High protein, low carb? How to eat well in pregnancy

No more sushi, no more carpaccio – and what was that rule about cheese? When it comes to nutrition during pregnancy, women are confronted with a whole list of no-gos. But according to Dr Dietmar Moosburger, a gynaecologist and expert in prenatal diagnostics in Salzburg, what’s much more important to monitor are macronutrients. Why? Because during pregnancy, nutrition (and other factors) shape the metabolism of the unborn child. In fact, research points to a person’s time in the womb shaping their probability of suffering from certain chronic diseases later in life.

**Pregnant women want to protect the growing life inside them – through their diet, too. Which foods should they avoid? **

**Dr Dietmar Moosburger: **Food infections caused by listeria and toxoplasmosis pathogens have become extremely rare in Western countries. In Austria, the woman’s blood is tested for immunity at the beginning of pregnancy. If antibodies are present, she’s protected from further infection. However, this doesn’t apply to listeria. You can’t develop immunity to these bacteria. The route of transmission is the same as for toxoplasmosis. Prevention is quite simple: avoid consuming raw animal products. Heat any animal products to 70 degrees Celsius. Sticking to a diet of freshly prepared meals is optimal. Be sure to very thoroughly wash any lettuce and vegetables that you eat. In addition, good hygiene in the kitchen and during your meal prep is paramount. Follow these guidelines, and you’re golden.

As an expectant mother, it can quickly feel like you can’t do anything right. Why is that?

If you ask me, the problem lies in a lack of information. Expectant mothers aren’t sufficiently informed about their baby’s nutritional needs – neither by their physicians nor through other sources of information. Even in specialist sources, all you’ll find on the internet are lists of additional requirements for specific micronutrients such as folic acid, iodine, iron, vitamin D and omega 3. Yet not a word is mentioned about the additional requirement of the macronutrient protein.I can’t say why this information isn’t more widely disseminated.

**Why is protein so important? **

In the process of forming a new body, what’s primarily required are building blocks, not fuel.

These building blocks are the macronutrients our body needs to grow – that is, protein. Fuel, on the other hand, is macronutrients that provide your body with energy for movement, thoughts, heat, and growth – that is, carbohydrates and fats.

Precisely. During pregnancy, your requirement for a number of vitamins and minerals increases. You can cover it by making appropriate food choices and, if necessary, by taking supplements. What’s most important, however, is to keep an eye on your increased protein needs. A baby has trillions of cells, which are made from amino acids obtained by breaking down protein. Proteins are chains of amino acids. Especially important are essential amino acids, which we can only get from food. If the unborn child doesn’t get these from food, it can only obtain them from the breakdown of its mother’s muscles. The lack of essential amino acids causes defective cells to develop. In addition, the unborn child can’t build up sufficient muscle cells of its own. I like to use the following analogy: for the baby, the essential amino acids from food are like an optimal triple glazing protection, while amino acids gained from the breakdown of the mother’s muscles are only a single glazing.

What specific nutritional tips do you give your pregnant patients?

The protein requirement during pregnancy is 2 g/kg body weight per day. You can use 30/20/30 as a rule of thumb: pregnant women should eat 30 grammes of protein in the morning, 20 grammes at lunch and another 30 grammes in the evening. When snacking, it’s also best to go for high-protein foods. For example, 500 ml of buttermilk, 200 g of cottage cheese, a Greek yoghurt or a can of tuna or sardines. I recommend my patients eat two eggs every day.

Is it true that you should eat for two?

There’s no need to increase your energy intake in the form of carbohydrates. Your energy consumption increases primarily due to the energy required for tissue formation and foetal growth – which only becomes relevant in the third trimester. However, by this stage, most women will be moving much less than usual, so their energy requirement doesn’t actually change compared to their non-pregnant state. So, you should only «eat for two» in the sense that you should consider that what you eat is also what your child eats.In other words, you need to think for the both of you; what you’d put on your child’s plate to support their healthy development.

It’s obvious, really, that what expectant mothers eat has an effect on their unborn child. But what few people are probably aware of is just how far-reaching the consequences can be.

The general public is greatly unaware of just how those first nine months before birth shape the rest of our lives. And yet, it’s been scientifically proved for decades and is substantiated more and more with each year. This is referred to as «foetal programming» – the idea that all diseases that you suffer from in the course of your life which aren’t triggered by an infection stem from the time before birth. Being aware of the prenatal origin means that intervening within the womb is a promising approach for preventing the most common diseases in our civilisation. Even before their child is born, expectant mothers can already do a lot of good for their child.

**Are there many scientific studies on foetal programming? **

There are a ton. If you search for «foetal programming», you’ll get about 190,000 hits on PubMed, and a whopping 20 million on Google. In a lecture, the International Federation of Gynecology and Obstetrics (FIGO) provided information on how the Western lifestyle in pregnancy is leading to a «slow-motion disaster». Conversely, this means that, as mentioned earlier, expectant mothers have an enormous opportunity to positively influence the circumstances of their child’s life.

How is the unborn child programmed in the womb?

The mother shares with the foetus everything she comes into contact with in daily life – the air she breathes, the food and drink she consumes, the toxins she consumes or is exposed to, and the emotions she feels. The foetus hungrily absorbs these maternal «gifts» and incorporates them into its body, turning them into its own flesh and blood. The baby’s cells not only have to be built, but their function must also be learned. I find the term «intrauterine university» to be very apt.It all comes down to so-called epigenetics, that is, the intrauterine environment in which genes develop.

**Do you have an example of this from research? **

The best studied example is the development of innate insulin resistance, which leads to diabetes and metabolic syndrome in later life, which is in turn responsible for the most common chronic diseases. What happens in the «intrauterine university» when the pregnant woman eats the typical diet in Western industrialised countries – that is, a lot of carbohydrates? Well, the carbohydrates are broken down into glucose, which then passes through the placenta and enters the foetus’s blood. But because the foetus has a very low energy requirement, it has to get rid of the huge amount of glucose somehow. How? By creating a large number of cells that produce insulin. These excess cells aren’t broken down after birth. They continue to produce insulin for all they’re worth. In order to now avoid hypoglycaemia (low blood sugar), the baby’s insulin receptors pull back. This is termed insulin resistance. In addition, the cells in the hypothalamus are permanently calibrated for carbs aplenty by the large amount of glucose in the blood. The result? In later life, the child will experience a normal diet as acute starvation. Very often, these children become overweight and have a high risk of developing diabetes.

**Are there any phases during which a mother’s proper nutrition has a particularly strong effect on the baby’s metabolism? **
Over the course of pregnancy, trillions of cells are created that make up the baby. Therefore, a constant supply of building materials – that is, protein – is essential at every stage of pregnancy. That said, the placenta is formed during the first 16 weeks of pregnancy. A protein-rich diet is especially important during this time. In 2022, Spanish prenatal physician Francesca Crevetto received the highest award from the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG). She was able to prove that a high-protein Mediterranean diet can prevent many cases of foetal growth disorders that stem from a developmental disorder of the placenta.

**Knowing that as a pregnant woman you may be giving your child diabetes creates immense pressure. As a gynaecologist, how do you help expectant mothers deal with this? **

Assuming maternal behaviour during pregnancy can leave a lifelong impact on the baby, the most important factor is the mother’s own motivation. As a medical professional, you can be empathetic and take the time to explain to the expectant mother what her baby needs. If you do this, chances are she’ll manage to adjust her lifestyle accordingly – because she’s doing it for her baby, not for herself. In my practice, I’m certain 90 per cent manage this without any stress at all. After all, they themselves notice how good they feel when having porridge with yoghurt and berries for breakfast instead of a sandwich with jam or Nutella. Knowledge about foetal programming shouldn’t create psychological pressure, but rather joy in the fact that pleasant and tasty changes to your own lifestyle can contribute a lot to your baby’s health. Provided this knowledge is published and communicated to women, I think we underestimate the power of changing our own behaviour.