3.1 Improving nutrition
Properly nourishing the body before and during pregnancy promotes a more optimal physical status for supporting pregnancy and healthy prenatal development. In addition to healthy eating habits, Health Canada (2009b) recommends a once per day multivitamin containing 0.4 mg of folic acid (a synthetic form of naturally occurring folate found in food) for individuals who could become pregnant and also during pregnancy to help prevent neural tube defects (NTDs). A neural tube defect may result if the neural tube (which develops into the brain and spinal cord) fails to properly close as the central nervous system develops within the embryo. Examples of this type of congenital malformation are spina bifida (lumbosacral area defect) or anencephaly (cranial region defect).
According to Imbard et al. (2013), there are genetic, environmental and lifestyle factors that appear to contribute to the occurrence of NTDs (p.4353). Exactly how folic acid supplementation may work to decrease the prevalence of NTDs is not yet clear through scientific evidence, although we do know folates are involved in susceptibility to NTDs (Imbard et al., 2013, p.4359). Current thought is the link between folates and NTD risk may be related to the substantial amount of nucleotides required for DNA replication, as cells are in the process of rapid division during neural tube development. More specifically, folates may play a role in correcting limited biosynthesis of nucleotides (Imbard et al., 2013, p. 4361). Another avenue of thought is folic acid supplementation may increase how available folate is at the cellular level. An increase in folate bioavailability would be beneficial if a deficiency due to altered bioavailability were present as a causative factor of NTDs (Imbard et al., 2013, p. 4360-4361). Additionally, given the role folates play in methylation, scientists are exploring a possible connection between folate and NTDs through disturbed methylation (Imbard et al., 2013, p. 4361). How methylation may interfere with the neurulation process through cellular, molecular and genetic mechanisms is an area of ongoing research (Imbard et al., 2013, p.4362).
Listen as Monica reflects on some influences on her preconception as well as prenatal nutrition choices.
Monica mentions reading literature influenced her decision to take a multivitamin prior to pregnancy to help prevent neural tube defects. The Government of Canada (n.d.-b) recommends prenatal multivitamins should also contain 16-20 mg of iron to address additional needs during pregnancy.
Further examples of folate food sources, more in-depth information about neural tube defects, as well as prenatal nutrition information including recommended healthy weight gain is available on the following link to the Government of Canada website. Read pages 2 – 8 in the booklet The Sensible Guide to a Healthy Pregnancy.
Another important aspect of nutrition is balancing energy intake with energy needs through physical activity. The following reading from The Society of Obstetricians and Gynaecologists of Canada website discusses more about exercise benefits, recommendations for how to safely incorporate physical activity into pregnancy and circumstances when exercise is not recommended.
Nutritional environments
In the next two videos, Dr. Wanda Phillips-Beck discusses the complexity of factors that have influenced nutrition for the Indigenous population. She also provides an example of what some First Nations communities are doing to promote healthier nutrition and physical activity practices.
A major shift in strategy, from individual-based science to population-based economics, will probably be required to reduce the global health burden of excessive energy intake and obesity. If the disease component of obesity lies not in adipose tissue itself, but in the interaction between adipose tissue biology and our modern industrialized environment, efforts to combat obesity would be much more effective if they prioritized ‘external’ environmental change rather than attempting to manipulate ‘internal’ biology through pharmaceutical or behavioral means” (Wells, J.C.K., 2012, p. 604).
In the next two readings on the Harvard T.H. Chan School of Public Health website, learn about physical and social environmental influences on obesity, as well as intriguing information about influences in early development on obesity. At the end of the second reading are key messages health care providers should relay while working with the childbearing-aged population towards improving health and limiting obesity.
Read the next webpage on the Obesity Canada website for information related to healthy weight and pregnancy. You may wish to explore more information under the tabs Resources then Professional and 5As of Obesity Management including the Healthy Pregnancy tab if you are health care professional looking for additional tools that may help support your practice discussions around obesity and pregnancy weight gain.
On a broader scale, producers, industry, institutions, governments and society as a whole are part of an interconnected network that may influence an individual attempting to make healthier food choices. Look at the following infographic on The Lancet website to see how government policy can potentially influence food culture in support of healthier food choices. You may also explore more on the topic of obesity by following the link to the 2015 series of obesity-related articles. If you would like to read any of these articles in full, note the need to register for free access on The Lancet website. Alternatively, there may be access through your library.
Prenatal nutrition programs
Canada has been evaluating the effectiveness of its prenatal nutrition programs. More about how the Canadian Prenatal Nutrition Program (CPNP) has supported pregnancies and healthier outcomes across the country is available on the Public Health Agency of Canada website. Click on the link below to explore the highlights of the Summative Evaluation of CPNP.
The next weblink is an example of CPNP funded programs in Renfrew county Ontario.
The second weblink features a Toronto Public Health program “Healthiest Babies Possible” on the City of Toronto website. Watch the video at the bottom of the webpage to learn more about how this nutrition support program is influencing outcomes.
Disease prevention and health promotion strategies
Listen as Sir Peter Gluckman, who served as the inaugural chief science advisor to the Prime Minister of New Zealand, shares his expert opinion from a public health perspective on what may help to reduce non-communicable disease risk for the next generation. His ideas include some thought-provoking strategies on improving nutrition.
One strategy to reduce risk for chronic disease, suggests Sir Gluckman, is to target future parents with improved nutrition education before they enter their childbearing years.
Read more about opportunities for interventions on the next link to the third Lancet journal article in the “Preconception Health” series. It is called “Intervention Strategies to Improve Nutrition and Health Behaviours Before Conception” by Barker et al. (2018). You may register for free access to the full text on The Lancet website (or you may have access through your library).
How do Sir Gluckman’s ideas for improving the health of the next generation as discussed in the previous video link with the key messages and intervention opportunities outlined in The Lancet article above?
Preconception health for men is an emerging area of research and practice. Read more about this topic on the next link to the Best Start website.
Watch as Dr. Joanne Weinberg, professor emerita and distinguished scholar, Faculty of Medicine, University of British Columbia, discusses alcohol and epigenetics, including what we are beginning to learn about alcohol effects on sperm prior to pregnancy that may impact embryo and fetal development.
Read more about alcohol and pregnancy on the CanFASD website below.
If you are a health care provider, you may also be interested in the next reading Talking about substance use during pregnancy: Collaborative approaches for health care providers on the Centre of Excellence for Women’s Health website.
Oral health is also linked to prenatal development and outcomes such as preterm birth and low birth weight babies. Read more about how poor oral health may affect a pregnancy and prenatal development on the Government of Canada website.
