How to Prevent Prematurity: Part 2

Premature birth is scary. The thought of seeing your tiny, helpless baby in an incubator with wires, tubes, CPAP, and more is heartbreaking. Unfortunately, prematurity rates are rising. Fortunately you can prevent premature birth.

Though many organizations act like prematurity is a mystery, it's not.  Sometimes babies are born early and we can't help it: chronic illness or congenital problems with the mother, accidents or natural disaster strikes.  But you as a mother can make a huge difference in your chances of carrying to term. In Part 1 we talked about how to prevent prematurity by rooting out chronic stress and anxiety.  In Part 2 we'll dig into another aspect of prematurity prevention – and cover preventing IUGR, low birth weight, etc. while we're at it.

Prevent Premature Birth: Nutrition

Lets Talk About What You Eat

Nutrition is important.  If you're reading something on NaturalBirthandBabyCare.com, you should know that I feel that pregnancy nutrition is incredibly important for many, many reasons.  But you should know three other things:

  • The prenatal nutrition advice you get from the government, pregnancy magazines, and most pregnancy books is wrong.  Government and magazine advice (magazines tote the government line) is especially dangerous much of the time.
  • I am not going to tell you it's “all about protein” because that's a simplistic approach that's also very dangerous.  If you're making the assumption that's what I'm going to teach you, please hear me out.
  • Your baby cannot “take” what he or she needs from your body.  Your baby can't take it if you're underweight, at your ideal weight, or even if you're overweight or obese.

Don't believe anybody who tells you that food makes no difference.  That's absolutely false – and it's deadly to you and your baby1.

Premature babies have beautiful, fighting spirits that inspire us.  But there is no mistaking that being born too early is a tragedy.  Premature babies have many, many struggles, complications, and possible developmental delays.  Even being born slightly early puts a baby at a disadvantage.  And even being born with a low birth weight is proven to has lifelong implications for your baby.

This should be a wake-up call in a culture that barely lets women eat enough to ovulate – and in a culture where many women openly state they're “trying to get a smaller baby.”  These aren't moms who had 10 or 11lb babies who want a modest 8lb baby.  These are moms hoping for a truly small baby… a baby with lifelong disadvantages.  Modern pregnancy advice does nothing to warn these moms of the possible consequences of restricting the growth of their baby in the womb.

Average birth weights are dropping and prematurity is rising.  It's time to feed mothers.

Weight Gain Matters

I'm not talking about your baby's weight here.  I'm talking about yours.  Weight gain is essential to a healthy pregnancy, for every mother and for every baby.

Your starting weight does not matter.  You need to eat, eat plenty, eat nourishing foods, and you need to gain weight.

Your baby is depending on you.  I'm not saying you need to gain 60+ pounds.  But a weight gain above the current recommendations is not only reasonable, its supported by evidence to be healthier for you and your baby.  On average, mothers in studies focused on optimal nutrition gained between 35-45lbs (current recommendations for a mother at her ideal weight are to gain 25-35lbs).  Mothers with a healthy weight gain were far less likely to have low birth weight or premature babies.  Look over this chart:

Birth Weight and Maternal Weight Gain

Moms who gained the current “recommended” amounts had only a 4.3% chance of having a low birth weight baby.  Moms who gained 36lbs or more had only a 3.0% chance – even less than the modern “optimal” range.

Notice that this data is from the Montreal Diet Dispensary – an organization headed by the late Agnes Higgins (the March of Dimes still gives an award in her name every year).  They focused on healthier pregnancies, fewer premature births, and healthier babies by giving mothers supplemental foods.  They made a difference for generations of babies by focusing on mom's diets.

Maybe you're skeptical because this is “old” data.  The sad fact is today's governments and health organizations are obsessed with keeping weight low, counting calories, and preventing obesity.  Focusing on weight restriction harms babies and mothers, it does not help them.  Honest nutrition studies are rarely done today because modern culture is obsessed with preventing fat people, and the logical notion that mothers must eat to make healthy babies gets lost in the single-minded drive to help people get thinner.

Restricting weight gain (even in obsese mothers) leads to prematurity, IUGR, and low birth weights.  Restricting weight gain also leads to babies predisposed to being fat.  Not only does modern advice hurt babies in the womb and make it more likely you'll have pregnancy complications, but it damages your baby's ability to stay slim… for life.

“Long-term studies of babies born small-for-dates due to maternal lack of calories show they have a higher rate of childhood obesity, adult obesity, insulin resistance, and adult-onset diabetes.  Lack of food during pregnancy (whether intentional or through poverty or famine) can program the developing baby's metabolism to the thrift phenotype where the body uses every bit of excess energy to lay down fat cells.”  ~Gail Hart2 (emphasis mine)

I quoted midwife Gail Hart because her writing is accessible to all mothers – and it's backed by reams of scientific evidence.  Having a baby born prematurely and at low birth weight changes the way your baby's metabolism works and programs him or her to store extra fat3.

I'm not advocating you go all out and eat all the calories and junk food you want – there is evidence that excessive weight gain isn't good for mothers and babies.  But excessive gain is not likely to be the result of eating a sensible, nutrient-dense pregnancy diet that's balanced in a healthy way (we'll talk more about what “balanced” means for pregnant women shortly).

A calorie-rich but nutrient poor diet is as bad as a low-calorie.  This not only nourishes you and baby, but it nourishes the placenta.  Proper placental nourishment is vital to preventing premature birth

(NOTE: Trying to balance your pregnancy, life, and getting ready for baby? Use my checklist pack stay healthy (naturally), organized, and confident throughout your pregnancy! Get them here.)

Ultimate Pregnancy Checklist Pack

Nourish the Placenta and Protect Your Baby

Taking care of your baby's placenta is taking care of your baby!  You nourish the placenta the same was as you do your baby – with food.

In order for a placenta to provide your baby with vital nutrients and waste management, it must have the nutrients to give your baby.  To reiterate what I said above, and make it even more clear:

Your placenta cannot “take” nutrients from your body to provide to your baby.

The nutrients must be there, available in your bloodstream.  Fat stores in your body may provide a little energy when they're broken down, but breaking down fat stores does not equal vitamins, minerals, proteins, probiotics, antibodies, and everything else the placenta needs to send to your baby.

How could you possibly get all of that out of a fat cell?  It's biologically impossible.

Studies have shown that women who have access to less food (for whatever reason) have smaller placentas with less extensive structure to the capillary network4.  This network is a vital part of nutrient exchange.

Your blood network is important too: “As pregnancy progresses, the mother's body has to make more blood in order to properly perfuse the placenta so it can work efficiently5.”  Your blood volume needs to expand dramatically during pregnancy to make nourishing the placenta possible.  If you have a restricted blood volume, your placenta may not function properly, or even begin shut down in places.  Good food is what expands the blood volume (more shortly).

Remember, as I said in Part 1, the body is very smart.  Its concern is with preserving the life and health of your baby.  If it determines that the placenta has been compromised and your baby is not growing well, labor begins and a baby is born prematurely with the hope that he or she will do better outside the womb6.

One study specifically correlates poor maternal weight gain with poor placental health – and premature birth, IUGR, and even fetal death7.

There's also evidence that poor placenta health leads to increase risk of infection as well as preterm premature rupture of membranes8.

There may be other factors that contribute to preterm labor and issues with the placenta: maternal hypertension (high blood pressure) and pre-eclampsia are both immediately apparent.  But the question then becomes, what role might nutrition, or sub-optimal nutrition, play in the development or prevention of these conditions?  As these are complex questions, they'll wait for another article.

Today's take-home is you need to feed the placenta to feed your baby… and you need to feed yourself to do both!

Specific Nutritional Factors

I hope I've convinced you at this point that overall maternal nutrition is an important component to preventing premature birth and boosting the health of your baby8, 9.

There's also evidence that some specific, nutrient-related issues may contribute to premature birth.  For instance, anemia can impact the placenta due to poor oxygen exchange that impacts the placenta10.

Low vitamin E and other vitamins and minerals have also been studied and cited in leading to prematurity, or leading to increased infection which then raises the risks of premature labor.

It's important to understand that this doesn't mean you should supplement with specific nutrients.  It means you need to eat good food to raise overall nutrient levels.

You might choose to focus on foods rich in vitamins, minerals, enzymes, protein, etc. You might make choices that maximize the absorption of certain nutrients (for instance, eating a Vitamin C rich food along with an iron rich food can help increase iron absorption).  But you should eat real, whole foods dense in a wide variety of nutrients.

If you're low in a particular nutrient, look to food as your first supplement (for instance, liver for iron levels).  You can discuss additional supplementation with your doctor or midwife (and research it for yourself) – but that supplementation is on top of a nutrient-dense pregnancy diet.

Eat.  Eat Nutrient Dense.  Eat Enough.

Follow those three rules: eat, eat nutrient dense, and eat enough during your pregnancy.

Before today's fat-phobic and skinny-jean-centric society reigned even in the hallowed halls of medical study, researchers had found that a diet of around 2300 to 2600 calories was right for most pregnant women.  They'd found that all mothers benefited from eating food rich in nutrients.

As I said back at the very beginning of this article, that does not mean you should only increase protein during your pregnancy.  Protein is vitally important to the expansion of your blood volume, building the placenta, building your baby, and maintaining your body.  It's critical and you do need more during pregnancy.  But you also need more overall calories.  For much greater detail on the “it's just more protein” myth, and several others, see my Pregnancy Diet Myths vs. Realities article.

What “Balanced” Really Means

Eat.  And what you eat is important.  Eat a balanced pregnancy diet.  That means to eat a nutrient-dense diet.  That means that things like processed freezer meals and candy full of preservatives, corn syrup, and not much else are probably out.  Don't stop there, however.

Huge salads that have a bunch of lettuce, some “colorful” veggies, and not much else – are probably out.  Heaping servings of “heart healthy whole grains” with a spritz of pesto or a dash of diced tomato and veggies – are probably out.  A plate of chicken breast with a modest side salad – is probably out.

What's wrong with those foods?

The salad is probably giving you some vitamins and minerals – but very little protein, and if you've used a low-calorie dressing, you're probably not absorbing those nutrients.  Go for a rich salad.  Add hardboiled egg, diced turkey, chicken, or steak, a generous handful of cheese, or maybe some nuts and avocado slices.  Top it all off with a rich, full-fat homemade dressing so you can actually use all of those fat-soluble vitamins.  Or serve the salad to the side of a full meal.

The huge servings of “heart healthy whole grains” definitely line up with government recommendations, but they're giving your body and your baby a huge sugar load and a relatively small exchange of nutrients (yes, even “whole grains” are carbohydrates, and all of that = sugar).   The splash of pesto or tomato on top of your noodles or bruschetta isn't really helping matters much.

Instead, have a smaller serving of pasta with a rich meat sauce (or cheesy cream sauce) and enjoy your bread thin-sliced and with substantial sandwich fixings.  I don't think you should eliminate carbohydrates from your diet, but the emphasis of your meals should be on foods that have high nutrient levels – meats, dairy foods, nuts, seeds, legumes… and round out with lots of veggies, healthy fats, and then have some carbohydrate goodness on the side 🙂

What about the chicken breast and lettuce?  That fits the high protein bill, right?  Well, yes, but protein isn't the only thing you and your baby need.  You need lots of nutrients, and you need healthy fats.  Serve some slices of chicken breast (preferably with crispy skin) along with that delicious side salad we discussed a couple of paragraphs ago.  Or slice it and stick it on that sandwich: add some cheese, avocado slices, tomato slices… and maybe some of that side salad, too 😉

In Summary, Eat!

The evidence that maternal weight gain (that's your weight gain in pregnancy) and nutrition status in pregnancy has a big impact on baby weight, prematurity, and other complications is staggering.  It's also been known for decades upon decades now.

(NOTE: Trying to balance your pregnancy, life, and getting ready for baby? Use my checklist pack stay healthy (naturally), organized, and confident throughout your pregnancy! Get them here.)

Ultimate Pregnancy Checklist Pack

I talk extensively about how to eat well for your baby in my MamaBaby Birthing Classes, and in almost every podcast I record or article I write.  It's the easiest thing that a mother can do for her baby, and it's possible for all mamas – even those who have low income, food allergies, or start pregnancy above their ideal weight.  It may take a little effort (parenting is always going to take effort) – but it's not hard to understand and what you eat when you're pregnant makes a lifelong difference for your baby.

The Premature Birth Prevention Series

References:

1. Several studies on low and very low birth weight outcomes: http://pediatrics.aappublications.org/content/107/1/e1.short, http://www.nejm.org/doi/full/10.1056/NEJMoa010856, http://www.jpeds.com/article/S0022-3476(05)83322-0/abstract, http://www.jstor.org/discover/10.2307/1602514?sid=21104911655791&uid=2&uid=3739728&uid=4&uid=3739256

2. Hart, Gail. (2014) Assuring Healthy Babies: Weight Gain in Pregnancy. Midwifery Today (112), 24-28.

3. http://press.endocrine.org/doi/abs/10.1210/jcem.83.3.4634, http://www.eje-online.org/content/160/3/337.full, http://press.endocrine.org/doi/abs/10.1210/jcem.85.12.7039, http://hyper.ahajournals.org/content/35/6/1301.short, http://europepmc.org/abstract/MED/19202511,

4. http://www.ncbi.nlm.nih.gov/pubmed/1165955

5. Krebs, G. S. (2000) The Brewer Pregnancy Hotline. Kalico Communications.

6. http://www.ejog.org/article/S0301-2115(03)00179-9/abstract, http://www.ajog.org/article/S0002-9378(04)02087-3/abstract, http://journals.lww.com/greenjournal/Abstract/2007/02000/Predictors_of_Neonatal_Outcome_in_Early__Onset.4.aspx

7. http://journals.lww.com/greenjournal/Abstract/1977/11000/Placental_Infarction_Leading_to_Fetal_or_Neonatal.13.aspx

8. http://www.ajog.org/article/S0002-9378(02)00380-0/abstract, http://journals.lww.com/greenjournal/abstract/1997/02000/placental_histology_and_clinical_characteristics.21.aspx

8. Jeans, P. C., et al. Incidence of prematurity in relation to maternal nutrition. J. Am. Dietet. Assn. 31
(1955): 576.

9. Cameron, C. S., & Graham, S. Antenatal diet and its influence on stillbirths and prematurity.

10. http://link.springer.com/chapter/10.1007/978-1-4899-2575-6_10#page-1
Glasgow Med. J. 24 (1944): 1.

Photo Credit

Prevent Premature Birth: Nutrition

About the author 

Kristen

Kristen is a wife and a mama to 8 - all born naturally! She has spent years helping mamas have healthy babies, give birth naturally, and enjoy the adventure of motherhood. Find her on her website NaturalBirthandBabyCare.com and helping families through her online childbirth class MamaBabyBirthing.com

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