Making Healthy Making Healthy BabiesBabies

Jacqueline A. Eberstein, Jacqueline A. Eberstein, R.N.R.N.

Controlled Carbohydrate Nutrition, Controlled Carbohydrate Nutrition, LLCLLC

Prevention: Prevention: It’s Never too Early to It’s Never too Early to StartStart

We Need to do BetterWe Need to do Better

2010 UN stats-US 502010 UN stats-US 50thth in maternal mortality. in maternal mortality.

Recent doubling maternal mortality.Recent doubling maternal mortality.

50% of maternal deaths are preventable.50% of maternal deaths are preventable.

COD: hemorrhage, HBP, infection, embolism, COD: hemorrhage, HBP, infection, embolism, cardiomyopathy, other CV conditions such as stroke.cardiomyopathy, other CV conditions such as stroke.

Economic and social costs.Economic and social costs.

More than 50% pregnancies are More than 50% pregnancies are unintended.unintended.

Unprepared for a Healthy Unprepared for a Healthy PregnancyPregnancy

Potential parents are overweight earlier Potential parents are overweight earlier in life & weigh more than ever before.in life & weigh more than ever before.

More than 60% of women of More than 60% of women of child-child-bearing agebearing age are overweight or obese. are overweight or obese.

33% of women are 33% of women are obeseobese at time they at time they conceive.conceive.

Unprepared for a Healthy Unprepared for a Healthy PregnancyPregnancy

20% women ages 20 to 44 have prediabetes and 20% women ages 20 to 44 have prediabetes and high triglycerides assoc. with GD and pre-high triglycerides assoc. with GD and pre-eclampsia.eclampsia.

Have more chronic and undiagnosed conditions Have more chronic and undiagnosed conditions such as diabetes, high blood pressure. such as diabetes, high blood pressure.

Many do not use birth control thinking they can’t Many do not use birth control thinking they can’t get pregnant.get pregnant.

Bodies are not prepared for pregnancy.Bodies are not prepared for pregnancy.

Increased Mortality Because…Increased Mortality Because…

Little follow-up care after delivery. Risk for Little follow-up care after delivery. Risk for embolism, hemorrhage, infection.embolism, hemorrhage, infection.

Increase in postpartum strokes, HBP and Increase in postpartum strokes, HBP and heart disease. Stroke risk lasts 12 weeks heart disease. Stroke risk lasts 12 weeks postpartum.postpartum.

Insurance allows for 1 postpartum visit only Insurance allows for 1 postpartum visit only following an uncomplicated delivery.following an uncomplicated delivery.

Risks for ComplicationsRisks for Complications

Obesity-even overweight with sl. increase in blood Obesity-even overweight with sl. increase in blood sugar is a risk.sugar is a risk.

Diabetes-prior to pregnancy or gestational diabetes Diabetes-prior to pregnancy or gestational diabetes (GD).(GD).

Poor prenatal, delivery or post partum care. Rural Poor prenatal, delivery or post partum care. Rural areas poorer access to care.areas poorer access to care.

Poor nutritional state before and during pregnancy.Poor nutritional state before and during pregnancy.

Substance abuse-includes smoking and alcohol.Substance abuse-includes smoking and alcohol.

Risks for ComplicationsRisks for Complications

Higher mortality in African-American women.Higher mortality in African-American women.

Increased use of medical interventions. US Increased use of medical interventions. US does more C sections and induction of labor does more C sections and induction of labor than other countries.than other countries.

Longer gestation time. Full term 40 weeks. Longer gestation time. Full term 40 weeks. Between 37 and 40 weeks brain and lungs Between 37 and 40 weeks brain and lungs are still reaching full maturity.are still reaching full maturity.

10 to 15 % of deliveries in US occur before 39 10 to 15 % of deliveries in US occur before 39 weeks for weeks for no medical reasonno medical reason..

Overweight and PregnancyOverweight and Pregnancy

Gestational diabetes-common complication of Gestational diabetes-common complication of pregnancy.pregnancy.

Increased risk C section with potential complications Increased risk C section with potential complications to Mom and childto Mom and child

Pre-eclampsia: high blood pressure, edema, protein in Pre-eclampsia: high blood pressure, edema, protein in urine. May lead to seizures and death. Higher lifetime urine. May lead to seizures and death. Higher lifetime stroke risk. Treatment is delivery of the baby.stroke risk. Treatment is delivery of the baby.

Increased health care costs for Mom and baby.Increased health care costs for Mom and baby.

Increased morbidity and mortality.Increased morbidity and mortality.

Overweight and PregnancyOverweight and Pregnancy

Birth defects- spina bifida, neural tube defects, Birth defects- spina bifida, neural tube defects, heart problems, cleft lip/palate, hydrocephaly.heart problems, cleft lip/palate, hydrocephaly.

Due to nutrient deficit, undiag DM and poor diet.Due to nutrient deficit, undiag DM and poor diet.

Miscarriage, stillbirth before term.Miscarriage, stillbirth before term.

Preterm birth. World rank is 131. As an adult Preterm birth. World rank is 131. As an adult have have decreaseddecreased insulin sensitivity. In US 1 in 9 insulin sensitivity. In US 1 in 9 babies; African-American 1 in 5.babies; African-American 1 in 5.

Overweight and PregnancyOverweight and Pregnancy

Brain development in 2Brain development in 2ndnd trimester may be trimester may be effected with increasing rates autism and effected with increasing rates autism and appetite dysregulation.appetite dysregulation.

Life long health risks to baby due to an Life long health risks to baby due to an unhealthy early fetal environment. Increased unhealthy early fetal environment. Increased risk chronic kidney disease.risk chronic kidney disease.

Gestational DiabetesGestational Diabetes

Associated with obesity, previous GD or family history Associated with obesity, previous GD or family history of diabetes.of diabetes.

18% of pregnancies.18% of pregnancies.

Used to disappear after delivery—not now.Used to disappear after delivery—not now.

Increased odds of Mom getting type 2 within 5 to 10 Increased odds of Mom getting type 2 within 5 to 10 yrs.yrs.

All women should be screened for GD at 24 weeks.All women should be screened for GD at 24 weeks.

Birth defects.Birth defects.

Gestational Diabetes Gestational Diabetes cont’dcont’d

Babies too large for safe delivery. Damage to shoulder during Babies too large for safe delivery. Damage to shoulder during delivery or C section. Also risk for hypoxia and intrauterine delivery or C section. Also risk for hypoxia and intrauterine death.death.

Improper uterine contractions. May lead to C section delivery.Improper uterine contractions. May lead to C section delivery.

Hypoglycemia in newborn.Hypoglycemia in newborn.

May increase risk of child developing obesity and diabetes May increase risk of child developing obesity and diabetes early in life. Also higher risk of asthma and cancer.early in life. Also higher risk of asthma and cancer.

GD-34% increase in cost of care for Mom and baby.GD-34% increase in cost of care for Mom and baby.

Obesity Related MortalityObesity Related Mortality

Babies are 3 times more likely to die within Babies are 3 times more likely to die within 4 weeks of birth.4 weeks of birth.

US leads all industrialized countries with US leads all industrialized countries with infant death rate in first 24 hrs.infant death rate in first 24 hrs.

In NY state 2/3 of maternal deaths are In NY state 2/3 of maternal deaths are associated with obesity.associated with obesity.

US infant mortality rank: 30US infant mortality rank: 30thth..

Not Eating for TwoNot Eating for Two

Normal wt women- 50% will gain too much.Normal wt women- 50% will gain too much. Over wt women- 64% gain too much. Over wt women- 64% gain too much. Need only 300 extra calories during Need only 300 extra calories during

pregnancy and not until the 3pregnancy and not until the 3rdrd trimester. trimester.

New Weight GuidelinesNew Weight Guidelines

Normal wt—gain 25 to 35 lbs.Normal wt—gain 25 to 35 lbs. Overweight – gain 15 to 25 lbs.Overweight – gain 15 to 25 lbs. Obese- gain 11 to 20 lbs.Obese- gain 11 to 20 lbs.

Breast Feeding is Breast Feeding is ProtectiveProtective

Milk production requires proper insulin functioning. Milk production requires proper insulin functioning. Women with BS/insulin dysregulation may have diff. with Women with BS/insulin dysregulation may have diff. with milk production.milk production.

Exclusively for 6 months then one year with food Exclusively for 6 months then one year with food introduction. US only 15% breast feed exclusively.introduction. US only 15% breast feed exclusively.

Follow a different growth pattern than formula feed Follow a different growth pattern than formula feed babies. Slower wt. gain encourages a healthier eating babies. Slower wt. gain encourages a healthier eating pattern.pattern.

Lowers level of insulin and growth factor in blood. May Lowers level of insulin and growth factor in blood. May help prevent obesity and diabetes in child. help prevent obesity and diabetes in child.

Breast Feeding Benefits MomBreast Feeding Benefits Mom

Immediately after delivery helps uterus to Immediately after delivery helps uterus to contract decreasing blood loss.contract decreasing blood loss.

Reduces risk of breast and ovarian cancer.Reduces risk of breast and ovarian cancer.

Help with weight loss.Help with weight loss.

Bonding with her child.Bonding with her child.

More economical.More economical.

Breast Feeding Benefits Breast Feeding Benefits BabyBaby

Healthier gut environment. Healthier gut environment.

Offer some protection from allergies, Offer some protection from allergies, eczema, asthma, ear infections, stomach eczema, asthma, ear infections, stomach infections.infections.

Less ADHD, obesity, diabetes.Less ADHD, obesity, diabetes.

Fatty acids and cholesterol promote better Fatty acids and cholesterol promote better growth brain’s white matter in 1growth brain’s white matter in 1stst yr. Higher yr. Higher IQ, higher verbal and nonverbal intelligence.IQ, higher verbal and nonverbal intelligence.

A Word About KetonesA Word About Ketones

Ketones cross the placenta and can be used Ketones cross the placenta and can be used by the fetus for energy.by the fetus for energy.

Later stages of development fetal liver Later stages of development fetal liver makes ketones.makes ketones.

Ketones are important source of fuel in Ketones are important source of fuel in newborn. Important for brain development. newborn. Important for brain development.

Not usually in ketosis until about 12 hrs after Not usually in ketosis until about 12 hrs after birth.birth.

Negative Lifelong Effects on ChildNegative Lifelong Effects on Child

Preconception wt may be more important Preconception wt may be more important than gain during pregnancy.than gain during pregnancy.

Genetic tendency obesity and DM.Genetic tendency obesity and DM.

Poor diet in womb may cause improper fat Poor diet in womb may cause improper fat storage later in life, esp. in liver and muscle storage later in life, esp. in liver and muscle leading to disease.leading to disease.

BMI at birth may predict adult weight.BMI at birth may predict adult weight.

Ongoing ResearchOngoing Research

Increasing wt in Mom linked to increasing Increasing wt in Mom linked to increasing leptin levels. Leptin receptors in fetal lungs. ? leptin levels. Leptin receptors in fetal lungs. ? risk asthma in child.risk asthma in child.

Vit. C defic. in Mom (don’t smoke) stunts Vit. C defic. in Mom (don’t smoke) stunts growth fetal hippocampus (memory center); growth fetal hippocampus (memory center); can’t be treated with C after birth.can’t be treated with C after birth.

MRIs in utero found the heavier the Mom the MRIs in utero found the heavier the Mom the larger fat deposits in the abdomens of babies larger fat deposits in the abdomens of babies (liver). This is not normal!(liver). This is not normal!

Obese women with elev. GGT before Obese women with elev. GGT before pregnancy more likely to get GD. A tool for pregnancy more likely to get GD. A tool for prevention?prevention?

Dad’s Important tooDad’s Important too

Dad’s folate levels at time of conception may Dad’s folate levels at time of conception may be just as important as Mom’s. Study in mice.be just as important as Mom’s. Study in mice.

Adequate levels of folate prevent birth defects Adequate levels of folate prevent birth defects and miscarriages.and miscarriages.

Recent study of newborns of obese men found Recent study of newborns of obese men found changes in DNA methylation of IGF2. ? changes in DNA methylation of IGF2. ? Increased risk of cancer.Increased risk of cancer.

Sperm of obese men pass on a molecular Sperm of obese men pass on a molecular signal that favors obesity in offspring. Mouse signal that favors obesity in offspring. Mouse study. Pass on diabetes tend. Affects females study. Pass on diabetes tend. Affects females more than males.more than males.

Healthy Pregnancy/ Healthy BabyHealthy Pregnancy/ Healthy Baby

A healthy Mom and Dad at least 6 months A healthy Mom and Dad at least 6 months before conception. Lose excess body fat before conception. Lose excess body fat beforebefore making a baby. making a baby.

Wait at least 2 yrs between pregnancies. Wait at least 2 yrs between pregnancies. Lose the previous pregnancy weight.Lose the previous pregnancy weight.

Stop smoking before conception-LBW, Stop smoking before conception-LBW, attention deficit. ? Bipolar.attention deficit. ? Bipolar.

Begin exercise before pregnancy.Begin exercise before pregnancy. Optimal nutrient status prior to conception.Optimal nutrient status prior to conception. Check vitamin D level and thyroid function.Check vitamin D level and thyroid function.

Healthy Baby & Pregnancy Healthy Baby & Pregnancy cont’dcont’d

Follow a healthy diet during pregnancy to keep Follow a healthy diet during pregnancy to keep weight gain within weight gain within newnew recommended ranges. recommended ranges.

Diet -- best to avoid empty calories with low Diet -- best to avoid empty calories with low nutrient value. Eat whole foods, minimally nutrient value. Eat whole foods, minimally processed. Eat natural fat. Regular protein intake.processed. Eat natural fat. Regular protein intake.

Lower risk of gallstones with low carb.Lower risk of gallstones with low carb.

Continue an appropriate exercise program during Continue an appropriate exercise program during pregnancy unless your doctor suggests otherwise.pregnancy unless your doctor suggests otherwise.

Take the prescribed supplements.Take the prescribed supplements.

Healthy Eating for Your ChildHealthy Eating for Your Child

Consume a wide range of healthy Consume a wide range of healthy unprocessed foods during pregnancy and unprocessed foods during pregnancy and lactation to help a child develop a wide range lactation to help a child develop a wide range of tastes that can continue throughout life.of tastes that can continue throughout life.

These preferences appear to be developed These preferences appear to be developed early in infancy.early in infancy.

A poor diet may have a negative impact on A poor diet may have a negative impact on the brain’s reward centers ? Leading to the brain’s reward centers ? Leading to addiction.addiction.

ThankThank You You

Jacqueline Eberstein Jacqueline Eberstein, , R.N.R.N.

www.controlcarb.com www.controlcarb.com