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Comment by DanBC | Hacker News Reader

There's a bunch of poor advice here.

Pre-natal nutrition: it is difficult for a pregnant woman to eat too little. There's no evidence of harm to mother or baby from mild undernourishment (if we ignore some condistions related to a need for vitamin supplementation). There is plenty of evidence of harm to mothers and babies for over eating. The risks of significant harm or death go up a lot if the mother or baby is overweight. These risks include, rarely, death.

A pregnant woman with a sensible diet needs only an extra 200 calories per day.

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You may be seeing things a little black & white here. His advice was to listen to cravings & not control diet "too much". You seem to have interpreted this as "let here constantly eat all the junk food she wants & become obese."

Maybe.

I was goig off things like:

> don't control it.

> Let her eat what she wants.

> Cravings are there for a reason.

> If you control it too much, a shrivelled rag will pop out without any extra body fat.

> Children get sick and need some extra incase they lose it.

All of those comments err on the "extra weight is preferrable", but that's just not true. It's hard to have an underweight baby, it's very easy to have an overweight baby, and the risks of harm from overweight mother or baby need to be taken into account.

I think you're both making good points here :) As with most things, extremes in either direction are harmful. As always it's a case of finding a healthy balance.

This is sort of my point. My wife chips in here...

Strict diet control is likely to be more harmful than people realise. Many many people end up in hospital during pregnancy after controlling things very strictly. The amount of mothers following silly baby friendly diets results in a lot of faceplants and ICU trips and occasionally tears.

I was an NHS maternity ICU nurse for about 5 years and if your child is not healthy to begin with, the risks to mortality are off the scale if the baby is underweight. If you can't get them feeding pretty soon, they rely on metabolising that fat to get through anything in the first couple of weeks.

An overweight baby has some loose and non conclusive statistics tied to childhood obesity and maternal diabetes. With proper sizing scans, induction etc, the risks are minimal and the diabetes risk treatable (metformin, dietary changes).

Edit: batou again... also c-sections are something you want to avoid, having watched a couple, so you're right about a balance.

Do you have any statistics about underweight mothers? Because all the research I've seen says it's not a problem. The child is going to be fine if the mother is underweight - although it's not ideal. But there is plenty of evidence that overweight mothers face increased risk of harm.

So, advising pregnant women to eat what they like, with no controls, increases risks and carries almost no benefit.

This is not suggesting that mothers should diet!

It's not a problem until there's a problem and there is no research on that really. There probably should be. According to my other half, anecdotal evidence from consultants suggest that the larger babies have a better outcome. They're a little less fragile. Also she said that most of the statistics are grouped into age and there is no association of an outcome at birth with later outcomes be they medical or surgical.

So there's not really any data.

Agree with your points for ref. It's all a compromise.

Actually it's more about infant health post-birth. If there any feeding problems, infection, secondary problems or surgery required then that body fat is very very important. Babies are notoriously fussy buggers and can deteriorate pretty sharpish if they are underweight.

We seem to be disagreeing about what the word "controlled eating" means.

I'm saying "don't eat too much; you're not eating for two; a woman with a healthy diet only needs an extra 200 calories per day".

You seem to be saying "don't go on a very restrictive diet".

I agree with that. But I'd be interssted to see any research showing harms from mothers on restrictive diets.

And you seem to be underplaying the risks of macrosomal babies, which are considerable.

See my other comment about this elsewhere in the thread. I'm saying eat what you feel you need to eat (within limits of course) so we're probably arguing the same point, just a different half of it.

Fetal macrosomia is something I know all about. 3 children, 3 c-sections due to this but all three under 9'15 which is considered the high risk limit. There are risks, you are right and I'm well aware of them. However that isn't possible to completely build a causality chain with calorific intake. AFAIK there is no research on this.

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