CHARTS

• Anchovies (Atlantic), ca. 900–1,300 mg DHA per 3.5 oz/100 g

• Herring (Atlantic), ca. 1,100–1,200 mg DHA per 3.5 oz/100 g

• Mackerel (Atlantic), ca. 700–900 mg DHA per 3.5 oz/100 g

• Salmon (Pacific), ca. 700–900 mg DHA per 3.5 oz/100 g

• Sardines (Atlantic), ca. 500 mg DHA per 3.5 oz/100 g

THE MTHFR MUTATION

MTHFR stands for “methylene tetrahydrofolate reductase,” which is quite a mouthful. The mutation is linked to some serious health problems—an increased risk of heart disease, colon cancer, stroke, recurrent miscarriage, Alzheimer’s disease, and depression—so I just started calling it the “motherf***** gene.”

The MTHFR gene instructs the body to create the MTHFR enzyme. When you have the MTHFR mutation, your body produces between 20–70 percent less of the MTHFR enzyme. This enzyme is needed to convert folate (whether from food or supplements) into L-methylfolate, the biologically active form that our body can use. Thus, the MTHFR mutation means that you will be deficient in L-methylfolate.

L-methylfolate, in turn, is crucial for the process of DNA methylation (that’s the process we discussed in the epigenetics section of chapter 2). DNA methylation is how unnecessary, unwanted, or potentially harmful genes are silenced during gene expression, which keeps our “cellular factories” running smoothly and prevents chronic diseases.

At the same time, when your body can’t convert the folate you’re consuming—and especially when you’re taking folic acid supplements during pregnancy—the unmetabolised folate can accumulate in your body and lead to liver damage, reduced immune function, and a heightened risk of some cancers.

Fortunately, there is a solution. You can buy supplements that contain L-methylfolate, the biologically active form of folate that your body can use directly. Unfortunately, they are more expensive than regular folic acid supplements. You also need to stick to the dose recommended on the packaging. L-methylfolate bypasses the body’s built-in safeguards against over-methylation, which can cause side effects like sore muscles, irritability, anxiety, and others. The brands that I use are BioCare Liquid Methylfolate and Metagenics FolaPro, but there are several to choose from (sometimes the L-methylfolate is labelled or branded differently, e.g., as L-5-methylfolate, 5-MTHF, Metafolin, or Quatrefolic)—see also www.growhealthybabies.com/supplements.

The only way to find out for sure if you have the MTHFR mutation is to take a genetic test. If your doctor can’t or won’t order a test for you, you could use genetic home-testing kits like 23andMe or Color. But genetic tests aren’t cheap, and maybe you’re also concerned about the privacy implications. Either way, whether you know that you have the MTHFR mutation, or whether you don’t know but want to be sure that your body can metabolise the folate supplements, you can take the L-methylfolate supplements mentioned above. They are fine to use whether you have the MTHFR mutation or not, as long as you stick to the recommended dose—but discuss it with your doctor to be sure.

On a side note, a lack of folate is also involved in fertility problems. One of the most common reasons for infertility—about 20 percent of cases—is failure to ovulate. Taking folate supplements reduces the risk of ovulatory failure drastically, so my doctor in London suspected that my body’s inability to process folic acid, due to the MTHFR mutation, could be causing my fertility problems. They recommended that I try the L-methylfolate supplement, and bam—two months later, I was pregnant.

Excerpt: Dietary sources of iron

Non-heme (plant-based) iron:

• Soybeans (8 mg per cup) and tofu (5 mg per cup)

• Lentils (7 mg per cup)

• Spinach (6 mg per cup)

• Sesame seeds and tahini (5 mg per ¼ cup, or a whopping 20 mg per cup)

• All types of beans and chickpeas (4 mg per cup)

• Olives (4 mg per cup)

• Pumpkin seeds (3 mg per ¼ cup = a small handful, or 12 mg per cup)

• Green leafy vegetables and herbs like swiss chard, beet greens, collard greens, bok choy, and parsley (2–4 mg per cup)

• Spices like cumin, chilli, and turmeric (1–2 mg per teaspoon)

• Many other vegetables like green peas, asparagus, brussels sprouts, kale, broccoli, cabbage, lettuce, squash, and fennel (1–2 mg per cup)

Heme (animal-based) iron:

• Canned sardines (2mg per can)

• Grass-fed beef or lamb (2 mg per 3.5 oz/100 g serving)

• Roasted chicken or turkey (1 mg per 3.5 oz/100 g serving)

• Eggs (1 mg per egg)

Excerpt: Dietary sources of choline

• Eggs (150 mg per egg yolk)

• Seafood: shrimp and (well-cooked!) scallops (125–150 mg per 3.5 oz/100 g serving); cod, salmon, and sardines (80–90 mg per 3.5 oz/100 g serving)

• Collard greens, brussels sprouts, and broccoli (60–70 mg per cup)

• Swiss chard, cauliflower, and asparagus (50 mg per cup)

• Peas, spinach, and cabbage (30–40 mg per cup)

• Meat: chicken and turkey (90–100 mg per 3.5 oz/100 g serving); beef (70 mg per 3.5oz/100 g serving)

• Dairy: milk or yoghurt (40 mg per cup)

• You will also get decent amounts from mushrooms, beans, squash, miso/tofu, tomatoes, and other vegetables.

BIRTH PLAN

Michelle and Victor Henning

We would love to have the most natural birth experience possible. It is extremely important to us to try and keep things as relaxed and natural as we can. Please keep the lights dim and the atmosphere calm.

We choose a home birth, but if that’s not possible, we’d like to go to:

• 1st choice: Sint Lucas Andreas Hospital

• 2nd choice: OLVG Hospital
  (Note: These are both hospitals in Amsterdam. We researched both options and asked around regarding what the atmosphere in the delivery rooms was like and what attitudes their staff had towards natural birth.)

People present at the birth:

• My husband, Victor

• My doula, Dana Lindzon

My wishes:

• Please speak English only, as we don’t speak Dutch yet.

• If we are at the hospital, no medical students attending the birth, please.

• Please don’t offer me pain relief; support me in delivering naturally instead. If I do need pain relief, I will ask.

• No medical intervention without speaking to me first, please. If I can’t speak for myself, please talk to my husband, Victor, or my doula, Dana.

• No continuous foetal heart monitoring unless medically necessary. Please don’t place a heart monitor on the baby’s head in the birth canal. I would prefer the stomach monitor. I would like to keep as mobile as possible during the birth; is there an option of wireless monitoring?

• No episiotomy.
  (Note: An episiotomy is a surgical cut between the vagina and the anus made just before delivery to avoid tearing the perineum. It’s still routine in many places, but evidence shows that it has higher infection rates and takes longer to heal than a natural tear. The World Health Organization now advises against routine episiotomies.)

• Please don’t wash the baby after delivery. Please pass her to me immediately and place her on my skin.
  (Note: This was to ensure that our baby could keep the vernix on her skin, which has several important functions and health benefits. See also “Baby Care: How We Keep Our Daughter Clean (But Not Too Clean)” in chapter 9 for more details.)

• Please delay the cord clamping until the pulsing stops. My husband, Victor, would like to feel the pulsing.
  (Note: In many places, it’s standard practice to clamp the umbilical cord immediately after birth—it was thought that this would reduce jaundice. Instead, it means that the baby loses out on valuable blood it would otherwise receive. A Swedish study found that babies whose cord clamping was delayed by at least three minutes had 45 percent more blood iron and a 90 percent lower risk of iron deficiency. In a follow-up study four years later, these children also had more advanced brain development with better social and fine motor skills. A good supply of iron is crucial for healthy immune and brain development, as you saw in chapter 7.)

• If I need a C-section for any reason, please help me to have the gentlest one I can. Please keep the lights as low as possible and place the baby on my chest as soon as possible. I would like to keep her with me at least for the first hour and to breastfeed and bond with her skin to skin as soon as I can. I want my husband with me at all times.

• After delivery, I or my husband have to be with the baby at all times.

• Please do not give the baby any medications (not even paracetamol) without checking with us first.

If you’re anything like me, words like “statistics,” “probability,” and “risk” might trigger heart palpitations and bad memories of high school maths tests. No sweat—all you need in order to understand the concept of “relative risk” is basic fifth-grade arithmetic like fractions and divisions. Let’s walk through an example so you can see for yourself!

Say we are interested in finding out whether taking antibiotics during pregnancy raises the child’s risk of developing asthma later in life. This is the question a cohort study in Copenhagen, Denmark, sought to answer by following the health outcomes of 411 babies for a period of five years after birth. Their mothers all had a history of asthma.

Sixty-three of the 411 babies were exposed to antibiotics during the third trimester of pregnancy—let’s call this the “antibiotics group.” The remaining 348 babies were not exposed to antibiotics in the womb—let’s call this the “no-antibiotics group.” The results after five years:

• Of the babies in the antibiotics group, about one in four experienced at least one asthma attack by the age of five, which means their probability of developing asthma was 25 percent.

• Of the babies in the no-antibiotics group, however, only about one in eight experienced an asthma attack by the age of five, which means a probability of 12.5 percent.

Here’s a visual summary:

Now, these percentages—25 percent asthma in the antibiotics group and 12.5 percent asthma in the no-antibiotics group—describe what’s called absolute risk: a child’s overall risk of developing asthma, depending on whether or not they were exposed to antibiotics in the womb. What if you want to compare the asthma risk between the two groups? Clearly, the risk in the antibiotics group is much higher, twice as high in this case. Researchers call this relative risk.

Relative risk is simply calculated by dividing the absolute risk of one group by the absolute risk of the other group. In this example, the relative risk is 25 percent divided by 12.5 percent = 2. This means that children exposed to antibiotics during the third trimester are two times as likely to develop asthma before the age of five. Another way of putting it is that exposure to antibiotics doubled the children’s risk of developing asthma. Here’s the summary of how you get from absolute risk to relative risk:

Let’s assume that the risk of asthma had been the same in both groups, e.g., 25 percent. Then the relative risk would be 25 percent divided by 25 percent = 1. A relative risk of 1 would mean that there is no difference between the groups and that taking antibiotics during pregnancy has no effect on the baby’s asthma risk.

And what if the risk of asthma had actually been lower in the antibiotics group? Imagine a result where 12.5 percent of children in the antibiotics group had developed asthma versus 25 percent in the no-antibiotics group. Then the relative risk would be 12.5 percent divided by 25 percent = 0.5. We would say that exposure to antibiotics during pregnancy reduces the child’s risk of developing asthma by 50 percent, or by half.

What if the relative risk isn’t a neat round number where we can say that the risk “halved” or “doubled,” e.g., what if the relative risk is 1.25? Then we would say that the risk is 1.25 times higher, or 25 percent higher, because if you multiply a number by 1.25, you increase it by 25 percent. If the relative risk is 0.75, we would say the risk is 25 percent lower, because if you multiply a number by 0.75, you decrease it by 25 percent.