30 Aug 2017 Guest Blog: Pregnancy ‘Eating for Two’ Myth Busting
Dr Margaret Charnley is a Registered Nutritionist and Senior Lecturer in Nutrition and Research Fellow at Liverpool John Moores University. Her key areas of research are surrounding the effects of nutrition on human health, particularly with regards to obesity, pregnancy and the trans-generational impact of intra-uterine programming on foetal development.
A recent study has found two thirds of women do not know how many calories they should be consuming during pregnancy. The story was extensively covered in the media, with many headlines reading ‘Eating for two myth still harming mothers and their babies despite best intentions’ (Royal College of Obstetricians and Gynaecologist), ‘Pregnancy myth busting: eating for two’ (The Guardian), ‘Women unsure of how much to eat during pregnancy’ (BBC News). This lack of education and awareness could be putting the health of pregnant women and baby at risk.
Pregnancy is known to be one of the primary factors for weight gain in women and the weight gained during pregnancy has been shown to be stubbornly difficult to get rid of in the months following delivery for many women and thus begins an endless life of weight cycling. As such, pregnant women are routinely advised not to ‘eat for two’ during pregnancy, to avoid unnecessary weight gain and in terms of quantity, it is hard to dismiss this advice. The Committee on Medical Aspects of Food & Nutrition Policy (COMA, 1991) determined that the energy cost of pregnancy is approximately 70,000kcals and when distributed over the 40-week average duration, equates to only an additional 200kcals in the final trimester. Now of course, this is very much dependent on an average intake of 2000kcals, many women regularly do not achieve this amount so would need more than 200kcals. Conversely, lots of women consume in excess of this so the additional calories are not required.
Although there are many factors associated with overweight and obesity, the basic premise is that it as a result of a positive energy balance, usually achieved by eating too much, particularly ‘empty calories’ and exercising too little. Research by David Barker amongst others demonstrated a link between maternal weight, gestational weight gain and birth outcomes, however, a link between maternal diet and birth outcomes has also been established. Most widely recognized is the association between folic acid and neural tube defects such as spina bifida. There are, however, other issues relating to inadequate micronutrient intakes, of iron, iodine, calcium, vitamin D for example, which include pre-term delivery, low birth weight, rickets, poor cognitive development or cretinism in severe cases of iodine deficiency as well as an increased risk for obesity, type 2 diabetes and cardiovascular disease in later life. As it is, the emphasis on weight as a proxy for health status is so entrenched in the public and health professionals psyche that it is possible that we are missing the bigger picture. More emphasis on positive healthy eating messages rather than a focus on weight would help overweight and obese pregnant women to connect more with importance of good nutrition for healthy pregnancy outcomes
So when it comes to the current advice of ‘not eating for two’ in terms of quantity, absolutely, but when it comes to quality of diet, mums need to remember that what they eat during pregnancy may have a profound impact on their baby’s future health so when it comes to quality they are in actual fact ‘eating for two’!