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Pregnancy and Pandemic

Please note: This article should NOT be considered medical advice. Information about COVID-19 is constantly evolving and subject to change. Following proper procedures for handwashing, social distancing, masking and surface cleaning remain the best interventions available. Personal recommendations for pregnancy planning should be discussed with your health care provider

Pregnancy is a time of hope and excitement as well as increased concern for what the future will bring for your growing family.   Pregnancy during a pandemic can add to the fear that any parent-to-be may feel. The areas of concern are three-fold: What effects COVID-19 (SARS-CoV2) may have prenatally, how it will inform labor and delivery, and what effects it might have in the first years of life and beyond.  Expectant mom’s need guidance to help them navigate the changing landscape of pregnancy during pandemic. Arming yourself with knowledge and a plan of action can help you navigate this confusing time. What should you know and what can you do now to protect your baby?

We do not have a lot of information about pregnancy and birth outcomes related to COVID-19 as of yet.  Studies are based on small population size, and only exist from women in their third trimester. While we do not know what, if any effects, in utero or early exposure to COVID-19 may have on baby’s early and long-term development, new information is continually emerging, and we can use the currently available data to guide our choices. 

Prenatally, protection and prevention are absolutely the first line of defense. Follow standard recommendations for social distancing, frequent hand washing, thorough surface cleaning, and face covering. Discuss with your provider their policies regarding in person vs. telehealth prenatal visits. Basic health measures such as high-quality nutrition, physical activity, restful sleep and stress reduction become even more important, even while quarantine conditions add an additional layer of challenge to achieving these goals.  Consider pregnancy safe immune support such as vitamin C and D, zinc and echinacea as appropriate, but be careful with any supplements-herbs such as licorice and andrographis being touted as protection against SARS-CoV2, they are unsafe during pregnancy. Other compounds such as quercetin and melatonin, which may have anti-COVOD-19 activity, are lacking in safety data regarding pregnancy.

Once baby is ready to enter the world, the goal is to minimize risk to mom and newborn.  There is a higher risk of preterm delivery and low birth weight in babies born to infected mothers but thankfully, vertical transmission (from mom to baby in utero) of COVID-19 appears unlikely. In only rare cases has a baby been born with positive antibodies (a sign of prior exposure) to the disease. Horizontal transmission (from mom to baby after delivery) has occurred, likely due to exposure to respiratory droplets after birth, but in most cases, the infants have recovered well, and appear less seriously affected than adults. Because of the fear of both vertical and horizontal transmission, as well as respiratory concerns for mom, C-section deliveries and separation of mom any baby after birth were regularly initiated in early cases, but with more information these guidelines have changed.  For COVID-19 infected mothers, the World Health Organization (WHO) currently does not recommend routine C-section, unless deemed necessary for other reasons. The CDC does not support routinely isolating a newborn from its mother and WHO maintains the importance of room-sharing, skin to skin contact and breastfeeding to provide the baby with optimal immune support. There is no evidence that the virus can be transmitted via breast milk, however, COVID-19 positive mothers must use precautions such as wearing a mask while nursing, washing hands before and after touching the baby, and disinfecting all surfaces. In addition, if a mom is expressing her breast milk for any reason, including being too ill to nurse, all equipment must be carefully and thoroughly cleaned.

For the first year and beyond

Preterm delivery, C-section birth, antibiotic use, as well as maternal fever, infection and use of acetaminophen during pregnancy have been associated with an increased risk for autism spectrum disorders, ADHD, developmental delay and depression in children.  We suspect this is linked to disruption of the infant microbiome and alteration of innate immune function. Research is clear that healthy balanced gut flora exerts powerful effects on not only digestion, but immune and neurologic function as well. Alterations in these pathways are correlated with a variety of developmental and mental health challenges in children and adults. 

HOWEVER, remember that having a baby should be a time of joy and hope.  We cannot and should not live in fear of negative outcomes. What we can do is be aware, and proactive in supporting normal immune and gut health in our newborns, and be especially mindful of those who have been exposed to SARS-CoV2.  Being proactive includes breastfeeding for 6 months or longer whenever possible. Breast milk provides important immune modulating compounds as well as molecules called Human Milk Oligosaccharides (HMOs) that are used specifically by the gut flora to grow and thrive.   If appropriate, Vitamin C and D, probiotics, omega 3 fatty acids, and zinc can be used to enhance immune function.  While these nutrients are safe for both breastfeeding moms and babies, appropriate dosing is essential. Parents should watch carefully for signs of digestive and immune dysfunction such as colic, reflux, poor sleep, eczema and ear infections.   If you suspect your child is not achieving appropriate developmental milestones, then modify the familiar saying and “if you don’t see something, say something”. Work closely with a provider experienced in functional care who will take your physical and developmental concerns seriously, and intervene early.

This information is not designed to scare but to educate.  By knowing the facts, working closely with your healthcare provider to decide what is best in your individual situation, and making decisions with both short and long-term effects in mind, you can lay the foundation for a happy thriving child. 

 

Vicki Kobliner MS RDN, is a Registered Dietitian/Nutritionist. Vicki has a passion for helping parents-to-be navigate preconception, pregnancy and baby’s first year of life in the face of increasing chronic childhood illness.  She employs a functional nutrition approach to optimal health and healing. Vicki also works with infants through adults with chronic illnesses, digestive disorders, food allergies, ADHD and autism and provides fertility and mental health focused nutrition counseling.   Click here to book an appointment with Vicki.

Looking for more information on being pregnant during a pandemic?  Join Vicki for a live webinar on May 14th at 12 pm where she will explain what information we know so far, and how best to use that information for prevention and protection. Click here to register.
Submit questions forVicki in the comments section – she will address them during this live call! Sign up here.

 

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Surviving and Thriving on a “Quarantine Diet”

Our lives have all been powerfully disrupted in the past few weeks. All signs indicate that they will remain so for at least the near future, and the adaptations can be exhausting!  Access to food and household needs, both in person and online, can be a lesson in frustration. For those of us who rely on a healthy, whole foods diet for optimal health, or may have dietary restrictions such as gluten or dairy, the search can be both harder and longer. As a Functional Registered Dietitian/Nutritionist, I can really relate.  If we choose not to stock up on pasta, rice and dry cereal, what are the options?

Here’s what I recommend: 

YOUR FREEZER IS YOUR FRIEND

  •   Stock your freezer as full as you can with unprocessed foods, including animal protein, vegetables and fruits- minimize processed boxed items which take up extra room. 
  •   Prep the items before you freeze them- for example, cook multiple chickens and cut the meat off the bone, and cut up fresh veggies, removing any parts you will not use before freezing to maximize space. 
  •   Freeze eggs! Drop individual eggs in sections of an ice cube tray. Once frozen you can store in a safe freezer bag such as https://www.green-n-pack.com/. If separating whites and yolks, add some salt to the yolk before freezing

PACK THE PANTRY

We want to maximize the nutrient density of the items we are storing. Although I haven’t officially calculated the protein or zinc per square inch ratio, these suggestions should keep your cabinets rich in foods that keep you healthy and satisfied. 

  •   While others are clearing the grocery aisles of white flour, don’t forget that nuts and seeds, their butters and ground meal are powerhouses of nutrition in small packages. Go heavy on these items. 
  •   Canned or dehydrated vegetables can last a long time. In addition to the usual carrots and peas, add some seaweed, jackfruit (it has a meat-like texture), artichoke hearts, hearts of palm, and pumpkin puree. Forager is one of many companies that make a variety of veggie chips. Boxed or homemade vegetable soups like tomato, carrot or squash can round out the assortment. 
  •   Dried fruits are another space-saving option to pack in the nutrients. Buy organic versions without added sugar. You can make your own trial mix or purchase a ready to eat option as well. 
  •   If canned tuna is in low supply, select canned salmon. It is better to rotate tuna and salmon anyway. Choose wild or pole caught options when buying fish. 
  •   Don’t forget legumes! Beans are rich in protein, fiber, and a variety of important nutrients. The dried versions are more cost and space friendly than cans, but either will work. Lentil chips, Brami snacking beans and Biena roasted chickpeas add textural variety to your choices. 
  •   Think like a cowboy and stock up on jerkies and meat sticks (like CHOMPS and PRIMAL ) which have a long shelf life. 
  •   Energy bars like EPIC, RX  and Lara are made with only real foods, and only a few of them. 
  •   Forget wheat pasta- bean pasta is readily available online and in many stores- try fiber and protein rich Explore Asian Mung Bean pasta, Banza chickpea pasta or Tolerant varieties which are organic and free of all major allergens. 
  •   Who needs rice when you can grab up some quinoa and buckwheat? Richer in protein and fiber, gluten free and not sold out! 
  •   Keep spirulina and nutritional yeast nearby.  Just a spoonful of spirulina  adds protein, iron and potassium, while nutritional yeast contains B vitamins and has a great cheesy taste. 
  •   Make sure you have herbs and spices on hand. Stressful times tax our immune systems and we can use these ingredients to add more than flavor.  Cinnamon, turmeric, thyme, oregano and rosemary contain compounds that boost our immunity, reduce inflammation and help kill germs. 
  •   My go-to ready-to-drink shake is from Orgain. Organic, tasty and comes in a dairy and vegan option.

SCHEDULE DELIVERY

Many grocery chains are scheduling deliveries two weeks out, and stock varies widely.

  •   Neighborhood shops may be able to meet your needs more quickly, and allow you to help the local economy. Call your local merchant and see what they offer.
  •   Sign up for a subscription service and you will know you have a steady supply of nourishing options coming straight to your door. Some of my favorites include:

o   Misfits Market supplies healthy, high quality produce at lower cost. It also reduces food waste!  (Use code COOKME-BB6IJG)

o   Walden Local Foods ships in the Northeast and supplies a wide variety grass-fed or cage free proteins (use the link to get some free eggs and bacon)

o   Butcher Box  delivers a variety of grass-fed, organic free range proteins directly to your door. 

o   Imperfect Foods https://www.imperfectfoods.com/ offers conventional and organic plans, which can be customized to your liking

In troubled times, nutrition becomes even more essential to support our immune system, modulate stress and keep us physically and emotionally resilient. Quarantine does not have to mean compromising on our well-being.

 

 

Vicki Kobliner is a Registered Dietitian/Nutritionist with over 20 years of expertise applying a Functional Nutrition approach to the care of children and adults. She utilized her wealth of experience with both traditional and integrative modalities, incorporating the power of food, herbs and targeted nutrition support for both prevention of and healing from both acute and chronic illnesses.    Vicki sees pediatric patients and their families at Blum Center for Health, and has extensive experience in addressing a wide variety of childhood illnesses.