Prenatal nutrition and resulting birth weight is linked to a child’s risk of obesity. There is growing evidence that a woman’s nutrition status–even her mother’s nutrition status–influences the metabolic health of children.
THE POTENT INFLUENCE OF PREGNANCY
The prenatal environment provides the growing embryo and fetus with everything. Whatever is available influences the baby’s growth and development. While genes don’t tend to be greatly influenced in one generation, how our genes respond to our environment is a very dynamic event. This area of study is called epigenetics and has completely redefined the meaning of evolution.
In January, 2010, Times Inc. published an article on epigenetics with the leader: “Why your DNA isn’t your destiny.” It seems we don’t need to change DNA sequences in order to profoundly change how we respond to our environment. This evolution is happening rapidly today every time a women is pregnant.
IS PREGNANCY THE BEST OPPORTUNITY FOR PREVENTION?
Nutrition and health status before pregnancy, during pregnancy and after pregnancy all have potent influence on the metabolism of offspring. If we are ever to get a handle on obesity, diabetes, and other life cycle disease states, it needs to start very early in the curve, maybe even before the curve.
Ironically, it seems that the public health sector has it all over the private pay medical world when it comes to preventive care. I know dietitians working in public health where protocols are in place to screen every pregnant woman. Prenatal nutrition counseling is a regular feature of care in the clinics and in federal programs such as WIC (Womens, Infants and Children Supplemental Food Program)
NUTRITION SUPPORT FOR PREGNANT WOMEN IN THE REAL WORLD
What about women getting care from in the private practice realm? When I first started my private practice over 25 years ago I was dismayed that so few pregnant women ever had the opportunity for a nutrition consultation with a registered dietitian. A few words about making good food choices or handing over a nutrition pamphlet by an infant formula company doesn’t really count.
Over the years, practitioners have become very good at screening most women for gestational diabetes close to the 26th week of pregnancy. With our current understanding of nutrition and epigenetics, that isn’t good enough.
I have yet to meet a private practice obstetrician who has a formal mechanism to provide nutritional screening for every pregnant woman at her first visit. How many private obstetric practices routinely direct women who are anticipating pregnancy or newly pregnant for nutrition counseling?
MAKING A DIFFERENCE
If your private practice has these systems in place, I have a few questions. Do the women go to the visits? Who pays? Does their medical insurance reimburse the costs? Most critically, can we track outcomes and document when sophisticated nutrition counseling with a registered dietitian or similarly trained nutritionist makes a difference?