IMPORTANT NUTRITIONAL ISSUES FACING PRE-CONCEPTION, PREGNANT AND POSTPARTUM WOMEN TODAY

Question 1

Key Questions Regarding
Optimal Nutrition in Pregnancy
• What are the goals of optimizing nutrition in pregnancy?
• Who is in the target population?
• When should people start optimizing nutrition for pregnancy?

Answer 1

• Mother: appropriate weight gain; free from nutritional insufficiency or excess; free from pregnancy complications; able to feed infant appropriately
• Infant: healthy time, size; minimal short and long-term complications (NCDs)
• Father: support healthy fetal development
• Women of child-bearing age
• Men of childbearing age
• When should people start optimizing nutrition for pregnancy?
• Before a couple gets pregnant

Question 2

GENERAL FEMALE
NUTRITION

Summary Statement 1:
Food-Based Approach to Healthy Nutrition

Answer 2

• A balanced and varied diet higher in vegetables, fruit,
whole grains, low- or non-fat dairy, seafood, legumes, and
nuts; moderate in alcohol (for non-pregnant and nonlactating women); lower in red and processed meats; and
low in sugar-sweetened beverages and refined grains
reduces the risk of chronic diseases including type 2
diabetes, cardiovascular disease, and cancer.

Question 3

Summary Statement 2

Social Determinants of Health Contribute to Nutritional Well-Being

Answer 3

• Women’s health, including their nutritional status, can be adversely
affected by psycho-social, economic, or geographic circumstances,
which compromise their “food environment”.
• Barriers to healthy eating may include individual factors, community
factors and relevant policies.
• Women at high risk for poor nutritional status may benefit from
additional dietary counselling or targeted interventions (III)

Question 4

Energy is required for…..

Answer 4

Growth of Products of Conception
Additional metabolic costs
Increased costs of physical activity
=Total Energy Cost ~80,000 kcal

goes to pdts of conception, materal tissues , blood, materal fat stores
diff yype of weight gain than normal weight gain

Question 5

Preganacy is risk factor of obesity
Move up 1 BMI category

Gestational Weight Gain Summary

Answer 5

see slide 18

• Weight gain is a hallmark of a healthy pregnancy; gaining
within guidelines is recommended
• Healthy dietary intake, physical activity and other
appropriate lifestyle behaviours should be encouraged
and supported.
• Few women consistently meet food-related guidelines for
pregnancy
• How could this be better supported?…e.g. consistent messages
about the importance of eating well from all Health Care Providers

Question 6

Folate Summary

Answer 6

• Overt folate deficiency was rare
• 24% of women had suboptimal RCB folate concentrations (<906
nm/L) at the start of pregnancy
• This group declined substantially in the 2nd (9%) and 3rd (7%) trimesters.
• Vitamin B12 and B6 deficiency was also rare (<1%)
• Women consuming folic acid supplements had high RBC
folate and plasma folate concentrations
• Folate supplementation during pregnancy in women who are healthy and at low risk for nutritional deficiencies should be within guidelines

Question 7

Choline Intake During Pregnancy and

Lactation

Answer 7

• Choline has been recognized as an essential nutrient
since 1998
• Needs increase in pregnancy and lactation
• Plays vital role in fetal development, particularly brain
• Little human data available to estimate requirements
• Adequate Intake values:
• Pregnancy 450 mg/d
• Lactation 550 mg/d
• Nutrient databases (CNF and USDA) have limited choline information

Normally not supplemented
In eggs and cows milk
more likely to meet AI if they had eggs and cows milk

Question 8

Choline Summary

Answer 8

• Average choline intake was below AI
• <25% of APrON women met AI during pregnancy
• <10% of APrON women met AI during lactation
• Milk and egg consumption were major contributors to total choline intake
• Differences in total choline intake reflect differences in the food content ofmfree choline, glycerophosphocholine, and phosphocholine
• Aug 2016: European Food Safety Authority used this information in revision of their Dietary Reference Values for Choline
• Dec 2020: DGA recommend choline for pregnant and lactatingnwomen

Question 9

Iron Needs in Pregnancy

Answer 9

• Suboptimal iron status is the most widespread nutritional deficiency worldwide.
• Substantial requirement for iron during pregnancy due to increased utilization:
• 450 mg to increase RBC mass
• 300 mg for fetal/placental use
• 250 mg lost at delivery (blood loss)
• This means that an additional 1000 mg is required
throughout pregnancy required to meet needs
• Menstrual losses have ceased

Question 10

Risks of Inappropriate Iron Status

Answer 10

Low iron status or iron deficiency
• 2-3 x increased risk of preterm birth or low birth weight
• Impaired infant development
• Language, gross motor skills, attention
• Infant has increased risk of iron deficiency
• Reduced maternal reserves
• Decreased productivity, caring for infant

High iron
• Gestational diabetes
• Inappropriate volume expansion
• Iron toxicity – generation of ROS, apoptosis, organ necrosis

Question 11

Iron Supplementation is Routine in

Canada

Answer 11

• Lower iron absorption is seen with:
• larger doses
• When supplements taken with food or other supplements
• Ferrous form is best absorbed
• Increasing absorption as pregnancy progresses
• Side effects: nausea, cramps, constipation, gas

Question 12

Iron Summary

Answer 12

• Iron supplementation in pregnancy is routine in Canada but there has been little measurement of it’s impact on women’s iron status since the 1980’s
• Optimal iron status starts with a diet that includes ironrich foods and Vit C rich foods to aid absorption of
non-heme iron
• Supplementation at a level that balances good status
and few side effects.

Question 13

OVERALL SUMMARY

Answer 13

• Optimal nutrition is critical to optimizing pregnancy outcomes
• A healthy diet before and during pregnancy is the foundation and supplements should be added on top of this.
• Pharmacists should emphasize this message whenever possible
• Team with RDs to serve clients who could benefit from nutrition counselling or additional support
• Nutrient supplementation in pregnancy is routine in Canada but formulations may be updated regularly
• Pharmacists are trusted health care providers with extensive knowledge about these products
• Need to stay up to date about latest concerns and developments to support women before, during and after pregnancy