Pregnancy & Supplemental Safety

by Dean McKillop 6944 views Supplements

Pregnancy & Supplemental Safety

If you’re a mum, a mum to be or a mum who has just had her baby and you’re wondering about the safety of protein use pre, during and post-pregnancy, this is the article for you.  All too often the question of “can I use protein powder” is left unanswered and as a mother, you’re left in the dark as to what you can and can’t consume around pregnancy.

Now while I am not here to undeniably claim what you can and can’t consume, as I am not medically in a position to do so, hopefully I can at least provide some insight into the literature currently available for women, pregnancy and what they are allowed to consume in the pre, during and postpartum phases.

40 years ago, women who were pregnant, ate their standardised diet, exercised when they felt like it and they essentially just carried on with their lives as per normal. These days there are recommendations on minimising the consumption of undercooked meats, not over-consuming dairy, minimising gluten, removing seafood, not over exerting yourself in training and a whole host of other ‘rules’ that mums should adhere to.

So what’s changed?

Well, nothing has changed in regards to how women carry a baby and there hasn’t been some reverse evolution of the gestational phase whereby the infant can longer tolerate the things you are all told to avoid either. Instead, it appears these changes have been made mainly for our need to be overly cautious.

Which isn’t such a bad thing in the grand scheme of things, but as with all of my supplement and dietary recommendations, I like them to be based on sound scientific knowledge that has been tested as a hypothesis and then either confirmed or denied by multiple findings in the literature.

But here is the problem…

The literature available on women, childbearing, childbirth and breastfeeding, is inherently quite scarce as it is ethically impossible to test a theory on a human life. And fair enough!

So instead, we need to rely on correlation as opposed to causation, which essentially looks at links between things as opposed to finding the specific cause of an outcome and we can also refer to rodent or animal studies for some potential insight into what we can expect with pregnancy for humans.


With that in mind the following 3 categories of supplementation and dietary recommendations will be discussed:

1.    Protein intake
2.    Whey protein supplementation
3.    Artificial sweetener (AS) consumption


How Much Protein?

In traditional dietary recommendations, protein consumption is estimated based on the lean mass (everything except fat) of an individual in order to ensure an adequate intake of essential amino acids (EAA) occurs. In doing so, adequate EAA consumption supports the building and repair of muscle tissue, bones, skin, hair and nails, as well as providing critical amino acids for cellular function, mood regulation and organ function.

protein

Similarly, it is critically important for a mother to consume adequate calories each day, as caloric control has been directly linked to the likelihood of having adequate vitamin and mineral intake to support the babies growth, of which women consuming less than 2700kcal per day were considered to have an increased risk of inadequate intake (1).

Now obviously not all women are of the same stature, so Blackburn et al (1976) looked into the individual requirements of each participant of their study and deemed the necessary caloric intake for pregnancy, depending on the trimester, to be between 30-35 calories per kg of bodyweight (the further into pregnancy the more calories you require).

For a 70kg female, this would mean they need to consume between 2100 and 2450 calories per day, depending on the trimester.

Within these parameters, all current research, of which a review of over 20 studies and thousands of women, indicates that the middle ground for efficient protein intake lies around 20% of total caloric intake coming from protein (3). Interestingly, albeit in rodents, there has been some indication, however, that too high a protein percentage may actually have adverse effects (4), with recommendations stating that excessive protein intake above the 20% region achieves zero health benefits for both the mother and the child (5).

When assessing the dietary intake of mothers who may be currently under consuming on protein, however, increasing protein through supplementation or improving its dietary intake via food from meats etc, has been shown to reduce the risk of low birth weights (5), while simultaneously improving actual birth weight and also birth heights (3).

Referring back to our example 70kg mother, this would mean that a goal intake of 105-123g of protein per day is adequate enough to achieve foetal development, with no current indication that consuming more than this will achieve any benefit for the child.

This is not to say that consuming more will undeniably cause adverse effects, as this is not the case, however eating excessively above the 20% recommendation does not appear to achieve anything positive for the foetus, so focusing on the consumption of both a nutrient dense and nutrient diverse diet is more advantageous than focusing on excessive protein intake.

What I mean by this is, provided the protein intake is sufficient, focusing your consumption on a diverse range of food type and food quantities, will provide more benefit from a vitamin and mineral perspective than excess protein will.

Can I Use Whey Protein?

There is currently no research indicating any concern for the consumption of whey protein as a sole ingredient during the pre, during or postpartum phases of pregnancy.

Interestingly, breast milk itself contains in the vicinity of 7% whey protein (6), alongside other protein sources such as casein and natural milk.

Like all other protein sources, whey protein is simply an easily digestible, highly bioavailable protein source that can be used to consume adequate protein intake via daily dietary consumption. Whey is also found in many dairy sources people commonly eat, such as cheese and yoghurt.

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Interestingly, some studies do indicate, however, that the consumption of a highly hydrolyzed (pre-digested and broken down) whey protein source may be more beneficial in the postpartum phase if the mother is still breastfeeding, as it is suggested that it is less likely to cause an allergenic response, such as dermatitis. Although this suggestion is merely just that, a suggestion.

If you are in the postpartum phase and want to ensure your child is able to be breastfed for as long as possible with the highest quality breast milk, it is currently suggested that mothers require an additional 500-1000 calories a day to ensure production is maintained at an optimal level (7), of which it is also recommended that an additional 20g of protein (25g of whey) above the dietary recommendation of 20% of calories is added to the diet in order to ensure the quality of the milk is maintained (8). 

Consuming less than the allocated 500-1000 calories above your requirements, as well as under consuming on dietary protein, may lead to less than optimal nourishment, a reduced production of milk or in some cases, complete cessation.

What About Artificial Sweeteners (AS)?

This is where it gets interesting…

The primary concern with AS and the development of the foetus are generally focused on the implied risk of AS and their effect on insulin, over stimulating the pleasure region of the brain, potential interruption of positive gut bacteria and proposed toxicity concerns of AS and their effect on increasing the risk of cellular damage, cancer and inflammation.

But are these concerns warranted?

Pope et al. (2009) and Rother et al (2015) sum it up the best -

sweeteners

“While data concerning the use of sugar substitutes during pregnancy are limited, they do not suggest an increased risk of toxicity, adverse pregnancy outcomes, or neonatal issues”

“There is currently inadequate human data on AS long-term effect”

However, this is not to say there shouldn’t at least be caution when considering your consumption of AS during the gestational period, but instead be aware of the potential pros and cons of their consumption.

In a review of the literature by Pope et al (2009), with the question of “Will AS consumption effect my pregnancy?” being proposed, it was concluded that pregnant women are able to follow the standardised adequate daily intake (ADI) recommendations of Canada’s Food and Drug Regulations department, whereby the intake of traditional diet soft drinks containing Sucralose, Acesulfame-K, Saccharin and Aspartame can be consumed in the vicinity of between 3-13 cans per day for a 60kg female, depending on the quantity of each AS in a can, without concern.

In essence, provided your consumption of diet soft drinks is not excessive, you have zero concern for adverse effects based on the research available.

Furthermore, additional research quoted within the review by Pope references no toxicity response to 5x the daily ADI of Aspartame and no malformation of birth response in mice when consuming Saccharin at levels of 100-400x the ADI of humans. Similarly, the consumption of sugar alcohols or non-digestible glucose polymers such as Polydextrose, do not currently show any indication of concern (9).

Taking all of this into consideration, this review, with over 24 references, indicates that there are no expected adverse effects with the consumption of 15+ cans (5.6L) of standardised diet soda containing AS.

One interesting point, however, is the sheer lack of research on natural sweeteners such as stevia in human trials. So while this may be a natural sweetener, it would be advised to wait for further research before consuming something like stevia in excess.

In saying all of this, however, with most scientific findings, there is always the other side of the story…

Both Araujo, et al (2014) and Reid et al (2016), indicate that early exposure to AS may increase the risk for obesity, metabolic syndrome and an increase in BMI, however these findings were only available in abstract form so the individual characteristics of the study such as the dosage, type of AS and methodology were not retrievable.

This is important as an abstract only discusses potential findings, without mentioning the context of the research, so there may be some underlying reasons for the results that need explanation.

Similarly, Rother et al (2015) and Zhang et al (2011), acknowledge that there is, in fact, a direct transfer of sweetness into the mother's milk post AS consumption, whereby it has been suggested that should AS consumption be high, the taste of the milk and the presence of AS in the mother's milk may impact the child’s receptiveness to sweetness later in life due to a change in flavour preference.

This is not to say, however, that the preferential shift to sweetness for the child will directly impact their health later in life, but instead it may simply create a variable environment for preferential flavour.

The major concern noted in the paper by Rother et al (2015), was in the presence of large AS consumption, the risk for both amniotic or lactational transfer of AS may lead to impaired gut microbiota of the child, which is not ideal in the foetus as their gastrointestinal system is highly adaptable in the early phases of life and relies on its nutrition to set up a positive environment from the beginning of life.

If we were to extend the premise of these thoughts into young children, however, Brown et al (2010), found that there was no causal effect from AS on BMI, blood glucose regulation or weight gain in children exposed to AS, of which leads us to the argument of whether the consumption of AS during pregnancy causes irreversible change or perhaps instead the diet of the child once born plays a more significant role in both their gastrointestinal and physiological health.

Now you may be thinking...

Why would anyone need an AS product during pregnancy when they provide no nutritional benefit?

Sometimes food isn't always about nourishment of the body, but instead, food can also nourish the mind. Artificially sweetened beverages offer mother's the ability to have something sweet that isn't loaded with sugar and calories, which may help maintain a healthier gestational weight, which we know is also important for both the health of the mother and her child. Similarly, after giving up alcohol, a beverage with AS may fill the void of removing these drinks when out socially with friends.

So as you can see, AS have both their pros and their cons when it comes to pregnancy, whereby their consumption should not be feared but instead at least acknowledged to prevent excessive intake and any potential risk.

So What Does All This Mean?

To refer to Pope et al one more time:

“While data concerning the use of sugar substitutes during pregnancy are limited, they do not suggest an increased risk of toxicity, adverse pregnancy outcomes, or neonatal issues”

However, we also have to recognise that the statement of there being "limited research on humans" is equally as important as it is stating the current research shows no adverse effects.

So what does the research conclude?
  • Protein consumption via dietary means can be supported through the consumption of whey based protein powder, of which there may be a slight benefit to ensuring it is hydrolysed to enhance absorption and minimise the risk of an allergic response.
  • Focusing on an over consumption of protein may lead to a reduction in nutrient density and diversity, so sticking within the range of 20-25% of calories will achieve enough nourishment for you and your baby without any risk of adverse effects.
  • While there is limited data suggesting adverse effects of AS consumption during pregnancy, keeping your intake to a minimum is advised for precautionary reasons.

And finally, should you want to use a protein powder or any product containing AS, please speak with your doctor prior to consuming any product. 

Nutrition During Lactation. 1991. 1st ed. Washington, D.C.: National Academy Press.

Blackburn, M.W., Calloway, D.H. (1976). Energy expenditure and consumption of mature, pregnant and lactating women. Journal of the American Dietetic Association, 69(1). pp 29-37.

Liberato, Selma C., Gurmeet Singh, and Kim Mulholland. 2013. "Effects Of Protein Energy Supplementation During Pregnancy On Fetal Growth: A Review Of The Literature Focusing On Contextual Factors". Food & Nutrition Research 57 (0). doi:10.3402/fnr.v57i0.20499.

Walther, Thomas, Nils Dietrich, Martina Langhammer, Marzena Kucia, Harald Hammon, Ulla Renne, Wolf-Eberhard Siems, and Cornelia C. Metges. 2011. "High-Protein Diet In Lactation Leads To A Sudden Infant Death-Like Syndrome In Mice". Plos ONE 6 (3): e17443. doi:10.1371/journal.pone.0017443.

Kramer, M.S., Kakuma, R. (2003). Energy and protein intake in pregnancy. Cochrane pregnance and childbirth group. Review

Khan, Sadaf, Ylenia S. Casadio, Ching T. Lai, Danielle K. Prime, Anna R. Hepworth, Naomi J. Trengove, and Peter E. Hartmann. 2012. "Investigation Of Short-Term Variations In Casein And Whey Proteins In Breast Milk Of Term Mothers". Journal Of Pediatric Gastroenterology And Nutrition 55 (2): 136-141. doi:10.1097/mpg.0b013e31824cf386.

Whichelow, M J. 1975. "Letter: Calorie Requirements For Successful Breast Feeding.". Archives Of Disease In Childhood 50 (8): 669-669. doi:10.1136/adc.50.8.669.

Dewey, Kathryn G. 1997. "ENERGY AND PROTEIN REQUIREMENTS DURING LACTATION". Annual Review Of Nutrition 17 (1): 19-36. doi:10.1146/annurev.nutr.17.1.19.

Pope, E., Koren, G. (2014). Sugar substitutes during pregnancy. Canadian Family Physician, 60(11). Pp 1003-1005.

Rother, Kristina I., Allison C. Sylvetsky, and S. S. Schiffman. 2015. "Non-Nutritive Sweeteners In Breast Milk: Perspective On Potential Implications Of Recent Findings". Archives Of Toxicology 89 (11): 2169-2171. doi:10.1007/s00204-015-1611-9.

Araújo, João Ricardo, Fátima Martel, and Elisa Keating. 2014. "Exposure To Non-Nutritive Sweeteners During Pregnancy And Lactation: Impact In Programming Of Metabolic Diseases In The Progeny Later In Life". Reproductive Toxicology 49: 196-201. doi:10.1016/j.reprotox.2014.09.007.

Reid, A. E., B. F. Chauhan, R. Rabbani, J. Lys, L. Copstein, A. Mann, and A. M. Abou-Setta et al. 2016. "Early Exposure To Nonnutritive Sweeteners And Long-Term Metabolic Health: A Systematic Review". PEDIATRICS 137 (3): e20153603-e20153603. doi:10.1542/peds.2015-3603.

Zhang, G.-H., M.-L. Chen, S.-S. Liu, Y.-H. Zhan, Y. Quan, Y.-M. Qin, and S.-P. Deng. 2011. "Effects Of Mother's Dietary Exposure To Acesulfame-K In Pregnancy Or Lactation On The Adult Offspring's Sweet Preference". Chemical Senses 36 (9): 763-770. doi:10.1093/chemse/bjr050.

Brown, Rebecca J., Mary Ann de Banate, and Kristina I. Rother. 2010. "Artificial Sweeteners: A Systematic Review Of Metabolic Effects In Youth". International Journal Of Pediatric Obesity 5 (4): 305-312. doi:10.3109/17477160903497027.

 

Dean McKillop

Exercise Scientist

I completed my Exercise Science Degree at the University of QLD and have worked in the fitness industry for over 8 years, including a short stint at the Brisbane Broncos in 2010 as a student. I also hold my Level 2 Strength and Conditioning Coach accreditation (ASCA) and have competed in 1 bodybuilding season, placing 2nd at the IFBB u85kg Nationals.

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