dosage of maintenance therapy drugs as the

pregnancy continues, as such an increase works in accordance with the additional maternal fluid

volume. The focus on opiate during pregnancy is especially important in today’s world.

According to recent research conducted by the Centers for Disease and Control, approximately

half of all pregnancies aren’t planned. Given that “taking opioids during the first weeks of

pregnancy can lead to congenital disabilities”, the emphasis on this issue mustn’t be decreased

(The Recovery Village, 2017). Although following such seemingly basic rules appears obvious,
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many people fail to consider that even something as simple as cigarette smoking accounts for

approximately twenty to thirty percent of low-birth weight babies (Brown, 2011). Therefore, the

best way to avoid the consequences of drugs and alcohol on pregnancies is to avoid the

substances altogether.

Diets, Eating Disorders, and Obesity

Despite the common belief that diet and nutrition are synonymous, there is a necessary

distinction to be made between these two words. A woman who eats a fully vegan diet, for

example, must be mindful to consume large quantities of soy protein, as it is the only complete

vegan protein source (International Food Information Council, 2009). Furthermore, experts

concur that maternal eating disorders—such as anorexia—that lead to excessive weight loss

increase the likelihood of the baby developing heart disease, diabetes, and more later on in life

(Brown, 2011). Likewise, the phenomenon of “pregoroexia”, in which women “overly restrict

energy intake and/or over-exercise during pregnancy to minimize weight gain”, endangers both

the mother and baby for early delivery and other issues (Brown, 2011).

On the other end of the spectrum, pre-pregnancy obesity is associated with Polycystic

Ovarian Syndrome and miscarriage, as well as a greater risk of “fetal anomalies” and caesarian

section delivery (Cox & Phelan, 2008). Maternal obesity carries with a plethora of other

complications too, and recent Centers for Disease Control research found that babies born to

mothers who were overweight at the time of conception are twice as likely than other babies to

develop or be born with heart anomalies (Brown, 2011). Ultimately, because a woman’s pre-

pregnancy weight is often a good predicator of how much gestational weight gain will occur, it is

important for these women to recognize certain risks to which they are susceptible and then do

what they can to decrease the dangers associated with them.

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In order to fully grasp the significance of BMI and weight during pregnancy, women

must feel comfortable stepping on the scale. In 1991, a study conducted by Dawes and

Grudzinskas found frequent weigh-ins at the hospital during routine pregnancy appointments

caused “unnecessary anxiety in women” (Allen-Walker et al., 2017). As a result of this study,

many hospitals began steering away from weigh-ins, leading to the conclusion that “weighing

women throughout pregnancy is no longer standard practice” (Allen-Walker et al., 2017). The

unfortunate effects of this change are represented in doctor frustration over the lack of patient

knowledge and patient anger over the inability to easily discuss gestational weight. Therefore, a

2015 study conducted by Daley and others gained special importance when it was released.

Daley’s study found that there is no reason to believe that women feel anxious about weigh-ins,

and that many women actually appreciate being weighed because of how it makes them feel,

both good and bad. This study determined that “women felt motivated to think about their

weight gain in terms of eating and physical activity habits as a result of being weighed, and

responded positively to the importance of being weighed routinely” (Allen-Walker, 2017).

Hence, routine weigh-ins are necessary components of checkups during pregnancy, and it

provides the perfect opportunity for doctors and patients to engage in honest, candid discourse

about weight management during pregnancy. Therefore, even though psychology and feelings

play a pivotal role in healthfulness during pregnancy, a woman’s anxiety about being weighed is

not a large factor in how the pregnancy plays out.

For many women, the changes they “make to their diet and physical activity behaviour do

not develop gradually during early pregnancy, but instead appear to be triggered by the

confirmation of conception” (Swift et al., 2017). Because early pregnancy is an opportune time

to change habits, many women naturally take advantage of it. Logically, the “growth and
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development of the unborn child” is apt to stimulate significant change, and women have a

legitimate reason to remain faithful to the goals they set for themselves (Swift et al., 2017).

Unfortunately, there is a lack of specificity in terms of the health recommendations available to

pregnant women; ideas such as “stay fit” or “engage in moderate-intensity workouts” are

severely oversimplified. As a result, many women find it difficult to stay on track with a

healthful lifestyle. Consequently, only with the assistance and guidance of health professionals,

family, and friends is it possible to develop and maintain such a lifestyle. They say it takes a

village to raise a child, but that village isn’t built overnight. Rather, it’s built up throughout the

pregnancy, as people work to provide women with advice and assistance where ever it may be

necessary. For all women, the area of nutrition is a place of particularly heavy emphasis when it

comes to help from others.

Conclusion

Research into the effects of nutrition on pregnancy and the topics surrounding gestational

and pre-pregnancy health unveils a variety of information regarding nutrient deficiencies, lack of

knowledge, and more. While some research focuses on the basic issues of nutrition during

pregnancy—nutrients, vitamins, calories—, other research delves into the uncomfortable topics

of drug addiction, dieting, and obesity. The general consensus that women must take control of

their health prior to and during pregnancy indicates the necessity of education and proper

nutrition for all individuals. That said, further research into the ways that lifestyle choices effect

nutrition, and, in turn, pregnancy outcomes, may shed light on the best methods to decrease the

risks associated with many pregnancies. Moreover, it appears at this moment that future research

will better explain the link between maternal weight and pregnancy outcomes, as this issue is not

an exact science at the current moment. In summation, healthful nutrition during pregnancy can
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be achieved partly through looking beyond the trivialities and misconceptions that so many

believe when it comes to pregnancy; rather than “eating for two”, pregnant women and all

individuals who may be affected by pregnancy at some point in time must work to understand

the basics of nutrition during pregnancy and recognize how it may be possible to improve

pregnancy outcomes.

After all, you are what you eat, and it wouldn’t be fair for a baby to be born looking like a

cheeto or fruit roll up.

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