Healthy eating in pregnancy
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1739 (Published 04 March 2014) Cite this as: BMJ 2014;348:g1739
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Dear Sir,
We read the BMJ Editorial “Healthy eating in pregnancy” with interest[1]. In particular, we note the photo employed in the printed edition of the BMJ which shows a smiling pregnant woman eating what appears to be a leafy salad and cheese (possibly soft cheese).
This would appear to be the archetypal healthy meal. Whether it is tasty is a different matter. Whilst this meal of salad and cheese is presented as a desirable and healthy option in pregnancy, we would like to point out that there are potentially serious microbiological risks associated with salad consumption.
There are well documented risks of bacterial gastroenteritis associated with salad consumption. For example, salads have been associated with Listeria monocytogenes, Salmonella java, Salmonellla enterica serovar typhimurium and Yersinia infections [2,3,4,5]. There is also a risk of toxoplasmosis from eating contaminated salads[6], and the German E. coli 0104 outbreak in 2011 was due to the consumption of contaminated raw sprouts.[7]
As we cannot clearly discern what type of cheese is in the pictured meal, we won't press home the risk of Listeria from that food type as salad also carries this risk.
Whilst salads are generally healthy when washed well, it is worthwhile highlighting that salad may pose health risks, particularly in those with a degree of immunosuppression, such as pregnant women.
References:
[1] Poston L. Healthy eating in pregnancy. BMJ 2014;348:g1739
[2] Cartwright E.J. Jackson K.A. Et al. Listeriosis outbreaks and associated food vehicles, United States, 1998-2008 Emerg Infect Dis 2013;19(1):1-9
[3] Gobin M, Launders N et al. National outbreak of Salmonella java phage type 3b variant 9 infection using paralel case-control and case-case study designs, Unite Kingdom July to October 2010. Eurosurveillance 2011;16(47):pii=20023
[4] Horby P.W. O'Brien S. J. et al. A national outbreak of multi-resistant Salmonella enterica serovar typhimurium definitive phage type (DT) 104 associated with consumption of lettuce. Epidemiol Infect 2003;130(2):169-78
[5] Macdonald E., Heier B. et al. Yersinia enterocolitica outbreask associated with ready-to-eat salad-mix, Norway, 2011. Emerg Infect Dis 2012;18(9):1496-9
[6] Jones J.L., Dubey J.P. Foodborne toxoplasmosis. Clin Infect Dis 2012;55(6:845-51
[7] Frank C, Werber D, Cramer JP et al. Epidemic profile of Shiga-toxin-producing Escherichia coli 0104:H4 outbreak in Germany. N Engl J Med 2011; 365: 1771-80.
Competing interests: No competing interests
Traditional Persian Medicine: Nutritional measures in 9th month of pregnancy
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Normal vaginal delivery is a physiologic process that encompasses labor and pain in a short period of time. Duration of delivery and the intensity of pain are considered as two main effective factors in the delivery progress. According to the Iran ministry of health report, the duration of labor is one of the main causes for priority of cesarean section to vaginal delivery near the pregnant women. The rate of c/s is higher in Iran compared to norms and standards in both developed and developing countries. Trend of c/s in Iran is increasing and has increased from 35% in 2000 to 46% in 2010. (1)
Traditional Persian medicine (TPM) as an ancient school of medicine offers many valuable suggestions in the field of marital health and delivery facilitation. In this regard, especial measures are considered for 9th month of pregnancy in pregnant women according to TPM resources. The sages of TPM believed that applying these measures would convey the delivery in a safe, easy and with less pain. (2)
Nutrition is considered as one of the most important principles of health and prevention according to the TPM approach. Rhazes mentioned that use of medicines is not wise if the disease could be managed with nutritional measures. Nutritional recommendation in TPM is based on determination of mezaj (temperament) and consideration of individual characteristic such as habits, social and economical status and body stamina. Diet and nutritional measures in pregnant women should set in the way that hydrate the body and increase flexibility especially in pelvic region to facilitate delivery. To achieve body hydration and prevent dryness, using humidifying and lenient diet and abstaining astringent and dry food should be considered in the 9th month of delivery. Astringent foods increase the tone of the muscles and density of tissues, decrease joint flexibility and induce constipation in susceptible women. On the contrary, lenient, aperient and humidifying meals decrease the tone of the muscles and tissue density, increase joint flexibility and loose bowels. (3, 4)
Pregnant women should avoid astringent and dense foods or meals that are heavy for the stomach to digest. Eating tender and palatable foods is the recommended diet for women in the 9th month of pregnancy to achieve an uncomplicated easy normal vaginal delivery. The common astringent and dense foods include sour foods, beef, canned foods, sausage, mushroom, dates, lentil, cabbage, aubergine, pasta, noodle soup, fried meals and halim (recipe containing lamb, wheat and oil). Pregnant women in the 9th month should use oily, soft and aperient meals more frequently. Porridge of espidbaj is a good example of lenient soft foods. Espidbaj contains fatty meat (lamb or fatty chicken) and aperient vegetables such as spinach and coriander, and rice or barley as a mucilaginous agent. (3, 5)
Nutritional measures recommended by the Iranian sages in medieval era in accompany with the other regimens including unction, moderate physical activity, good quality normal sleep as well as using safe herbal remedies based on the pregnant women's temperament warranty uncomplicated and facilitated normal vaginal delivery. However, the efficacy and safety of these measures should be confirmed by double blind well-designed clinical trials.
1. Yasaman Vazani y-vazani@razi.tums.ac.ir Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, I.R. Iran.
2. Maryam Kashanian maryamkashanian@yahoo.com Obstetrics and Gynecology Department, Iran University of Medical Sciences, Tehran, I.R. Iran.
3. Mansoor Keshavarz mkeshavarz@tums.ac.ir Department of Physiology, School of medicine, Tehran University of Medical Sciences, Tehran, I.R. Iran.
4. Majid Nimrouzi mnimruzi@yahoo.com Department of Traditional Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
References
1. Yazdizadeh B, Nedjat S, Mohammad K, Rashidian A, Changizi N, Majdzadeh R. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Serv Res. 2011;11:159.
2. Kharazmshahi JIZ-y. in Persian. Edited by Dr MR Mohhareri Tehran: Academy of Medical Sciences of IR Iran. 2002.
3. Avicenna H. Ghanoon Dar Teb [The Canon of Medicine], Bulaq Edition. Sharafkandi A, trans Tehran: Univ of Tehran Pr. 1978.
4. Jorjani E. Zakhire Kharazmshahi 2002.
5. MA. A. Mofareh Al-Gholub (in persian). Lahoor: salim lahoor; 1915.
Competing interests: No competing interests