Maternity Dietitians Ireland Conference
I had the chance recently to attend the first conference by Maternity Dietitians Ireland (MDI) titled Nutrition for Preconception and Pregnancy. That they made this an event open to everyone and anyone interested enough to go was invaluable. Fingers crossed that in 5 years it will be the norm for maternity dietitians to be surrounded by coaches, personal trainers and beyond at their annual event. I was lucky enough to have been given the heads up by an FFS member working in the field who knew I’d be interested.
When I coach pregnant and postpartum women either 1:1 or in a group environment it is never my place or intention to be their nutritionist or dietitian. But as someone providing a service with the goal of having the healthiest pregnancy and postpartum period as possible nutrition is naturally top of mind. I got 5mins with one of the key speakers during the coffee break and braved the question ‘So many women I work with can’t face anything but beige food in their first 12 weeks, or even longer - how is that taken into account [by maternity dietitians doing the research]?’. She was absolutely appreciative of the reality and clear that her job (and that of her colleagues) is to carry out scientific research, the outcome of which goes on to eventually inform best practice guidelines for people like you and like me. So in reading this understand that I wanted to share what I have learned so that hopefully a few more of us can be better informed and maybe ask more questions, not to make anyone feel they’re not doing enough or not making the ‘right’ choices during a current, previous or future pregnancy. None of us will have a perfect pregnancy because it simply doesn’t exist. We’ll each do the best we can with the knowledge and skills we have at the time and that alone is our role as mums or mums-to-be. With that in mind I’ll add that it was evident throughout the day that these researchers are working to improve pregnancy and its outcomes for every woman who becomes pregnant in the country. And with an average of 64,000 babies born annually in Ireland they’re doing invaluable work. If you’re interested specifically in nutritional guidance for pregnancy, keep your eyes peeled for next week's blog post by my colleague, Sinead Brophy.
In this post I have cited sources where possible and where not possible I have shared the information which was mentioned on the day as I interpreted it. Not that I feel I’ve misinterpreted anything, but I’m very aware this is a highly important and personal topic considering it’s impact on our lives and in particular how matter of fact clinical research has to be.
Some Main Take-Aways
What Happens in the Womb Lasts a Lifetime
The overarching message from the conference was that nutrition pre-pregnancy and during pregnancy impacts the lifetime of a baby and consequently the offspring of that child when they themselves become a parent. I had never considered nutrition during a single period to have such a far reaching impact. What struck me even more was that a woman’s nutrition and body composition pre-pregnancy and during pregnancy affects the risk of non communicable disease throughout that baby’s lifetime. I’ll go as far as to say that I find it somewhat overwhelming.
A longitudinal study carried out in UCD has provided a wealth of information. It began by studying 800 second time mothers during pregnancy and consequently the development of each child*. One of the results highlighted was that higher amounts of protein in early pregnancy means offspring are more likely to be at a healthy weight, rather than overweight, aged 5. Similarly, the children of women who are at a healthy weight pre-pregnancy are less likely to be overweight themselves throughout childhood and teenage years. The link between gestational diabetes and consequent risk of obesity in offspring was also discussed, and consequently the importance of consuming low GI foods (Voerman et al, 2019).
*It’s referred to as the ROLO study if you’re interested in looking for papers on Google Scholar or another resource.
As an organisation, MDI strongly encourages breastfeeding. Whether breastfeeding is the best option for each mum is of course a very personal decision and one which takes many factors into account. It was noted that relative to other European countries we have a very low breastfeeding rate at just 35%. Breastfeeding culture and breastfeeding in public were listed as one of the main influencing factors and when the room was asked who had seen a mother breastfeeding in the previous 24 hours there were just a few hands raised. It seems unbelievable that a mother would be self conscious feeding her child in public or that her friends and family wouldn’t see it as something to be encouraged.
The other factor which struck me was the support of her partner. It reminded me of the first episode of The Rotunda in RTE (I’ve only watched that one, it was an excellent but very emotional 60 minutes) where a father-to-be told his partner that she was “absolutely amazing” and “the strongest woman he had ever met” which was followed 5 minutes later by describing a sandwich as the best thing he had “ever tasted”. But in his defence, he didn’t seem short of respect for what she faced in the coming hours. Maybe we’re at a stage where our dads-to-be are great at appreciating the challenge of childbirth but aside from sleep deprivation, some don’t expect many other challenges specifically for mum.
An initial trial with 100 women to test the water for a large scale study (AKA a feasibility study) was carried out in Dublin and Wexford by the UCD Perinatal Research Centre (Alberdi et al, 2018) and the findings look promising. When provided with one-to-one time with a lactate consultant before leaving the hospital, followed by access to a breastfeeding helpline from home, as well as online resources and a ‘postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant’, the amount breastfeeding at 3 months was 70-80%. It was noted that mothers found access to the lactate consultant to be the most useful aspect, closely followed by having a ‘support partner’ (this was mostly their partner but not all. I’m presuming non partners were either a close friend or grandmother of the baby but it wasn’t detailed). A great bonus was that the support partners themselves reported having a much better understanding of the benefits of breastfeeding and felt more able to support the mother. I’m looking forward to seeing the results of the full study if completed - fingers crossed for sufficient funding.
The Director of the UCD Centre for Human Reproduction spoke about folic acid and its role during pregnancy in preventing neural tube defects, i.e. defects of the brain, spine or spinal cord. He opened with a reminder to the room that while we focus on the importance of folic acid, approximately 30% of all spinal tube defects aren’t preventable. This of course leaves around 70% that are preventable and highlights how crucial it is for women to ensure that folic acid supplementation is adequate before conception. In 2015 it was found that less than 25% of pregnant women had taken folic acid daily from 12 weeks or more before becoming pregnant. While 12 weeks preconception may seem early, it’s the recommended time frame for daily supplementation to reach an effective level (Cawley et al., 2015). The good news is that it’s not taxed and available for a few cents a day.
A draft guideline (at the time of writing) for 2019 from the Department of Health is that ‘All women who may become pregnant should take a Folic Acid supplement of 400 micrograms orally once a day to reduce their risk of having a baby with a Neural Tube Defect’. To me this makes sense but is a big ask considering this includes a massive amount of teens and women who are not yet sexually active or are years away from even considering becoming a mother. Then again 50% of all pregnancies are unplanned, definitely something to think about. It was mentioned that some suppliers of the contraceptive pill in the US add folic acid to their product which in part seems very ironic but also makes a whole lot of sense.
All in all, it was genuinely exciting to hear about the latest and most pertinent information in the field of nutrition in relation to something which is so important to us all at some stage, whether for ourselves or close friends and family. As I said, every pregnancy is unique and can’t be compared to another. The decisions we each make in relation to a pregnancy are ours and ours alone. We make those decisions based on our experience and knowledge of our own lives and how all the pieces of daily logistics, resources and everything in between fall into place. Hopefully the information here leaves you more informed and more intrigued to continue learning. As per the MDI mantra, 'Everybody eats. Nutrition is everybody's business'.
Alberdi, G., O'Sullivan, E. J., Scully, H., Kelly, N., Kincaid, R., Murtagh, R., ... & Sheehy, L. (2018). A feasibility study of a multidimensional breastfeeding-support intervention in Ireland. Midwifery, 58, 86-92.
Cawley, S., Mullaney, L., McKeating, A., Farren, M., McCartney, D., & Turner, M. J. (2015). An analysis of folic acid supplementation in women presenting for antenatal care. Journal of Public Health, 38(1), 122-129.
Voerman, E., Santos, S., Golab, B. P., Amiano, P., Ballester, F., Barros, H., ... & Chrousos, G. P. (2019). Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis. PLoS medicine, 16(2), e1002744.
Find out More
If you would like to find out more about Maternity Dietitians Ireland, follow them on Twitter at @MatDietIrl
If you would like to find out more about Pre & Postnatal Training at FFS then visit ffs.ie/pregnancytraining or if you would like to work directly with Aoife, then email her at email@example.com or find her on Instagram @aoifemacneill
About the Author
Aoife has been a coach at FFS Gyms since October 2016. She is passionate about pregnancy and postnatal exercise and coaches Small Group Training for both in Leeson Street as well as being the primary point of contact for all members training during pregnancy. Aoife is also an Olympic Weightlifter with international experience and currently undertaking an MSc in Strength and Conditioning.
Email Aoife at firstname.lastname@example.org
Find Aoife on Instagram at @aoifemacneill