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This is the third article related to nutrition during the treatment of paediatric cancer. The previous article covered pre-conception nutrition. Optimal nutrition during the 38 to 40 weeks of a normal pregnancy is essential for both mother and child; this includes adequate amounts of all of the required vitamins, minerals, and energy. In addition to her normal nutritional requirements, the pregnant woman must provide nutrients and calories for the foetus, the amniotic fluid, the placenta, the increased blood volume, breast, uterine, and fat tissue1. Studies have shown a relationship between the mother’s diet and the health of the baby at birth2.

Women who consumed a nutritious diet during pregnancy are more apt to bear a healthy infant than those who did not3.balanced meal. Malnutrition of the mother is believed to cause Intra Uterine Growth Restriction (IUGR) which increases the risk of developing childhood malformations such as cancer4.

Dietary recommendations are mostly the same as for a normal healthy diet except for additional requirements for some nutrients, namely; energy, protein, vitamins A, D, C, B6, folic acid, iron, zinc, iodine, selenium, and calcium. Calcium is essential for the development of the infant’s bones and teeth as well as for blood-clotting and muscle action. If the mother is not consuming adequate calcium in her diet, the baby will obtain its calcium from her bones. Taking a folic acid supplement at least 1 month prior to conception helps to prevent brain and spinal cord defects5. According to National Childhood Leukemia Study (NCCLS), maternal consumption of the vegetable and protein source food groups was associated with reduced risk of their offspring having Acute Lymphoblastic Leukemia or ALL6.

One of the best ways of providing these nutrients is by consuming at least 4 balanced meals each day with a variety of fruits and vegetables.fruit and milk.Snacking between meals is good for meeting micro-nutrient needs, but the snacks should mostly comprise of fruits and vegetables. It’s one ideal way of meeting the heightened nutrient demand.

Another way of meeting these requirements is by drinking additional milk each day or using appropriate substitutes. The extra milk will provide protein, calcium, phosphorus, thiamine, riboflavin, and niacin. Fat-free milk contributes no fat and provides 90 calories per glass-serving and thus is the better choice.

To be sure that the vitamin requirements of pregnancy are met, obstetricians, nurse midwives, and physician’s assistants may prescribe a prenatal vitamin supplement in addition to an iron supplement.vitamin supplements on shelf.It is not advisable for the mother to take any un-prescribed nutrient supplements, as an excess of vitamins or minerals can be toxic to mother and infant7.

However, there is no need for increased vitamin A during pregnancy. Excess vitamin A has been known to cause congenital anomalies such as hydrocephaly, microcephaly, mental retardation, ear abnormalities, eye abnormalities, cleft lip and palate, and heart defects8.

By the principles of nutrition, health problems related to nutrition originate within cells, poor nutrition can result from both inadequate and excessive levels of nutrient intake; poor nutrition can influence the development of certain chronic diseases and that is why adequacy, variety, and balance are considered key characteristics of a healthy diet.

Nutritional needs should be met at every stage of the life-cycle because nutritional status at one stage influences health status in the next ones. Lack of adequate nutrition during pregnancy, for example, can program gene functions for life in ways that set the stage for life-long metabolic changes that increase the risk of chronic-disease development, including cancer9.

The fact that a woman’s nutritional status can support fertility does not necessarily mean that it can support pregnancy. Many women conceive while consuming a nutritionally inadequate diet, but the incidence of low birth weight (LBW) and prematurity in their newborns is generally higher than those in normal-weight individuals. Underweight HIV-positive women are advised to adhere to their medication because a diminished CD4 count increases chances of their being susceptible to infections—especially food borne illnesses which could harm the child. The disease can lead to nutrient losses and fat malabsorption due to diarrhea. Inflammatory responses to the infection cause the loss of lean-muscle mass, loss of calcium from bones, and decreased bone density10.

Some of the foods and beverages to avoid during pregnancy include:

Food/beverage Consequence
Half-cooked/raw fish Can cause several infections either viral, bacterial, or parasitic, eg. norovirus, Vibrio, Salmonella
Half-cooked/raw meat Can cause infection from several bacteria or parasites, including Toxoplasma, E. coli, and Salmonella
Raw eggs Can be contaminated with Salmonella. Foods which usually contain “raw eggs” include: poached egg, salad dressing, cake icing, homemade cake icing, and mayonnaise
Liver Contains high amounts of vitamin A and copper, pregnant women are advised to limit their intake of this and other organ meats to no more than once a week
Caffeine High caffeine intake during pregnancy can limit foetal growth and cause low birth weight
Unwashed fruits/vegetables Can be contaminated with bacteria and fungi
Alcohol High levels of alcohol consumption during pregnancy cause foetal damage and intrauterine growth retardation

Maternal diet and nutritional status are important factors that influence the course and the outcome of pregnancy, if the maternal diet is inadequate, foetal growth is impaired11.

We know that exposure to certain factors can affect the health of the expectant mother and her child. Birth defects in humans have been blamed on the exposure of pregnant women to teratogens in the diet and the environment12.

We stress the point that during pregnancy, mothers should be careful about what they take in their diet and the environment they expose themselves and the baby to, between 75 to 90% of childhood cancers are of unknown origin its best to play safe than sorry13.

Our next article will cover nutrition during the lactation and weaning period of infancy.

Photos by Toro Tseleng, Gayatri Malhotra, Carissa Gan and Angel Sinigersky via Unsplash.

Notes   [ + ]

1, 3, 5, 7. Ruth, R. A. Nutrition & Diet Therapy, 10th Edition. New York: Cengage, 2010.
2. Marilyn, K. L., Christopher , J. D., Gladys Block, & Mark , H. L. (2004). “Maternal dietary risk factors in childhood acute lymphoblastic leukemia.” Cancer Causes and Control, 559–570.
4. WebMD. “Fetal Growth Restriction (FGR).” Retrieved from www.webmd.com, 2019, May 4.
6. Kwan, M., Block, G., Selvin, S., Month, S., & Buffler, P. (2004). “Food Consumpion by Children and the Risk of Childhood Acute Leukemia.” Am J Epidemiology, 160:1098–107.
8. Kathleen, M. L., & Janice, R. L. Food & The Nutrition Care Process. St. Louis, Missouri: Elsevier, 2017.
9. Judith, B. E., Janet, I. S., Beate, K. U., Ellen, L., Maureen, M. A., Carolyn, S., … Nancy, W. H. Nutrition Through the Life Cycle. Belmont: Cengage, 2011.
10. Committee on Substance Abuse and Committee on Children with Disabilities. (2000). “Foetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorders.” Pediatrics, 106:358–61.
11. Vishwanath, M. S. Introduction to Clinical Nutrition. New York: Marcel Dekker, Inc., 2003.
12. Harold, K. Teratology in the Twentieth Century Plus Ten. Cincinnati: Spinger, 2010.
13. Birch, J. M. (1999). “Genes & Cancer.” Arch Dis Child, 80:1–3.
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