Making Healthy Babies

1. Making Healthy Babies Jacqueline A. Eberstein, R.N. Controlled Carbohydrate Nutrition, LLC

2. Prevention: It’s Never too Early to Start

3. We Need to do Better • 2010 UN stats-US 50th in maternal mortality. • Recent doubling maternal mortality. • 50% of maternal deaths are preventable. • COD: hemorrhage, HBP, infection, embolism, cardiomyopathy, other CV conditions such as stroke. • Economic and social costs. • More than 50% pregnancies are unintended.

4. Potential parents are overweight earlier in life & weigh more than ever before. More than 60% of women of child-bearing age are overweight or obese. 33% of women are obese at time they conceive. Unprepared for a Healthy Pregnancy

5. Unprepared for a Healthy Pregnancy 20% women ages 20 to 44 have prediabetes and high triglycerides assoc. with GD and pre-eclampsia. Have more chronic and undiagnosed conditions such as diabetes, high blood pressure. Many do not use birth control thinking they can’t get pregnant. Bodies are not prepared for pregnancy.

6. Increased Mortality Because… • Little follow-up care after delivery. Risk for embolism, hemorrhage, infection. • Increase in postpartum strokes, HBP and heart disease. Stroke risk lasts 12 weeks postpartum. • Insurance allows for 1 postpartum visit only following an uncomplicated delivery.

7. Risks for Complications • Obesity-even overweight with sl. increase in blood sugar is a risk. • Diabetes-prior to pregnancy or gestational diabetes (GD). • Poor prenatal, delivery or post partum care. Rural areas poorer access to care. • Poor nutritional state before and during pregnancy. • Substance abuse-includes smoking and alcohol.

8. Risks for Complications • Higher mortality in African-American women. • Increased use of medical interventions. US does more C sections and induction of labor than other countries. • Longer gestation time. Full term 40 weeks. Between 37 and 40 weeks brain and lungs are still reaching full maturity. • 10 to 15 % of deliveries in US occur before 39 weeks for no medical reason.

9. Overweight and Pregnancy • Gestational diabetes-common complication of pregnancy. • Increased risk C section with potential complications to Mom and child • Pre-eclampsia: high blood pressure, edema, protein in urine. May lead to seizures and death. Higher lifetime stroke risk. Treatment is delivery of the baby. • Increased health care costs for Mom and baby. • Increased morbidity and mortality.

10. Overweight and Pregnancy • Birth defects- spina bifida, neural tube defects, heart problems, cleft lip/palate, hydrocephaly. Due to nutrient deficit, undiag DM and poor diet. • Miscarriage, stillbirth before term. • Preterm birth. World rank is 131. As an adult have decreased insulin sensitivity. In US 1 in 9 babies; African-American 1 in 5.

11. Overweight and Pregnancy • Brain development in 2nd trimester may be effected with increasing rates autism and appetite dysregulation. • Life long health risks to baby due to an unhealthy early fetal environment. Increased risk chronic kidney disease.

12. Gestational Diabetes • Associated with obesity, previous GD or family history of diabetes. • 18% of pregnancies. • Used to disappear after delivery—not now. • Increased odds of Mom getting type 2 within 5 to 10 yrs. • All women should be screened for GD at 24 weeks. • Birth defects.

13. Gestational Diabetes cont’d • Babies too large for safe delivery. Damage to shoulder during delivery or C section. Also risk for hypoxia and intrauterine death. • Improper uterine contractions. May lead to C section delivery. • Hypoglycemia in newborn. • May increase risk of child developing obesity and diabetes early in life. Also higher risk of asthma and cancer. • GD-34% increase in cost of care for Mom and baby.

14. Obesity Related Mortality • Babies are 3 times more likely to die within 4 weeks of birth. • US leads all industrialized countries with infant death rate in first 24 hrs. • In NY state 2/3 of maternal deaths are associated with obesity. • US infant mortality rank: 30th.

15. Not Eating for Two • Normal wt women- 50% will gain too much. • Over wt women- 64% gain too much. • Need only 300 extra calories during pregnancy and not until the 3rd trimester. New Weight Guidelines • Normal wt—gain 25 to 35 lbs. • Overweight – gain 15 to 25 lbs. • Obese- gain 11 to 20 lbs.

16. Breast Feeding is Protective • Milk production requires proper insulin functioning. Women with BS/insulin dysregulation may have diff. with milk production. • Exclusively for 6 months then one year with food introduction. US only 15% breast feed exclusively. • Follow a different growth pattern than formula feed babies. Slower wt. gain encourages a healthier eating pattern. • Lowers level of insulin and growth factor in blood. May help prevent obesity and diabetes in child.

17. Breast Feeding Benefits Mom • Immediately after delivery helps uterus to contract decreasing blood loss. • Reduces risk of breast and ovarian cancer. • Help with weight loss. • Bonding with her child. • More economical.

18. Breast Feeding Benefits Baby • Healthier gut environment. • Offer some protection from allergies, eczema, asthma, ear infections, stomach infections. • Less ADHD, obesity, diabetes. • Fatty acids and cholesterol promote better growth brain’s white matter in 1st yr. Higher IQ, higher verbal and nonverbal intelligence.

19. A Word About Ketones • Ketones cross the placenta and can be used by the fetus for energy. • Later stages of development fetal liver makes ketones. • Ketones are important source of fuel in newborn. Important for brain development. • Not usually in ketosis until about 12 hrs after birth.

20. Negative Lifelong Effects on Child • Preconception wt may be more important than gain during pregnancy. • Genetic tendency obesity and DM. • Poor diet in womb may cause improper fat storage later in life, esp. in liver and muscle leading to disease. • BMI at birth may predict adult weight.

21. Ongoing Research • Increasing wt in Mom linked to increasing leptin levels. Leptin receptors in fetal lungs. ? risk asthma in child. • Vit. C defic. in Mom (don’t smoke) stunts growth fetal hippocampus (memory center); can’t be treated with C after birth. • MRIs in utero found the heavier the Mom the larger fat deposits in the abdomens of babies (liver). This is not normal! • Obese women with elev. GGT before pregnancy more likely to get GD. A tool for prevention?

22. Dad’s Important too • Dad’s folate levels at time of conception may be just as important as Mom’s. Study in mice. • Adequate levels of folate prevent birth defects and miscarriages. • Recent study of newborns of obese men found changes in DNA methylation of IGF2. ? Increased risk of cancer. • Sperm of obese men pass on a molecular signal that favors obesity in offspring. Mouse study. Pass on diabetes tend. Affects females more than males.

23. Healthy Pregnancy/ Healthy Baby • A healthy Mom and Dad at least 6 months before conception. Lose excess body fat before making a baby. • Wait at least 2 yrs between pregnancies. Lose the previous pregnancy weight. • Stop smoking before conception-LBW, attention deficit. ? Bipolar. • Begin exercise before pregnancy. • Optimal nutrient status prior to conception. • Check vitamin D level and thyroid function.

24. Healthy Baby & Pregnancy cont’d • Follow a healthy diet during pregnancy to keep weight gain within new recommended ranges. • Diet -- best to avoid empty calories with low nutrient value. Eat whole foods, minimally processed. Eat natural fat. Regular protein intake. • Lower risk of gallstones with low carb. • Continue an appropriate exercise program during pregnancy unless your doctor suggests otherwise. • Take the prescribed supplements.

25. Healthy Eating for Your Child • Consume a wide range of healthy unprocessed foods during pregnancy and lactation to help a child develop a wide range of tastes that can continue throughout life. • These preferences appear to be developed early in infancy. • A poor diet may have a negative impact on the brain’s reward centers ? Leading to addiction.

26. Thank You Jacqueline Eberstein, R.N. www.controlcarb.com