Reducing the risk of obesity through perinatal nutrition
A mother's perinatal diet has a significant impact on the baby's future obesity risk. Melanie McGrice offers advice on how women can reduce the risk of obesity in the next generation.
If you could wave a magic wand and cure one health problem, I’m sure that obesity would be on your short list. Obesity is the root cause of dozens of other major health issues, including but not limited to heart disease, diabetes, asthma, depression, cholecystitis and many types of cancer. Yet, this insidious disease has been increasing exponentially over the past few decades. Why? Is it our sugar intake? Technology reducing our incidental activity? Researchers have determined that the cause of obesity is multifactorial, however, one very important factor is early life nutrition.
During the first thousand days of life, from what a mother-to-be consumes in the months leading up to conception, throughout pregnancy, and through infancy have been found to have a significant impact on metabolic programming, particularly when it comes to future obesity risk. Let’s review some of the key factors that influence childhood obesity, which in turn predisposes adult obesity:
1. Pre-conception BMI
Overweight or obese mothers are significantly more likely to have overweight children, with evidence showing that a woman’s BMI at the start of pregnancy is a strong predictor of her offspring’s risk for obesity in adult life. Obesity and pregnancy are associated with insulin resistance and inflammatory changes that exacerbate in combination, increasing lipid transfer earlier in gestation.
Utilise this topic to initiate discussions around weight management with female clients who need to lose weight – although some women won’t be motivated to exercise and eat healthily for themselves, they will for their future children.
Refer women diagnosed with PCOS to a dietitian, exercise physiologist and/or psychologist so they can start working on their weight before they are ready to conceive.
Consider encouraging women who are struggling to conceive to attempt some weight loss before attempting medical procedures (if they are healthy and under the age of 35 years).
2. Gestational weight gain
Even if a mother-to-be has a healthy weight at conception, gaining excessive weight during gestation can contribute to childhood obesity risk. The Southampton Women’s Study found that children born to mothers who gained excessive weight during pregnancy had a greater fat mass at birth and at 6 years than children whose mother’s GWG was within the recommended range.
Research shows that women who know what they pregnancy weight gain goal should be have double the chance of meeting it, so advise them how much weight they should be aiming to gain based on their pre-conception BMI.
Even though women need to ‘eat for two’ in terms of diet quality, they don’t need to in terms of quantity. Educate women that unless they are underweight, they only need an additional 1200kJ per day (an additional 2 slices of bread each day).
Encourage them to download a copy of The Pregnancy Weight Plan to follow the suggested meal and exercise plans for each trimester.
3. Maternal nutrition
Research suggests that maternal perinatal nutrition can impact the establishment of the set points of hypothalamic appetite control systems in the offspring. The hypothalamus integrates signals of nutrient availability to control feeding behaviour via secretion of appetite-stimulating and appetite-suppressing neuropeptides.
Encourage women to eat low mercury, cooked fish such as salmon or tinned tuna two to three times per week during pregnancy to increase her omega 3 intake.
Encourage pregnant women to get outdoors for 10-30 minutes each day to increase their vitamin D intake, or else commence vitamin D supplements.
Remind pregnant mums that their baby’s tastebuds are being developed in utero, so their baby will like the foods they eat during pregnancy. If they want their child to eat broccoli, mums need to be eating broccoli during pregnancy!
4. Microbial diversity
Bacterial composition of the gut modulates the weight gain and altered metabolism that drives obesity. Over the course of pregnancy, maternal bacterial load increases, and gut bacterial diversity changes and is influenced by pre-pregnancy- and pregnancy-related obesity. Alterations in the bacterial composition of the mother have been shown to affect the development and function of the gastrointestinal tract of her offspring, impacting the infant’s risk of obesity.
Encourage pregnant women to eat a diet rich in pre-biotic foods such as wholegrain bread, pasta and vegetables.
Encourage mums to include yoghurt in their diet during pregnancy. Not only does it make a nutritious snack, but it’s rich in good probiotics.
Encourage new mums to breastfeed exclusively for at least six months if possible.
By educating mothers-to-be prenatally and/or during pregnancy, clinicians can help to reduce the risk of obesity in the next generation.
Melanie McGrice BScNutr, Hons, MNutrDiet, AdvAPD, MAICD
Melanie McGrice is an Accredited Practising Dietitian with a Masters degree in Dietetics. Melanie is one of Australia’s most well-known dietitians, writing for a host of popular periodicals including the Australian Women’s Weekly, Kidspot and Good Health magazine, and is regularly interviewed by TV and radio. Melanie has also authored three books including ‘The Pregnancy Weight Plan’ and her blog is read by thousands of mums and mums-to-be each week. Melanie is also the Director of Nutrition Plus, a Melbourne-based dietetic company that specialises in fertility, pregnancy and women’s health. She is a past Board Director of the Dietitian’s Association of Australia and Weight Management Council of Australia.