The reproductive period is a critical time for establishing risks of chronic diseases in offspring later in life. “Nutrition plays a vital role during this developmental period, and because it is a determinant of lifetime risk of disease, it is potentially a modifiable risk factor,” explained Marshall et al. “Although the World Health Organization (WHO) provides guidelines for antenatal care, comprehensive guidelines detailing nutritional needs of women throughout reproduction from preconception through pregnancy and lactation are lacking,” they cautioned.1 

PRE-CONCEPTION COUNSELLING SHOULD INCLUDE SUPPLEMENTATION

According to Glick et al, pregnant women of AMA should be encouraged to optimise their health when preparing for pregnancy, stop smoking and drinking alcohol, start physical activity, achieve normal body weight, take folic acid supplements, and stabilise comorbidities (e.g. gestational diabetes and hypertension).3 

The American Academy of Family Physicians’ position paper on preconception care states that all women of reproductive age should be advised to take a daily supplement (prenatal or multivitamin), or 400mcg to 800mcg of folic acid daily, and to consume a balanced, healthy diet of folate-rich foods.4 

Folic acid supplementation should start prior to conception and continue through 12 weeks of pregnancy. A higher dose of preconception folic acid (4mg starting one month prior to attempting pregnancy and continuing through the first three months of pregnancy) is recommended for women at high risk of pregnancy complications.5 

Similarly, the World Health Organization’s 2020 maternal and perinatal guidelines recommend antenatal multiple micronutrient supplements that include iron, folic acid, as well as vitamin D for all pregnant women and adolescent girls.5 

More recently (2022), the authors of an expert review that focused on the importance of nutrition in pregnancy and lactation, state that evidence supports the benefit of comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy). Comprehensive nutritional supplementation is associated with improved birth outcomes, stressed Marshall et al.1 

Well-nourished women who consume an adequate diet may not require additional multivitamin supplementation, but in the absence of comprehensive evaluation by a dietitian, routine supplementation is encouraged.1 

NUTRITION DURING PREGNANCY 

“When it comes to advising what a healthy diet for a pregnant women should look like, Marshall et al, state that the message should be “eat better, not more”. 

“This can be achieved by basing diet on a variety of nutrient-dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids that include nuts and seeds, and fish, in place of poorer quality highly processed foods,” they said. “Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight.” 

Marshall et al. strongly advised against diets that severely restrict any macronutrient class, specifically the ketogenic diet that lacks carbohydrates, the Paleo diet because of dairy restriction, and any diet characterised by excess saturated fats.1 

POSTNATAL SUPPLEMENTATION 

After giving birth the body needs to heal, produce breast milk, and replenish depleted nutrients. Victoria Wells, nutritionist at Emma Cannon Clinic, stressed the need for mothers to focus on nourishing not just their new baby, but themselves too. “Protein needs are increased at this time, and if you are breastfeeding you will need more energy. Continue taking a pregnancy multivitamin that contains vitamin D as well as a probiotic with live cultures to support breastfeeding. Zinc is a brilliant nutrient to support immunity and healing.”6 

REFERENCES 

• Marshall NE, Abrams B, Barbour LA, et al. The importance of nutrition in pregnancy and lactation: lifelong consequences. American Journal of Obstetrics & Gynecology, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9182711/ 
• https://www.medicalacademic.co.za/news/7-tips-to-improve-management-of-geriatric-pregnancy/ 
• Glick I, Kadish E, Rottenstreich M. Management of Pregnancy in Women of Advanced Maternal Age: Improving Outcomes for Mother and Baby. Int J Womens Health, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364335/ 
• American Academy of Family Physicians. Preconception Care (Position Paper), 2016. https://www.aafp.org/about/policies/all/preconception-care.html 
• Nutritional interventions update: multiple micronutrient supplements during pregnancy. https://www.who.int/publications/i/item/9789240007789 
• https://sheerluxe.com/life/parenting/supplements-take-during-and-after-pregnancy