The following Pregnancy Care document was written by Annaliese Jones who specialises in nutrition, naturopathy and herbal medicine and has a Bachelor of Health Science (Complementary medicine). She consults from her clinic in Mount Eden.
Her wonderful services are highly recommended by Auckland HypnoBirthing.
Our children’s health starts in the womb. Preconception and pregnancy health really is the ultimate form of preventative health. We now know the first nine months in the womb can influence your child’s health for the rest of their lives. What a wonderful opportunity to have a positive effect on your wee ones life!
It is empowering to think that by improving your health through preconception and pregnancy you can actually make a dent in the growing epidemic of chronic diseases such as type 2 diabetes, cardiovascular disease and obesity in the next generation.
Latest research into preconception health focuses on something called epigenetics. Epigenetics refers to modifications to genes that alter the way they behave or are ‘expressed’, without actually causing any change to DNA. This can lead to changes that predispose your child to certain diseases even though you don’t have the genes for the predisposition. A tragic but good example of this happened during the Dutch famine of 1944. The Nazi occupied western Netherlands was highly rationed and eventually cut off from food supply. Malnourished pregnant women developed a change in their genes that produced a change in expression of their children’s genes. This change caused the offspring of these women to be predisposed genetically to cardiovascular disease, kidney problems, diabetes, obesity and other health problems. All despite having plenty of food and good nutrition themselves. The babies of these malnourished women were, as expected, a smaller than normal birth weight, but interestingly their children were also smaller than normal. The research done into these women, their babies and grandchildren was the first of it’s kind and has led to more understanding of how important maternal nutrition is to the health of your offspring, and the health of their offspring too.
The eggs and sperm that you conceive with are formed up to 100 days before conception. For this reason three to four months of preparation is ideal to ensure the healthiest eggs and sperm possible.
In 1978 the Forsight Center in the UK did some groundbreaking research about fertility and the reduction of miscarriages and foetal health problems. Their approach was based on what we now call ‘preconception care’ and involved diet, supplementation and lifestyle measures that would correct any deficiencies in parents before they conceived. The results were quite astounding. They found that over 75% of couples with fertility issues went on to have healthy babies. Additionally, they worked with high risk couples over a period of 10 years, and were able to reduce the rate of birth defects in that group to 0.47%. The national average in the UK is 6%. As well as correcting deficiencies, the Forsight approach is focused on avoiding toxins of all kinds for the critical 3 months before conception (and during pregnancy) and the men’s health is vitally important too. They continue to do research and work in the area of preconception care today.
Exciting research for allergies – A clinical trail on a particular strain of probiotic called lactobacillus rhamnosus GG has produced some promising results regarding eczema and allergies in children. They found that when taken in the last trimester of pregnancy and through breast feeding, this particular strain may reduce the incidence of eczema in children, and reduce the incidence of children with atopic conditions such as allergic rhinitis and food allergy. I certainly get my clients onto it if there are allergies in the family, and it seems to be very helpful.
Get the basics right
Folic acid – Most people have heard about the importance of folic acid supplementation for at least 3 moths pre pregnancy. Certain drugs can interfere with the absorption or utilization of folic acid including the oral contraceptive. Folic acid is a type of B vitamin and also referred to as B9 or folate. It is an important nutrient for, among other things, rapid cell division and therefore required in larger amounts during pregnancy when our bodies are busy dividing cells like there’s no tomorrow. Neural tube defects are the most frank sign of this deficiency, although it is likely that less severe changes arise in the embryo with milder deficiencies. Your doctor will prescribe a folic acid from the pharmacy although I have noticed a few doctors recommending the more expensive brand name folic acid/pregnancy multivitamin lately. My advice is to ask for the standard subsidized folic acid because although it looks impressive, the other (popular) folic acid/multivitamin is really just folic acid with a sprinkling of other nutrients and a high price tag. You are better off to take the subsidized folic acid and a decent multivitamin. And remember your food sources too! Green leafy vegetables, legumes, liver and nuts are the best source of folic acid in food.
One last word about folic acid. Some research has suggested that up to 30% of the population may not be able to convert folic acid within the body to it’s activated form. This would leave a person with a deficiency even if they were taking folic acid. If I suspect this in a client due to recurrent miscarriage or a previous child with birth defects, I will get them on to a special form of folic acid that their body doesn’t have to activate.
Iodine – is an important mineral for the proper functioning of the thyroid gland, which governs growth and development. From conception through to adulthood it is vital for brain development and cognitive function. This makes it an important preconception consideration.
A study in 2005 found that infants that were breastfed had iodine levels half that of formula fed infants, showing the high rate of deficiency among New Zealand mothers. This is no reason to use formula, but a good reason to consult with someone about taking iodine.
Iodine deficiency became quite widespread in the early 1900’s in New Zealand but leveled out with the iodisation of salt. Unfortunately the iodine status of kiwis has been declining again to such a level that intervention is once again required. Iodine was recently added to bread in an attempt to increase the general populations intake.
Iodine is naturally found in seafood and shellfish, seaweed, eggs and spinach. Most other fruits, vegetables, meat and grains should contain some level of iodine but it is reflective of the amount of iodine in the soil. New Zealand now has very low levels of iodine in our soil as does our animal feed (whether grass or chicken feed etc). Three other reasons for the mass deficiency include:
High consumption of commercially prepared foods that usually contain non-iodised salt (it is cheaper). The decrease in use of iodised salt for health reasons and also the rise of rock salt etc.
The declining use of iodine containing sanitizers (cleaning products) in the dairy industry, leading to a decline of iodine in our dairy products. Some doctors now make it a standard prescription when you fall pregnant and I often recommend continuing it through breastfeeding. It is important not to self prescribe iodine in case you really don’t need it. Some people can get palpitations, overactive thyroid and anxiety if they take iodine when they don’t need it. There are a myriad of other options, some necessary, some not, you will hear about on your journey to becoming pregnant and/or having your child. You and your baby’s requirements will be unique, therefore seek advice from experts.
Calcium – 600mg, increasing to 1000mg during the 2nd & 3rd trimesters. Calcium and magnesium are essential during the second and third trimesters when baby’s bones are forming, or if symptoms such as leg cramps indicate an increased need. If calcium stores are deficient, baby will leach the calcium out of your bones for its own growth. This can lead to osteoporosis later in life. Calcium is vital for strong bones and teeth, heart and nervous system function, muscle growth and contraction. Sugar consumption and stress both pull calcium from the bones. Low calcium contributes to increased risk of pregnancy-induced hypertension and pre-eclampsia. Good food sources include green leafy vegetables, sesame seeds, almonds and dairy products.
Chromium – 100-400mcg daily (upper limit for those with sugar cravings) Improves glucose tolerance in gestational diabetes. May help prevent morning sickness. Food sources include apples, animal products, molasses, nuts, eggs and vegetables.
Iron – (only if need proven). A ferritin test should be performed at the end of each trimester. How low you are will determine what level of supplementation you need. I often monitor patients ferritin levels more closely than your LMC because I believe it to be such an important parameter. It will be so important in determining your energy levels in the latter stage of your pregnancy, your stamina for the birth (equivalent to running a marathon!) and your ability to cope with the lack of sleep and breastfeeding post partum.
Magnesium – 260mg, increasing to 460mg in the 2nd & 3rd trimesters A deficiency during pregnancy can lead to fluid retention, pre-eclampsia and toxaemia, sugar cravings, retarded development of the foetus, premature labour, low birth weight. Adequate magnesium may help prevent muscle cramps and keep blood pressure normal. It also plays an important role in regulating normal blood sugar and insulin levels and nourishing the nervous system. Good food sources include almonds, seeds (such as sunflower) and nuts.
Zinc – 20-60mg/day (depends on zinc taste test) at night on an empty stomach. Zinc is the most important mineral during pregnancy. Zinc deficiency during pregnancy can be related to foetal growth retardation leading to low birth weight. Zinc deficient women may be more prone to developing stretch marks, having perineums that don’t stretch, nipples which crack readily and longer labours. Zinc deficient women may also be more prone to postnatal depression. Good food sources of zinc include seafood, whole grains, nuts, pumpkin seeds, dairy products and red meat.
Fish/Flax Oils – 1000mg 3 times daily. The rapidly developing foetus has a high need for fatty acids. They are necessary for healthy brain and liver development and for placental growth. Fatty acids are also necessary for the mother to support mammary gland and uterine growth. Omega-6 fatty acids are readily sourced from the diet in the form of vegetable oils however omega-3 (EPA and DHA) are often lacking. DHA plays an important role in the growth and functional development of the brain during the third trimester and the early postnatal period when maximal growth occurs. It also plays an important role in retinal development. Postnatal deficiencies have been associated with reduced visual acuity, poor neurodevelopment and ill effects on behaviour. The latest scientific research shows that if the mother’s diet is deficient in DHA, the baby will take the DHA from a part of her brain (the hippocampus – associated with memory) and the hippocampus shrinks (perhaps this explains the phenomena of baby brain!) Fish oil supplementation during pregnancy may reduce the risk of allergy in infants. Fish oils help to relax the muscular tissue of the uterus, which may slow the process of labour, so it’s important to stop taking them at about 37 weeks, before your due date.
Evening Primrose Oil – 10 days before due date insert 2000mg (x2 1000mg capsules) vaginally every night to prepare and ripen the cervix for labour.
Herbal medicine has been used for thousands of years to support women through pregnancy, birth and the breastfeeding process. In modern practice, nothing is given in the first trimester unless there is a specific reason such as threatened miscarriage, nausea, depression etc. In the second and third trimesters a trained medical herbalist can provide an individualised tonic for you depending on you and your unique pregnancy.
Herbal medicine can provide effective and safe antidotes to fluid retention, anxiety, stress, sleeplessness, reflux and heartburn, constipation, fatigue, poor milk supply etc, etc. Self-prescribing is not recommended except with Red raspberry leaves as below.
Red raspberry leaf – tones the uterus and cervix and all the pelvic muscles therefore preparing the uterus for birth. Not to be taken in the first trimester. It may decrease the likelihood of preterm or post-term labour. Studies show that it decreases the second stage of labour by 9.6 minutes and a lower rate of forceps deliveries was noted. It may help prevent haemorrhage and help the uterus and pelvic area recover postpartum. If taken as a tea you should drink 1 cupful three times daily from 30 weeks onwards. You can get a fluid extract (more concentrated) form of it from an herbalist, and you can just take one dose daily in this case.
Preparing for Birth
Red Raspberry leaf is not the only herb used to aid the birthing process and postpartum recovery. Many other herbs are used (with the guidance of a herbalist to encourage this process. We call this formula (unique for everyone) a partus preparator and it is taken in the last few weeks of pregnancy and following the birth.
There is a Birth Aid kit available from Naturo Pharm which includes a Pre-Birth formula to take 3 weeks before birth and Birth Aid. These formulas are purely to help you recover from birth quickly and heal the effects of trauma to the muscles. They are not designed to make your labour faster or less painful. You can take the remedy Caulophyllum 30c potency from week 37 onwards to soften the cervix, tone the uterus and facilitate an on-time delivery. Take it once a week on the same day.
It is best to consult a natural health practitioner before taking any remedies as there are different remedies for different constitutions. The best time to make an appointment would be a 6 weeks before your due date.
Bringing on labour
Remember that only 4% of babies are born on their due date so don’t get worried if you pass “the date” and there is no sign of labour. I like to think of it more as a due week, but any time 2 weeks before and 10 days after your due date is quite acceptable. As long as you and the baby are healthy and being monitored. There are of course some situations where an induction is necessary, but talk to your LMC about the why, what if’s and alternatives if you are healthy and there seems to be no other reason to do it (other than being a bit late).
Many natural methods exist to encourage labour from things you can do at home (spicy food, sex) to those that require professional help from a naturopath. Acupuncture can also be helpful in these cases.