Current recommendations and advice: Promoting a healthy diet during pregnancy and the early years Dr Helen Crawley March 2016

Where should we get advice – and what are the key things to consider? Who should we take advice from? What are the key things we should focus on to improve nutrition from pre-conception to five years? What works – and what support is there out there for you?

Maternal and child nutrition Implementing NICE guidance 2 nd edition March 2012 NICE public health guidance 11

NICE Quality Standards (98) 2015 NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. nce/qs98/chapter/List-of- quality-statements

Who do we listen to? There are global codes and conventions which have been set up to protect women and children

What does this mean? This means that in public health we work within the WHO Code of marketing of breastmilk substitutes and relevant WHA resolutions - and do not use any materials, resources or information produced by a company which makes breastmilk substitutes, or markets food for infants under 6 months.

Nutrition matters We are in a new era of understanding about the importance of nutrition in determining inter- generational health.

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Unfit for pregnancy? Young women in the UK are the most malnourished group of the population They typically have low status of a wide range of nutrients, some are too thin and many too fat, most eat too few fruits and vegetables and dietary variety may be limited.

Young women in low income households Studies show young women in low income households: Have high fat, salt and sugar intakes. 1/3 have very low intakes of iron, zinc, potassium, riboflavin. Intakes of vitamin A, calcium, magnesium and iodine are frequently very low. If they smoke diet is often worse.

Does it matter? Children born to poorly nourished parents are unlikely to reach their full potential. Iodine deficiency disorders are the commonest cause of learning disabilities worldwide If a woman has little or no dairy foods and does not eat fish it is unlikely she will have adequate iodine status in the UK – new data suggests this is becoming a significant problem among some young women in particular.

Low maternal iodine status was associated with an increased risk of suboptimum scores for verbal IQ at age 8 years, and reading accuracy, comprehension and reading score at age 9 years Results suggested a worsening trend in cognitive outcome with decreasing maternal status Possible in-utero effect of sub-optimal iodine status 2013;382:331-37

Folic acid and vitamin D An association between the development of neural tube defects (NTD) and folic acid was first suggested more than 35 years ago – and has been recommended for women planning a pregnancy – and in the first 12 weeks of pregnancy since Recommendations that all women should take vitamin D in pregnancy and when breastfeeding have been in place since 2003 – and new recommendations are due this month to increase amount suggested for some

Healthy Start The UK revised welfare food scheme – revamped in 2006 to offer vouchers to buy milk, vitamins and fruit and vegetable to low income families and women under 18 years. Food vouchers worth £3.10 a week, £6.20 for infants in first year. Also free vitamins for pregnant and nursing women and children 1-4 years. Universally free in some areas.

Finding out more about Healthy Start