Early life nutrition: The importance of nutrition before, during and after pregnancy

Dr. Annette Britt Briley, a consultant midwife and researcher, emphasizes the critical importance of early life nutrition from conception to age two. This period is pivotal for establishing healthier futures as it significantly impacts brain development, growth, and immune system strength. Proper nutrition during these first thousand days can influence lifelong health outcomes and reduce the risk of obesity later in life.

Malnutrition significantly contributes to chronic diseases like diabetes and hypertension, accounting for 49% of deaths in children under five. This preventable issue affects around 100 million children globally who are stunted physically or intellectually due to chronic malnutrition. Poorly nourished women face higher risks during pregnancy, with irreversible damage occurring from inadequate nutrition both prenatally and postnatally. While famine-stricken areas often come to mind when discussing malnutrition, it's essential also to consider the impact of calorie-dense but nutritionally poor foods.

Mary Bulk discussed her father's hypothesis linking growth restriction, low birth weight, and premature births to long-term health issues like hypertension, coronary heart disease, and type 2 diabetes. This theory is based on registry data from the Dutch famine and the Leningrad siege. The timing of maternal starvation during pregnancy significantly affected infant outcomes and future health risks. In particular, children exposed to prolonged malnutrition developed what was termed a 'thrifty phenotype,' leading to various adverse health conditions later in life.

Low birth weights can lead to significant health issues later in life, particularly through a phenomenon known as catch-up growth. This rapid growth increases the risk of metabolic syndrome, which includes obesity, insulin resistance, dyslipidemia, and elevated blood pressure. Visceral adiposity develops early on due to this catch-up growth; fat accumulates around vital organs rather than being distributed more evenly throughout the body. Studies have shown that children as young as four exhibit signs of increased truncal obesity and higher fasting insulin levels linked to low birth weight conditions. Ultimately, these factors contribute significantly to an elevated risk for type 2 diabetes in affected individuals.

Small-for-gestational-age (SGA) infants are defined as those with a birth weight below the 10th percentile for their gestational age, while intrauterine growth restriction (IUGR) refers to babies whose birth weight is less than what their genetic potential would allow due to pathological issues during pregnancy. There is ongoing debate regarding the definitions and measurement methods used for SGA, including whether population or customized centiles should be applied. Both SGA and IUGR have been linked to long-term health risks such as obesity, type 2 diabetes, coronary artery disease, hypertension, kidney disease—including reduced glomerular filtration rates—and conditions like polycystic ovarian syndrome.

Babies born large for gestational age face significant health risks, including a predisposition to obesity in both childhood and adulthood. They often exhibit insulin resistance and are less likely to be breastfed, leading to rapid weight gain during infancy. Additionally, these infants may experience high blood pressure and other metabolic issues such as hypoglycemia. There is also an increased risk of certain cancers like breast and ovarian cancer in female children.

Preconceptual time is crucial for addressing excess weight and establishing a healthy lifestyle. It’s an ideal period to optimize health through diet changes and the introduction of folic acid supplements.

Parental BMI significantly impacts fertility and child health. High or low maternal BMI correlates with reduced fertility rates, increased pregnancy loss, gestational diabetes, preeclampsia, and adverse outcomes for the child such as obesity and diabetes. Paternal high BMI also impairs embryo development while undernutrition in fathers can lead to higher body mass index in offspring due to epigenetic changes in sperm. A meta-analysis shows that complications during pregnancy increase linearly with rising maternal obesity levels; normal vaginal delivery rates decline correspondingly. Neonatal outcomes worsen with higher maternal BMIs—infants are more likely to need resuscitation or face congenital abnormalities.

Addressing BMI issues before conception is crucial for reducing perinatal mortality. Large clinical trials, including studies from Ireland and the UK, indicate that the antenatal period offers insufficient time to effect change in overweight and obese women. With nearly half of pregnancies being unplanned in the UK, this presents significant challenges. Healthcare professionals are urged to support women with a BMI of 30 or more in weight reduction efforts prior to pregnancy.

Preconception nutrition is crucial for optimizing health before pregnancy. Women should quit smoking, alcohol, and drugs while managing pre-existing conditions like hypertension or diabetes with the help of healthcare providers. Folic acid supplementation is essential at least a month prior to conception, especially in higher doses for women with specific medical needs or those who are overweight. Pregnancy serves as a teachable moment regarding weight management; however, many women face barriers such as fatigue and lack of knowledge about healthy eating during this time.

Pregnant women often encounter conflicting information about nutrition, particularly regarding foods to avoid. The NHS Choices page highlights various food items that should be excluded during pregnancy due to potential risks. This can create anxiety and confusion for expectant mothers trying to make healthy choices in urban environments where access to fresh produce may be limited. It's crucial for pregnant women to focus on balanced diets while being mindful of the specific guidelines provided by health authorities.

The Eat Well Plate emphasizes a balanced diet during pregnancy, focusing on what to include rather than just restrictions. It suggests that one-third of the plate should consist of starchy foods for energy, another third dedicated to fruits and vegetables, and the remaining portion filled with 60 to 100 grams of lean protein along with healthy fats like extra-virgin olive oil and low-fat dairy products.

Pregnant individuals should aim for a daily water intake of 1.5 to 2 liters and focus on specific micronutrient needs rather than the outdated notion of eating for two. Essential nutrients include increased folic acid, vitamin D (10 micrograms), an additional 100 micrograms of vitamin A, and an extra 6 grams of protein. Importantly, only about 200 extra calories are needed in the third trimester.

200 calories can be visualized through various snacks and foods: it equates to 34 grams of peanut butter, about 32 M&Ms (which is less than a full packet), or a handful of Doritos. Additionally, you could enjoy around 10 gummy bears—often taken from the stash of a research assistant—or consume approximately 1425 grams of celery. For those craving something sweet, this amount also corresponds to roughly 496 milliliters of Coca-Cola or just over half a bagel.

Being active during pregnancy offers numerous benefits, including easing physical changes, reducing fatigue and back pain, improving muscle tone and endurance for labor challenges, enhancing well-being while lowering anxiety and depression levels. Regular activity can also improve sleep quality and may prevent gestational diabetes or hypertension; if already diagnosed with gestational diabetes, exercise helps manage blood sugar levels. Strength conditioning exercises are linked to shorter labor times. However, many women do not engage in regular activities like swimming or jogging; instead focusing on simple daily increases in movement is encouraged.

Breastfeeding is recognized by the World Health Organization as the best method for providing essential nutrition to infants, promoting healthy growth and development. It plays a crucial role in maternal health as well. Global public health guidelines recommend exclusive breastfeeding for the first six months of life, followed by nutritionally adequate complementary foods to support ongoing developmental needs.

The UK Infant Feeding Survey reveals trends in breastfeeding practices over the years. In 2005, 76% of women initiated breastfeeding, increasing to 81% by 2008; however, a shift in questioning from initiation to exclusive breastfeeding showed only 69% reported exclusivity at birth in 2010. By one week postpartum, exclusive breastfeeding dropped significantly to just under half (46%), and further declined to only 23% at six weeks. The survey highlights that among demographics most likely to breastfeed are women aged over thirty from minority ethnic groups such as Chinese (97%), Black (96%), and Asian (95%). These mothers often have higher education levels or professional backgrounds.

Breastfeeding offers numerous health benefits for both infants and mothers. It significantly lowers the risk of infections, particularly respiratory and gastrointestinal issues, as well as severe eczema and childhood asthma. Extended breastfeeding duration enhances protection against non-atypical asthma, reduces sudden infant death syndrome (SIDS), boosts general intelligence in children, and decreases obesity rates by 15% compared to formula-fed infants. Additionally, it provides long-term protection against type 1 and type 2 diabetes for children while also lowering the mother's risks of developing these conditions along with metabolic syndrome and cardiovascular diseases.

Post-pregnancy nutrition is crucial for recovery and meeting the demands of motherhood. A calcium-rich diet is essential to replenish depleted stores, while Omega-3 fatty acids support both maternal weight loss and critical brain development in infants. Antioxidants like vitamins C and A help combat cellular damage, aging, cancer risks, and influence breast milk quality. Additionally, B vitamins are vital for carbohydrate metabolism and red blood cell formation; adequate hydration supports breastfeeding efforts.

At six months, babies are typically ready for solid foods when they can sit up steadily and have hand-to-mouth coordination. First foods should be soft and easy to swallow, such as mashed vegetables or baby rice mixed with milk. Cow's milk can be introduced in food but not as a drink. Suitable finger foods include soft bananas and cooked meats like chicken without bones, along with pasta, toast, lentils, and rice.

At eight to nine months, infants should transition to three meals a day featuring soft finger foods and mashed or chopped options like fruits, vegetables, bread, pasta, rice, meat, fish, eggs, beans and dairy (excluding cow's milk). By one year old they should maintain this meal structure along with breast milk or whole cow’s milk. Healthy snacks such as fruit sticks and toast are essential for their diet. Full-fat dairy is crucial for providing necessary fats and vitamins; children need three to four servings of starchy foods daily.

Poor nutrition during pregnancy can lead to serious health issues in adulthood, known as the fetal origins of adult disease. Insufficient intake of fruits, vegetables, and protein sources like meat or pulses is linked to conditions such as diabetes mellitus, obesity, dyslipidemia, hypertension, coronary artery disease and stroke. Additionally, it may contribute to kidney failure with glomerular sclerosis and liver complications including cholestasis. Other potential outcomes include lung abnormalities like reactive Airways disease and reduced bone mass leading to osteoporosis.

Research highlights the critical link between BMI changes during pregnancies and perinatal outcomes. A Swedish study involving over 456,000 women revealed that 41% experienced an increase in BMI between pregnancies. Women gaining two to four BMI points (6-11 kg) faced a 27% higher risk of stillbirth, while those with gains exceeding four units (over 11 kg) had a staggering 60% increased risk. Conversely, overweight or obese women who lost six kilograms showed improved outcomes.

Pregnancies significantly lower the risk of perinatal death by fifty percent. This reduction highlights the importance of prenatal care and monitoring during pregnancy to ensure better outcomes for both mothers and infants.

The first thousand days of a child's life, from conception to age two, are crucial for development. This period significantly impacts health and well-being later in life. Support from organizations like Tommy's and collaborations with the EU consortium play an essential role in funding research and initiatives that focus on this vital stage.