A reader from Bedfordshire has followed up on the question last week about the advantages to mother and baby of fish meals, or fish oil, during pregnancy and the baby’s early life. The reader asked why I hadn’t discussed other foods of value. What else should she be taking to improve the health of her unborn child?

Besides a good all-round diet with no smoking and probably no alcohol – there is doubt about the former British advice that one or two drinks a week is harmless – the most important measure is to have additional folates. Folic acid supplements should be taken for a few weeks before conception is planned. Adequate levels of the vitamin reduce the risk to congenital malformations of the central nervous system, whereas inadequate levels at conception and after increase the likelihood that the baby will suffer from spina bifida, hydrocephalus, an abnormally small brain and other neurological defects. The usual supplementary dose is 400 micrograms, but larger doses should be taken if there is a family history of neurological birth defects.

Putting folic acid into the nation’s bread supply, as has been proposed, will be of some help for babies conceived as the result of unplanned pregnancies, but neither folic acid-enhanced bread nor a diet brimming with foods rich in it can be certain to provide enough of this vital vitamin without additional supplements.

Recent work from Aberdeen indicates that a high intake of foods rich in zinc and vitamin D and E during pregnancy reduced the incidence of asthma and allergic diseases in the children as they grew up. The study also suggests, as did research at Utrecht University, that adequate consumption of fish and apples during pregnancy reduced asthma and improved lung function in children born to mothers who had taken these foods. The result of this research was presented to the American Thoracic Society’s International Conference in San Francisco last week.

The medical properties of apples are real, not mere folklore. The work at Aberdeen and Utrecht reinforces results of other recent research that our ancestors’ faith was not misplaced. The statistics reported to the San Francisco conference indicate that having fish even once a week reduced the number of cases of eczema in children at the age of 5 by 43 per cent. The benefits of apples were more related to wheezing than itching. If the mother had four apples a week during pregnancy her children were 37 per cent less likely to be wheezing in early childhood, and 53 per cent less likely to have asthma confirmed as the cause of this wheezing. Other fruits didn’t have a marked, if any, effect on the asthma statistics.

Recent research links with the studies of Dr Eric Gershwin and Dr Carl Keen, of the University of California. This offered possible mechanisms that might account for the beneficial effect of the flavonoids, natural organic chemicals found in apples. These flavonoids have an effect on the body’s cells that could account for its benefits. An association between taking apples regularly and an improvement in chest disorders has been noted over the years.

The advantages of apples are not confined to the chest. Dr Thomas Shea, of the University of Massachusetts, has shown that they have an effect on the amount of acetylcholine, the neurotransmitter. This is the chemical that gives a proven benefit for those with a failing memory. Research on animals has demonstrated that apple juice consumption increases the amount of acetylcholine in Shea’s apple-fed mice. These had been specially bred to be prone to Alzheimer’s disease. Those given generous portions of apple remained brighter and cleverer than a control group. The equivalent dose of apples to that given to the mice in human patients would be two 8oz tumblers of apple juice, or two to three whole apples daily. Other research has indicated that apples lower cholesterol levels, increase the resistance of overtrained athletes to chest infections, and possibly reduce the incidence of malignancies.

Research workers at Glasgow University have just made a wide index of the quantities of antioxidants present in different fruits. Concord grapes, cranberries and cloudy apple juice were the winners, and all these were comparable to the amount in beaujolais (not recommended for our pregnant reader).

A reader has drawn attention to the recent World Hypertension Day that highlighted the importance of a raised blood pressure. He asks if we are doing enough to combat this leading and increasing cause of death.

There is no doubt that high blood pressure is the root cause of many strokes and heart attacks. It is also responsible for damaging other organs including the kidneys, eyes and brain. It is one of most important chronic conditions that patients face.

The increasing prevalence of high blood pressure cannot be entirely explained by suggesting that as it is a problem of old age, and as we are living longer, more people will inevitably be suffering from it. Dangerously high blood pressure can also affect people still in their thirties, forties and fifties. Other important factors accounting for its increased incidence are obesity and lack of exercise.

The NHS and NICE, the government advisory body on prescribing, have taken measures in the UK to improve treatment of high blood pressure. They have now given doctors a guide to its efficient treatment. The first measure, whatever drugs may be used, is to adjust lifestyle. This includes cutting out added salt and reducing the proportion of fat in the diet. This should help to reduce any excess weight. The patient should also take regular brisk exercise (fast walking is the best) for about 20 minutes, preferably twice daily.

Unfortunately, many of the drug regimes may involve taking more than one tablet. Patients rarely care for this and they often fail to follow instructions, although doctors realise this may be inevitable.

Fortunately, Exforge has now been introduced. This pill contains a combination of two drugs from the recommended regime. Both are frequently prescribed, well tried and proven hypotensive, blood-pressure lowering agents.

Exforge is composed of Valsartin (diovan), an angiotensin2-receptor blocker (ARB) and amlodipine, also known as Istin, a calcium channel blocker. Nigel Poulter, professor of preventive cardiovascular medicine at St Mary’s Hospital, London, says that Exforge is a logical combination of two drugs that had been evaluated in large studies. He adds that although it is important that people with high blood pressure have access to effective treatments, even if it means taking more than one tablet, it is of more benefit because more comply with the regime if the number of tablets taken every day is reduced.

It has been shown that Exforge reduces blood pressure by 30 to 36mmHg, the aim being to reduce it to under 130/85. Combining these two drugs has the advantage that, unlike taking amalodipine alone, it is less likely to cause ankle swelling. This side-effect is reduced by 54 per cent.

Ask Dr Stuttaford

Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.