Preconception care is where it’s at today for men and women wanting to have a healthy baby. What’s more, the nutritional status of a mother can have lifelong adverse effects on her baby that may not emerge until decades later.
Surprisingly, many pregnant women are found to have inadequate levels of certain nutrients such as vitamin D, iron, folate and calcium.
Men too need to do their bit to improve sperm quality by achieving a normal BMI and giving up smoking.
Poor folate status in either men or women can affect gene regulatory properties and the way sperm behave.
Alcohol “destroys folate status”, according to Dr Daniel McCartney, lecturer in human nutrition and dietetics at Dublin Institute of Technology and a spokesman for the Irish Nutrition and Dietetic Institute (INDI).
Neural tube defects (NTDs), which had been in decline, now appear to be rising again.
In March, a study showed that while 96 per cent of women reported that they took folic acid after becoming pregnant, only 25 per cent had taken it for the recommended three months before conception, the length of time needed to achieve the necessary level in the body.
The risk of NTDs is greater in obese women, who need a greater amount of folic acid, yet fewer than 6 per cent were taking the higher dose (on prescription) as recommended.
Dr Michael Turner, director of the UCD centre for human reproduction and professor of obstetrics and gynaecology at the Coombe Women & Infants University Hospital, adds that other maternal risk factors that can be addressed before pregnancy are to stop smoking, lose weight if you are obese, make sure you are immune to rubella and chickenpox, have the flu vaccine, and continue to exercise and to eat well.
Certain medicines can have an effect on sperm quality and can even affect a baby's development, according to Dr Fionnuala McAuliffe, professor of obstetrics and gynaecology at UCD and the National Maternity Hospital.
So before a woman becomes pregnant it is worth reviewing her prescribed medicines. “We want people to think about their health status,”she says, describing preconception care as “essential”.
A study two years ago at the National Maternity Hospital found that the high incidence of maternal vitamin D deficiency during winter months in northern latitudes may have detrimental effects on foetal skeletal growth. Dark-skinned people are at particular risk, as are those who cover their skin.
Oily fish twice a week is needed to provide sufficient vitamin D. Women who don’t eat fish should consider a supplement of 10 mcg (microgrammes), according to McAuliffe.
Iron levels
Surprisingly low levels of calcium have also been found in pregnant women, says McAuliffe. Iron levels frequently aren’t good enough either.
Haem iron from meat sources is much better absorbed by the body, at 15-39 per cent, than non-haem iron from plant sources and supplements, at between 2 and 10 per cent, according to McCartney.
For women who are vegan there are risks of deficiencies in vitamins D and A, B12, iron and possibly calcium, zinc and iodine, he adds.
Vegetarians also may be at risk of similar deficiencies, especially iron.
“We know that 50 per cent of young women in Ireland don’t get enough iron in their diet,” says McCartney.
With the “architecture of foetal tissues” being laid down in the first eight to 12 weeks, he says, “the key is to ensure that women enter pregnancy with an optimal nutrition status”.
Perhaps most shocking is the lifelong damage that can be caused by poor maternal nutrition. For example, McCartney explains, if the foetus is not receiving adequate nutrition from the mother when its kidneys are being formed, it will divert resources from growing organs such as kidneys and lungs, whose work the mother is doing during pregnancy, to an organ such as the brain.
As a result, it may not be until the third decade that the baby, now an adult, finds that his or her compromised kidneys are coming under increased strain and this can lead to, for example, raised blood pressure from the late 20s.
The age of parents also plays a role. The best outcome for women is pregnancy in their late 20s and early 30s, as egg quality deteriorates from the mid-30s onwards.
A father’s age starts to come into the birth defects story from their 50s, according to McAuliffe.
Exercise is also important, improving not only a mother’s mood, but helping to regulate blood sugar levels and improve a baby’s wellbeing.
"We need subsidised programmes out there for all women to reduce weight before they get pregnant," says Cecily Begley, professor of nursing and midwifery at Trinity College Dublin and co-author of an overview of 573 pieces of research on maternal obesity published in May.
For women who are overweight, the risks are higher than for those of normal weight. The key, she says, is a low GI diet with walking, cycling and swimming all possible for women who are obese.
Women need to give themselves plenty of time to get their weight, whether under or over
, to a normal level prior to conceiving, says Nancy Murphy, a midwife and antenatal teacher at the Women’s Health Clinic in Newcastlewest, Co Limerick.
Supplements
Murphy has written a sequel to her first childbirth book published 22 years ago,
Preparation for Pregnancy, Birth and Motherhood
, and advises that over-the-counter medicine should be checked out with a pharmacist to avoid doing any damage.
Apart from folic acid, she says, women don’t need supplements. “All they need is a healthy diet.” Ideally, says Murphy, all prospective parents should seek professional health screening at least six months prior to a planned pregnancy.
Most women take good care of their health once they know they’re pregnant but with more than 50 per cent of pregnancies unplanned “this grey area between conception and diagnosis of pregnancy can be a dangerous time and a woman can unintentionally be doing something that could harm her baby before she even knows she is pregnant”.
Nancy Murphy’s book is available in bookshops and at iti.ms/1SaWc7h
