Issue 137 Eating eggs during pregnancy

COMPETITION WINNER

IN ASSOCIATION WITH BRITISH LION EGGS

EATING EGGS DURING PREGNANCY Cordelia Woodward RD Freelance Dietitian Cordelia is a Freelance Dietitian with an interest in pregnancy, cardiovascular disease, weight management and recipe analysis.

REFERENCES Please visit the Subscriber zone at NHDmag.com

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For a healthy pregnancy, it is recommended that women follow a varied balanced diet to ensure the best outcomes for both mother and baby. Eggs are a valuable source of protein, fatty acids, vitamins and minerals, which all play important roles during pregnancy. This article will discuss the safety and nutritional benefits of egg consumption during pregnancy.

For many years, pregnant women and other vulnerable groups were advised to avoid eating eggs with runny yolks due to the risk of salmonella contamination, which can cause food poisoning.

However, recently, the Foods Standards Agency (FSA) updated their guidelines in response to a report showing that British eggs are highly unlikely to contain salmonella, and now state that pregnant women, infants, children and elderly people can safely eat raw or lightly cooked eggs, so long as they are produced under the British Lion Code of Practice.1 HOW MANY EGGS ARE SAFE TO EAT?

Many people ask the question, “How many eggs can I eat per week?” when in fact, the NHS advises that there is no recommended limit on how many eggs people should eat, whether pregnant or not.2 A small proportion of individuals with familial hypercholesterolaemia require restriction of dietary cholesterol, for which eggs are a source (as are other foods, such as prawns and liver).

However, for most people, it is now generally accepted that the cholesterol found in food does not have a significant effect on blood cholesterol levels and that there is no need to limit egg consumption if you have raised blood lipids or Type 2 diabetes. In the diet, saturated fats have the most dominant effect on blood cholesterol levels and should be limited to a maximum of 30g and 20g per day for men and women

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respectively.3 This advice also applies during pregnancy.

THE BENEFITS OF EATING EGGS DURING PREGNANCY

There are many nutrients in eggs which can all help play a role in a healthy pregnancy as outlined in Table 1.

Protein Eggs are a rich source of high quality protein; they contain all nine essential amino acids which cannot be synthesised in our bodies and must be obtained from the diet. Pregnant women require between two and three servings of protein foods per day (such as eggs, beans, fish, meat and other proteins including tofu, nuts and Quorn) to help ensure healthy foetal growth and development.4 Two medium eggs, as shown in Table 1, provide approximately 15g of protein, which would be considered as one serving.5 Fats and omega-3 The composition of eggs shows a beneficial breakdown for fats; 71% of the fats found within eggs are unsaturated.6 The contribution to omega-3 fatty acids that eggs can provide is particularly beneficial for pregnancy. Analysis of UK eggs has shown that they qualify as ‘a source’ of the omega-3 fatty acid Docosahexaenoic acid (DHA), according to European Commission (EC) nutrition claims regulations.7 DHA (alongside Eicosapentaenoic acid (EPA)), is critical

Table 1: Nutrient content of a medium-sized (58g) hen’s egg20 Nutrition Information

Per Medium Size Egg (58g)

Energy kcal (calories)

66

Energy kJ

277

Fat (g)

4.6

Saturates (g)

1.3

Monounsaturates (g)

1.7

Polyunsaturates (g)

0.7

Carbohydrate (g)

trace

Sugars (g)

trace

Protein (g)

6.4

Salt (g)

0.20

to foetal and infant central nervous system growth and development.7 Research has shown that higher intakes of omega-3 fatty acids in mothers are associated with reduced risk for intrauterine growth restriction, increased infant birth weight, reduced depression and reduced risk of preterm birth.8 VITAMINS AND MINERALS

Iron Two medium eggs provide 2mg of iron.6 Pregnant women require 14.8mg per day to prevent iron deficiency anaemia.9 Although this is not an increased requirement compared to non-pregnant women (due to the body’s natural compensating effects, such as cessation of the menstrual cycle), many women can still become deficient and require iron supplements which can have undesirable side effects such as constipation and nausea. Thus, ensuring adequate dietary intake of iron, for which eggs can certainly contribute, could help reduce the need for high dose supplements.

Vitamin B12 Eggs are a rich source of vitamin B12, with two medium eggs providing 3.1µg.6 The daily B12 requirement during pregnancy is 1.5µg9 and, so, just one medium egg will meet this requirement.6 During pregnancy, vitamin B12 helps maintain healthy nerve cells and red blood cells. It is also needed to make DNA (genetic material for all cells) and helps the body use folate, a B vitamin discussed opposite which is of utmost importance during pregnancy.

Folate Folic acid is the supplemental form of the B vitamin, folate. A daily prenatal 400µg folic acid supplement is recommended three months before conception and during the first trimester of pregnancy to help prevent neural tube defects and other negative effects associated with low folate levels.10 It is very hard to achieve adequate amounts of folate by diet alone hence the need for a supplement. Indeed, the latest National Diet and Nutrition Survey19 reported that the majority of UK women of childbearing age have an inadequate folate status. However, women are still encouraged to ensure good sources of folate in the diet, as well as taking a folic acid supplement. This is where eggs can help out again, providing 55µg of folate per two medium eggs.6 Iodine Iodine plays a key role in cognitive function and thyroid function. Iodine deficiency has been found in up to 40% of pregnant women11 and some UK studies have demonstrated that deficiency may be associated with low birth weight and delays in infant neurological and behavioural development.7 The European Food Safety Authority (EFSA) recommends that pregnant women should have 200µg of iodine daily12 to ensure healthy iodine levels for both mother and baby. There is an increased requirement in pregnancy because of the need for the mother www.NHDmag.com August/September 2018 - Issue 137

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COMPETITION WINNER to make sufficient thyroid hormones to transfer to the baby for brain development.13 Two eggs daily would provide about one quarter of this recommendation (58µg for two medium eggs).6

This is another nutrient where eggs can make a valuable contribution, with two medium eggs daily meeting 60% of the AI.7

Vitamin D There are a limited number of foods naturally high in vitamin D, but after oily fish, eggs are the richest source, providing 3.7µg of vitamin D per two medium eggs (coming from the yolk of the hen’s egg).6 Vitamin D deficiency in pregnancy is linked to an increased risk of preeclampsia, gestational diabetes, urine infections and caesarean deliveries.14 The National Institute of Health and Clinical Excellence (NICE) recommends 10µg per day15 of vitamin D for all adults, including pregnant women (some experts, including the Endocrine Society,16 believe this should be higher during pregnancy).

While we can obtain vitamin D from some foods, it will not be enough for pregnant women and so a supplement containing 10µg of vitamin D is advised. As some experts recommend higher amounts of vitamin D than the NICE advice, a diet with foods containing vitamin D, such as eggs, can only be of benefit.

There is an increasing amount of evidence to show that eating eggs could help with weight management due to their satiating effects.

A number of studies have shown that meals containing eggs can reduce hunger, desire to eat and subsequent short-term energy intake.7 In addition, an interesting study showed that the proteins from eggs were broken down and metabolised at a slower rate than comparable proteins, suggesting that eggs offer unique effects on appetite hormone production.18 It is certainly a myth that pregnant women should be ‘eating for two’; excessive weight gain is undesirable and can have serious negative effects on both mother and baby. It is only in the last trimester of pregnancy that women are advised to increase their energy intake by 200 calories per day. In view of the research mentioned above, eggs may be a valuable inclusion in a woman’s diet during pregnancy to potentially help with excessive weight gain by promoting satiety.

Choline Choline is a vitamin-like nutrient needed for the normal functioning of all cells, especially those in the liver and the central nervous system. In pregnancy, it is essential for foetal development, especially for brain development, neural tube formation and learning function. In the UK, there are currently no recommendations for choline. However, in 2016, the European Food Safety Authority (EFSA) set adequate intakes (AI) for pregnant women at 480mg per day (for adults the value is set at 400mg per day).17

WEIGHT MANAGEMENT

SUMMARY

Without a doubt, eggs can contribute significantly to nutrient intakes during pregnancy, a life stage when eating a nutritious diet is key for the good health of mother and baby. They are a low cost food yet provide high quality protein, healthy fatty acids and an array of vitamins and minerals. Pregnant women should be made aware of the overturning of previous safety concerns regarding egg consumption and enjoy eggs in many different ways.

Judges: Carrie Ruxton & Emma Coates “A thorough article which was well researched and enjoyable to read. The author demonstrates a broad knowledge of the areas of health associated with egg consumption and has been able to bust several myths around cholesterol and food safety. The standard of writing is particularly high. I am sure NHD readers will enjoy it.” Carrie “This article stood out for me as the most informative of all the competition entries.

It has been well researched and flows well. I enjoyed the read. It makes a for a great reference article.” Emma

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www.NHDmag.com August/September 2018 - Issue 137