The previous section presented that proper nutrition in pregnancy is vital for the health of the mother and the baby (THL 2019). Likewise, abstinence from fast foods and other harmful foods during preg-nancy is crucial for the health of the mother and her offspring (AND 2019). Evidence from different studies show that fast food consumption during pregnancy can have detrimental health conse-quences. One study found a connection between frequent maternal fast food consumption during pregnancy and asthmatic symptoms in young children (Von Ehrenstein et al. 2015). Another study re-vealed that frequent fried food consumption in pregnancy is significantly associated with a higher risk for GDM (Bao et al. 2014). Furthermore, intake of sweets in overweight/obese pregnant women have been found to have a potential influence on the weight status of the infant (Phelan et al. 2011). More-over, high intakes of sugar and saturated fats have been associated with poorer semen quality and decreased fertility for men (Panth et al. 2018).
Besides eating a balanced diet and limiting the consumption of fast foods, there are certain precau-tions that pregnant women should take in order to limit their risk of getting a food-borne illness or exposing their growing fetus to harmful substances. According to findings, pregnant women are more likely to reduce harmful foods from their diet than increase their consumption of nutrient-rich foods that are essential for pregnancy (Forbes et al. 2018). Table 4 describes a list of foods that should be avoided during pregnancy, according to the American Pregnancy Association (APA) (APA 2017).
A large portion of the foods that APA has listed as foods-to-be-avoided during pregnancy carry a risk of contracting a bacterium called listeria. Listeria is a common bacterium that lives in the soil and wa-ter, as well as in some animals. Unlike most bacteria, listeria can grow even in cold temperatures. In order to kill it, a food needs to be properly cooked or pasteurized. Listeria causes an infection called listeriosis. Pregnant women have approximately 20 times higher risk of getting listeriosis compared to
generally healthy, non-pregnant population. Listeriosis is not a dangerous infection for the mother, but can cause miscarriage, stillbirth or life-long health problems for the baby. Therefore, following public health guidelines on safe food preparation and consumption is crucial for pregnant women who desire healthy pregnancies (WHO 2018a).
Table 4. Foods to avoid during pregnancy (APA 2017).
Food/Drink The Reason to Avoid
Raw meat Risk of contamination
with bacteria
Deli meat Risk of contamination
with listeria
Fish with mercury Has been linked to developmental de-lays and brain damage
Smoked seafood Listeria risk
Fish exposed to industrial pollutants Risk of industrial pollutants
Raw shellfish Risk of infection
Raw eggs Salmonella risk
Soft cheeses Listeria risk
Unpasteurized milk Listeria risk
Pate Listeria risk
Caffeine Limit caffeine to 200 mg per day to
avoid the risk of miscarriage
Alcohol Can interfere with healthy development
of the baby
Unwashed vegetables Risk of toxoplasmosis
A study from Belgium, that investigated pregnant versus non-pregnant women on their dietary be-havior and the perceived role of food for health, found that pregnant women followed nutritional rec-ommendations on safe food handling practices. They also had a reduced consumption of those foods that have safety risks, and they consumed tobacco and alcohol less than non-pregnant women (Verbeke and Bourdeaudhuij 2007).
In Brazil, the opposite phenomenon was found. A study found that pregnant and lactating Brazilians do not change their food intake to meet nutritional goals. Their high intake of sodium and processed foods, as well as their low intake of health-promoting foods, is a public health concern (Dos Santos et al. 2014). Similarly, a study from the United States found that pregnant women had not understood
the connection between consuming risky foods in pregnancy and the potential implications for their unborn child. These women had the assumption that their food was safe and demanded strong evi-dence for proven wrong (Athearn et al. 2004). Section 2.2.7 discusses more in detail why women make certain dietary choices in pregnancy.
Alcohol
Alcohol was first discovered to have a negative impact on the fetus in 1968 (Lemoine et al.1968). This finding was made by studying alcoholic mothers and the harmful health outcomes displayed in their children. In 1973, other researchers confirmed this idea by presenting similar findings. Since then, more evidence has come out about the impact of alcohol on the fetus, and today, the medical com-munity acknowledges that exposing fetus to alcohol can cause a wide range of health problems in the areas of development and emotional-, behavioral- and social health (Clarke and Gibbard 2003). Some evidence suggests that high intakes of alcohol and caffeine, and low intakes of antioxidants, may also be associated with impaired fertility (Derbyshire 2011).
The most common developmental disabilities and birth defects in the western world, related to alco-hol consumption during pregnancy, are Fetal Alcoalco-hol Syndrome (FAS), which is considered to be part of the Fetal Alcohol Spectrum Disorders (FASD), and Alcohol Related Neurodevelopmental Disorder (ARND) (Clarke and Gibbard 2003). In the United States, it is estimated that 10 per 1000 children are impacted by one of the above disorders/syndromes (May et al. 2018). FASDs are life-long disabilities (May et al. 2018) and include a whole range of different health effects (CDC 2019). The other impacts of alcohol use during pregnancy, besides potential developmental disabilities and birth defects, are higher risk of preterm labor, decreased production of breastmilk, and increased risk for spontaneous abortion, especially during the first trimester (Bhuvaneswar et al.2007).
There are certain risk factors for alcohol use in pregnancy. These risk factors include poverty, home-lessness, preconception substance use, partner’s substance use, physical or sexual abuse and psychiat-ric illness. The strongest predictor of these is preconception substance use (Bhuvaneswar et al.2007). A
limited number of studies point to the notion that psychological and educational interventions may have a positive impact on women’s drinking behavior during pregnancy (Stade et al. 2009).
The frequency of alcohol consumption in pregnancy changes from country to country. A multinational European study found that almost 16 % of women residing in Europe consumed alcohol while preg-nant (Mårdby et al. 2017). However, notable cross-country variations existed. Over half of pregpreg-nant women living in Italy, Switzerland and the UK had at least one alcohol unit per month and the two countries with the highest alcohol consumption in pregnancy were the UK (28.5 %) and Russia (26.5
%). On the contrary, the lowest countries for alcohol consumption in pregnancy were Norway (4.1 %) and Sweden (7.2 %). The predictors for consuming alcohol in pregnancy were higher education and smoking before pregnancy (Mårdby et al. 2017). A similar study from the United States reported that 10.2 % of pregnant women used alcohol during pregnancy and 3.1 % engaged in binge drinking in pregnancy (Tan et al. 2015). Worldwide estimation of drinking during pregnancy is 20 % (Stade et al.
2009).
Although alcohol consumption in or outside of pregnancy is not uncommon for women living in west-ern countries, it is rare for women coming from Africa (THL 2018a). The most common drinking pat-tern among African women is a lifetime abstention. Female drinking is traditionally not culturally ac-cepted because of religious-, traditional-, cultural- and gender-based reasons (Martinez et al. 2011).