Healthy mum, happy baby – nutritional support for new mums

For many, becoming a new mum is one of the most beautiful and rewarding experiences in the their lives. The first few months can feel like they’re floating on cloud nine, however continued sleep deprivation, skipped meals and inadequate nutrients can quickly take a toll.

It takes approximately 2-3 years for a mother’s body to fully recover after birth. Pregnancy, giving birth and breast feeding can lead to postnatal depletion which can affect the mother’s wellbeing for up to 10 years. Nutritional support is crucial to help mothers restore their energy levels, produce nutrient dense breast milk (for baby’s development), stabilise their mood and minimise stress levels.

Inadequate intake of specific micronutrients during pregnancy and the lactation period is very common even in developed countries. This applies to DHA (docosahexaenoic acid), vitamin D, choline, iron and folate. The risk of not getting adequate levels of nutrients may also be associated with a selected group of women in childbearing: those who follow elimination diets, adolescents, underweight or overweight/obese, those who smoke or have had multiple pregnancies in close proximity or previous miscarriages1.

Iron: Women lose a lot of blood during child birth and haemoglobin levels may be very low afterwards which can be associated with reduced levels of iron. In many cases this results in long lasting fatigue after the birth, weakness, dizziness, cold hands and feet, shortness of breath and pale skin. Low levels of iron can lead to anaemia. The are two different types of iron – Heme iron found in red meat which is more absorbable by the body and non-heme iron found in plants such as vegetables, grains, nuts and seeds and legumes. Great sources of iron to include in a new mum’s diet include: beef, lamb, pork, liver, eggs, fish, grains, wild and black rice, legumes such as chick peas, lentils, beans, soybeans and green leafy vegetables such as spinach, kale, Swiss chard, broccoli, Brussel sprouts and green peas. Vitamin C supplements can also support better iron absorption, whereas milk and tea can prevent iron supplementation2. 100g of spinach contains 110% more Iron than 100g of red meat and 220% more than the same amount of salmon (26, 27).

Infants up to 6 months old receive enough iron from their mothers milk. When breastfeeding is not an option then formula fortified with iron should be sufficient. However if the baby is exclusively breast fed then it may be under the risk from iron deficiency from month four. The American Academy of paediatrics recommended that exclusively breastfed infants from 4 months and up should receive an iron supplement of 1mg per kg per day. Babies with iron deficiency can exhibit slow weight gain, be less physically active and appear more cranky, fussy and their development may be slower3. Iron should be supplemented to breastfed infants until they start eating solid food rich in Iron3.

Vitamin D: Shortly after birth most babies require an additional source of Vitamin D. Vitamin D is necessary for the bones to absorb calcium, which plays a crucial role in bone health and reducing the risk of developing rickets in children. The foetus accumulates about 30g of calcium in the uterus from its mother – 80% of this transfer occurs in the last trimester. Maternal vitamin D is important for the respiratory health of developing lungs in young children (Litonjua, J Allergy Clin Immunol 2007). Vitamin D deficiency has also been associated with obesity (adipose tissue sequestration and decreased bioavailability of Vitamin D).

Scientists discovered that the risk of type 1 diabetes was reduced by 50% after supplementing children during their first year of life with vitamins D (400-1000UI), and 80% when giving them 2000IU of vitamin D daily4.

Studies show that higher Vitamin D intake by pregnant mothers reduces the risk of developing asthma in the first 10 years of life5. It is recommended that exclusively breast-fed infants and children are supplemented with at least 400 IU/day of vitamin D3 daily6. Vitamin D deficiency has been associated with postpartum depression which impacts mental and physical health in children. It has been suggested that Vitamin D may act as a neuroactive hormone and its deficiency alters neurotransmitters involved in the development of depression7.

It is also recommend that women take a Vitamin D supplement straight after birth. The safe upper limit for Vitamin D supplementation is 1,000–1,500 IU/day for babies, 2,500–3,000 IU/day for children aged 1–8 years, and 4,000 IU/day for children 9 years of age to adulthood including pregnant and lactating women4. Vitamin D can be found in oily fish, eggs, fortified foods, some fortified dairy products, organic free range pork and pork liver.

Omega3 (especially DHA) commonly found in oily fish such as salmon, sardines, herrings and seafood.

Although EPA and DHA are both required in the child’s early development, DHA is regarded as the more important Omega 3 in the early stages of babies development. During pregnancy, a higher intake of n-3 PUFAs (polyunsaturated fatty acids Omega 3) and/or fish, its primary dietary source, is associated with improved foetal growth8. Studies suggest that DHA plays a significant role in the child’s cognitive function, brain development and neural connectivity. Because baby is dependent on its mother’s DHA during breastfeeding, insufficient maternal levels mean that exclusively breastfed infants are at risk of not receiving adequate amounts of DHA from mother’s milk9. If a baby doesn’t receive sufficient levels of DHA then supplementation of Omega 3 fish oil is recommended.

Studies suggest that providing a good source of fish oil to children in the first year of their life may decrease the risk of developing asthma and symptoms of atopic eczema. Fish oil has also been associated with the impact on reducing the maternal obesity during pregnancy10.

Choline is one of the most essential nutrients during lactation. The requirements for choline during breastfeeding are much higher than during any other time of life. Choline is an essential nutrient that is required for the production of neurotransmitters involved in brain and nervous system functions. This compound is especially important in the early stages of brain development and lifetime memory function in children. Babies up to six months old require 125 mg and children over one year old 200mg. This is equivalent to two eggs a day. Breastfeeding mums need almost double the dose at 550mg choline a day, equivalent to two slices of chicken liver or five eggs. Including foods such as eggs, beef and chicken liver, broccoli and on daily basis may help new mums to support their nervous system (regulate memory, mood, muscle control) and babies brain development11. If mother doesn’t regularly include eggs, meat or fish in her diet then supplementing can be an effective way to give new mums a starting base towards their daily intake from food.

Folate (Vitamin B9 and folacin) is required for the development of the babies skull, brain and spinal cord and is required to prevent neural tube defects (NTDs) in babies. It is also a crucial component which supports the production of red and white cells. Folate is often found to be low in the diet of breastfeeding mums. Research suggests that the folate levels in mothers milk is maintained at the expense of maternal folate reserves, so it is vitally important for breastfeeding mothers to supplement their diet with foods containing folate/folic acid to maintain supply12. Good sources of folate include green leafy vegetables, chick peas, peas, bananas, potatoes, oranges, melon, kidney beans, poultry, pork, shellfish, wholegrain foods, nuts and seeds, eggs, liver. If folate rich foods are difficult to include in lactating mums diet, 5mg of folate (folic acid) is recommended to supplement daily13.

If any of the information given above may relate to your current situation and you would like advice or detailed postnatal nutritional support please get in touch via magda@persea.clinic, or www.persea.clinic.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084016/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528681/
  4. https://spectrum.diabetesjournals.org/content/24/2/113
  5. https://erj.ersjournals.com/content/45/4/1027
  6. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-d.html
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946263/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994920/
  9. https://academic.oup.com/ajcn/article/99/3/734S/4577501
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560373/
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441939/
  12. https://pubmed.ncbi.nlm.nih.gov/22123635/
  13. https://www.nhs.uk/medicines/folic-acid/