Dr Soon acknowledges the different cultures having their own myths and taboos about postpartum diet, all of which should be respected as long as they do not cause harm to both the mother and the baby.
TRUE to saying ‘you are what you eat’, the types of food that a woman consumes do affect the outcome of her pregnancy.
According to Dr Soon Khai Cherng, the consultant obstetrician and gynaecologist at Columbia Asia Hospital Miri, a woman who is capable of becoming pregnant should get 400 microgrammes (mcg) of folic acid every day.
“Folic acid is the synthetic form of folate, which is a naturally-occurring Vitamin B. Folate helps make DNA and other genetic materials, and it is especially important in prenatal health.
“Studies show that consuming 400mcg of folic acid per day can reduce risk of neural tube defect by more than 70 per cent,” he tells thesundaypost.
Adding on, he talks about the two most common types of neural tube defects.
“Anencephaly is a serious birth defect in which parts of a baby’s brain and skull do not form correctly. Almost all babies born with anencephaly will die shortly after birth.
“The other (neural tube defect) is spina bifida, in which a baby’s spine does not form correctly and can result in some severe physical disabilities,” says the doctor.
There are three ways for women to ensure sufficient daily intake of folic acid, says Dr Soon.
Dr Soon Khai Cherng
They can either take a vitamin supplement containing 400mcg of folic acid; eat a fortified breakfast cereal that contains 100 per cent of the recommended daily amount of folic acid (400 mcg); or they can also increase the consumption of foods fortified with folic acid such as enriched cereal, bread, rice, pasta and other grain products, in addition to consuming food folate from a varied diet, including orange juice and green vegetables.
Big no to alcohol
Dr Soon strongly advocates against any intake of alcohol at any time during pregnancy.
Most importantly, he strongly advocates against any intake of alcohol at any time during pregnancy.
“It’s so important for women to say no to alcohol consumption during pregnancy.
“Alcohol in the mother’s blood passes to the baby through the umbilical cord.
“Alcohol consumption during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioural, and intellectual disabilities. These disabilities are known as ‘foetal alcohol spectrum disorders (FASDs),” he underlines.
Elaborating, Dr Soon says children with FASDs may exhibit several characteristics and behaviours such as abnormal facial features such as a smooth ridge between the nose and the upper lip (this ridge is called the philtrum); small head size; shorter than average height; low body weight; poor coordination; hyperactive behaviour; difficulty with attention; and having poor memory.
They may also experience difficulties in school, especially with mathematics; learning disabilities; speech and language delays; intellectual disability or low IQ; poor reasoning and judgment skills; sleep and sucking problems as a baby; vision or hearing problems; as well as problems with the heart, kidney or bones.
“There is no known safe amount of alcohol use for mothers during pregnancy, or while trying to get pregnant.
“There is also no safe time for alcohol use during pregnancy. All types of alcohol are equally harmful, including all wines and beer. FASD is preventable if the baby is not exposed to alcohol before birth,” he stresses further.
Stay away from tobacco, e-ciggies
Another thing to avoid during pregnancy is smoking, reminds Dr Soon.
He warns that tobacco use during pregnancy can increase the risk of preterm birth, low birth weight, and birth defects of the mouth and lips.
“E-cigarettes and other tobacco products containing nicotine are not safe to use during pregnancy. Nicotine is a health danger for pregnant women and developing babies. It can damage a developing baby’s brain and lungs.
“Also, some of the flavourings used in e-cigarettes may be harmful to a developing baby,” he says.
Moreover, maintaining normal body weight before pregnancy is also vital as obesity is a strong adverse risk factor for any pregnant woman.
According to Dr Soon, obesity is associated with increased risks of almost all pregnancy complications including gestational hypertension, preeclampsia, gestational diabetes mellitus, delivery of large-for-gestational-age infants, higher incidence of congenital defects (heart and neural tube defects), thromboembolism and also miscarriage.
Dr Soon says by managing a proper diet and maintaining a negative calorie balance, weight loss is possible.
“Yet, most obesity cases are modifiable risk factors for pregnancy via lifestyle changes. A healthy pre-pregnancy weight can be achieved via regular exercise and diet control,” he points out.
“Remember, you are what you eat.
“By managing a proper diet, and maintaining a negative calorie balance, weight loss is possible.
“A negative calorie balance state occurs when you burn more calories than you take in.”
Dr Soon says obese women also have higher chances of developing Type 2 diabetes mellitus, which itself can increase the risks of congenital foetal anomaly.
“A lifestyle modification is hard for the majority of people, but once you can deliver a healthy baby, all your effort would be worthwhile.
“This said, as a woman you must do your part and be assured that the obstetrician would guide you through your wonderful pregnancy journey,” he advises.
Healthy post-natal practices
Dr Soon says fruits and vegetables provide the fibres, as well as a variety of vitamins and minerals that are beneficial for mothers undergoing confinement.
On the principles of food consumption during the postnatal period, Dr Soon says these would rely on postpartum body recovery, adding that the ingredients can be transmissible via breast milk to the growing infant – if the mother is breastfeeding.
“Breast milk is the best nutrient for growing infants. Hence, every mother should be encouraged to breastfeed her child but she must also be aware of certain food or drugs that can be transmitted to the baby.
“This said, different cultures have their own myths and taboos about postpartum diet.
“Regardless of which race or taboo we are referring to, these should be respected as long as they do not cause harm to both the mother and the baby,” he points out.
From an evidence-based point of view, Dr Soon says there are limited studies regarding cultural postpartum taboos about food, and its significant impact on the mother and baby.
He then talks about the Chinese tradition of food, in relation to confinement, being divided into two categories: ‘hot’ and ‘cold’.
“It’s about attaining a ‘yin-and-yang’ balance (cold and hot).
“The ‘hot’ foods are commonly consumed, while the ‘cold’ ones are to be avoided.
“Ginger, rice wine and sesame seed oil are among ingredients considered ‘hot’ and used in large amounts, as are rice, chicken and pork.
“Most vegetables and fruits are considered ‘cold’ and thus, are prohibited during the confinement period.”
Rice, be it white or brown, is another good source of folic acid.
Dr Soon highlights a local study, which has revealed that most Chinese Malaysian mothers conform to ‘Zuo Yue Zi’, a traditional Chinese post-partum set of beliefs and practices, and one of these practices include the prohibition of fruits and vegetables during confinement because they are viewed as ‘cold foods’.
“Fruits and vegetables actually provide the fibres, as well as a variety of vitamins and minerals that are beneficial for mothers undergoing confinement.
“The mothers also consume red meat and chicken in abundance to ensure an adequate supply of iron, which is a mineral that is vital for nursing.
“In general, the principles to be followed include to avoid alcohol, avoid high-mercury-content fish, limit caffeine intake, as well as take prenatal or postnatal vitamins.”
Green vegetables and fruits such as avocado are high in folate.
Reminders for nursing mums
Talking more about alcohol intake during the postnatal period, Dr Soon said 30 to 60 minutes after an alcoholic beverage is consumed, the alcohol level in a mother’s breast milk is at its highest.
“In general, alcohol can be detected in breast milk even after two to three hours of alcohol consumption.
“The more alcohol a mother consumes, the longer it stays in the breast milk. Over time, excessive alcohol consumption can shorten the duration of an infant’s breastfeeding due to a decreased milk production.
“It also affects the infant’s sleep patterns and early development,” he points out.
On fish with high mercury content, he names king mackerel, shark, swordfish, orange roughy (deepsea perch), tilefish and marlin as among those in this list.
“The safer choices are salmon, tilapia, cod, catfish, flounder, herring and pollock.
“Mercury can pass from a mother to her baby through the placenta during pregnancy and, in smaller amounts, through breast milk after birth.
“The exposure to mercury can affect the development of the infant’s brain and nervous system during pregnancy and after birth.”
On caffeine, Dr Soon says coffee, sodas, tea and chocolates are common sources of this stimulant, adding that when a nursing mother consumes them, some of that caffeine can end up in her breast milk.
“This can be a problem as babies have a hard time breaking down and getting rid of caffeine.
“Over time, the caffeine accumulates in the baby’s system, causing irritability and trouble sleeping.
“According to the Center for Disease Control and Prevention in the US, mothers who are breastfeeding should not consume more than 300 milligrammes of caffeine per day, which is equivalent to two or three cups of coffee,” he points out.
As for vitamins, Dr Soon says while there are clear benefits of taking prenatal vitamins before and during pregnancy, there is also significant evidence that they may help even after delivery.
Vitamins can improve the nutritional needs of breastfeeding mothers, enhance energy and regulate moods, as well as prevent anaemia and calcium deficiencies, he adds.
Nuts, grains and cereals are good sources of folic acid.
“Mothers who are vegetarian or vegan may not get adequate nutrients through their diet alone, and thus, may be at greater risk of deficiencies.
“However, there are foods to make up for iron and zinc such as chickpeas, lentils, tofu, cashew nuts and chia seeds.
“Most healthcare providers recommend mothers to continue taking prenatal vitamins as long as they are breastfeeding to ensure that their babies would continue to get sufficient nutrients like vitamins A, D and B as well as DHA and iodine,” he says.
