Preventing Infections during Pregnancy

The foetus’s brain development during pregnancy is reliant on it’s mother’s health. Different factors could be at play including nutrition, stress, hormonal balance and the mother's immune system.

Infections with certain microbes, parasites or viruses during pregnancy can directly or indirectly infect the foetus at specific times during gestation, while some only infect the placenta.

In general, the placenta have a unique capacity to prevent expansion of the virus and its transmission to the baby but some findings have shown that the placenta in the first trimester appears to be more sensitive to the effects of bacterial infection, potentially leading to an increased exposure of the embryo to toxins at a critical time in development, whereas viral infections may disrupt the placenta in later stages of pregnancy (Lye et al., 2015; Spann et al., 2018 ).

If an expectant mother picks up an infection during pregnancy, her immune system will take action to clear the infection, but this self-defence mechanism could have an influence on how her baby’s brain develops in the womb.

A strong immune response known as 'maternal immune activation' can alter the activity of neurotransmitters or multiple genes, and pathways in the baby’s brain. This could explain why some infections during pregnancy may be associated with an increase in atypical neuro-development including autism spectrum disorders, depression, ADHD and schizophrenia (Al-Haddad et al. , 2019; Lombardo et al., 2018; Ronovsky et al., 2017). The timing of infection is also very important and can lead to varying outcomes based on which stage of brain development is affected. This can potentially explain the complexity of psychiatric disorders (Vasistha et al., 2019; Lins et al., 2019).

The sex of the baby can also influence maternal inflammation, with female foetuses heightening their mother’s inflammatory response compared to male foetuses (Mitchell et al., 2017).

In addition to neuro-development disorders , infection during pregnancy have been linked to an increased risk of birth defects, preterm birth, miscarriage, intrauterine growth restriction, behavioural problems, as well as sparking the development of type 1 diabetes and congenital heart disease (Ye et al., 2019 ; Shulman et al., 2014).

How to prevent infections during Pregnancy ?

Mothers want to give their babies the best possible start in life but colds and flu are often unavoidable. In general, the maternal immune system is well prepared to control infections and ensure the survival of the foetus.

But sometimes pregnant women do not always know when they have an infection, and the common signs and symptoms could be masked during pregnancy (Rowe et al., 2011).

However, in addition to optimal hygiene habits, exercise, sleep and diet you can take additional steps to decrease the chance of developing a potentially harmful infection while pregnant with the following tips:

Vitamin D

Also known as the ‘sunshine vitamin’ , insufficient levels of vitamin D is not only a serious public health issue but is related to a deficiency in our innate immune defences that protect us from infections and autoimmune conditions.

Vitamin D has a protective effect against acute viral and bacterial respiratory infections. One study has shown that it could actually reduce the risk of developing at least one acute respiratory infection by 12% (Martineau et al., 2017).

Vitamin D supplementation are now being investigated in several trials and in hospital settings for prevention against COVID-19 with a recommendation of 10,000 IU per day for a few weeks followed by 5000 IU per day (Grant et al., 2020).

Pregnant women are especially at risk for vitamin D deficiency , taking vitamin D supplements during pregnancy can prevent complications such as pre-eclampsia , gestational diabetes , preterm labour / birth as well as infections. The greatest beneficial effects were seen among women taking 6,400 IU vitamin D per day as it was also beneficial when they started breastfeeding as they had enough vitamin D to meet the demands of their babies (Hollis et al., 2015).

Optimal Vitamin D in pregnancy can also reduce the risk of respiratory infections during infancy and the occurrence of wheezing during early childhood (Esposito and Lelii, 2015).

FACTS ABOUT VITAMIN D

• Vitamin D supplements should be taken in the form of D3 in conjunction with K2 (to ensure calcium is absorbed), magnesium ( to aid in the activation of vitamin D) and should also be taken with a meal that contains fat to be absorbed easily ( as it is fat soluble ).

• Vitamin D acts like a hormone and regulates the activity of over 200 genes

• The primary sources of vitamin D are sun, certain foods and supplementation.

• The darker the skin the more sun exposure is needed to produce adequate amounts.

• Sunscreens block vitamin D production by around 95% therefore it is recommended to get sun exposure on bare skin ( simply avoid long periods of time in the sun and of course sunburns).

Choline & Folate

Choline is an essential nutrient that is rarely talked about outside of academia, but like folate (or folic acid), it plays a role in preventing neural tube defects such as spina bifida . It also contributes to a more favourable placental functioning, thus enhancing nutrient supply to the growing baby.

Higher maternal levels of Choline and Folate/Folic acid have shown to play a protective role in the baby’s brain development and in the behaviour of infants following birth even when the mother had an infection during pregnancy (Freedman et al., 2019) .

Choline supplements in pregnancy can have a lifelong benefit for the infant. The essential B vitamins Choline and Folate (B9) play critical roles in reproductive outcomes and women’s health.

Choline dips naturally during the second trimester of pregnancy , making it a particular period of vulnerability for the foetus. Only about 10% of pregnant women meet the recommended intake of Choline (450mg per day) and little or no amounts are present in prenatal vitamins.

FACTS ABOUT CHOLINE & FOLATE

• The body creates some choline on its own and it is also naturally present in certain foods, including egg yolks, organ meats, fish roe, wild game, fatty fish and other animal products.

• 2 eggs a day can meet about half of a pregnant woman’s need for choline.

• Supplementation with choline bitartrate or sunflower lecithin in pregnancy is recommended especially if following a vegetarian diet.

• Folate (B9) is naturally present in a wide variety of foods, including vegetables (especially dark green leafy vegetables), spinach, asparagus, and Brussel sprouts.

• Supplementation of at least 600 microgram/day of folate/folic acid during pregnancy is recommended as this level of intake might be difficult for some women to achieve through diet alone.

• Supplementation with the correct form of folate in preconception and pregnancy is especially important as 60% of people have a reduced ability to use folic acid due to their genetics therefore requiring the active form L-methyfolate.
  
  
  
  

Omega3

Omega-3 fatty acid supplements are strongly recommended for pregnant women to support foetal and placental development especially in assisting with the formation of neurons and protecting the brain from inflammation and damage. But they can also dampen strong inflammatory reactions due to infection -which could trigger preterm birth, miscarriage or stillbirth- thus bringing the body back to homeostasis (Garcia-So et al., 2019; Mildenberger et al., 2017).

Fish oils have been found to play a critical role in the interaction between viruses and the human immune system , making it a promising strategy for the treatment of patients with severe influenza virus infections (Morita et al., 2013).

FACTS ABOUT OMEGA3

• Omega-3 long chain polyunsaturated fatty acids include eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA).

• Omega-3 have anti-depressant and anti-inflammatory properties.

• Pregnant and lactating women should consume a minimum of 300 mg DHA per day.

• 2-3 servings of cold water fatty fish per week can meet a pregnant women’s needs.

Flu Vaccine (it depends)

When the flu vaccine is “well matched” to the circulating flu viruses, it can reduce the risk of influenza by 40–60%. If the viruses contained in the vaccine and the circulating viruses differ, the flu shot’s effectiveness is reduced.

Pregnant women and young babies are among those most at risk for complications such as stillbirth, miscarriage, hospitalisation, and death from the flu so vaccination is important.

Severe cases were mostly analysed during the 2009 A(H1N1)pdm09 pandemic which includes pneumonia , high fever , miscarriage, still birth, preterm birth, low birth weight , hospitalisation and death (Mertz et al., 2017) , this lead to World Health Organization (WHO) recommending the flu vaccine it to all pregnant women in 2012.

Underlying conditions , especially anaemia , obesity and asthma increase the risk of influenza related hospitalisation in pregnant women (He et al., 2017; Schanzer et al., 2007).

Although, prior influenza vaccinations seem to weaken the antibody response and its protective effect. Pregnant women who haven’t received a flu jab in the previous year had a better initial immune responses to the vaccine (Christian et al., 2017). But the benefits of maternal vaccination for the baby remains the same and can significantly reduce it’s risk of acquiring influenza during the first 8 weeks of life, then the efficiency decreases as the infant grows (Shakib et al., 2016; Munoz, 2016; Nunes et al., 2016 ).

Pregnant women experiencing depressive symptoms and certain stressors had higher levels of inflammatory markers and tend to have a stronger biological reaction to the flu vaccine. Since their immune systems are not functioning typically, they could be more susceptible to complications after a jab.

It is preferable to get the single injection pre-loaded syringe of influenza vaccine compared to other types of flu jabs/mists. Discuss with your GP if there is a tendency for severe allergies to gelatin , antibiotics or eggs , a reaction to a previous flu vaccine, a diagnosis with Guillain-Barré syndrome and if not feeling completely healthy .

The Microbiome

The microbiome composition in the gut, nose, mouth and vagina of pregnant women could have an influence on bacterial and viral infections (Schaupp et al. 2020; Shi et al., 2019; Lammert et al., 2018; Lehtinen et al., 2018; Becattini et al., 2017).

A recent study demonstrated that a foetus has its own microbiome passed down by its mother’s in the womb. And depending on her own biome and her exposure to certain bugs she can train her baby’s developing immune system and metabolism (Younge et al., 2019) . A healthy diverse microbiome can quickly clear viruses in the nervous system and developing brain (Brown et al., 2019).

Luckily, the microbiome can be modified either through diet or probiotic (good bacteria) supplementation during pregnancy.

FACTS ABOUT THE MICROBIOME

• The microbiome includes bacteria, archaea, protists, fungi and viruses.

• Eating more fermented and cultured foods introduces probiotics to the biome. Suguki (a pickled turnip) for example, was found to be protective against the flu.

• Supplementing with probiotics can provide a boost to probiotic foods. Studies have shown that probiotic supplementation can reduce a baby’s risk of certain non-communicable diseases during pregnancy.

• Supplementation should contain at least 30 billion CFUs per serving and contain both Lactobacillus and Bifidus strains.

• Providing nourishment to the beneficial microbes by having fibre daily (prebiotic)

• A diverse range of fibre sources of 25-35 g/ day provide the most health benefits and support a more diverse microbiome composition.

• Flavonoids, which are found in blueberries and black tea, may help to control immune response by working with the gut microbes to protect against severe flu infections.

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DR NAUF ALBENDAR

My name is Dr Nauf AlBendar and I am the founder of The Womb Effect. As a medical scientist with a BSc in Molecular Genetics and Genomics, an MSc in Nutrition & Food Science and a PHD in clinical medicine, I have developed a deep appreciation and understanding for the developmental origins of health and disease.