Maternal Health

Most people were shocked when 30-year-old Dr. Chaniece Wallace,  a chief piediatric resident at the Indiana School of Medicine, died on October 26, 2020, shortly after giving birth to her daughter. Conventional wisdom suggests that in the United States women don’t die from problems associated with childbirth. This is especially true for those like Dr. Wallace, who have access to good medical care.

While I have no information on Dr. Wallace’s health status, her untimely death highlighted a long-standing problem in the American healthcare system. Although maternal mortality rates have been dropping in most places around the world,  over the past three decades the number of pregnancy-related deaths in America has been rising steadily.

It’s sad to say but the United States has the highest maternal mortality rate in the Western world. Moreover, racialized women (this includes Black and indigenous women) are almost three times more likely to die from pregnancy complication than white women. The United States also has the highest rate of infant mortality in the industrialized world. Not surprisingly, the greatest percentage of infant deaths are babies born to racialized women.

Since an infant’s health is closely connected with that of its mother, these statistics raise an obvious question: Are the number of women experiencing pregnancy-related deaths and the number of newborns that don’t survive long enough to celebrate their first birthday connected in any way? The answer is yes. Both can be linked with socioeconomic inequality.

Fitting this puzzle together involves another marker: Low birthweight (LBW; when a baby weighs less than 5 pounds 8 ounces), which directly links a mother’s health with the health of her baby. In the United States LBW is associated with socioeconomic inequality so it’s not surprising that African-American infants are about twice as likely to be born with LBW than non-Hispanic white infants. Low birth weight is not necessarily a product of poverty --- it can result from premature or multiple births, for instance. However, when a fetus fails to grow at a normal rate it often reflects a failure to thrive, which can be linked to factors like poor nutrition and chronic stress. This condition is known as fetal growth restriction and it is a risk factor for the development of chronic illness as an adult

Thanks to the science of epigenetics, we are seeing how the effects of hardscrabble lives are passed on like a biological memory, handed down through the generations. Social inequities extract a toll on women’s bodies. Poor nutrition plays a key role in the eventual outcomes and its effects take hold at both an individual and collective level.

When malnutrition is prolonged over several generations, diseases begin to show up as historical phenomena. Examples include the Stroke Belt in the American South and runaway rates of diabetes in previously nonindustrialized nations with long histories of poorly nourished people, such as India and China. Over the long term it has undermined women’s ability to have healthy pregnancies and give birth to robust infants.

Consider that females are born with their lifetime supply of eggs. That means a pregnant woman’s eggs were formed while she was still a fetus in her mother’s womb. Those eggs reflect the quality of her mother’s diet and life history. If her mother was malnourished and/or belongs to a group that has been historically disadvantaged, those experiences will have left a biological imprint on her and also on the eggs she passes on to her female baby. In other words, a baby’s grandmother plays an active role in their lifelong health. This is an area of research known as transgenerational inheritance .

Dr. David Barker, a British epidemiologist, got the ball rolling on the first stage of this science, now known as The Developmental Origins of Health and Disease, in the early 1970’s. Dr. Barker’s interest was piqued when he noticed that heart disease, then believed to be associated with affluence, was much more prevalent in more impoverished areas of the country. He also found that in Britain the most reliable predictor of stroke rates in any location was the maternal mortality rate 70 years earlier.

His gut instinct, now supported by a substantial body of research, was that many chronic illnesses can be traced back to fetal development in the womb.

By 1986, when he published his findings in The Lancet, he had identified low birth weight as a marker linked with a raft of chronic diseases as an adult, including high blood pressure, type-2 diabetes and cardiovascular disease.

A developing fetus draws on the nourishment provided in utero like a plant soaks up minerals from the soil. If soil is not cared for, over time its quality declines, as does its ability to sustain healthy plants. We know from studying developing countries, that the effects of malnutrition are multigenerational.

Simply stated, a mother’s nutritional status at the onset of pregnancy reflects the experience of previous generations. Once pregnant, an undernourished woman will not be able to provide her fetus with the nutrients it needs to develop optimally. And, if she belongs to a group that has been historically disadvantaged, she is not likely to have stored enough nutritional reserves for the fetus to draw on. This sets the stage for the likelihood of delivering a baby with low birth weight,  extending the cycle of chronic illness.

Experts now consider the health care costs associated with treating our so-called “epidemics” of chronic disease to be unsustainable. That’s one reason why in hard economic terms, maternal health matters. We now know that in addition to increasing the risk of both maternal and infant death, factors that affect the mother like poor nutrition and chronic stress reprogram how a fetus develops, setting the stage for disease development later in life. We need to prioritize taking better care of pregnant women. The benefits of improving their health extend far beyond the well-being of the individuals involved. Over time they will flow through the generations, contributing to lower rates of chronic illnesses (and reduced health care costs) in the years to come.

 

 

 

A Whole Grains Primer

As a parent, you play a key role in fostering the healthy development of your offspring. Good nutrition is one of the most valuable tools you have for helping to keep your children on the proper growth trajectory and its benefits begin early. Reseach indicates that a healthy diet in early childhood can help to overcome any deficiencies that may have developed during pregnancy. A nutrient-dense diet will also help to ensure that those body systems that are still quite plastic in children, such as the brain, liver and immune system, will develp properly. Because all parts of their bodies are still developing, children have a vital need for the nutrients that a healthy, balanced diet provides.

Your parental responsibilities also extend to yourself.  Best parenting practices include taking care of your own health by consuming food that supports your well-being.

Whole grains are a key component of a nutritious diet. Expert opinions, such as those compiled in the US dietary guidelines and Canada’s Food Guide recommend eating whole grains as part of a healthy eating pattern. The problem is, there is a lot of confusion about whole grains --- what they are and  even whether they are good for you.  The following “whole grain primer”  is intended to answer any questions you might have about whole grains and further your education on why they are beneficial for your family’s health.

What are Whole Grains?

Whole grains are the seeds of certain plants. The inedible outermost layer (husk) of the grain is removed, leaving the resulting “berry” or “groat.” They differ from grains that are not whole (refined) because they contain all three parts of the grain: bran, germ and endosperm.

Most of the grains typically consumed in North America — for instance, white wheat flour, white rice, pearled barley and steel-ground cornmeal — are highly refined. During the milling process, the bran and the germ, which contain valuable nutrients, are removed, leaving the endosperm. While the endosperm is the largest part of the grain, it also has the fewest vitamins and minerals. Although refined grains are subsequently “enriched” with the addition of some nutrients, such as riboflavin, thiamin and iron, they are far less nutritious than whole grains. Not only do they lack the full range of vitamins, minerals, healthy fats, antioxidants and phytonutrients found in whole grains, refined grains provide far less fiber.They also lack the  synergy of whole foods.  Scientists are now seeing that the various components of whole grains work together to promote health and well-being.

Why Should I Eat More Whole Grains?

Not only do whole grains taste good, they contain a wide range of nutrients. Although the nutrient content of individual grains varies, in general terms, most whole grains will provide at least small amounts of B vitamins (niacin, riboflavin, thiamine and folate), vitamin E, manganese, magnesium, potassium, iron, copper and selenium. They also contain fiber, beneficial fatty acids, antioxidants and phytonutrients. All these substances work together to fight disease and keep you healthy.

As we understand more about the relationship between diet and health, it’s becoming increasingly clear that eating nutritious food can help to reduce the risk of illness and disease. Today our nutritional focus is shifting, from limiting how much we eat toward understanding that eating certain foods can actually be beneficial to our health.

            Studies show that regular consumption of whole grains:

  • reduces the possibility you will develop Type-2 diabetes
  • makes it less likely you will have a heart attack
  • helps to keep your blood pressure under control
  • reduces your risk of having a stroke
  • lowers your risk for certain types of cancer
  • assists with keeping your weight under control and helps to ensure that you have a healthier waist-to-hip ratio
  • helps to keep your cholesterol levels low
  • fights gum disease
  • promotes regularity

And, if that isn’t enough, scientists are actively engaged in studying substances contained in whole grains, such as lignans and oligosaccharides, which function as prebiotics. Prebiotics are ingredients that stimulate the growth of healthy bacteria, such as lactobacilli and bifidobacteria (which are known as probiotics). By promoting the growth of beneficial intestinal flora, prebiotics help to keep your gut in tiptop health, which is linked with a wide range of other health benefits.

What about Fiber?

When scientists started noticing that the consumption of whole grains could help to keep you healthy, they initially attributed these positive results to their high fiber content. We now know that fiber is just one of many healthful substances found in whole grains. By keeping you regular, a fiber supplement may help to keep you well, but it won’t help your body to ward off disease.

 There are two kinds of fiber — insoluble and soluble. The substance we traditionally associate with fiber is insoluble fiber, which doesn’t dissolve in water. (It’s what my mother called “roughage.”) Insoluble fiber absorbs water in your digestive track and moves waste through your system, preventing constipation. The other kind of fiber, soluble fiber, does dissolve in water, forming a gel-like substance. It helps to lower blood cholesterol levels and to control blood sugar levels.

Despite its many benefits, most people in North America do not consume enough fiber. Adult women should consume 21 to 25 grams a day, while men should eat 30 to 38 grams a day. Some health professionals recommend that children should consume, on a daily basis, an amount equal to or greater than their age plus 5 grams. A diet high in whole grains will help you to meet these goals.

The fiber in whole grains is concentrated in the bran, which explains why whole grains (which also include the endosperm and the germ) may contain less fiber per comparable weight than some refined cereals, such as bran. However, the whole grain does contain the entire package of nutrients, which may create synergy in the health-promoting effects.

Fiber Fights Fat

Did you know that fiber helps to keep your weight under control? Because foods that are high in fiber take longer to chew, your body has time to recognize its appetite has been satisfied, reducing the possibility you’ll overeat.Studies have linked the consumption of whole grains with having a lower body mass index (BMI.)

Whole Grains and Diabetes

The fiber in whole grains has been linked with a reduced risk of developing diabetes. The Nurses’ Health Study found that when women ate whole grain cereals providing  more than 5 grams of fiber a day, it reduced the likelihodd that they would develop type-2 diabetes by about 30 percent.

Whole Grains and Antioxidants

In 2004, Dr. Rui Hai Liu and his colleagues at Cornell University discovered a previously unknown benefit to eating whole grains: they contain potent antioxidants. Although scientists have been aware of the antioxidant power of fruits and vegetables for many years, the ones in whole grains were overlooked because they appeared in a different form and there was no known way of identifying their presence. Their antioxidant component helpsto explain why diets high in whole grains appear to be protective against diseases, such as diabetes and heart disease, as well as colon, breast and prostate cancers. Over 80% of these protective substances are found in the bran and the germ, which are removed when the grain is refined.

Whole Grains and Heart Health

A study published in Nutrition, Metabolism and Cardiovascular Diseaseconcluded that eating whole grains benefits cardiovascular health. People who consumed on average 2.5 daily servings of whole grains reduced their risk of heart disease and stroke by 21%, compared with those who consumed only 0.2 servings.Other studies have produced similar results. Eating whole grains has also been shown to help keep blood pressure under control In addition, research suggests that people who consume the most cereal fiber reduce their risk of developing metabolic syndrome, a condition that increases the risk of heart disease and stroke, among other chronic illnesses.

Whole Grains and Cancer

Numerous studies have linked the consumption of whole grains with a reduced risk of developing cancer. Whole grains contain a number of substances that appear to have cancer-fighting properties. These include antioxidants and phytochemicals, such as lignans, saponins and phytoestrogens. They also contain fiber, the consumption of which has been linked with lowering cancer risk. When the American Institute for Cancer Research combined data from 40 studies, they concluded that people who consumed large amounts of whole grains reduced their cancer risk by 34% when compared with those who ate small quantities.

How Much Should I Eat?

Although guidelines differ slightly, in both the U.S. and Canada, experts recommend about 4 servings of whole grains every day. The USDA defines a serving of whole grains as any food containing 16 grams of whole grain or an “ounce equivalent” (28 grams) of bread or cereal. Sixteen grams is just a little more than half an ounce — so three servings (48 grams) of whole grains are just under two ounces.

What’s a Serving?

  • 1/2 cup (125 mL) cooked brown rice or other cooked grain
  • 1/2 cup (125 mL) cooked hot cereal, such as oatmeal
  • 1 ounce (30 g) uncooked whole grain pasta, brown rice or other grain
  • 3 cups (750 mL) popped popcorn

Recognizing Whole Grains

Increasing your intake of whole grains may be challenging because it’s not always clear from labels whether grains are whole or refined.You can, however, look for the whole-grain health claim on food product labels. It reads: “Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat and cholesterol, may help reduce the risk of heart disease and certain cancers.” A food bearing this label must contain 51% or more whole grains by weight. Canadians will see these labels on imported whole-grain products.

The Whole Grains Council, an industry association in the United States, has developed an eye-catching stamp, a sheaf of grain on a golden-yellow background, with a black border. It has two variations: 100% whole grain or whole grain. You’ll know you’ve eaten four  servings of whole grains when you eat fourfoods with the 100% stamp or eight  foods with the whole-grain stamp. If there is no stamp on the product, the labeling should say “100% WHOLE Grain or Excellent Source.”

Adapted from The Complete Whole Grains  by  Judith Finlayson