DEC

2

An Excuse to Eat Chocolate

Chocolate, wine, caffeine; it seems like every couple of days a new report on the benefits of one of these substances comes out. Unfortunately, a lot of those pro-wine and pro-caffeine arguments go out the window when you’re pregnant. But I have good news; if you’re pregnant, you may want to consider eating more chocolate.

A number of research studies have shown that chocolate, especially dark chocolate, benefits pregnancy. A study in 2008 found that theobromine (a key chemical in chocolate) concentrations in the umbilical cord were inversely associated with preeclampsia.1 A study in 2010 found that pregnant women with preeclampsia consumed significantly less chocolate than those who did not experience preeclampsia.2 And a randomized control trial, published in 2012, found that pregnant women given daily doses of high-cocoa chocolate had significantly reduced blood pressure, compared to the control group.3

Of course, you still don’t want to eat too much chocolate. The common attitude that pregnancy is an excuse to stop being careful with the calories is harmful; we’ve discussed the dangers of gestational diabetes in a previous blog post. But chocolate, in moderation, can be a beneficial sweet to eat, for both you and baby!


1: Triche, E. W., Grosso, L. M., Belanger, K., Darefsky, A. S., Benowitz, N. L., & Bracken, M. B. (2008). Chocolate consumption in pregnancy and reduced likelihood of preeclampsia. Epidemiology (Cambridge, Mass.), 19(3), 459.

2: Saftlas, A. F., Triche, E. W., Beydoun, H., & Bracken, M. B. (2010). Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension?. Annals of epidemiology, 20(8), 584-591.

3: Di Renzo, G. C., Brillo, E., Romanelli, M., Porcaro, G., Capanna, F., Kanninen, T. T., … & Clerici, G. (2012). Potential effects of chocolate on human pregnancy: a randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine, 25(10), 1860-1867.

OCT

6

Back Pain During Pregnancy

With the increased weight of the baby bump pulling your center of gravity off and the increased stress as you try to prepare for your baby, it’s no wonder mothers so often complain of back pain.

But it’s not just the baby’s weight or your tense muscles contributing to back pains — it’s your hormones, too. The hormones that physically prepare you for giving birth affect joints and ligaments throughout your body, leaving you more prone to injury — and back aches.

This pain may be localized in the lower back, or it may radiate down through the buttocks and into the legs. Obviously, neither experience is particularly enjoyable. But thankfully there are some things you can do to reduce the stress you’re putting on your back!

Possibly the easiest thing you can do to improve the state of your back is to work on your posture. Try not to slouch. Try not to stand still for long periods of time; try to walk when you can, or switch your weight between feet. When sleeping on your side, it’s usually recommended to sleep with a pillow between your legs (whether or not your pregnant!) to lessen the stress on your back.

Make sure you have shoes with good support.

If you can get someone to help you when it comes to bending over or lifting heavy things, you should. Your body already has more than enough stress on it!

Exercise is often a wonderful cure for almost everything that ails us, including, potentially, back pain. Not only are the endorphins nice, but stronger muscles may help you carry your new weight better. It’s especially important to make certain that your doctor approves of your exercise regimen as you move further into your pregnancy, however.

Remembering to take time to yourself to relax can also be especially important for preventing back pain. The more stressed you are, the more likely you are to hold yourself stiffly and have tense muscles. A massage may be a perfect way to unwind, but you’ll want to discuss with your doctor what kinds of massage are and aren’t safe for your pregnancy first.

Of course, it’s always a good idea to talk to your doctor about any pain you experience during your pregnancy, even if you’re not planning on exercising or getting a massage!

APR

17

Weight Gain During Pregnancy

Everyone’s heard the phrase “eating for two.” Many women enjoy their ability to eat however much they want while pregnant, no longer having to worry about developing a belly. But a pregnant woman should not be eating for two, at least not if she wants to stay healthy and have the safest pregnancy. In fact, during the first trimester, there should be virtually no increase in caloric intake, and only a very small weight gain.

Being underweight or overweight during pregnancy can increase the risk of of complications including preeclampsia, gestational diabetes, preterm delivery, miscarriage, and more. Gaining more weight than is necessary may make it more difficult to get back to normal after pregnancy — many women complain about how they never lost all their pregnancy weight, and this extra weight can be an extra emotional stress for a woman suffering postpartum depression. And if a woman really wants to avoid those pregnancy stretch-marks, the best way to do so is by carefully controlling her weight gain.

So what is the right kind of weight gain? How much more should a pregnant woman eat?

The IOM actually has guidelines for pregnancy weight gain. You can check them out here. The recommended rates of weight gain are based off of BMI classifications — underweight, “normal” weight, and overweight. While these numbers are very useful, they’re broad recommendations. What you really need is a conversation with your personal doctor.

After all, while you don’t want to put on too much weight (or for your baby to put on too much weight), you also want to make certain that baby is getting all the nutrients needed. The best thing you can do is discuss your diet with your doctor — and make sure you’re taking a good prenatal vitamin that gives you and your baby all the extra nutrients your diet is missing!

APR

7

Over the Counter Prenatal Vitamins: Are They Safe?

The dietary supplement industry made headline news last February, and it wasn’t good news. Unfortunately, the story was part of a much larger problem. Let me explain.

The State of Dietary Supplements

Dietary supplements sold within the United States are not evaluated by the FDA before sale. Examples of products that fall under the dietary supplement umbrella include: capsules of a powdered botanical, multivitamin gummies, bottles of fish oil, over-the-counter weight loss pills, and more. If you’re wondering if a product is classified as a dietary supplement or not, check the label. Dietary supplements are required to use the “Supplemental Facts” label (not “Nutritional Facts”).

A dietary supplement is, for the most part, defined by two qualities. The first quality is rather straight-forward: “A dietary supplement is a product taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet.”1 The second quality has to do with what counts as a “dietary ingredient.” Dietary ingredients are things like vitamins, minerals, amino acids or enzymes, and they can’t be “new” compounds.2

The FDA can (and has) made rules regarding dietary supplements. Dietary supplements aren’t allowed to make certain kinds of claims, are required to list their ingredients, must follow certain manufacturing guidelines, and so on.

However, due to the Dietary Supplement Health and Education Act (DSHEA), it is very difficult for the FDA to actually control the sale of dietary supplements. A product marketing itself as a dietary supplement may be blatantly illegal, but it doesn’t need approval to reach the shelves of stores across the United States. Companies selling these products are simply trusted to follow the rules. If the FDA discovers a product that is unsafe and/or doesn’t follow regulations, the burden of proof rests with the FDA. It is not easy for the FDA to pull a product from the market.3

Maybe this situation doesn’t sound all that problematic. There are certainly lawmakers and lobbyists who say that the FDA oversight of dietary supplements is just fine as it is. They say that, even while contaminated dietary supplements take lives, as study after study shows that dietary supplement labels are typically inaccurate, and as the FDA fights a losing battle against dietary supplements with unlisted, illegal, addictive and/or dangerous ingredients.

That’s right. Dangerous and illegal substances — steroids, analogs of Viagra, antidepressants, amphetamines or amphetamine-like substances, etc. — are being sold in stores across the United States, marketed as diet pills or sexual enhancement supplements. The FDA is trying to stay on top of this practice, but they can’t do anything about it until the product has already hit the shelves.4,5

The same law that restricts the FDA’s ability to keep controlled substances off the shelves similarly restricts the FDA’s control of the multivitamins and herbal supplement market.

It’s common knowledge that weight loss pills are dangerous. But people trust their multivitamins. Of course, you’re not likely to get an amphetamine analogue in your store-brand multivitamin — that doesn’t mean that our vitamins are without problems of their own.

Way back in 2005, the IOM expressed concern regarding the product reliability of dietary supplements. Their concerns have proven to be accurate. Various studies have shown contaminants or vastly inaccurate supplemental facts labels in herbal and vitamin products.6 With services like ConsumerLab.com and LabDoor, it’s become much more evident that our most trusted vitamin products aren’t what they claim to be. For example, labdoor.com found that otc prenatal vitamins range most in their amount of folic acid, with lab tests showing that the products had anything from ~ 6% to ~ 300% the amount of folic acid claimed on the label.7

February: The New York Attorney General

All of this sets the stage for what happened in February. Attorney General Eric Schneiderman had herbal supplements from a handful of major retailers tested. The tests failed to detect the listed ingredients in a majority of the supplements tested — name-brand supplements from GNC, Walgreens, Walmart and Target. Mislabeling is illegal and the attorney general sent cease and desist letters to these retailers, requesting the sale of these apparently illegal supplements be stopped immediately. The media reported the results of the attorney general’s test with fervor.

The media also reported that the tests revealed contamination of many of these products. Ingredients that were not listed on the labels were found by the tests.

Then the backlash began. The media realized that there was a major flaw to the tests in question — the tests were for DNA in the products, while a properly processed herbal supplement may have none of the DNA of its plant source. It isn’t the DNA of, for example, echinacea, that people consume for potential health benefits. Rather, benefits are attributed to other chemicals from the plant. A perfect echinacea extract would have no DNA at all.

Of course, the tests did still turn up important information; products were contaminated with DNA from sources that were not listed on the labels. For example, one ginkgo biloba product that advertised itself as “gluten free” was found to contain wheat DNA.8 Contamination uncovered by these tests raises concerns especially for consumers with allergies.

How this situation in New York plays out remains to be seen. Legal actions are ongoing and more tests are underway. GNC has already reached a settlement with the New York Attorney General and will be implementing stricter testing and transparency standards.

The Upshot

Over-the-counter dietary supplements are largely unregulated. A savvy consumer without extra health concerns may feel comfortable using a resource like LabDoor to ensure they know what they’re paying for. But what about people with allergies? What about mothers who don’t want to risk not getting the nutrients they need during pregnancy?

For these people especially, we recommend choosing a prescription vitamin.

Prescription vitamins may, additionally, be able to provide formulations that you can’t get over the counter. For example, prescription prenatal vitamins can contain more folic acid than OTC prenatal vitamins.

Going with a prescription vitamin also ensures that you talk with your doctor before beginning a vitamin regimen that could potentially cause health issues. For example, higher doses of vitamin E are especially dangerous for pregnant women.

Either way, though, we always recommend talking with your doctor before beginning (or stopping) any supplement regimen.


References

1 Q&A on Dietary Supplements

2 Dietary Supplement Health and Education Act of 1994

3 Dangerous Dietary Supplements Return to Store Shelves

4 American Roulette — Contaminated Dietary Supplements

5 Questions and Answers about FDA’s Initiative Against Contaminated Weight Loss Products

6 Many “Natural” Supplements Are Contaminated

7 Top 10 Prenatal Vitamins

8 New York Attorney General Targets Supplements at Major Retailers

MAR

31

Your Voice and Your Baby

You may have heard (or read) about your baby’s mental and especially auditory development. If you haven’t asked specifically about the baby’s development in the womb, you may only have heard about hearing milestones after birth. Language — not just the ability to talk, but the ability to recognize speech patterns and try to join in — is one of the developmental milestones that people care the most about, but we don’t tend to see significant signs of it till months after birth.

The thing is, this development begins before birth. Your baby’s inner ear becomes fully developed somewhere around the 20th week — only a little more than halfway through pregnancy! And though it’s true that the parts of the brain involved in hearing are still developing, we know that your baby’s auditory environment affects your baby even before birth.

What does an unborn baby hear? Your heartbeat. The grumbling of your stomach. Coughs or burps or hiccups. And especially your voice.

Your baby also gets the muffled sounds from the outside world, but your baby really hears your voice as it travels through your body. Many parents have thought their newborns recognized mommy’s voice, either being calmed by it or becoming more alert. They were right; it was shown that newborns can recognize and prefer their mother’s voices over other women’s back in the ’80s.

Not only can your baby recognize the sound of your voice from the womb, but your baby can also make out speech rhythms — they’ve even been shown to recognize the difference between familiar and unfamiliar languages, and familiar and unfamiliar words!

We don’t know what the long-term effects of different auditory experiences in the womb might be for baby. There’s no good research on the relationship between being read to in the womb and how quickly a baby learns language. There’s no proof that reading to your unborn baby will help your baby become a reader.

But talking to your baby is a great bonding experience. Your baby can hear you. Reading to your baby — exposing your baby to the calm tones of your voice and the rhythm of your language — may have all sorts of benefits for your baby’s mental development. At the very least, you’re familiarizing your baby with the sound of your voice.

If you want more about the research on auditory learning in the womb, this Science news article is a great read.