Vitamins, weight gain, preterm birth and more

Ironically, despite excessive caloric intake, many obese women are deficient in vitamins vital to a healthy pregnancy. This and other startling statistics abound when obesity and pregnancy collide. Together, they present a unique set of challenges that women and their doctors must tackle in order to achieve the best possible outcome for mom and baby.

In the December issue of the journal Seminars in Perinatology, maternal fetal medicine expert Loralei L. Thornburg, M.D., reviews many of the pregnancy-related changes and obstacles obese women may face before giving birth. The following myths and truths highlight some expected and some surprising issues to take into account before, during and after pregnancy.

“I treat obese patients all the time, and while everything may not go exactly as they’d planned, they can have healthy pregnancies,” said Thornburg, who specializes in the care of high-risk pregnancies and conducts research on obesity and pregnancy. “While you can have a successful pregnancy at any size, women need to understand the challenges that their weight will create and be a partner in their own care; they need to talk with their doctors about the best way to optimize their health and the health of their baby.”

Myth or Truth?

Many obese women are vitamin deficient.

True

Forty percent are deficient in iron, 24 percent in folic acid and 4 percent in B12. This is a concern because certain vitamins, like folic acid, are very important before conception, lowering the risk of cardiac problems and spinal defects in newborns. Other vitamins, such as calcium and iron, are needed throughout pregnancy to help babies grow.

Thornburg says vitamin deficiency has to do with the quality of the diet, not the quantity. Obese women tend to stray away from fortified cereals, fruits and vegetables, and eat more processed foods that are high in calories but low in nutritional value.

“Just like everybody else, women considering pregnancy or currently pregnant should get a healthy mix of fruits and vegetables, lean proteins and good quality carbohydrates. Unfortunately, these are not the foods people lean towards when they overeat,” noted Thornburg. “Women also need to be sure they are taking vitamins containing folic acid before and during pregnancy.”

Obese patients need to gain at least 15 pounds during pregnancy.

Myth

In 2009, the Institute of Medicine revised its recommendations for gestational weight gain for obese women from “at least 15 pounds” to “11-20 pounds.” According to past research, obese women with excessive weight gain during pregnancy have a very high risk of complications, including indicated preterm birth, cesarean delivery, failed labor induction, large-for-gestational-age infants and infants with low blood sugar.

If a woman starts her pregnancy overweight or obese, not gaining a lot of weight can actually improve the likelihood of a healthy pregnancy, Thornburg points out. Talking with your doctor about appropriate weight gain for your pregnancy is key, she says.

The risk of spontaneous preterm birth is higher in obese than non-obese women.

Myth

Obese women have a greater likelihood of indicated preterm birth – early delivery for a medical reason, such as maternal diabetes or high blood pressure. But, paradoxically, the risk of spontaneous preterm birth – when a woman goes into labor for an unknown reason – is actually 20 percent lower in obese than non-obese women. There is no established explanation for why this is the case, but Thornburg says current thinking suggests that this is probably related to hormone changes in obese women that may decrease the risk of spontaneous preterm birth.

Respiratory disease in obesity – including asthma and obstructive sleep apnea – increases the risk for non-pulmonary pregnancy complications, such as cesarean delivery and preeclampsia (high blood pressure).

True

Obese women have increased rates of respiratory complications, and up to 30 percent experience an exacerbation of their asthma during pregnancy, a risk almost one-and-a-half times more than non-obese women. According to Thornburg, respiratory complications represent just one piece of the puzzle that adds to poor health in obesity, which increases the likelihood of problems in pregnancy. She stresses the importance of getting asthma and any other respiratory conditions under control before getting pregnant.

Breastfeeding rates are high among obese women.

Myth

Breastfeeding rates are poor among obese women, with only 80 percent initiating and less than 50 percent continuing beyond six months, even though it is associated with less postpartum weight retention and should be encouraged as it benefits the health of mom and baby.

Thornburg acknowledges that it can be challenging for obese women to breast feed. It often takes longer for their milk to come in and they can have lower production (breast size has nothing to do with the amount of milk produced). Indicated preterm birth can result in prolonged separations of mom and baby as infants are admitted to the neonatal intensive care unit or NICU. This, coupled with the higher rate of maternal complications and cesarean delivery – up to 50 percent in some studies – in obese women, can make it harder to successfully breast feed.

“Because of these challenges, mothers need to be educated, motivated and work with their doctors, nurses and lactation professionals to give breast feeding their best shot. Even if you can only do partial breastfeeding, that is still better than no breastfeeding at all,” said Thornburg.

During pregnancy there are several supplements that show clear benefit in addition to a healthy non-junk food diet:  Vitamin D, Fish Oils (prefer high DHA) and probiotics.

Here are a few articles posted in the past about the benefits of probiotics during pregnancy:

• Reduce infant dermatitis
• Reduce atopic dermatitis
• Reduces incidences of eczema
• Given to infants it can reduce colic

A recent literature review of probiotics during pregnancy evaluated all the gold standard studies which means they are double-blind, placebo controlled.    What they found was that probiotics given during pregnancy reduced the incidence of eczema in their children from ages 2-7 years old.   What is interested is that it was only for the lactobacillus genus and not other strains such as bifidobacteria or products that contained a mixture of strains. Read the rest of this entry

A new study was released from the British Medical Journal showed the benefit of using L-arginine and antioxidants supplements during pregnancy to prevent preeclampsia.   Preeclampsia is a condition that comes on after the 20th week of pregnancy (but often 3rd trimester) where there is high blood pressure (over 140/90) as well as protein in the urine (proteinuria).  Read the rest of this entry

For many years I’ve strongly recommended to my perinatal patients that they take a high dose DHA fish oil supplement. DHA is docosahexaenoic acid found in fatty fish which is one of the beneficial longer chain fatty acids we get from fish – the other being EPA (eicosapentaenoic acid). I’m not sure where I first learned of the benefits of DHA for the brain and using it during pregnancy, but it makes sense given the plethora of research on its neurological benefits.

I had my wife take a high DHA fish oil throughout pregnancy and 2 years of breast feeding. The proof is in the pudding as our child will be attending Harvard next fall. He is only 2 years old.
Read the rest of this entry

Research published last week out of Stanford University concluded that acupuncture is an effective treatment for depression during pregnancy. This was reported in Science Daily.

In our clinical practice we certainly find that women who get regular treatments during pregnancy report a much greater well being.   Certainly we’ve helped women stay off anti-depressant medication, which now unfortunately is given as a preventative. Read the rest of this entry

Maternal intake of omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) during pregnancy has decreased, possibly contributing to a current increased risk of childhood allergy. Aim: To describe the effects of maternal omega-3 long-chain PUFA supplementation during pregnancy and lactation on the incidence of allergic disease in infancy. Methods: One hundred and forty-five pregnant women, affected by allergy themselves or having a husband or previous child with allergies, were included in a randomized placebo-controlled trial. Daily maternal supplementation with either 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo was given from the 25(th) gestational week to average 3-4 months of breastfeeding. Skin prick tests, detection of circulating specific immunoglobulin E (IgE) antibodies and clinical examinations of the infants were performed. Results: The period prevalence of food allergy was lower in the omega-3 group (1/52, 2%) compared to the placebo group (10/65, 15%, p < 0.05) as well as the incidence of IgE-associated eczema (omega-3 group: 4/52, 8%; placebo group: 15/63, 24%, p < 0.05). Conclusion: Maternal omega-3 fatty acid supplementation may decrease the risk of food allergy and IgE-associated eczema during the first year of life in infants with a family history of allergic disease.

Read the entire article here.

I do believe that it is important to take a multivitamin/mineral for good health. Our food supply isn’t what it was even 50 years ago and our requirements for nutrients have increased because of pollution and other stress factors.   In women of childbearing age nutrient supplementation is even more imperative. There is plenty of research that points to a few supplements that are very important during pregnancy:  Read the rest of this entry

It is important for women planning to conceive to be in good physical shape in order to support the pregnancy and health of their offspring. Women should have their nutritional status and diet analyzed to make sure they are not deficient in nutrients such as Vitamin D nor anemic which can lead to postpartum depression.

I’m a strong believer that taking a high quality multivitamin during pregnancy as well as fish oil and Vitamin D can have lasting benefits for the offspring.   Read the rest of this entry

There are so many natural options available for the majority of cases known as acid reflux, GERD (GastroEsophageal Reflux Disease ), heartburn, or whatever you want to call that it is appalling how these are indiscriminately handed out given their potential deleterious effects. There are certainly times when someone may need a Proton Pump Inhibitor (i.e. Prilosec) or H2 Antagonists (i.e. Ranitidine).  However those cases are when there is concern about esophogeal cancer, throat cancer, ulcers etc. where  the symptoms have become more severe or there is concern about it getting that severe.

During pregnancy almost 9 out of every 10 women have acid reflux symptoms and often they are prescribed these medication to treat the symptoms.  However, many women find that acupuncture and/or abdominal massage offers outstanding results for eliminating acid reflux or at least reducing it to a tolerable level so that medications aren’t required.   A study to be published next month out of Children’s Hospital in Boston determined that pregnant women who take acid medication increase their child’s risk of asthma by nearly 50% if the mother had no prior allergy history. Read the rest of this entry

The news has been loaded with a plethora of articles touting the benefits of vitamin D reported in nutrition journals. Based on research of the past few years it appears that Vitamin D plays a large role in regulating the immune system. Most recently the American Academy of Pediatrics have doubled its recommended daily dosage of Vitamin D for kids. Read the rest of this entry