Healthy mum, healthy baby: Part 1

Updated 22 February 2021

Over the last few months, I’ve been collecting numerous medical journal articles on pregnancy, birth and breastfeeding which I’m going to summarise in a special series on maternal and child health.

Part 1 of this series will cover the most important steps for women to take before they become pregnant.

Pre-conception care

Not every pregnancy is planned, as many of us know only too well – after all, as John Lennon sang, “Life is what happens to you while you’re busy making other plans.”

However, if a woman has the ability to plan and prepare herself for motherhood, and is wondering what she should do to maximise her chances of having a trouble-free pregnancy, normal vaginal delivery and a healthy baby, there are a couple of critically important actions to take:

1. Attain a healthy weight

The Environmental Influence on Early Aging (ENVIRONAGE) study began recruiting mother-newborn pairs from a large Belgian hospital in February 2010 and has been monitoring the health of study participants ever since.

One sub-study of ENVIRONAGE, ‘Association Between Maternal Prepregnancy Body Mass Index and Anthropometric Parameters, Blood Pressure, and Retinal Microvasculature in Children Age 4 to 6 Years‘, investigated the link between mothers’ prepregnancy body mass index (BMI) and their children’s birth weight, BMI, waist circumference, blood pressure, and retinal vessel tortuosity (a marker of damage to the fragile blood vessels in the eye, which is associated with obesity, diabetes, high blood pressure, coronary heart disease, and stroke).

Women who were heavier before becoming pregnant gave birth to heavier babies, and by the age of 4-6, these children were themselves heavier, and had larger waistlines, higher blood pressure, and increased retinal tortuosity.

The relationship between the mothers’ prepregnancy BMI and their children’s BMI, blood pressure and retinal tortuosity was linear. For every 1 point increase in a mother’s BMI, her child’s blood pressure was 0.26–mm Hg higher and retinal tortuosity index was 0.4 higher.

Relatively small differences in such biomarkers are known to increase as children grow older, a phenomenon known as ‘tracking’. For example, children who are only a little heavier than their peers tend to be become much heavier by the time they reach their teens, and the differences only magnify in adulthood. The same tracking occurs with blood pressure.

The ‘foetal programming’ hypothesis suggests that the environment a baby experiences inside the womb influences the default settings of fundamental mechanisms that control various aspects of his or her metabolism throughout life. One of the most significant determinants of that intrauterine environment is the mother’s degree of body fatness. Hence, the researchers concluded,

Another ENVIRONAGE sub-study, Maternal Pre-Pregnancy Body Mass Index and Newborn Telomere Length, found that babies of mothers who were overweight before becoming pregnant had shorter telomeres.

Often compared to the protective caps on the ends of shoelaces, telomeres shorten every time cells divide. When telomeres get too short, cells can’t divide at all and become senescent – still alive, but unable to properly function. When too many of our cells become senescent, our bodies are unable to carry out basic activities, and we die.

Telomere length is an indicator of biological ageing, and is associated with the development of age-related diseases such as type 2 diabetes, atherosclerotic heart disease and other forms of cardiovascular disease, as well as increased mortality.

The researchers found that every 1-point increase in mothers’ pre-pregnancy BMI reduced the telomere length in their babies’ cord blood by 0.50%, and placental telomere length by 0.66%.

Telomere length in early life is predictive of longevity, so the fact that babies of overweight mothers have shorter telomeres at birth indicates that their health and potential lifespan are compromised from the very beginning of their lives.

It is believed that the increased inflammation and oxidative stress generated by overfatness damage the telomeres of both the pregnant mother and her baby.

Sadly, as the authors of the study point out, 30% of women of reproductive age in affluent societies are overweight.

And in more bad news on preconception obesity: brain scans of foetuses whose mothers were obese before becoming pregnant with them showed distinct structural differences in regions associated with attention, decision-making and regulation of behaviour.

In other words, being obese at the time of conception may increase the risk that your child will develop an attention deficit and/or hyperactivity disorder.

The most important goal for any women who has a BMI of 25 or above (23 or above for those of Asian ethnicity) and wishes to start a family, should be to commit to a healthy diet and moderate exercise program in order to reach a healthy weight before becoming pregnant.

A wholefood plant-based diet emphasising foods with low energy density (vegetables, fruits, legumes and whole grains) is the most effective, health-promoting and sustainable way to lose weight.

2. Get off antidepressants – safely

In a study of over 3000 kindergarten-age Canadian children, those whose mothers took a selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine inhibitor (SNRI) antidepressant while pregnant with them, had roughly 40% higher odds of showing two or more developmental vulnerabilities, and in particular, deficits in language and cognition, as assessed by the Early Development Instrument (EDI).

The EDI is a questionnaire administered to all Canadian children by kindergarten teachers, which examines 5 domains: physical health and well-being; language and cognitive development; social competence; emotional maturity; and community skills and general knowledge. Children are considered developmentally vulnerable in a domain if they score in the bottom 10th percentile.

The study, ‘In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners‘, only included children whose mothers had been diagnosed with a mood or anxiety disorder at least 90 days before becoming pregnant with them, because it is known that mental health issues in mothers affect neurodevelopmental outcomes in their children.

Hence, the study compared outcomes in the children of mothers who were all depressed and/or anxious, with the only difference being that just under one-fifth of the mothers took an SSRI or SNRI while pregnant.

With over 10% of pregnant women currently receiving prescriptions for antidepressants, their conclusion is concerning:

The authors of the study also note that recent research using magnetic resonance imaging (MRI) has found that prenatal SSRI exposure impacts on foetal brain development, while other studies have found that children whose mothers took antidepressants while pregnant with them have a higher risk of language difficulties and worse academic outcomes in early childhood.

The physiological and psychological demands of pregnancy can exacerbate pre-existing mental health conditions. Women who have a history of depression and/or anxiety are well advised to proactively work on their coping skills and psychological resilience and, if already taking antidepressants, to safely wean off them under the supervision of a competent and experienced practitioner, before becoming pregnant.

(See my previous article Depression: bringing your black dog to heel for tips.)

In Part 2, I’ll be taking you on a deep dive into research on pregnancy and birth.

Planning for pregnancy? Now is the time to optimise your health and well-being! Apply for a Roadmap to Optimal Health Consultation today; online and in-person appointments are available.