There was a time when the prevailing dietary wisdom was simple: food contained calories, weight was a function of caloric imbalance. If you used less calories than you took in you gained weight, and vice versa. It was intuitively appealing and it still is; anybody with even an elementary grasp of mathematics understands. But it is becoming increasingly apparent that all calories are not equal. Health uses a different equation than hunger. So should the pregnant woman.
Of course, this comes as no surprise: it has long been apparent that a diet of potato chips and cola does not often foster a healthy newborn. Unfortunately, it has been far too easy to attribute more of the blame to other competing lifestyle factors. And it has always been difficult to separate the effects of smoking, diet, illicit drug use, alcohol, obesity and a myriad other lifestyle factors that have to be teased, strand by strand, out of the morass. They all contribute in their own ways, of course, and yet I sometimes think that we treat food choice as merely a weight regulating phenomenon -caloric intake once again.
But amongst a host of other similar investigations that seem to be appearing recently, the British Medical Journal published a review of over 66,000 women from the Norwegian Mother and Child Cohort Study linking dietary choices to -in this study- premature delivery. Preterm delivery is responsible for a large proportion newborn infant deaths, not to mention health problems both long and short-term. It is a significant problem that has multiple causes to be sure, but diet is one that may be more easily amenable to manipulation.
The original article was enlightening, albeit a little dense, so I will refer to the brief summary of the parameters of the study from the Huffington Post:
The researchers classified the women’s diets as “prudent,” “traditional” or “Western.” A prudent diet consisted of raw and cooked vegetables, salad, fruit and berries, nuts, vegetable oils, whole grain cereals, poultry and water to drink. A “traditional” diet, by contrast, was mainly composed of boiled potatoes, fish, gravy, margarine, rice pudding, low-fat milk and cooked vegetables. Lastly, a “Western” diet contained a lot of salty snacks, chocolate and sweets, cakes, French fries, white bread, ketchup, sugar sweetened drinks, processed meat products, and pasta.
Anyway, guess which diet was the healthiest? When asked in this rather black and white format, the correct answer is easier to see than in the supermarket or fast-food outlet where cost is often the biggest determinant of choice.
One has to be careful not to attribute cause to something that may be only an associative phenomenon, however. Maybe women who make unhealthy choices can only afford a certain diet -are only exposed to certain ways of eating. Maybe they have other characteristics that might lead to premature delivery. Why one makes certain dietary decisions is often -if not usually- an indication of the river in which the individual is already swimming. And it would be naïve to assume that merely changing what she eats will solve the other health and lifestyle issues that may affect the foetus developing inside her. But pregnancy is a time when most women are motivated and open to suggestions that might help their babies. It is an opportunity that should not be wasted: education has ripples that extend far beyond the health clinic.
It seems to me that food choice is one of those things that can be taught without seeming to impose a moral -or social- structure to the lesson. Wise but economic choices can be outlined and promulgated without seeming to judge other decisions she may have made. It is a confidence building manoeuver which suggests that, however small they might seem, there are things she can do that might have long term benefits for her unborn child. And if this develops rapport and trust, it may help her to make other more difficult choices.
In the health care field, we are not wardens: we carry very few weapons; we depend more on persuasion than force. We are merely guides, educators, comforters, and encouragers. It is not the stick that persuades, but the smile, the attempts to understand her situation, the willingness to listen without undue prejudice, offering suggestions where possible, or expectant patience until a better opportunity arises. This more patient approach does not abrogate the authority inherent in the more traditional antenatal healthcare system -or discourage trying to correct and modify other detrimental behaviours in the pregnancy; it merely acknowledges the necessity of a firm bridge and an open gate to gain access to the other side.
So many factors play a role in prematurity, and correcting just one of them is not likely to be a panacea. But it is a start. A wedge. A present, perhaps, to the next generation.