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Motherhood

Nutrition during pregnancy and breastfeeding is one of the areas where specific interventions have the greatest impact on the health of two generations simultaneously: adequate maternal nutrition during pregnancy and breastfeeding contributes… Read more.

13 factors with evidence, ordered from most to least effective. Information, not medical advice.

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⏱ 3 min read

Breastfeeding is one of the most powerful interventions in infant nutrition and, nevertheless, one of those that generate the greatest cultural ambivalence in many societies: the data are unequivocal in its favor, breastfed babies have a lower risk of gastrointestinal and respiratory infections and otitis, better cognitive outcomes, a lower risk of childhood leukemia and celiac disease, and mothers who breastfeed have a lower risk of breast and ovarian cancer, but rates of exclusive breastfeeding at six months remain low in many developed countries because of a combination of factors that include a lack of institutional, workplace, and family support.

Breast milk is not simply a food: it is a biologically active and dynamic fluid whose composition changes from one feeding to the next, from day to night, from the first day to the sixth month, and in response to the specific needs of the infant, including their microbiome, immune status, and circadian rhythms; the colostrum produced in the first days is especially rich in immunological factors and relatively low in lactose, whereas mature milk contains a complex mixture of proteins, fats, carbohydrates, and bioactive factors that has no equivalent in any industrialized formula.

Key components of breast milk

Human milk oligosaccharides, or HMOs, are the third most abundant component of milk after fat and lactose, with more than 200 types identified, and their main function is not nutritional but prebiotic: they serve as a substrate for the beneficial bacteria of the infant's gut and as structural decoys that prevent pathogens from adhering to the epithelial cells of the intestine; each mother's HMO profile is unique and genetically determined, which means that breast milk is literally personalized to the microbial and immune needs of her own child.

Omega-3 fatty acids, particularly DHA, are critical for infant brain development: neuroimaging studies in newborns show that the children of mothers with higher omega-3 intake have larger brain volumes in regions of the frontal cortex and the corpus callosum, areas linked to attention, memory, and sensorimotor integration; the DHA concentration in breast milk is strongly influenced by the maternal diet, and supplementation with 400 mg of DHA daily increases the concentration of this fatty acid in milk by 123 percent compared with placebo.

Cognitive and cardioprotective benefits

A meta-analysis of 17 studies found that children and adolescents who had been breastfed in infancy scored almost three points higher on intelligence tests than those who were not breastfed, even after adjusting for maternal intelligence; and data from randomized controlled trials show that babies exclusively breastfed for at least three months have greater white matter growth, especially in areas associated with language, emotional regulation, and cognition, compared with formula-fed babies, with differences of 20 to 30 percent in the growth of these brain regions.

As for cardioprotection, long-term follow-up data from more than 900 preterm infants in the United Kingdom show that those fed breast milk had greater ventricular volume, better stroke volume, and lower blood pressure in adolescence and early adulthood compared with those fed formula, suggesting that early exposure to breast milk may modulate cardiovascular development in a lasting way beyond the first years of life.

References

  1. Eidelman, A.I. et al. (2012). Breastfeeding and the Use of Human Milk. Pediatrics 129, 3.
  2. Oddy, W.H. (2001). Breastfeeding protects against illness and infection in infants and children. Breastfeed Rev 9, 2.
  3. Dieterich, C.M. et al. (2013). Breastfeeding and Health Outcomes for the Mother-Infant Dyad. Pediatr Clin North Am 60, 1.
  4. Centers for Disease Control. (2014). Breastfeeding Report Card.
  5. Rollins, N.C. et al. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet 387, 10017.
  6. Neville, M.C. et al. (2012). Lactation and neonatal nutrition: defining the critical questions. J Mammary Gland Biol Neoplasia 17, 2.
  7. Pang, W.W.; Hartmann, P.E. (2007). Initiation of Human Lactation: Secretory Differentiation and Secretory Activation. J Mammary Gland Biol Neoplasia 12, 4.
  8. Neville, M.C. et al. (2002). Nipple stimulation and milk secretion. Semin Perinatol 26, 1.
  9. Ballard, O.; Morrow, A.L. (2013). Human Milk Composition. Pediatr Clin North Am 60, 1.
  10. Saarela, T. et al. (2005). Macronutrient and energy contents of human milk fractions during the first six months of lactation. Acta Paediatr 94, 9.

In depth

⏱ 3 min read

Nutrition during pregnancy and breastfeeding is one of the areas where specific interventions have the greatest impact on the health of two generations at once: adequate maternal nutrition during pregnancy and breastfeeding contributes to the mother's present and future health, proper fetal development, the prevention of birth defects, and the infant's well-being. Some nutritional interventions have such solid evidence that they are part of universal obstetric recommendations.

Essential supplementation during pregnancy

Folic acid (400-800 µg/day from 1-3 months before conception until week 12): the intervention with the best support. It reduces neural tube defects (spina bifida, anencephaly) by approximately 70%. Universal recommendation.

Iodine (150-200 µg/day during pregnancy and breastfeeding): essential for fetal brain development. Spain is a country with insufficient iodization; potassium iodide supplementation is recommended by endocrinology and obstetrics societies.

Iron: increased intake during pregnancy; supplementation if there is a deficiency (common). Maternal iron deficiency during pregnancy is associated with low birth weight and greater neonatal risk.

Vitamin D: subclinical deficiencies are common; supplementation is recommended in many contexts.

Calcium: in countries with low dietary intake, supplementation reduces preeclampsia.

DHA (from algae or oily fish/fish oil low in contaminants): important for fetal brain and eye development; 200-300 mg DHA/day recommended.

Vitamin B12: especially important in mothers on strict vegetarian/vegan diets.

Foods to avoid during pregnancy

  • Fish high in mercury: swordfish, bluefin tuna, shark. Limit albacore tuna; prefer small fish.
  • Unpasteurized dairy, unpasteurized soft cheeses: risk of listeria.
  • Raw meat and cured meats: risk of toxoplasmosis, listeria.
  • Raw fish (sushi, sashimi) in countries with a risk of anisakis or parasites.
  • Raw eggs: risk of salmonella.
  • Alcohol: no level is considered safe; fetal alcohol syndrome is one of the most significant preventable causes of intellectual disability.
  • Liver and organ meats at high frequency: due to the risk of excess vitamin A.
  • Caffeine: limit to less than 200 mg/day.

Supplements to avoid during pregnancy

  • Vitamin A in high doses (more than 10,000 IU/day): teratogenic. The amounts in standard prenatal multivitamins are safe.
  • Herbs with uterotonic effects: chasteberry, rue, sage, wormwood, licorice at high doses, mucuna pruriens, lion's mane in some contexts.
  • Herbs with limited data during pregnancy: most adaptogens (ashwagandha, rhodiola), ginkgo, St. John's wort, kava.
  • Megadoses of vitamins in general.
  • Herbs for weight loss or "detox".

Breastfeeding

  • Nutritional needs are even higher than in pregnancy for some nutrients (calcium, iron restored after delivery, vitamins).
  • Adequate fluid intake.
  • Maintain iodine supplementation (200 µg/day), vitamin D, DHA.
  • Avoid alcohol or limit it significantly; alcohol passes into breast milk.
  • Limit caffeine (some babies are sensitive).
  • Some herbs inhibit lactation: sage, parsley at high doses, herbs with very high doses of vitamin B6.

Polycystic ovary syndrome and fertility

In women with PCOS who are trying to conceive: - Myo-inositol + d-chiro-inositol (4 g/day): improves ovulation. - Metabolic optimization: weight loss if appropriate, Mediterranean diet, exercise. - Vitamin D if deficient.

Pregnancy symptoms

  • Nausea and vomiting: vitamin B6 (pyridoxine) has support, alone or combined with doxylamine (Diclegis).
  • Constipation: increased dietary fiber, hydration, prunes, occasionally psyllium.
  • Heartburn: dietary measures, elevating the head of the bed, ranitidine replaced by famotidine if necessary (proton pump inhibitors are generally safe).

The reasonable conclusion

Pregnancy is probably the life stage where nutrition has the most documented impact and where specific interventions (preconception folic acid, iodine, iron if deficient, DHA) have the best support. Preconception nutritional planning (ideally 3 months before trying to conceive) optimizes outcomes. Nutritional recommendations during pregnancy and breastfeeding should be individualized with obstetric/midwifery follow-up; supplements not specifically recommended and medicinal herbs without clear safety data should be avoided by default.

References

  1. De-Regil, L.M. et al. (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev 12. doi:10.1002/14651858.CD007950.pub3
  2. Hofmeyr, G.J. et al. (2018). Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 10. doi:10.1002/14651858.CD001059.pub5
  3. Bath, S.C. et al. (2013). Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children. Lancet 382, 9889. doi:10.1016/S0140-6736(13)60436-5
  4. Koren, G. et al. (2010). Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy. Am J Obstet Gynecol 203, 6. doi:10.1016/j.ajog.2010.07.030
  5. Coletta, J.M.; Bell, S.J.; Roman, A.S. (2010). Omega-3 fatty acids and pregnancy. Rev Obstet Gynecol 3, 4. PMID 21364845
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Motherhood

⏱ 3 min read

Nutrition during pregnancy and breastfeeding is one of the areas where specific interventions have the greatest impact on the health of two generations at once: adequate maternal nutrition during pregnancy and breastfeeding contributes to the mother's present and future health, proper fetal development, the prevention of birth defects, and the infant's well-being. Some nutritional interventions have such solid evidence that they are part of universal obstetric recommendations.

Essential supplementation during pregnancy

Folic acid (400-800 µg/day from 1-3 months before conception until week 12): the intervention with the best support. It reduces neural tube defects (spina bifida, anencephaly) by approximately 70%. Universal recommendation.

Iodine (150-200 µg/day during pregnancy and breastfeeding): essential for fetal brain development. Spain is a country with insufficient iodization; potassium iodide supplementation is recommended by endocrinology and obstetrics societies.

Iron: increased intake during pregnancy; supplementation if there is a deficiency (common). Maternal iron deficiency during pregnancy is associated with low birth weight and greater neonatal risk.

Vitamin D: subclinical deficiencies are common; supplementation is recommended in many contexts.

Calcium: in countries with low dietary intake, supplementation reduces preeclampsia.

DHA (from algae or oily fish/fish oil low in contaminants): important for fetal brain and eye development; 200-300 mg DHA/day recommended.

Vitamin B12: especially important in mothers on strict vegetarian/vegan diets.

Foods to avoid during pregnancy

Supplements to avoid during pregnancy

Breastfeeding

Polycystic ovary syndrome and fertility

In women with PCOS who are trying to conceive: - Myo-inositol + d-chiro-inositol (4 g/day): improves ovulation. - Metabolic optimization: weight loss if appropriate, Mediterranean diet, exercise. - Vitamin D if deficient.

Pregnancy symptoms

The reasonable conclusion

Pregnancy is probably the life stage where nutrition has the most documented impact and where specific interventions (preconception folic acid, iodine, iron if deficient, DHA) have the best support. Preconception nutritional planning (ideally 3 months before trying to conceive) optimizes outcomes. Nutritional recommendations during pregnancy and breastfeeding should be individualized with obstetric/midwifery follow-up; supplements not specifically recommended and medicinal herbs without clear safety data should be avoided by default.

References

  1. De-Regil, L.M. et al. (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev 12. doi:10.1002/14651858.CD007950.pub3
  2. Hofmeyr, G.J. et al. (2018). Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 10. doi:10.1002/14651858.CD001059.pub5
  3. Bath, S.C. et al. (2013). Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children. Lancet 382, 9889. doi:10.1016/S0140-6736(13)60436-5
  4. Koren, G. et al. (2010). Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy. Am J Obstet Gynecol 203, 6. doi:10.1016/j.ajog.2010.07.030
  5. Coletta, J.M.; Bell, S.J.; Roman, A.S. (2010). Omega-3 fatty acids and pregnancy. Rev Obstet Gynecol 3, 4. PMID 21364845