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Biological Mechanisms for Nutritional Regulation of Maternal Health and Fetal Development
Abstract
This review paper highlights mechanisms for nutritional regulation of maternal health and fetal development. Malnutrition (nutrient deficiencies or obesity) in pregnant women adversely affects their health by causing or exacerbating a plethora of problems, such as anaemia, maternal haemorrhage, insulin resistance, and hypertensive disorders (e.g. pre-eclampsia/eclampsia). Maternal malnutrition during gestation also impairs embryonic and fetal growth and development, resulting in deleterious outcomes, including intrauterine growth restriction (IUGR), low birthweight, preterm birth, and birth defects (e.g. neural tube defects and iodine deficiency disorders). IUGR and preterm birth contribute to high rates of neonatal morbidity and mortality. Major common mechanisms responsible for malnutrition-induced IUGR and preterm birth include: (i) abnormal growth and development of the placenta; (ii) impaired placental transfer of nutrients from mother to fetus; (iii) endocrine disorders; and (iv) disturbances in normal metabolic processes. Activation of a series of physiological responses leading to premature and sustained contraction of the uterine myometrium also results in preterm birth. Recent epidemiologic studies have suggested a link between IUGR and chronic metabolic disease in children and adults, and the effects of IUGR may be carried forward to subsequent generations through epigenetics. While advanced medical therapies, which are generally unavailable in low-income countries, are required to support preterm and IUGR infants, optimal nutrition during pregnancy may help ameliorate many of these problems. Future studies are necessary to develop effective nutritional interventions to enhance fetal growth and development and alleviate the burden of maternal morbidity and mortality in low- and middle-income countries.
... There is a well-established association between the perinatal environment and potential future disease [5][6][7][8][9][10][11]. Adequate maternal nutrition is crucial for fetal growth and development [12,13]. It supports the physiological demands of the body to support the placenta and offspring during pregnancy [12]. ...
... There is a well-established association between the perinatal environment and potential future disease [5][6][7][8][9][10][11]. Adequate maternal nutrition is crucial for fetal growth and development [12,13]. It supports the physiological demands of the body to support the placenta and offspring during pregnancy [12]. Pregnant women with a history of MBS have been found to experience micronutrient deficiencies [14][15][16][17][18][19], with the most common being vitamin B 12 and D deficiencies [20]. ...
... It supports the physiological demands of the body to support the placenta and offspring during pregnancy [12]. Pregnant women with a history of MBS have been found to experience micronutrient deficiencies [14][15][16][17][18][19], with the most common being vitamin B 12 and D deficiencies [20]. A recent systematic review revealed the association between bariatric surgery and pregnancy complications such as low gestational weight gain, which affects neonatal weight [21]. ...
Metabolic bariatric surgery (MBS) helps reduce comorbidities, such as hypertension and gestational diabetes, and is more effective than diet management for women with obesity-related health issues. Vitamin B12, vitamin D, and iron play important roles in ensuring the health of a neonate. However, pregnancies occurring after MBS may face complications related to micronutrient deficiencies, particularly of vitamins B12 and D and iron. This study aimed to investigate the vitamin B12, vitamin D, ferritin, and iron status of pregnant women who underwent MBS compared with women without MBS history. The study included 217 pregnant women (105 with a history of MBS and 112 without a history of MBS) who visited a major maternity hospital in Abu Dhabi, United Arab Emirates (UAE) between July 2021 and November 2022. The maternal vitamin B12, vitamin D, iron, and ferritin levels were measured twice, initially during the first or second trimester and subsequently during the third trimester. The iron was measured once during the pregnancy. Vitamin B12 deficiency was higher among pregnant women with MBS history compared to non-bariatric pregnant women (24.4% vs. 3.9%, p < 0.001). Women with a history of MBS had a higher prevalence of vitamin D deficiency (62.3% vs. 37.7%, p < 0.002). Linear regression analysis indicated that vitamin B12 levels decreased by 55 pg/mL in women with a history of MBS and by 4.6 pg/mL with a unit increase in body mass index (kg/m2). Furthermore, vitamin D levels in women with a history of MBS decreased by 4.9 ng/mL during pregnancy. Metabolic bariatric surgery is associated with vitamin B12, vitamin D, and iron deficiencies during pregnancy.
... It is noteworthy that whereas total protein was not low in the study, the amount of high-quality protein may be an issue and may lead to deficiencies in critical amino acids for women during pregnancy. Animal protein foods such as fish, meat, eggs, and dairy are important sources of essential amino acids, iron, folate, vitamin B-12, PUFAs such as DHA, and calcium, which play important roles in fetal growth and development (28). Amino acids regulate key metabolic Animal protein intake and adverse birth outcomes 3 pathways; they also serve as precursors for the synthesis of nitrogenous substances such as NO (28,29). ...
... Animal protein foods such as fish, meat, eggs, and dairy are important sources of essential amino acids, iron, folate, vitamin B-12, PUFAs such as DHA, and calcium, which play important roles in fetal growth and development (28). Amino acids regulate key metabolic Animal protein intake and adverse birth outcomes 3 pathways; they also serve as precursors for the synthesis of nitrogenous substances such as NO (28,29). Low maternal dietary protein intake means that specific amino acids may be deficient in both mother and fetus (29). ...
... Low maternal dietary protein intake means that specific amino acids may be deficient in both mother and fetus (29). A deficiency in arginine, for example, may cause preterm labor by stimulating the uterine myometrium due to the reduced bioavailability of NO (28). Iron, folate, and vitamin B-12 are crucial in erythropoiesis (30). ...
Background
The prevalence of adverse birth outcomes is highest in resource-limited settings such as sub-Saharan Africa. Maternal consumption of diets with adequate nutrients during pregnancy may protect against these adverse outcomes.
Objective
To determine the association between maternal dietary animal source foods (ASF) consumption and the risk of adverse birth outcomes among HIV-negative pregnant women in Tanzania.
Methods
Using dietary intake data from 7564 HIV-negative pregnant, we used Poisson regression with the empirical variance (GEE) to estimate the relative risk (RR) of adverse birth outcomes (preterm birth, very preterm birth, small for gestation age (SGA), low birth weight (LBW), stillbirth and neonatal death) for higher versus lower ASF frequency of intake.
Results
Median (interquartile range) daily dietary intake of animal protein was 17 (1-48) grams. Higher ASF protein intake frequency was associated with lower risk of neonatal death (Q4 vs Q1 RR: 0.59; 95% CI: 0.38, 0.90; P for trend = 0.01). Higher fish intake was associated with lower risk of very preterm birth (high vs low tertile RR: 0.76; 95% CI: 0.58, 0.99; P for trend = 0.02). Meat intake was protective of preterm birth (RR = 0.73; 95% CI: 0.65, 0.82; P<0.001), very preterm birth (P<0.001), LBW (P<0.001), and neonatal death (P = 0.01) but associated with increased risk of SGA (RR = 1.19; 95% CI: 1.01, 1.39; P = 0.04). Any egg intake was protective of very preterm birth (RR = 0.52; 95% CI: 0.32, 0.86; P = 0.01) compared to no egg intake. Finally, dairy intake was associated with lower risk of preterm birth (RR = 0.82; 95% CI: 0.68, 0.98; P = 0.03) and very preterm birth (RR = 0.53, 95% CI: 0.34, 0.84; P = 0.01).
Conclusions
Higher frequency of dietary intake of ASF is associated with lower risk of adverse birth outcomes in urban Tanzania. Promoting prenatal dietary intake of ASF may improve birth outcomes in this region and similar resource-limited settings.
Clinical Trial Registry Number: NCT00197548.
... Intrauterine embryo growth is affected by maternal nutrition, systemic metabolism, and endocrine signals (1)(2)(3)(4)(5). Malnutrition, in particular a diet poor in protein or severe caloric restriction, can cause intrauterine growth retardation (IUGR) leading to infants that are born small-for-gestational age (SGA), i.e., their birth weight is within the lowest decile of the population. ...
... Malnutrition, in particular a diet poor in protein or severe caloric restriction, can cause intrauterine growth retardation (IUGR) leading to infants that are born small-for-gestational age (SGA), i.e., their birth weight is within the lowest decile of the population. Infants that are SGA are at higher risk of developing obesity and metabolic diseases later in life (2,3,(5)(6)(7)(8)(9). Clinical studies and studies in animal models of IUGR showed that the intrauterine environment can adversely affect pancreatic development, reduce β cell mass and function (10,11), and cause abnormalities in placental development and its ability to support embryonic growth (1,(12)(13)(14). ...
... Caloric restriction and protein deficiency can lead to IUGR and a reduction in β cell mass and function in rodents (5,6,10,11), possibly since fetal islets secrete insulin in response to amino acids (54,55). SG-operated mice, however, gained weight normally during pregnancy and had the same weight as sham-operated mice at term. ...
Mothers that underwent bariatric surgery are at higher risk for delivering a small-for-gestational age (SGA) infant. This phenomenon is attributed to malabsorption and rapid weight loss following surgery. We compared pregnancy outcomes in lean mice that underwent sham surgery or sleeve gastrectomy (SG). SG led to a reduction in glucose levels and an increase in postprandial levels of glucagon-like peptide 1 (Glp1) without affecting mice weight during pregnancy. Pups of SG-operated mice (SG pups) were born SGA. The placenta and pancreas of the pups were not affected by SG, although a high-fat diet caused hepatic steatosis and glucose intolerance in male SG pups. Treatment with a Glp1 receptor antagonist during pregnancy normalized the birth weight of SG pups and diminished the adverse response to a high-fat diet without affecting glucose levels of pregnant mice. The antagonist did not affect the birth weight of pups of sham-operated mice. Our findings link elevated Glp1 signaling, rather than weight loss, to the increased prevalence of SGA births following bariatric surgery with metabolic consequences for the offspring. The long-term effects of bariatric surgery on the metabolic health of offspring of patients require further investigation.
... One possible explanation could be the chronic adaptation of the body to a malnourished state might have reduced the vulnerability of women with AN during pregnancy. Maternal anaemia, postpartum haemorrhage, and hypertensive disorders such as pre-eclampsia have been reported in studies of malnourished pregnant women [49]. Maternal anaemia is associated with iron deficiency [49]. ...
... Maternal anaemia, postpartum haemorrhage, and hypertensive disorders such as pre-eclampsia have been reported in studies of malnourished pregnant women [49]. Maternal anaemia is associated with iron deficiency [49]. Hypertensive disorders are associated with inadequate calcium intake [50]. ...
... IUGR has been found to be associated with maternal undernutrition [49], which concurs with the most reported fetal complication in pregnancies of women with active AN. It is unclear whether IUGR in women with active AN is a result of nutritional undersupply, placental failure, or both. ...
Background
It is a common misconception that women with active anorexia nervosa (AN) are less likely to conceive. Pregnancies in women with AN are considered high risk. The purpose of this systematic review was to explore pregnancy complications in women with active AN, including maternal, fetal, and neonatal complications.
Methods
The authors conducted a systematic review in accordance with PRISMA statement guidelines with stringent selection criteria to include studies on patients with active AN during pregnancy.
Results
There were 21 studies included in our review. Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.
Discussion
Women with active AN have a different profile of pregnancy complications comparing to malnourished women and women in starvation. We recommend early discussion with women diagnosed with AN regarding their fertility and pregnancy complications. We recommend clinicians to aim to improve physical and psychological symptoms of AN as well as correction of any nutritional deficiency ideally prior to conception. Management of pregnancies in women with active AN requires regular monitoring, active involvement of obstetricians and psychiatrist. Paediatric follow-up postpartum is recommended to ensure adequate feeding, wellbeing and general health of the infants. Psychiatric follow-up is recommended for mothers due to risk of worsening symptoms of AN during perinatal period.
... During early infancy, these needs are covered by breast milk or by infant formula. The diet of the pregnant and lactating mother has to provide enough nutrients for fetal and infant growth and development, while still fulfilling her own needs (1). Adequate status of the nutrients iodine and selenium are essential for thyroid function (2,3). ...
... One individual can be present in supplement group during pregnancy, but in non-supplement group during lactation. 1 Adjusted to the mothers mean urinary specific gravity (SGmean = 1.017). 2 Adjusted to the infants mean urinary specific gravity (SGmean = 1.004). ...
... Test between two groups per time was made with Mann-Whitney U test and significant differences between groups are presented with matching letters in superscript. 1 Non- Table Salt includes use of Flake Salt/Coarse sea Salt, Rock Salt (e.g., Himalayan Salt), Mineral Salt (low in Sodium e.g., Seltin) or Other Salt. 2 Adjusted to the mothers mean urinary specific gravity (SGmean = 1.017). 3 Adjusted to the infants mean urinary specific gravity (SGmean = 1.004). ...
Iodine and selenium are essential trace elements. Recent studies indicate that pregnant and lactating women often have insufficient intake of iodine and selenium, but the impact on fetal and infant status is unclear. Here, we assessed iodine and selenium status of infants in relation to maternal intake and status of these trace elements in the birth cohort NICE, conducted in northern Sweden ( n = 604). Iodine was measured in urine (UIC) in gestational week 29, and in breast milk and infant urine 4 months postpartum, while selenium was measured in maternal plasma and erythrocytes in gestational week 29, and in breast milk and infant erythrocytes 4 months postpartum, in both cases using ICP-MS. Maternal intake was assessed with semi-quantitative food frequency questionnaires in gestational week 34 and at 4 months postpartum. The median intake of iodine and selenium during pregnancy (98 and 40 μg/d, respectively) and lactation (108 and 39 μg/d, respectively) was below recommended intakes, reflected in insufficient status (median UIC of 113 μg/L, median plasma selenium of 65 μg/L). Also, breast milk concentrations (median iodine 77 μg/L, median selenium 9 μg/L) were unlikely to meet infant requirements. Median UIC of the infants was 114 μg/L and median erythrocyte selenium 96 μg/kg, both similar to the maternal concentrations. Infant UIC correlated strongly with breast milk levels (rho = 0.64, p < 0.001). Their erythrocyte selenium correlated with maternal erythrocyte selenium in pregnancy (rho = 0.38, p < 0.001), but not with breast milk selenium, suggesting formation of prenatal reserves. Our results indicate that the transport of iodine and selenium to the fetus and infant is prioritized. Still, it is uncertain whether most infants had sufficient intakes. Further, the results might indicate an involvement of iodine in asthma development during the first year of life, which is essential to follow up. The low maternal and infant dietary intake of both iodine and selenium, especially when the mothers did not use supplements or iodized table salt, suggest a need for a general screening of women and young children.
... WRA (15-49 years) are of special concern given the role of preconception and pregnancy nutrition on foetal outcomes. Malnutrition in the preconception period can increase the risk of adverse foetal outcomes and negatively affect placental development and function (King, 2016;Wu et al., 2012). Preconception folate status is of particular concern as deficiency can increase the risk of neural tube defects (King, 2016). ...
... Preconception folate status is of particular concern as deficiency can increase the risk of neural tube defects (King, 2016). On the other hand, nutrient deficiencies during pregnancy increase the risk of adverse birth outcomes, including neural tube defects, cretinism, intrauterine growth restriction (IUGR), low birthweight (LBW) and preterm birth (Wu et al., 2012). Similarly, nutrition plays an important role in maternal health during delivery, including survival from haemorrhage, hypertension disorders of pregnancy, anaemia and obstructed labour (Wu et al., 2012). ...
... On the other hand, nutrient deficiencies during pregnancy increase the risk of adverse birth outcomes, including neural tube defects, cretinism, intrauterine growth restriction (IUGR), low birthweight (LBW) and preterm birth (Wu et al., 2012). Similarly, nutrition plays an important role in maternal health during delivery, including survival from haemorrhage, hypertension disorders of pregnancy, anaemia and obstructed labour (Wu et al., 2012). ...
In rural Bangladesh, intake of nutrient-rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity, consumption of specific food groups and markers of nutritional status, including underweight [body mass index (BMI) < 18.5 kg/m2 ], overweight (BMI ≥ 23 kg/m2 ) and anaemia (haemoglobin < 120 g/dl) among WRA in Bangladesh. This analysis used data from the third round of a longitudinal observational study, collected from February through May of 2017. Dietary data were collected with a questionnaire, and Women's Dietary Diversity Score (WDDS) was calculated. Associations between WDDS, food group consumption and markers of nutritional status were assessed with separate adjusted logistic regression models. Among WRA, the prevalence of underweight, overweight and anaemia was 13.38%, 40.94% and 39.99%, respectively. Women who consumed dark green leafy vegetables (DGLV) or eggs were less likely to be anaemic or underweight, respectively, and women who consumed ASFs, particularly fish, were less likely to be underweight compared with women who did not consume these foods. WDDS did not show any consistent relationship with WRA outcomes. Interventions that focus on promoting optimal nutritional status among WRA in Bangladesh should emphasise increasing consumption of specific nutrient-rich foods, including ASFs, DGLV and eggs, rather than solely focusing on improving diet diversity in general.
... Anaemia is known to be a significant predictor of malnutrition among pregnant mothers as iron deficiency type is apparently the most prevalent cause of anaemia during gestation (21). As anaemia causes inadequate oxygen and nutrient supply to the foetus during the late stage of pregnancy (22,23), it could lead to deficient supply of these nutrients to the foetus which subsequently causes death of the foetus either inutero or within short period after birth (24). This study also found that self-employed mothers have increased odds of stillbirth delivery. ...
... Coincidentally, large proportion of these mothers who served as possible predictors of stillbirths (thus self-employed mothers and mothers who did not use insecticide-treated bed nets) made less than eight ANC visits and had anaemia during each trimester of pregnancy. This implies that, lesser ANC visits and low haemoglobin levels in each trimester during pregnancy could precipitate unfavourable intra-uterine and gestational conditions (22,23) leading to an increased maternal risk for stillbirths delivery (27,28) in the study area. ...
Background
Stillbirths during pregnancy do not only trigger maternal psychological trauma but also affect the economic growth in developing countries. Since the predictors of stillbirths and their dynamics are diverse in different settings, it requires adequate knowledge to mitigate these predictors in reducing perinatal deaths in Ghana. This study aimed to determine the prevalence and determinants of stillbirths in a referral hospital in Northern Region of Ghana.
Methods
This study is a portion of a retrospective cohort study conducted from April to July 2020 in Savelugu municipality of Northern Ghana. Sociodemographic and obstetric data were collected using a structured questionnaire from antenatal and delivery records. We used binary logistic regression to identify independent predictors of stillbirths.
Results
Four percent (4.0%) of the 422 deliveries were stillborns. Anaemia in the first trimester of pregnancy (aOR: 3.15; 95%CI: 0.94 - 10.6; p=0.034), self-employed mothers (aOR: 7.75; 95%CI: 2.33 - 25.8; p=0.018), and non-use of insecticide-treated bed nets during pregnancy (aOR: 12.9; 95%CI: 1.55 - 107; p=0.001) were independent predictors of stillbirths.
Conclusion
The relatively high stillbirth prevalence at the referral facility is affected by gestational anaemia and lifestyle factors including non-use of insecticide-treated bed nets and self-employed jobs. Management of Savelugu Municipal Hospital (Ghana Health Service), program planners, and other stakeholders who are engaged in improving perinatal and maternal health should be made aware of these predictors in order to reduce the stillbirth rate and its psychological effect on families in Savelugu.
... Maternal nutritional status during pregnancy is essential for both maternal and fetal health. Of particular importance are micronutrients such as folate acid, iron, calcium, and zinc, all of which are considered to be positively related to fetal brain development (Wu et al., 2012;Parisi et al., 2019). However, it has been suggested that diet alone may not fully meet the heightened nutritional requirements during pregnancy (Wu et al., 2012;Mousa et al., 2019). ...
... Of particular importance are micronutrients such as folate acid, iron, calcium, and zinc, all of which are considered to be positively related to fetal brain development (Wu et al., 2012;Parisi et al., 2019). However, it has been suggested that diet alone may not fully meet the heightened nutritional requirements during pregnancy (Wu et al., 2012;Mousa et al., 2019). Furthermore, micronutrient deficiencies are common during pregnancy, especially in resource-poor environments and in low-and middle-income countries (Keats et al., 2019;Lander et al., 2019;Parisi et al., 2019). ...
Objectives: This study aimed to assess the prevalence of trimester-specific dietary supplements (DS)s use and their possible correlates during pregnancy.
Method: Pregnant women were convenience sampled and recruited from a comprehensive obstetric care center in Shanghai, China. Data relating to the use of DS during pregnancy, social support and other social-demographic and obstetric data were collected. Trimester-specific DS use and factors related DS were explored.
Results: Of the 2803 women participating in this study, 94.8%, 96.2%, 93.8%, and 94.4% reported the use of at least one DS during pregnancy (all trimesters) and in the first, second, and third trimesters of pregnancy, respectively. Significant differences were noted in the use of DS containing folic acid, calcium, iron, vitamins, and docosahexaenoic acid (DHA), during the three trimesters of pregnancy. A higher proportion of DS use was negatively associated with certain categories of pregnant woman, including unemployed/housewife, low education level, obese, and low social support. A positive association was identified with gestational age.
Conclusion for practice: Considering the high prevalence of DS use during pregnancy, future studies are needed to evaluate the accuracy and suitability of DS usage during pregnancy.
... Maternal diet during the periconceptional, pregnancy and lactation period is important for both mother and child [1,2], and specifically, the fatty acid (FA) levels play a crucial role during pregnancy [3][4][5]. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are specially critical regarding central nervous system, retinal photoreceptors, and immune systems development [6]. Correct concentrations (or status) both in the first trimester (T1) and the third trimester (T3) of pregnancy are of great importance considering their role during the onset of neurogenesis [7,8], and the fetal brain development [8]. ...
... Adequate levels of FAs in T1 are of great importance considering the part they play in the onset of neurogenesis [7,8]. EPA and DHA are particularly critical for supporting the development of the central nervous system, retinal photoreceptors and immune system [6]. Nevertheless, few investigations have reported reference intervals for serum individualized FA concentrations, mainly due to the technical complexity of FAs evaluation compared to other nutrients or biomarkers. ...
In the course of pregnancy, increasing importance is being placed on maintaining optimal fatty acid (FA) levels and particularly n-3 PUFAs to ensure correct fetal development. However, reference ranges for FA have been reported in only a few studies. Our objective is to provide quantitative reference intervals for SFAs, MUFAs, and PUFAs (n-6 and n-3) in a large population of healthy pregnant women from a developed country. A prospective study of pregnant women (n = 479) was conducted from the first trimester (T1) to the third trimester (T3). A total of 11 fatty acids were analyzed in serum by gas chromatography-mass spectrometry and were expressed as absolute (µmol/L) and relative (percentage of total FA) concentration units. Serum concentrations of SFAs, MUFAs, n-6 PUFAs, n-3 PUFAs, various FA ratios, and the EFA index were determined. The reference intervals (2.5/97.5 percentiles) in absolute values from T1 ranged from 1884.32 to 8802.81 µmol/L for SFAs, from 959.91 to 2979.46 µmol/L for MUFAs, from 2325.77 to 7735.74 µmol/L for n-6 PUFAs, and from 129.01 to 495.58 µmol/L for n-3 PUFAs. These intervals mainly include the values of other studies from European populations. However, reference ranges vary according to some maternal factors. The FA levels proposed, obtained from a large sample of pregnant women, will be a useful tool for assessing the degree of adequacy of FAs in pregnant women and will help to carry out dietary interventions based on certain maternal factors.
... To date, the government of Nepal hasn't addressed the impacts of the covid-19 outbreak on maternal health, which can be more impactful than the disease itself. 11,24 Still, no specific provision has been made for expectant mothers or those in their postpartum period on how they can access the hospitals and receive maternal health care services in this crisis. Reports have shown that there was a 200 percent increase in maternal deaths as a result of restricted access to essential healthcare services during the COVID-19 lockdown compared to the epidemic itself. ...
The COVID-19 pandemic has affected the healthcare system worldwide, and maternal healthcare is no exception. Nepal, a low-income country with a high maternal mortality rate, faces unique challenges in providing adequate maternal healthcare during the pandemic. The pandemic has resulted in decreased access to maternal healthcare services, with pregnant women facing barriers to accessing antenatal care, delivery, and postpartum care. The pandemic has also exacerbated existing inequalities, with marginalized groups and rural communities being disproportionately affected. The COVID-19 pandemic has highlighted the need for Nepal to prioritize maternal healthcare, particularly in the context of a public health crisis. This article presents the impact of the COVID-19 pandemic on maternal healthcare in Nepal, focusing on the challenges faced by pregnant women.
... The increased production of NO caused by the accumulation of L-arginine may lead to the delayed initiation of labor (Wu et al., 2012). In addition to being a precursor for NO synthesis, L-arginine also plays an important regulatory role in the function of immune cells. ...
Background
Arginase 1 (Arg1) encodes a key enzyme that catalyzes the metabolism of arginine to ornithine and urea. In our recent study, we found that knockdown of Arg1 in the lungs of fetal mice induces apoptosis of epithelial cells and dramatically delays initiation of labor. As the most abundant internal mRNA modification, N ⁶ ‐methyladenosine (m ⁶ A) has been found to play important roles in lung development and cellular differentiation. However, if the knockdown of Arg1 affects the RNA m6A modification in fetal lungs remains unknown.
Methods
In the current study, the RNA m6A levels and the expression of RNA m6A related enzymes were validated in 13.0 dpc fetal lungs that Arg1 was knocked down by adeno‐associated virus carrying Arg1‐shRNA, using western blot, immunofluorescence, and RT‐qPCR.
Results
No statistical differences were found in the expression of methyltransferase, demethylases, and binding proteins in the fetal lungs between AAV‐shArg1‐injected mice and AAV‐2/9‐injected mice. Besides, there is no significant change of overall RNA m6A level in fetal lungs from AAV‐shArg1‐injected mice, compared with that from AAV‐2/9‐injected mice.
Conclusions
These results indicate that arginase 1 does not affect RNA m6A methylation in mouse fetal lung, and the mechanisms other than RNA m6A modification underlying the effects of Arg1 knockdown on the fetal lung development and their interaction with labor initiation need to be further explored.
... According to Black RE et al., maternal undernutrition in low-and middle-income countries (LMICs) significantly hinders successful pregnancy outcomes, contributing to 800,000 neonatal deaths annually [56]. Wu et al., discovered that maternal malnutrition during gestation impairs embryonic and fetal growth, leading to adverse outcomes such as intrauterine growth restriction (IUGR), low birthweight, preterm birth and birth defects (e.g., neural tube defects and iodine deficiency disorders) [57]. Encouraging supplements and fortified foods ensures adequate nutrient supply for both mother and fetus [58]. ...
ABSTRACT Congenital heart defects (CHDs) contribute significantly to heightened infant mortality rates. This review explores the intricate link between maternal infections and CHDs, emphasizing diverse factors influencing fetal development, such as bacterial, fungal, protozoan and viral agents. These infections pose reproductive health risks, potentially leading to complications like prematurity, stillbirth and heart defect to the fetus. The TORCH acronym (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex) identifies infectious teratogens related to congenital issues, emphasizing vertical transmission through the placenta or ascending from the vagina. Rubella and Cytomegalovirus play a significant role in heart defects, particularly when maternal infections amplify CHD risk during pregnancy. Specific scrutiny is placed on Rubella and Cytomegalovirus for their impact on pregnancy outcomes and potential links to congenital heart defects, with preventive strategies discussed, including vaccination and antiviral therapy. The timing and severity of these infections are pivotal in determining their impact on fetal heart development. Environmental exposures and maternal nutrition are critical factors influencing fetal development. Maternal undernutrition in low- and middle-income countries associates with adverse pregnancy outcomes, including congenital heart defects. Emphasizing the importance of maintaining a nutritious maternal diet, rich in essential nutrients, is crucial for improved fetal health and successful pregnancy outcomes. This review offers insights into preventive measures and underscores the need for continued research to enhance prenatal care strategies.
... Ibu hamil yang mengalami KEK memiliki risiko melahirkan bayi dengan berat lahir rendah (BBLR) dan cenderung melahirkan prematur (Guoyao, 2012 Kesehatan, Vol. 12, No. 2, 2023, Hal, 105-119 e-ISSN : 2715 Kesehatan, Vol. 12, No. 2, 2023, Hal, 105-119 e-ISSN : 2715-9957 p-ISSN: 2354 Sehubungan dengan uraian diatas, maka pada penelitian ini akan mengamati efek formulasi nutraseutikal jelly drink kombinasi ekstrak daun kelor dan temulawak sebagai antistunting pada ibu hamil dengan mengunakan hewan coba mencit bunting dengan malnutrisi. ...
Stunting dapat diartikan sebagai kekurangan gizi kronis atau kegagalan pertumbuhan dimasa lalu dan digunakan sebagai indikator jangka panjang untuk gizi kurang pada anak yang dapat terjadi sejak proses kehamilan. Oleh karena itu diperlukan alternatif lain dengan dari bahan alam seperti Daun Kelor (Moringa oleifera L) dan Rimpang Temulawak (Curcuma zanthorrhiza L) yang di formulasikan dalam bentuk jelly drink sebagai nutrasetikal. Penelitian ini bertujuan untuk mengetahui aktivitas antistunting dari jelly drink kombinasi ekstrak daun kelor dan temulawak pada mencit dengan gizi buruk. Penelitian ini menggunakan metode randomized pre test post test control group design dan menggunakan 28 mencit bunting malnutrisi, dibagi menjadi 7 kelompok dengan 4 mencit/kelompok. Dalam pengobatan kelompok diberi Nutraceutical ekstrak daun kelor dengan dosis 720; 850 dan 1000 mg/hari selama 19-21hari kehamilan. Parameter yang dianalisis adalah berat badan dan tinggi badan fetus. Hasil penelitian menunjukkan bahwa pemberian jelly drink dengan dosis 1000mg/hari dapat meningkatkan berat badan dan tinggi badan fetus secara signifikan (p<0,05). Berdasarkan hasil penelitian ini di simpul kan bahwa Nutraseutikal jelly drink kombinasi daun kelor dan temulawak memiliki aktivitas antistunting. Kata kunci: Malnutrisi, stunting , daun kelor, temulawak , mencit.
... The maternal dietary nutrition status throughout pregnancy has long-term consequences on maternal and offspring health [1]. Maternal gestational diabetes mellitus (GDM), gestational hypertension, intrauterine growth restriction of the fetus, abnormal neurocognitive development, congenital defects [2], macrosomia [3], obesity [4], and offspring allergy [5] can all be caused by inadequate or excessive nutrition during pregnancy. Therefore, suitable dietary guidance throughout pregnancy is important to ensure a balanced nutrient intake for pregnant women and sustain the mother's and offspring's health [6]. ...
Background
The dietary nutritional status of pregnant women is critical for maintaining the health of both mothers and infants. Food exchange systems have been employed in the nutritional guidance of patients in China, although their application in the dietary guidance of healthy pregnant women is quite limited. This study aimed to develop a novel food exchange system for Chinese pregnant women (NFES-CPW) and evaluate the relative validation of its application.
Methods
NFES-CPW covers approximately 500 types of food from ten categories and has more elaborate food portion sizes. It established a recommendation index for guiding food selection and used energy, water content, and protein as the exchange basis to balance the supply of energy and important nutrients throughout pregnancy. Furthermore, dietitians used the NFES-CPW and traditional food exchange system to generate new recipes based on the sample recipe. There were 40 derived recipes for each of the two food exchange methods. The food consumption, energy, and key nutrients of each recipe were calculated, and the differences between the two food exchange systems were compared using the Wilcoxon rank sum test or the Chi-square test.
Results
The results revealed that compared to those derived from traditional food exchange system, the NFES-CPW derived recipes had a better dietary structure, as evidenced by the intakes of whole-grain cereals, beans excluding soybeans, potatoes, fruits, fish, shrimp and shellfish, as well as eggs (P < 0.05), which were more conducive to reaching the recommended range of balanced dietary pagoda. After calculating energy and nutrients, although these two food exchange systems have similar effects on the dietary energy and macronutrient intake of pregnant women, the intake of micronutrients in NFES-CPW derived recipes was significantly higher than that from the traditional food exchange system, which was more conducive to meeting the dietary requirements of pregnant women. The outstanding improvement are primarily vitamin A, vitamin B2, folic acid, vitamin B12, vitamin C, calcium, iron, and iodine (P < 0.05). Moreover, when compared to recipes obtained from the traditional food exchange system, the error ranges of energy and most nutrients were significantly reduced after employing the NFES-CPW.
Conclusions
Therefore, NFES-CPW is an appropriate tool that adheres to Chinese dietary characteristics and can provide suitable dietary guidance to pregnant women.
... Balanced ω-3 and ω-6 PUFA supplementation during pregnancy is essential to maintain stable metabolic activities [9••, 117]. DHA is highly concentrated in the gray matter of brain and retina lipids [117]. DHA exerts a wide range of biological activities like membrane function, differentiation of photoreceptor cells, activation of rhodopsin, functioning of ion channels, neurogenesis, and metabolism of neurotransmitters. ...
Docosahexaenoic acid and eicosapentaenoic acid are the two essential long-chain ω-3 polyunsaturated fatty acids (ω-3 PUFAs) promoting human health which are obtained from diet or supplementation. The eicosanoids derived from ω-6 and ω-3 PUFAs have opposite characteristics of pro- and anti-inflammatory activities. The proinflammatory effects of ω-6 PUFAs are behind the pathology of the adverse health conditions of PUFA metabolism like cardiovascular diseases, neurological disorders, and inflammatory diseases. A balanced ω-6 to ω-3 ratio of 1–4:1 is critical to prevent the associated disorders. But due to modern agricultural practices, there is a disastrous shift in this ratio to 10–20:1. This review primarily aims to discuss the myriad health potentials of ω-3 PUFAs uncovered through recent research. It further manifests the importance of maintaining a balanced ω-6 to ω-3 PUFA ratio.
ω-3 PUFAs exhibit protective effects against diabetes mellitus–associated complications including diabetic retinopathy, diabetic nephropathy, and proteinuria. COVID-19 is also not an exception to the health benefits of ω-3 PUFAs. Supplementation of ω-3 PUFAs improved the respiratory and clinical symptoms in COVID-19 patients.
ω-3 PUFAs exhibit a variety of health benefits including anti-inflammatory property and antimicrobial property and are effective in protecting against various health conditions like atherosclerosis, cardiovascular diseases, diabetes mellitus, COVID-19, and neurological disorders. In the present review, various health potentials of ω-3 PUFAs are extensively reviewed and summarized. Further, the importance of a balanced ω-6 to ω-3 PUFA ratio has been emphasized besides stating the diverse sources of ω-3 PUFA.
... Poor nutrition of pregnant women adversely affects growth of foetus and contributes to intrauterine growth retardation (IUGR) and low birth weight (LBW) and this in turn increases the occurrence of a wide range of metabolic disorders and chronic diseases when adults [10,11]. It is postulated that a mechanism for survival results in the adaptation of IUGR foetus or offspring to in vitro or extrauterine environments with evolutionary advantages for survival, resulting in inappropriate programme offspring with adverse consequences in adulthood [12]. Today, under nutrition in early childhood is recognised to be an important factor for increasing the chances of adult-onset chronic diseases such as diabetes, cardiovascular diseases, etc. with negative impact on work capacity, health expenditure and earnings. ...
Implications of child undernutrition is not limited to adverse impact on physical growth but on optimum brain growth, mental health and cognitive development. The adverse effects of micronutrient deficiencies in mothers and children are serious with impact on morbidity, mortality, anemia, school performance, overall productivity and national development. Only in the last two decades, studies on the month-wise trend in the prevalence rate of child undernutrition in under five years has drawn attention to the fact that the stunting and underweight rate increases steadily up to 24 months, peaks at about two years of age and then stabilises. Efforts are therefore being directed to the significance of concentrating on implementation of child undernutrition preventive measure in the first 1000 days of life. As per the globally accepted conceptual framework of child malnutrition and the evidence available of effective interventions, emphasis is to ensure universal coverage of selected package of essential nutrition interventions (ENIs) and coupling these with nutrition sensitive interventions. Priority interventions in the first 1000 days comprise nutrition care package linked to antenatal care services, intensive efforts for universal adoption of appropriate infant and young child feeding practices and context specific nutrition sensitive measures .For effective implementation, special attention to mapping of the 'at risk' households having a member falling in the 1000 days window needs special attention. The contacts of health workers with antenatal care and routine child immunization services need to be effectively used for promoting appropriate maternal nutrition care and breastfeeding and complementary feeding practices in the first 1000 days of life. Along with universal coverage of 'at risk' households with ENIs, it is imperative to ensure that the context specific nutrition sensitive interventions are simultaneously addressed, as reflected in the design of India's National Nutrition Mission/Poshan2.0.
... Poor nutrition of pregnant women adversely affects growth of fetus and contributes to intrauterine growth retardation (IUGR) and low birth weight (LBW) and this in turn increases the occurrence of a wide range of metabolic disorders and chronic diseases in adults [17,18]. It is postulated that a mechanism for survival results in the adaptation of IUGR fetus or offspring to in-vitro or extra-uterine environments with evolutionary advantages for survival, resulting in inappropriate programme offspring with adverse consequences in adulthood [19]. Undernutrition in early childhood is recognised to be an important factor for increasing the chances of adult-onset chronic diseases, with negative impact on work capacity, health expenditure and earnings [3,20]. ...
The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the 'at risk' households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services.
... Poor nutrition of pregnant women adversely affects growth of foetus and contributes to intrauterine growth retardation (IUGR) and low birth weight (LBW) and this in turn increases the occurrence of a wide range of metabolic disorders and chronic diseases when adults [10,11]. It is postulated that a mechanism for survival results in the adaptation of IUGR foetus or offspring to in vitro or extrauterine environments with evolutionary advantages for survival, resulting in inappropriate programme offspring with adverse consequences in adulthood [12]. Today, under nutrition in early childhood is recognised to be an important factor for increasing the chances of adult-onset chronic diseases such as diabetes, cardiovascular diseases, etc. with negative impact on work capacity, health expenditure and earnings. ...
Implications of child undernutrition is not limited to adverse impact on physical growth but on optimum brain growth, mental health and cognitive development. The adverse effects of micronutrient deficiencies in mothers and children are serious with impact on morbidity, mortality, anemia, school performance, overall productivity and national development. Only in the last two decades, studies on the month-wise trend in the prevalence rate of child undernutrition in under five years has drawn attention to the fact that the stunting and underweight rate increases steadily up to 24 months, peaks at about two years of age and then stabilises. Efforts are therefore being directed to the significance of concentrating on implementation of child undernutrition preventive measure in the first 1000 days of life. As per the globally accepted conceptual framework of child malnutrition and the evidence available of effective interventions, emphasis is to ensure universal coverage of selected package of essential nutrition interventions (ENIs) and coupling these with nutrition sensitive interventions. Priority interventions in the first 1000 days comprise nutrition care package linked to antenatal care services, intensive efforts for universal adoption of appropriate infant and young child feeding practices and context specific nutrition sensitive measures .For effective implementation, special attention to mapping of the ’at risk’ households having a member falling in the 1000 days window needs special attention. The contacts of health workers with antenatal care and routine child immunization services need to be effectively used for promoting appropriate maternal nutrition care and breastfeeding and complementary feeding practices in the first 1000 days of life. Along with universal coverage of ‘at risk’ households with ENIs, it is imperative to ensure that the context specific nutrition sensitive interventions are simultaneously addressed, as reflected in the design of India’s National Nutrition Mission/Poshan2.0.
... 137,138 However, many studies recognized that a nutritional deficiency before or during pregnancy may adversely affect the health of the mother, 139 alter fetal growth, and alter the immune response of the mother and neonate against tetanus, 140 145,146 Similarly, the low maternal intake of omega-3 fatty acids during pregnancy has been associated with alteration in blood cytokines and increased prenatal or postnatal depression risk. 147,148 Likewise, different animal studies suggested the positive role of maternal supplementation of micronutrients and antioxidants in optimizing the immune response during pregnancy for both mother and infant. 136,149,150 It was observed that supplementation of different vitamins and minerals such as vitamin A, vitamin E, zinc sulfate, and plant extracts have pronounced effects on parturient cows in the form of reduction of parturition stress, improvement in the immune system, and rise in the quality of colostrum. ...
... Congenital defects prevalence related to malnutrition in pregnant women reached 1-10/1000 births worldwide. These congenital defects include neural tube defect, congenital heart disease, and limb or orofacial defects [38], [39]. Compared with the previous study, the incidence of congenital defects was significantly higher in chronic energy deficient pregnancy. ...
Introduction : Malnutrition in pregnant women disrupts the First Thousand Days of Life (DOL). DOL is known as the Window of Opportunity or the Golden Period, which occurs for 1000 DOL to improve children's growth and development optimally. Disturbances that arise during this period will impact the survival of the child and child’s growth and development, which is permanent. However, malnutrition in pregnant women can be prevented by early intervention. Therefore, this study aims to describe the maternal and neonatal outcomes in pregnant women with chronic energy deficiency malnutrition. Method: This research is a retrospective cohort study with a descriptive research design. Eighty-one pregnant women with malnutrition who came to Cipto Mangunkusumo Hospital from 2017 to 2020 were included. Subject characteristic, maternal and neonatal outcome were collected from the medical record. Result : Some of our subjects had moderate (26%) and severe (16%) malnutrition before pregnancy. The average weight gain is 8.78 kg, lower than the recommendation. The results of this study showed a high incidence of anemia (51,9%) and perinatal maternal complications (54,4%). The neonatal outcome showed a high incidence of congenital defects and hyaline membrane disease (p = 0.031) and NICU care (p = 0.001). The incidence of hyaline membrane disease and congenital defects is 15(18,5%) and 5(6.1%) in this study. Conclusion : Chronic energy deficiency in pregnancy could lead to significant maternal and neonatal complications. Keywords: Maternal malnutrition, chronic energy deficiency, maternal outcome, neonatal outcomes.
... 137,138 However, many studies recognized that a nutritional deficiency before or during pregnancy may adversely affect the health of the mother, 139 alter fetal growth, and alter the immune response of the mother and neonate against tetanus, 140 145,146 Similarly, the low maternal intake of omega-3 fatty acids during pregnancy has been associated with alteration in blood cytokines and increased prenatal or postnatal depression risk. 147,148 Likewise, different animal studies suggested the positive role of maternal supplementation of micronutrients and antioxidants in optimizing the immune response during pregnancy for both mother and infant. 136,149,150 It was observed that supplementation of different vitamins and minerals such as vitamin A, vitamin E, zinc sulfate, and plant extracts have pronounced effects on parturient cows in the form of reduction of parturition stress, improvement in the immune system, and rise in the quality of colostrum. ...
Pregnancy is a critical period associated with alterations in physiologic, biologic, and immunologic processes, which can affect maternal‐fetal health through development of several infectious diseases. At birth, neonates have an immature immune system that makes them more susceptible to severe viral infections and diseases. For this reason, different maternal nutritional and immunization interventions have been used to improve the immune and health status of the mother and her neonate through passive immunity. Here, we reviewed the protective role of maternal immunization with different types of vaccines, especially genetic vaccines, during pregnancy in maternal‐fetal health, immune response, colostrum quality, immune response, and anti‐oxidative status. For this purpose, we have used different scientific databases (PubMed and Google Scholar) and other official web pages. We customized the search period range from the year 2000 to 2023 using the key words “maternal immunization” OR “gestation period/pregnancy” OR “genetic vaccination” OR “maternal‐fetal health” OR “micronutrients” OR “neonatal immunity” “oxidative stress” OR “colostrum quality”. The evidence demonstrated that inactivated or killed vaccines produced significant immune protection in the mother and fetus. Furthermore, most recent studies have suggested that the use of genetic vaccines (mRNA and DNA) during pregnancy is efficient at triggering the immune response in mother and neonate without the risk of undesired pregnancy outcomes. However, factors such as maternal redox balance, nutritional status, and the timing of immunization play essential roles in regulating immune response inflammatory status, antioxidant capacity, and the welfare of both the pregnant mother and her newborn.
... To maintain maternal metabolism and tissue growth, nutritional needs rise throughout pregnancy (5). Poor maternal nutrition during pregnancy has several long-term negative repercussions on the health of the mother and her offspring, including higher neonatal morbidity and mortality (6). To promote necessary one-carbon metabolism for DNA methylation processes during embryogenesis and normal fetal development, sufficient dietary quantities of micronutrients like folate, riboflavin, thiamine, vitamin B6, and vitamin B12 are required (7). ...
During pregnancy, many physiologic changes occur in order to accommodate fetal growth. These changes require an increase in many of the nutritional needs to prevent long-term consequences for both mother and the offspring. One of the main vitamins that are needed throughout the pregnancy is thiamine (vitamin B1) which is a water-soluble vitamin that plays an important role in many metabolic and physiologic processes in the human body. Thiamine deficiency during pregnancy can cause can have many cardiac, neurologic, and psychological effects on the mother. It can also dispose the fetus to gastrointestinal, pulmonological, cardiac, and neurologic conditions. This paper reviews the recently published literature about thiamine and its physiologic roles, thiamine deficiency in pregnancy, its prevalence, its impact on infants and subsequent consequences in them. This review also highlights the knowledge gaps within these topics.
... During gestation, the fetus receives macronutrients such as amino acids, carbohydrates and lipids, and micronutrients such as vitamins and minerals from the mother reportedly through the placenta [1]. The fetally-derived placenta, in addition to its role in facilitating nutrient, gas and waste exchange and producing hormones needed for optimal fetal growth and development, serves as a barrier at the feto-maternal interface. ...
Introduction:
During pregnancy, the growth of the fetus is supported by the exchange of nutrients, waste, and other molecules between maternal and fetal circulations in the utero-placental unit. Nutrient transfer, in particular, is mediated by solute transporters such as solute carrier (SLC) and adenosine triphosphate-binding cassette (ABC) proteins. While nutrient transport has been extensively studied in the placenta, the role of human fetal membranes (FM), which was recently reported to have a role in drug transport, in nutrient uptake remains unknown.
Objectives:
This study determined nutrient transport expression in human FM and FM cells and compared expression with placental tissues and BeWo cells.
Methods:
RNA sequencing (RNA-Seq) of placental and FM tissues and cells was done. Genes of major solute transporter groups, such as SLC and ABC, were identified. Proteomic analysis of cell lysates was performed via nano-liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS) to confirm expression at a protein level.
Results:
We determined that FM tissues and cells derived from the fetal membrane tissues express nutrient transporter genes, and their expression is similar to that seen in the placenta or BeWo cells. In particular, transporters involved in macronutrient and micronutrient transfer were identified in both placental and FM cells. Consistent with RNA-Seq findings, carbohydrate transporters (3), vitamin transport-related proteins (8), amino acid transporters (21), fatty acid transport-related proteins (9), cholesterol transport-related proteins (6) and nucleoside transporters (3) were identified in BeWo and FM cells, with both groups sharing similar nutrient transporter expression.
Conclusion:
This study determined the expression of nutrient transporters in human FMs. This knowledge is the first step in improving our understanding of nutrient uptake kinetics during pregnancy. Functional studies are required to determine the properties of nutrient transporters in human FMs.
... Optimal nutrient intake during pregnancy reduces the risk of preterm baby, low birth weight, infant mortality, and small for gestational age [13][14][15]. Moreover, in women who are underweight during their pregnancy supplementation of multiple micronutrients before 20 weeks of gestation reduces the risk of a preterm baby [16][17][18]. ...
Objective: This study aimed to assess the dietary diversity and its associated factors among pregnant women in Addis Ababa, Ethiopia, 2021.
Methods: An institution-based Cross-sectional was conducted among 320 participants from four health facilities in Addis Ababa selected based on a simple random sampling method from 01 September to 30 December 2021. An Interviewer-administered structured questionnaire was used, following informed consent. Binary (Bivariate and multivariate) logistics regression was applied for the identification factors associated with dietary diversity with their respective 95% confidence interval and less than 5% p-value.
Results: The prevalence of inadequate dietary diversity during pregnancy was 51.6% (95% CI: 46.1%–57.0%). Being illiterate (AOR: 0.591; 95% CI: 1.88–1.901; p < 0.05) and primary education (AOR: 0.347; 95% CI: 0.166–0.728; p < 0.05), having poor knowledge (AOR: 0.437; 95% CI: 0.252–0.757; p < 0.05) and lower monthly income (AOR: 0.395; 95% CI: 0.184–0.845; p < 0.05) were factors associated with inadequate dietary diversity.
Conclusion: A higher level of inadequate dietary diversity was reported. Being illiterate, having primary education, having poor knowledge, and having lower monthly income were associated with inadequate dietary diversity during pregnancy. Concerned bodies were suggested to work on the identified factors.
... Fortunately, glutathione can be recycled by the body if it is properly optimized, and it can also be destroyed (Aljaser et al., 2021). Oxidative stress in the placenta and foetus may be exacerbated by a lack of nutrients and oxygen (Wu et al., 2012). The findings of this study confirm this theory, indicating that treating gestational hypertension with haramonting can increase placental efficiency and restore birth weight. ...
High blood pressure during pregnancy can signal a high-risk pregnancy and result in difficulties. The expression of Fas is critical for maintaining hypertensive immunity. Fas is prevalent in the trophoblast and enhances maternal-derived apoptosis. Because it contains acylphloroglucinol, flavonoids, tannins, and triterpenes, Rhodomyrtus tomentosa (haramonting) is commonly used in traditional Indonesian medicine to treat high blood pressure. This study aimed to investigate and determine the role of haramonting in lowering Fas expression in hypertensive rats’ placental histopathology. The rats were confirmed to be pregnant and divided into five groups: normal pregnant rats (control); hypertensive rats without treatment; and hypertensive rats given nanoherbal Rhodomyrtus tomentosa (NRT) at different doses: 100 mg/kg body weight (BW), 200 mg/kg BW, and 400 mg/kg BW. On gestation day 20, pregnant rats were euthanized under ketamine anaesthesia. Enzyme-linked immunosorbent assay (ELISA) analysis was used to examine the expression of the HSP family. Immunohistochemistry was used to assess Fas expression. In hypertensive rats, NRT lowered the systolic and diastolic blood pressure (P < 0.01), and NRT improved placental efficiency and restored birth weight. In hypertensive rats, higher doses of NRT were associated with higher levels of HSP27, HSP70, and HSP90. In placental histology, NRT suppresses Fas expression, acting as an anti-apoptotic agent in trophoblast cells. Because NRT is high in antioxidants and protects cells from hypoxia and dehydration, it suppresses Fas activity in the labyrinthine zone, basal zone, and yolk sac.
... growth. 87 For example, one study in Brazil reported that prepregnant individuals consuming a highly processed diet, based on refined grains, high-fat foods, and low in fiber, were at increased risk of delivering a small-for-gestational age baby. 88 Similar findings have been reported elsewhere and in controlled trials testing nutritional supplements. ...
Latin America has notably elevated rates of adolescent fertility and obesity in women. Although numerous studies document associations between adolescent fertility and obesity across the life course, the pathways explaining their association are insufficiently theorized, especially regarding the factors in Latin America that may underpin both. Additionally, much of the existing research is from high‐income countries, where fertility and obesity are trending down. In this paper, we review the various complex pathways linking adolescent fertility and obesity, highlighting research gaps and priorities, with a particular focus on Latin American populations. We carefully consider pregnancy's distinct impact on growth trajectories during the critical period of adolescence, as well as the cumulative effect that adolescent fertility may have over the life course. We also articulate a pathway through obesity as it may contribute to early puberty and thus, to adolescent fertility. If obesity is a cause of adolescent fertility, not a result of it, or if it is a mediator of early‐life exposures to adulthood obesity, these are critical distinctions for policy aiming to prevent both obesity and early fertility. Research to better understand these pathways is essential for prevention efforts against obesity and undesired adolescent fertility in Latin America.
... [1][2][3] Maternal malnutrition during pregnancy impairs embryonic and fetal growth and development, resulting in harmful outcomes. [4] Trace elements are known to protect cells from toxic superoxide anion and ensure normal fetal growth, cell energy metabolism and immune function. Maternal and child undernutrition and micronutrient deficiencies affect approximately half of the world's population. ...
Twenty five percent of pregnant women have some degree of vaginal bleeding during the first trimester, and about 50% of those pregnancies end in spontaneous abortion (SA) because the fetus is not developing typically. As studies have reported that inadequacies of trace metals such as Copper (Cu), Zinc (Zn), Magnesium (Mg) can predispose to various adverse pregnancy outcomes (PO); multiple micronutrient (MMN) supplementations are given without justifying their deficiency and toxicities on the fetus. Earlier studies on effects of MMN supplementations during pregnancy have not considered the need, duration, dose, and time of initiation of supplementations leading to inconclusive results. So, there is a need to optimize this to prevent their abuse and side effects. This study can help in establishing critical cut-offs of these minerals in maternal serum that can forecast future pregnancy outcomes. Study measured the serum Zn, Cu, Mg, and Fe in pregnant women who presented with (n = 80) and without (n = 100) SA at 5–2 weeks of pregnancy using iron -ferrozine method, magnesium-calmagite method, zinc reaction with nitro-PAPS, copper reaction with Di-Br- PAESA methods, respectively. Data analyzed using the student t test and cutoff value was established using Receiver Operating Characteristic (ROC) by SPSS software. Maternal serum Cu, Mg, Fe, and Zn levels measured were significantly lower in SA as compared to that of controls (p < 0.005) (Fig. 1) and maternal age and Body mass index were not statistically significant different among study group. Maternal serum Cu, Mg, Zn and Iron (Fe) measured in 5–12 weeks of pregnancy has the potential to forecast future occurrence of SA. The study has been registered under “The Clinical Trials Registry- India (CTRI),” -REF/2020/01/030393.
... It is very likely that malnutrition induced by poverty plays a role similar to that of alterations in the placental function that trigger FGR [32,33]. Poverty in Yucatan is associated with malnutrition [34] and maternal malnutrition that has an impact on fetal development using placental growth dysregulation and its vascularization, which modify the placental function of micronutrients transportation thus provoking alteration of oxygen transportation and protein synthesis in the placenta and the fetus [35]. Additionally, poverty causes maternal stress, which generates fetal stress, altering the development of the central nervous system and therefore normal neurodevelopment [36]. ...
Background:
Fetal growth restriction (FGR) may be related to ethnicity. Additionally, ethnic groups experience adverse socioeconomic circumstances that increase FGR risk. However, the dearth of evidence of the interaction between socioeconomic factors and FGR highlights the need for additional research.
Objective:
To analyze the association between socioeconomic factors and FGR in Maya and non-Maya populations in Yucatan, Mexico.
Methods:
A total of 21,320 singleton births in 2017 in Yucatan were analyzed. The student's t-test and the chi-square test were used to compare the means and proportions of maternal and perinatal variables between the FGR group and the birthweight appropriate for gestational age (AGA) group. Path analysis was performed to identify the direct and indirect effects of socioeconomic factors on FGR and mediators between predictors and FGR.
Results:
The prevalence of FGR at birth was 9.06%; this rate was higher in the Maya population (12.4, 95% CI 11.3-13.5), without differences between socioeconomic levels. Path analysis revealed sociostructural variables (ethnicity and poverty) are reliable predictors of FGR at birth mediated by maternal education (β = -.152, p < .001) and teenage pregnancy (β = .065, p = .037). The proposal path model had a good fit index CFI = .968, TLI = .920, RMSEA = .046.
Conclusion:
The prevalence of FGR was higher among Maya women than non-Maya women The socioeconomic conditions associated with FGR at birth were ethnicity, poverty, maternal education, and teenage pregnancy. Maternal education and teenage pregnancy act as mediators between sociostructural variables and FGR at birth.
... [AAs], and vitamins) are essential for the maturation of reproductive cells and the production of proteins, hormones, and secretions (Lin et al., 2014;Wu et al., 2012). ...
Nutrition and lifestyle have a great impact on reproduction and infertility in humans, as they are essential for certain processes such as implantation, placental growth, angiogenesis, and the transfer of nutrients from the mother to the fetus. The aim of this review is to provide the interconnection between nutrition and reproductive health through the insight of omics approaches (including metabolomics and nutrigenomics). The effect of various macronutrients, micronutrients, and some food‐associated components on male and female reproduction was discussed. Recent research work was collected through database search from 2010 to 2020 to identify eligible studies. Alterations of metabolic pathways in pregnant women were deliberated with an emphasis on different strategies of lifestyle and dietary interventions. Several nutritional methods, which are important for embryonic and child neurological development, nutritional supplements to lactation, and improved gestational length along with birth weight have been emphasized. Considerable advances in omics strategies show potential technological development for improving human reproductive health. In this review, we clarify the importance of nutrition and dietary substrates in the reproductive health of humans. Omics (including metabolomics and nutrigenomics) have been employed to report the nutrients’ impact on physiological functions at the molecular level and to explain how diet and specific nutrients interact with genes, proteins, or metabolites to influence metabolic phenotypes and disease outcomes. Novel nutritional methods and compositions containing essential nutrients were explored to enhance embryonic, fetal, and child neurological development, afford nutritional supplementation to lactation, and improve gestational length and birth weight.
... Maternal prepregnancy BMI categories at both upper and lower extremes may affect infant adverse birth outcomes in several ways. First, prepregnancy overweight and obesity usually cause metabolic abnormalities during pregnancy [such as gestational hypertension and diabetes (6, 7)] which may lead to placental abnormalities (27)(28)(29)(30)(31), and ultimately affect adverse birth outcomes. Second, excessive or poor maternal periconceptional weight status may increase the risk of abnormal growth and development of the offspring through epigenetic imprinting or methylation (32)(33)(34). ...
Background and Aims
Infant adverse birth outcomes have been suggested to contribute to neonatal morbidity and mortality and may cause long-term health consequences. Although evidence suggests maternal prepregnancy body mass index (BMI) categories associate with some birth outcomes, there is no consensus on these associations. We aimed to examine the associations of maternal prepregnancy BMI categories with a wide range of adverse birth outcomes.
Methods
Data were from a population-based retrospective cohort study of 9,282,486 eligible mother–infant pairs in the U.S. between 2016 and 2018. Maternal prepregnancy BMI was classified as: underweight (<18.5 kg/m²); normal weight (18.5–24.9 kg/m²); overweight (25.0–29.9 kg/m²); obesity grade 1 (30–34.9 kg/m²); obesity grade 2 (35.0–39.9 kg/m²); and obesity grade 3 (≥40 kg/m²). A total of six birth outcomes of the newborn included preterm birth, low birthweight, macrosomia, small for gestational age (SGA), large for gestational age (LGA), and low Apgar score (5-min score <7).
Results
Maternal prepregnancy overweight and obesity increased the likelihood of infant preterm birth, with odds ratios (ORs) (95% CIs) of 1.04 (1.04–1.05) for overweight, 1.18 (1.17–1.19) for obesity grade 1, 1.31 (1.29–1.32) for obesity grade 2, and 1.47 (1.45–1.48) for obesity grade 3, and also for prepregnancy underweight (OR = 1.32, 95% CI = 1.30–1.34) after adjusting for all potential covariates. Prepregnancy overweight and obesity were associated with higher odds of macrosomia, with ORs (95% CIs) of 1.53 (1.52–1.54) for overweight, 1.92 (1.90–1.93) for obesity grade 1, 2.33 (2.31–2.35) for obesity grade 2, and 2.87 (2.84–2.90) for obesity grade 3. Prepregnancy overweight and obesity was associated with higher odds of LGA, with ORs (95% CIs) of 1.58 (1.57–1.59) for overweight, 2.05 (2.03–2.06) for obesity grade 1, 2.54 (2.52–2.56) for obesity grade 2, and 3.17 (3.14–3.21) for obesity grade 3. Prepregnancy overweight and obesity were also associated with higher odds of low Apgar score, with ORs (95% CIs) of 1.12 (1.11–1.14) for overweight, 1.21 (1.19–1.23) for obesity grade 1, 1.34 (1.31–1.36) for obesity grade 2, and 1.55 (1.51–1.58) for obesity grade 3.
Conclusion
Our findings suggest maintaining or obtaining a healthy body weight for prepregnancy women could substantially reduce the likelihood of important infant adverse birth outcomes.
... Therefore, stimulus or insult at this critical period can result in developmental adaptations that produce structural, physiological, and metabolic changes, thereby predisposing descendants to chronic diseases in adulthood, including cardiovascular and metabolic diseases and cancer (Barker et al., 2002;Kwon and Kim, 2017;Herring et al., 2018). Human and animal data have shown that maternal postconception malnutrition, especially low dietary protein intake, can cause embryonic losses and intrauterine growth restriction (IUGR) that leads to hormone imbalances, metabolic disorders, and cell signaling defects (Fernandez-Twinn and Ozanne, 2010;Wu et al., 2012). In the meantime, these alterations have been associated with increased breast cancer risk (Mellemkjaer et al., 2003;Ozanne et al., 2004;Diaz-Santana et al., 2020). ...
Studies have shown that maternal malnutrition, especially a low-protein diet (LPD), plays a key role in the developmental mechanisms underlying mammary cancer programming in female offspring. However, the molecular pathways associated with this higher susceptibility are still poorly understood. Thus, this study investigated the adverse effects of gestational and lactational low protein intake on gene expression of key pathways involved in mammary tumor initiation after a single dose of N -methyl- N -nitrosourea (MNU) in female offspring rats. Pregnant Sprague–Dawley rats were fed a normal-protein diet (NPD) (17% protein) or LPD (6% protein) from gestational day 1 to postnatal day (PND) 21. After weaning (PND 21), female offspring (n = 5, each diet) were euthanized for histological analysis or received NPD (n = 56 each diet). At PND 28 or 35, female offspring received a single dose of MNU (25 mg/kg body weight) (n = 28 each diet/timepoint). After 24 h, some females (n = 10 each diet/timepoint) were euthanized for histological, immunohistochemical, and molecular analyses at PDN 29 or 36. The remaining animals (n = 18 each diet/timepoint) were euthanized when tumors reached ≥2 cm or at PND 250. Besides the mammary gland development delay observed in LPD 21 and 28 groups, the gene expression profile demonstrated that maternal LPD deregulated 21 genes related to DNA repair and DNA replication pathways in the mammary gland of LPD 35 group after MNU. We further confirmed an increased γ-H2AX (DNA damage biomarker) and in ER-α immunoreactivity in mammary epithelial cells in the LPD group at PND 36. Furthermore, these early postnatal events were followed by significantly higher mammary carcinogenesis susceptibility in offspring at adulthood. Thus, the results indicate that maternal LPD influenced the programming of chemically induced mammary carcinogenesis in female offspring through increase in DNA damage and deregulation of DNA repair and DNA replication pathways. Also, Cidea upregulation gene in the LPD 35 group may suggest that maternal LPD could deregulate genes possibly leading to increased risk of mammary cancer development and/or poor prognosis. These findings increase the body of evidence of early-transcriptional mammary gland changes influenced by maternal LPD, resulting in differential response to breast tumor initiation and susceptibility and may raise discussions about lifelong prevention of breast cancer risk.
... The EAA/NEAA values of the hydrolysates and the digests were 0.789 and 0.767, respectively, suggesting that some EAA is used up in the digestion process (Moro et al., 2020). The EAA are vital in the process of building proteins, synthesis of hormones/neurotransmitters, and in many metabolic pathways (Wu, Imhoff-Kunsch, & Girard, 2012). Some essential amino acids such as His and Lys are found in high amounts in seal meat hydrolysates. ...
Seal meat is of high nutritive value but currently a by-product and waste from seal oil processing. Seal meat hydrolysates were generated from alcalase catalysis and were subjected to a soft dynamic digestion system to study their nutritional value and the health benefits. The total amino acid content was determined as 568.54 and 384.65 mg/g for seal meat hydrolysates and its intestinal digests, respectively, using UPLC, and both of the samples were rich in essential amino acids such as Leu and Lys. There were no harmful minerals observed by ICP-MS analyses. Both the gastric and intestinal digests revealed nutritive minerals, i.e., Ca, Fe, Mg, Zn, among which the contents of Fe were 548 and 602 mg/kg, respectively, higher than common meat products. The absorbable Fe²⁺ ions content remained almost the same during the gastric and intestinal digestion, while the content of undesirable Fe³⁺ ions declined drastically in intestinal digests. The change of Fe²⁺ and Fe³⁺ ions was probably due to the antioxidant activities of seal meat hydrolysate observed via scavenging of DPPH and hydroxyl radicals. This study provides knowledge on seal meat hydrolysates as healthy food supplement.
... The elevated odds of stunting related to maternal height could be attributed to the maternal organ size (i.e., pelvic), maternal poor nutrition status and foetal programming, which adversely impact the unborn child's growth in utero. It has been previously suggested that short women have an increased probability of having a narrow pelvis, which impacts the uterus for optimum foetal growth, resulting in low birth weight (LBW) or small-for gestational-age babies [47,48]. Babies born under this condition are more prone to infectious diseases, have increased odds of acute undernutrition and have impaired absorption of vital micronutrients [49], leading to early child stunting. ...
Trends of Stunting Prevalence and Its Abstract: Every year in Nigeria, malnutrition contributes to more than 33% of the deaths of children below 5 years, and these deaths mostly occur in the northern geopolitical zones (NGZs), where nearly 50% of all children below 5 years are stunted. This study examined the trends in the prevalence of stunting and its associated factors among children aged 0-23 months, 24-59 months and 0-59 months in the NGZs. The data of 33,682 recent live births in the NGZs, extracted from the Nigeria Demographic and Health Surveys from 2008 to 2018, were used to investigate the factors associated with stunting using multilevel logistic regression. Children aged 24-59 months reported the highest prevalence of stunting, with 53.3% (95% confidence interval: 52.0-54.6%). Multivariable analyses revealed four common factors that increased the odds of a child's stunting across all age subgroups: poor households, geopolitical zone (northwest or northeast), being a male and maternal height (<145 cm). Interventional strategies focused on poverty mitigation through cash transfer and educating low socioeconomic mothers on the benefits of gender-neutral supplementary feeding and the timely monitoring of the offspring of short mothers would substantially reduce stunting across all age subgroups in the NGZs.
According to the developmental origins of health and disease (DoHaD) hypothesis, the conditions during intrauterine development have a long-term effect on postnatal growth and animal health. This study aimed to determine the relationship between fetal micronutrient provision in the last three months of intrauterine development and growth intensity indicators in the first 180 days after birth. This study focused on 40 clinically healthy Simmental heifers. Samples of non-pigmented tail hair were collected from newborns before their first colostrum feeding. The micronutrient content (selenium, copper, zinc, manganese, cobalt, iron, chromium, and molybdenum) was analyzed using inductively coupled plasma mass spectrometry (Nexion 300D, Perkin Elmer, USA). Calf weight was measured on the first day of life and at 180 days, and average daily weight gain was calculated. The relationships between the variables were analyzed using Spearman’s rank correlation coefficient in IBM SPSS Statistics 20.0 (IBM Corp., USA). No significant correlations were found between the weights of the newborn calves and the micronutrient content in their hair samples. However, at 180 days of age, calf weight and average daily weight gain (in the first 180 days of life) correlated with the selenium (r = 0.349 and r = 0.408, p < 0.05, respectively), copper (r = 0.378 and r = 0.440, p < 0.01, respectively), zinc (r = 0.455 and r = 0.481, p < 0.01, respectively), and cobalt (r = 0.304 and r = 0.344, p < 0.05, respectively) contents in the hair samples of newborns. No correlations were found for manganese, iron, chromium, and molybdenum.
Objective: To investigate whether early-life exposure to the Great Famine of 1959-1961 in China was associated with the risk of digestive system cancer. Methods: The prospective cohort study involved 17,997 participants from the Kailuan Study (Tangshan, China) that began in 2006. All participants were divided into three groups based on their date of birth. The unexposed group (born from October 1, 1962, to September 30, 1964), fetal-exposed group (born from October 1, 1959, to December 30, 1961), and early-childhood-exposed group (born from October 1, 1956, to December 30, 1958). Cox proportional hazards model was used to analyze the association between early famine exposure and digestive system cancer. Results: During the mean follow-up period of (10.4 ±2.2) years, a total of 223 digestive system cancer events occurred. Including 54 cases in the unexposed group (62.14/100,000 person-years), 57 cases in the fetal-exposed group (114.8/100,000 person-years), and 112 cases in the early-childhood-exposure group (122.2/100,000 person-years). After adjusting covariates, compared with the unexposed group, the HR and 95% CI were 1.85(1.28, 2.69) for participants in the fetal-exposed group and 1.92(1.38, 2.66) for participants in the early-childhood-exposed group. No interactions were observed in our study. Conclusions: Early-life famine exposure was associated with a higher risk of digestive system cancer in adulthood. Fetal-exposed individuals might increase the risk of colorectal and liver cancer, and early childhood-exposed might increase the risk of colorectal cancer.
Objective: to conduct a clinical analysis and evaluate the significance of micronutrient status and vaginal microbiocenosis in pregnant women and develop a method for correcting the identified disorders based on the use of Bellakt Mama+ powdered milk product.
Materials and methods. We conducted a prospective study on the basis of the professorial advisory center of the EE “Grodno State Medical University”. In the course of the work, we examined 110 pregnant women, 55 of whom took Bellakt MAMA + dry milk product for 3 months, and the second half were observed only according to the clinical protocol. The assessment was made: anamnestic - assessment of the anamnesis of life and disease; generally accepted clinical, laboratory and instrumental (ultrasound examination of the pelvic organs) research methods. Performed blood sampling from the cubital vein in the morning on an empty stomach with the determination of the levels of ferritin, calcium i, iron, total vitamin D, folic acid, osteocalcin. An assessment of the biocoenosis of the urogenital tract was carried out “Femoflor Screen”; statistical processing of the results was carried out.
Results. We found that in patients who took a dry dairy product of Belarusian production, a persistent positive trend in the increase in the level of folic acid (p = 0,0049), total vitamin D (p = 0,0041), serum iron (p = 0,0041) was established, ferritin (p = 0,0040), as well as improvement of the vaginal biocoenosis (p = 0,0040). There were no statistically significant differences in the levels of ionized calcium and osteocalcin. It should be noted that the patients of the main group had no complaints of discomfort in large joints, bones and cramps in the calf muscles, in contrast to the women of the control group.
Conclusion. The above results confirm the need to control and correct micronutrient deficiency and vaginal dysbiosis in women at the stage of preconception preparation and in the first trimester of pregnancy.
Fetal development and parturition are precisely regulated processes that involve continuous crosstalk between the mother and the fetus. Our previous discovery that wild-type mice carrying steroid receptor coactivator (Src)-1 and Src-2 double-deficient fetuses exhibit impaired lung development and delayed labor, which indicates that the signals for parturition emanate from the fetus. In this study, we perform RNA sequencing and targeted metabolomics analyses of the lungs from fetal Src-1/-2 double-knockout mice and find that expression of arginase 1 (Arg1) is significantly decreased, accompanied by increased levels of the Arg1 substrate L-arginine. Knockdown of Arg1 in the lungs of fetal mice induces apoptosis of epithelial cells and dramatically delays initiation of labor. Moreover, treatment of human myometrial smooth muscle cells with L-arginine significantly inhibits spontaneous contractions by attenuating activation of NF-κB and downregulating expression of contraction-associated protein genes. Transcription factors GR and C/EBPβ increase transcription of Arg1 in an Src-1/Src-2-dependent manner. These findings provide new evidence that fetus-derived factors may play dual roles in coordinating fetal lung development and the initiation of labor.
Maternal mineral nutrition during the critical phases of fetal development may leave lifetime impacts on the productivity of an individual. Most research within the developmental origins of the health and disease (DOHaD) field is focused on the role of macronutrients in the genome function and programming of the developing fetus. On the other hand, there is a paucity of knowledge about the role of micronutrients and, specifically, minerals in regulating the epigenome of livestock species, especially cattle. Therefore, this review will address the effects of the maternal dietary mineral supply on the fetal developmental programming from the embryonic to the postnatal phases in cattle. To this end, we will draw a parallel between findings from our cattle model research with data from model animals, cell lines, and other livestock species. The coordinated role and function of different mineral elements in feto-maternal genomic regulation underlies the establishment of pregnancy and organogenesis and, ultimately, affects the development and functioning of metabolically important tissues, such as the fetal liver, skeletal muscle, and, importantly, the placenta. Through this review, we will delineate the key regulatory pathways involved in fetal programming based on the dietary maternal mineral supply and its crosstalk with epigenomic regulation in cattle.
Little is known about the impact of small-quantity lipid-based nutrient supplements (SQ-LNSs) on maternal morbidity. This secondary outcome analysis aimed to compare morbidity symptoms among women in two trials evaluating the efficacy of SQ-LNSs. From enrolment (≤20-week gestation) to 6 months postpartum, Ghanaian (n = 1320) and Malawian (n = 1391) women were assigned to consume daily: 60 mg iron and 400 µg folic acid until childbirth and placebo thereafter (iron and folic acid [IFA] group); or multiple micronutrients (MMN); or 20 g/day SQ-LNSs. Within country, we used repeated measures logistic regression and analysis of variance models to compare group differences in the period prevalence and percentage of days of monitoring when women had fever, gastrointestinal, reproductive, and respiratory symptoms during the second and third trimesters of pregnancy (n ~ 1243 in Ghana, 1200 in Malawi) and 0-3 and 3-6 months postpartum (n ~ 1212 in Ghana, 730 in Malawi). Most outcomes did not differ significantly among groups, with the following exceptions: in Ghana, overall, the prevalence of vomiting was lower in the LNS (21.5%) than MMN (25.6%) group, with the IFA group (23.2%) in-between (p = 0.046); mean ± SD percentage of days with nausea was greater in the LNS (3.5 ± 10.3) and MMN (3.3 ± 10.4) groups than the IFA (2.7 ± 8.3) group (p = 0.002). In Malawi, during 3-6 month postpartum, the prevalence of severe diarrhoea was greater in the LNS (8.1%) than the MMN (2.9%) group, with IFA (4.6%) in-between, p = 0.041). We conclude that the type of nutrient supplement received during pregnancy and lactation generally does not influence morbidity symptoms in these settings. Clinicaltrials.gov identifiers: NCT00970866; NCT01239693.
The aim of the present case study is to assess prospectively the HIA of a proposed mobile health intervention to reduce MMR in 10-years. PHIA was carried out on a proposed mHealth intervention to MMR. In addition, an online feasibility pilot study was carried out involving 41 participants from September 1st 2021, to January 2022. The intervention improved the well-being of pregnant women via education on good nutrition. It has the potential to reduce MMR, travel costs, frequency of visits to healthcare centers, and increase equality in healthcare accessibility. Due to the reduced frequency of hospital visits, the risk of transportation and road accidents were noticed. About 88% of participants stated the intervention is feasible and worthwhile. While nearly 95% said they are eager and prepared to use the intervention when implemented. The intervention can improve the health of mothers, MMR, and reduce health inequality. Feasibility and willingness to use the new intervention were very high, hence the intervention should be tested on a larger population and in different geographical regions
The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health‐promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations. The FIGO Nutrition Checklist addresses key nutrition concerns for pregnancy. It can be used by healthcare professionals, or women themselves, to identify potential nutritional risks.
Background:
The current study aimed to assess the association between low maternal protein intake during pregnancy and child developmental delay at age 3 years.
Methods:
This research used data obtained from the Japan Environment and Children's Study. In total, we analyzed 77,237 mother-child pairs. Dietary intake was assessed using the Food Frequency Questionnaire. Developmental outcomes at age 3 years were evaluated with the Japanese version of the Ages and Stages Questionnaire, Third Edition. A multivariate logistic regression analysis was performed to assess the association between maternal protein intake during pregnancy and child development delays at age 3 years.
Results:
Based on the protein-to-total energy intake ratio during early pregnancy, the participants were categorized into three groups: <9.39% (>2 standard deviation below the mean), the severely low protein (SLP) group; 9.39-<13%, the low protein group; and ≥13%, the normal protein group. After adjusting for potential confounding factors, SLP intake was found to be significantly correlated with a higher risk of developmental delay according to the communication, fine motor and problem-solving skill domains.
Conclusions:
SLP intake caused by inadequate diet during early pregnancy was associated with a higher risk of child developmental delay at age 3 years.
Impact:
Animal studies have shown that maternal protein restriction during pregnancy and lactation causes abnormal brain development among offspring. Birth cohort studies to date have not assessed the effects of maternal low protein exposure during pregnancy on child development. Severely low protein intake during early pregnancy was associated with a higher risk of child developmental delay at age 3 years. Since nutritional imbalance in early pregnancy affects not only fetal growth but also postnatal neurodevelopment, nutritional management before pregnancy is considered important.
The present review comes from five previous studies of a multicenter cohort of nulliparous pregnant women from different regions of Brazil. The first study showed a wide difference in consumption of industrialized foods among women from the south and southeast regions compared with northeastern women who chose to eat a healthier diet with fresh natural food. The second investigation intended to understand maternal eating habits, where five dietary patterns were identified: two considered healthy and three with excess protein, ultra‐processed foods, fats, and sweets. Considering some barriers to classifying nutrition status during prenatal care, when data on pre‐pregnancy weight is unknown, the third study developed a tool to identify three levels of risk for each gestational age range, assessed by measuring arm circumference. Applying those new tools, the associations between maternal nutrition and pregnancy outcomes were investigated: prematurity, pre‐eclampsia, gestational diabetes mellitus, and small‐for‐gestational‐age infants. From these analyses, a predictive model was developed indicating that obesity, non‐white color, and dietary pattern with excess protein consumption were associated with a greater probability of adverse pregnancy outcomes. Moreover, the potential of the intergenerational influence of head circumference as a proxy for maternal nutrition was analyzed. Using a Path Analysis method, the model was evidenced by different socioeconomic variables. Finally, understanding the complexity of the nutritional assessment, the present conceptual framework was proposed for nutritional assessment, and tracking and monitoring of pregnant women.
Background: Maternal nutrition represents a critical risk factor for adverse health outcomes in both mother and offspring. We aimed to investigate associations between maternal nutritional habits, biomarker status, and pregnancy outcome among Italian healthy normal-weight pregnancies. Methods: Multicenter prospective cohort study recruiting Italian healthy normal-weight women with singleton spontaneous pregnancies at 20 ± 2 weeks (T1) in Milan and Naples. All patients underwent nutritional evaluations by our collecting a 7-day weighed dietary record at 25 ± 1 weeks (T2) and a Food Frequency Questionnaire at 29 ± 2 weeks (T3). Maternal venous blood samples were collected at T3 to assess nutritional, inflammatory and oxidative biomarker concentrations (RBCs folate, vitamin D, hepcidin, total antioxidant capacity). Pregnancy outcomes were collected at delivery (T4). General linear models adjusted for confounding factors were estimated to investigate associations between maternal dietary pattern adherence, nutrient intakes, biomarker concentrations and delivery outcomes. Results: 219 healthy normal-weight pregnant women were enrolled. Vitamin D and RBCs folate concentrations, as well as micronutrient intakes, were consistently below the recommended range. In a multi-adjusted model, maternal adherence to the most prevalent ‘high meat, animal fats, grains’ dietary pattern was positively associated with hepcidin concentrations and negatively associated with gestational age at delivery in pregnancies carrying female fetuses. Hepcidin plasma levels were further negatively associated to placental weight, whereas vitamin D concentrations were positively associated to neonatal weight. Conclusions: A high adherence to an unbalanced ‘high meat, animal fats, grains’ pattern was detected among Italian normal-weight low-risk pregnancies, further associated with maternal pro-inflammatory status and gestational age at delivery. This evidence underlines the need for a dedicated nutritional counseling even among low-risk pregnancies.
Sufficiency of nutrition in terms of macro and micronutrients is crucial during the period of pregnancy and lactation to shape not only the health of the mother but also the health and development of the baby and may predispose future health problems for the baby. The ideal behavior of feeding infants during the first 6 months is exclusive breastfeeding, it is an essential source of energy and nutrients and protects against gastrointestinal and other infections [1]. Strong immune and digestive systems are considered to develop in breastfeeding infants because of the growth of positive bacteria in the gut that provides a healthy microbial population [1]. Nutritional intakes should be planned by a dietitian considering the body mass index (BMI), ethnicity, food selection according to culture, ability to reach food, and the socioeconomic status of the patient [2].KeywordsFood allergyFood intolarenceNutritionPregnancyPostpartum period
Objectives: The objective of this study was to review data from randomized controlled trials to assess whether or not the supplementation of L-Arginine (L-Arg) is effective in reducing the incidence of preeclampsia (PE) in pregnancies at risk of developing the disorder. Methods: We aimed to systematic review randomized controlled trials, including those which compared L-Arg supplementation with placebo in pregnant women at high risk of PE development, analyzing PE incidence as the main outcome. Data were collected from MEDLINE/ Pubmed, EMBASE/ Elsevier, LILACS/ BVS and Cochrane. Results: A total of 46 papers were identified in the primary search. After analysis of eligibility, inclusion and exclusion criteria, two articles (which respected in detail all the stages of evaluation) were included in the present review. A risk of bias assessment was performed. Data analysis revealed that the incidence of PE was significantly lower in both studies, and no major adverse effects were reported. The limitations of this study were the lack of standardization between the trials analyzed and the relative low number of studies included. Conclusions: The supplementation with L-Arg appears to reduce the incidence of PE in pregnant women with high risk for its development.
This study aimed to examine the prevalence, associated factors and perceptions of dietary supplement use among pregnant Chinese women. A cross-sectional study was conducted to collect data about prevalence, purchase channels, perceptions, and related factors of dietary supplement use from 572 pregnant women, through a face-to-face survey, using a self-designed questionnaire. Of the respondents, 94.8% used at least one dietary supplement, whereas 29.8% used more than four supplements in the previous month. The majority of the pregnant women were highly educated (81.2% had a bachelor’s degree or above) and had the perception that dietary supplements could prevent and improve (89.2%), or treat, nutrition-related diseases (78.7%). Multivariate analysis showed that pregnant women who had used multiple (more than four) supplements were more likely to have a larger gestational age, received fertility treatment, more prenatal visits, and hypothyroidism during pregnancy. Furthermore, pregnant women not only purchased dietary supplements through hospitals (72.6%) and pharmacies (45.1%), but overseas Daigou or online purchases (31.8%) were also a major channel of purchase. A high prevalence of dietary supplement use during pregnancy was observed, with extensive and repeated consumption of nutrients. Pregnant women’s craze for dietary supplements calls for more comprehensive guidelines in China.
Growth in the fetal and infant periods is critical for both short- and long-term health and disease. The increasing use of ultrasonography provides clinicians and researchers with a more detailed and timely assessment of fetal growth in various dimensions, instead of a single summary measure at birth. With this serial fetal biometric data, it has been possible to identify factors contributing to variation in fetal growth (e.g. maternal size, ethnicity, SEP) across gestation and also the downstream effects of particular patterns of fetal growth. Furthermore, there now exists a range of fetal growth charts with which to assess the adequacy of fetal growth, though the longstanding considerations which apply to charts used at birth and in infancy, i.e. standard versus reference/ethnic-specific/customized, pertain to these charts also. The development of 3- and 4-D ultrasound offers the possibility of obtaining estimates of fetal body composition and dynamic assessments of fetal development, ultimately providing a more holistic assessment of fetal development. However, in many settings such fetal surveillance is not possible and fetal growth is summarized using size at birth, and classifications such as SGA and LGA are used to identify those who may have experienced sub-optimal fetal growth and may require more intensive monitoring.
The obesity epidemic observed in many HICs has given rise to an increasing number of children becoming obese and at younger ages. An increased growth rate in infancy has been viewed as a prime candidate contributing to the increase in childhood obesity and subsequent increased risk of poor cardiometabolic health. However, it is vital to understand whether any excessive infant growth is the risk factor, or whether risk differs depending on whether the increased growth is in response to a degree of fetal constraint in utero, or is simply a result of excess energy intake. The increasing availability of fetal biometry data means it is now possible to understand the relationship between fetal and infant growth in much more detailed and nuanced ways and how these interact to affect future health and wellbeing.
AIMS/HYPOTHESIS: Raised maternal plasma total homocysteine (tHcy) concentrations predict small size at birth, which is a risk factor for type 2 diabetes mellitus. We studied the association between maternal vitamin B12, folate and tHcy status during pregnancy, and offspring adiposity and insulin resistance at 6 years. METHODS: In the Pune Maternal Nutrition Study we studied 700 consecutive eligible pregnant women in six villages. We measured maternal nutritional intake and circulating concentrations of folate, vitamin B12, tHcy and methylmalonic acid (MMA) at 18 and 28 weeks of gestation. These were correlated with offspring anthropometry, body composition (dual-energy X-ray absorptiometry scan) and insulin resistance (homeostatic model assessment of insulin resistance [HOMA-R]) at 6 years. RESULTS: Two-thirds of mothers had low vitamin B12 (<150 pmol/l), 90% had high MMA (>0.26 micromol/l) and 30% had raised tHcy concentrations (>10 micromol/l); only one had a low erythrocyte folate concentration. Although short and thin (BMI), the 6-year-old children were relatively adipose compared with the UK standards (skinfold thicknesses). Higher maternal erythrocyte folate concentrations at 28 weeks predicted higher offspring adiposity and higher HOMA-R (both p < 0.01). Low maternal vitamin B12 (18 weeks; p = 0.03) predicted higher HOMA-R in the children. The offspring of mothers with a combination of high folate and low vitamin B12 concentrations were the most insulin resistant. CONCLUSIONS/INTERPRETATION: Low maternal vitamin B12 and high folate status may contribute to the epidemic of adiposity and type 2 diabetes in India
Background: Oxidative stress has been implicated in the pathophysiology of pre-eclampsia. This randomised controlled trial investigated the effect of supplementation with vitamins C and E in women at increased risk of the disorder on plasma markers of vascular endothelial activation and placental insufficiency and the occurrence of pre-eclampsia. Methods: 283 women were identified as being at increased risk of pre-eclampsia by abnormal two-stage uterine-artery doppler analysis or a previous history of the disorder and were randomly assigned vitamin C (1000 mg/day) and vitamin E (400 IU/day) or placebo at 16-22 weeks' gestation. Plasma markers of endothelial activation (plasminogen-activator inhibitor 1 [PAI-1]) and placental dysfunction (PAI-2) were measured every month until delivery. Pre-eclampsia was assessed by the development of proteinuric hypertension. Analyses were done by intention to treat, and in the cohort who completed the study. Findings: Supplementation with vitamins C and E was associated with a 21% decrease in the PAI-1/PAI-2 ratio during gestation (95% CI 4-35, p = 0.015). In the intention-to-treat cohort, pre-eclampsia occurred in 24 (17%) of 142 women in the placebo group and 11 (8%) of 141 in the vitamin group (adjusted odds ratio 0.39 [0.17-0.90], p = 0.02). In the cohort who completed the study (81 placebo group, 79 vitamin group), the odds ratio for pre-eclampsia was 0.24 (0.08-0.70, p = 0.002). Interpretation: Supplementation with vitamins C and E may be beneficial in the prevention of pre-eclampsia in women at increased risk of the disease. Multicentre trials are needed to show whether vitamin supplementation affects the occurrence of pre-eclampsia in low-risk women and to confirm our results in larger groups of high-risk women from different populations. (Lancet 354:810-816, 1999)
Aims/hypothesis
Raised maternal plasma total homocysteine (tHcy) concentrations predict small size at birth, which is a risk factor for type 2 diabetes mellitus. We studied the association between maternal vitamin B12, folate and tHcy status during pregnancy, and offspring adiposity and insulin resistance at 6 years.
Methods
In the Pune Maternal Nutrition Study we studied 700 consecutive eligible pregnant women in six villages. We measured maternal nutritional intake and circulating concentrations of folate, vitamin B12, tHcy and methylmalonic acid (MMA) at 18 and 28 weeks of gestation. These were correlated with offspring anthropometry, body composition (dual-energy X-ray absorptiometry scan) and insulin resistance (homeostatic model assessment of insulin resistance [HOMA-R]) at 6 years.
Results
Two-thirds of mothers had low vitamin B12 (<150 pmol/l), 90% had high MMA (>0.26 μmol/l) and 30% had raised tHcy concentrations (>10 μmol/l); only one had a low erythrocyte folate concentration. Although short and thin (BMI), the 6-year-old children were relatively adipose compared with the UK standards (skinfold thicknesses). Higher maternal erythrocyte folate concentrations at 28 weeks predicted higher offspring adiposity and higher HOMA-R (both p < 0.01). Low maternal vitamin B12 (18 weeks; p = 0.03) predicted higher HOMA-R in the children. The offspring of mothers with a combination of high folate and low vitamin B12 concentrations were the most insulin resistant.
Conclusions/interpretation
Low maternal vitamin B12 and high folate status may contribute to the epidemic of adiposity and type 2 diabetes in India.
Gestational hypertensive disorders are the second leading cause of maternal death worldwide. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal morbidity and mortality. A literature search was carried out on PubMed, WHOLIS, PAHO and Cochrane Library. Only randomised trials were included in the review. Data were extracted into a standardised Excel sheet. Primary outcomes were pre-eclampsia, preterm birth and birthweight. Other neonatal outcomes such as neonatal mortality, small-for-gestational age and low birthweight were also evaluated. A total of 15 randomised controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy reduced risk of pre-eclampsia by 52% [relative risk (RR) 0.48; 95% confidence interval (CI) 0.34, 0.67] and that of severe pre-eclampsia by 25% (RR 0.75 [95% CI 0.57, 0.98]). There was no effect on incidence of eclampsia (RR 0.73 [95% CI 0.41, 1.27]). There was a significant reduction for risk of maternal mortality/severe morbidity (RR 0.80 [95% CI 0.65, 0.97]). Calcium supplementation during pregnancy was also associated with a significant reduction in risk of pre-term birth (RR 0.76 [95% CI 0.60, 0.97]). There was an extra gain of 85 g in the intervention group compared with control (mean difference 85 g [95% CI 37, 133]). There was no effect of calcium supplementation on perinatal mortality (RR 0.90 [95% CI 0.74, 1.09]). There was a statistically non-significant increased risk of urolithiasis in the intervention group compared with control (RR 1.52 [95% CI 0.06, 40.67]). In conclusion, calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertensive disorders and pre-term birth and an increase in birthweight. There is no increased risk of kidney stones.
l-Arginine (Arg) is synthesised from glutamine, glutamate, and proline via the intestinal-renal axis in humans and most other
mammals (including pigs, sheep and rats). Arg degradation occurs via multiple pathways that are initiated by arginase, nitric-oxide
synthase, Arg:glycine amidinotransferase, and Arg decarboxylase. These pathways produce nitric oxide, polyamines, proline,
glutamate, creatine, and agmatine with each having enormous biological importance. Arg is also required for the detoxification
of ammonia, which is an extremely toxic substance for the central nervous system. There is compelling evidence that Arg regulates
interorgan metabolism of energy substrates and the function of multiple organs. The results of both experimental and clinical
studies indicate that Arg is a nutritionally essential amino acid (AA) for spermatogenesis, embryonic survival, fetal and
neonatal growth, as well as maintenance of vascular tone and hemodynamics. Moreover, a growing body of evidence clearly indicates
that dietary supplementation or intravenous administration of Arg is beneficial in improving reproductive, cardiovascular,
pulmonary, renal, gastrointestinal, liver and immune functions, as well as facilitating wound healing, enhancing insulin sensitivity,
and maintaining tissue integrity. Additionally, Arg or l-citrulline may provide novel and effective therapies for obesity, diabetes, and the metabolic syndrome. The effect of Arg
in treating many developmental and health problems is unique among AAs, and offers great promise for improved health and wellbeing
of humans and animals.
Hypovitaminosis D is common in India. In the present prospective partially randomised study of vitamin D (D3) supplementation during pregnancy, subjects were randomised in the second trimester to receive either one oral dose of 1500 μg vitamin D3 (group 1, n 48) or two doses of 3000 μg vitamin D3 each in the second and third trimesters (group 2, n 49). Maternal 25-hydroxyvitamin D (25(OH)D) at term, cord blood (CB) alkaline phosphatase (ALP), neonatal serum Ca and anthropometry were measured in these subjects and in forty-three non-supplemented mother-infant pairs (usual care). Median maternal 25(OH)D at term was higher in group 2 (58·7, interquartile range (IQR) 38·4-89·4 nmol/l) v. group 1 (26·2, IQR 17·7-57·7 nmol/l) and usual-care group (39·2, IQR 21·2-73·4 nmol/l) (P = 0·000). CB ALP was increased (>8.02 μkat/l or >480 IU/l) in 66·7 % of the usual-care group v. 41·9 % of group 1 and 38·9 % of group 2 (P = 0·03). Neonatal Ca and CB 25(OH)D did not differ significantly in the three groups. Birth weight, length and head circumference were greater and the anterior fontanelle was smaller in groups 1 and 2 (3·08 and 3·03 kg, 50·3 and 50·1 cm, 34·5 and 34·4 cm, 2·6 and 2·5 cm, respectively) v. usual care (2·77 kg, 49·4, 33·6, 3·3 cm; P = 0·000 for length, head circumference and fontanelle and P = 0·003 for weight). These differences were still evident at 9 months. We conclude that both 1500 μg and two doses of 3000 μg vitamin D3 had a beneficial effect on infant anthropometry, the larger dose also improving CB ALP and maternal 25(OH)D.
Epidemiological and animal studies have demonstrated a close link between maternal nutrition and chronic metabolic disease in children and adults. Compelling experimental results also indicate that adverse effects of intrauterine growth restriction on offspring can be carried forward to subsequent generations through covalent modifications of DNA and core histones. RECENT ADVANCES: DNA methylation is catalyzed by S-adenosylmethionine-dependent DNA methyltransferases. Methylation, demethylation, acetylation, and deacetylation of histone proteins are performed by histone methyltransferase, histone demethylase, histone acetyltransferase, and histone deacetyltransferase, respectively. Histone activities are also influenced by phosphorylation, ubiquitination, ADP-ribosylation, sumoylation, and glycosylation. Metabolism of amino acids (glycine, histidine, methionine, and serine) and vitamins (B6, B12, and folate) plays a key role in provision of methyl donors for DNA and protein methylation.
Disruption of epigenetic mechanisms can result in oxidative stress, obesity, insulin resistance, diabetes, and vascular dysfunction in animals and humans. Despite a recognized role for epigenetics in fetal programming of metabolic syndrome, research on therapies is still in its infancy. Possible interventions include: 1) inhibition of DNA methylation, histone deacetylation, and microRNA expression; 2) targeting epigenetically disturbed metabolic pathways; and 3) dietary supplementation with functional amino acids, vitamins, and phytochemicals.
Much work is needed with animal models to understand the basic mechanisms responsible for the roles of specific nutrients in fetal and neonatal programming. Such new knowledge is crucial to design effective therapeutic strategies for preventing and treating metabolic abnormalities in offspring born to mothers with a previous experience of malnutrition.
Amino acids (AA) were traditionally classified as nutritionally essential or nonessential for animals and humans based on nitrogen balance or growth. A key element of this classification is that all nonessential AA (NEAA) were assumed to be synthesized adequately in the body as substrates to meet the needs for protein synthesis. Unfortunately, regulatory roles for AA in nutrition and metabolism have long been ignored. Such conceptual limitations were not recognized until recent seminal findings that dietary glutamine is necessary for intestinal mucosal integrity and dietary arginine is required for maximum neonatal growth and embryonic survival. Some of the traditionally classified NEAA (e.g. glutamine, glutamate, and arginine) play important roles in regulating gene expression, cell signaling, antioxidative responses, and immunity. Additionally, glutamate, glutamine, and aspartate are major metabolic fuels for the small intestine and they, along with glycine, regulate neurological function. Among essential AA (EAA), much emphasis has been placed on leucine (which activates mammalian target of rapamycin to stimulate protein synthesis and inhibit proteolysis) and tryptophan (which modulates neurological and immunological functions through multiple metabolites, including serotonin and melatonin). A growing body of literature leads to a new concept of functional AA, which are defined as those AA that regulate key metabolic pathways to improve health, survival, growth, development, lactation, and reproduction of organisms. Both NEAA and EAA should be considered in the classic "ideal protein" concept or formulation of balanced diets to maximize protein accretion and optimize health in animals and humans.
Long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of maternal DHA supplementation on infant morbidity is unknown. We investigated the effects of prenatal DHA supplementation on infant morbidity.
In a double-blind randomized controlled trial conducted in Mexico, pregnant women received daily supplementation with 400 mg of DHA or placebo from 18 to 22 weeks' gestation through parturition. In infants aged 1, 3, and 6 months, caregivers reported the occurrence of common illness symptoms in the preceding 15 days.
Data were available at 1, 3, and 6 months for 849, 834, and 834 infants, respectively. The occurrence of specific illness symptoms did not differ between groups; however, the occurrence of a combined measure of cold symptoms was lower in the DHA group at 1 month (OR: 0.76; 95% CI: 0.58-1.00). At 1 month, the DHA group experienced 26%, 15%, and 30% shorter duration of cough, phlegm, and wheezing, respectively, but 22% longer duration of rash (all P ≤ .01). At 3 months, infants in the DHA group spent 14% less time ill (P < .0001). At 6 months, infants in the DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and "other illness," respectively, but 74% longer duration of vomiting (all P < .05).
DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months.
Macronutrients, such as protein or amino acid, not only supply calories but some components may also play as signaling molecules to affect feeding behavior, energy balance, and fuel efficiency. Leucine, a branched-chain amino acid is a good example. After structural roles are satisfied, the ability of leucine to function as signal and oxidative substrate is based on a sufficient intracellular concentration. Therefore, leucine level must be sufficiently high to play the signaling and metabolic roles. Leucine is not only a substrate for protein synthesis of skeletal muscle, but also plays more roles beyond that. Leucine activates signaling factor of mammalian target of rapamycin (mTOR) to promote protein synthesis in skeletal muscle and in adipose tissue. It is also a major regulator of the mTOR sensitive response of food intake to high protein diet. Meanwhile, leucine regulates blood glucose level by promoting gluconeogenesis and aids in the retention of lean mass in a hypocaloric state. It is beneficial to animal nutrition and clinical application and extrapolation to humans.
Folate and the metabolically related B-vitamins, vitamin B12 and riboflavin, have attracted much scientific and public health interest in recent years. Apart from a well established role in preventing neural tube defects (NTDs), evidence is emerging to support other potential roles for folate and/or related B-vitamins in protecting against cardiovascular disease (especially stroke), certain cancers, cognitive impairment and osteoporosis. However, typical folate intakes are sub-optimal, in that although adequate in preventing clinical folate deficiency (i.e. megaloblastic anaemia) in most people, they are generally insufficient to achieve a folate status associated with the lowest risk of NTDs. Natural food folates have a limited ability to enhance folate status as a result of their poor stability under typical cooking conditions and incomplete bioavailability when compared with the synthetic vitamin, folic acid (as found in supplements and fortified foods). Current folate recommendations to prevent NTDs (based primarily on folic acid supplementation) have been found to be ineffective in several European countries. In contrast, in North America and Chile, the policy of mandatory folic acid-fortification has proven itself in terms of lowering the prevalence of NTD, but remains controversial because of concerns regarding potential risks of chronic exposure to high-dose folic acid. In the case of vitamin B12, the achievement of an optimal status is particularly difficult for many older people because of the common problem of food-bound B12 malabsorption. Finally, there is evidence that riboflavin status is generally low in the UK population, and particularly so in younger women; this warrants further investigation.
A deficiency of dietary protein or amino acids has long been known to impair immune function and increase the susceptibility of animals and humans to infectious disease. However, only in the past 15 years have the underlying cellular and molecular mechanisms begun to unfold. Protein malnutrition reduces concentrations of most amino acids in plasma. Findings from recent studies indicate an important role for amino acids in immune responses by regulating: (1) the activation of T lymphocytes, B lymphocytes, natural killer cells and macrophages; (2) cellular redox state, gene expression and lymphocyte proliferation; and (3) the production of antibodies, cytokines and other cytotoxic substances. Increasing evidence shows that dietary supplementation of specific amino acids to animals and humans with malnutrition and infectious disease enhances the immune status, thereby reducing morbidity and mortality. Arginine, glutamine and cysteine precursors are the best prototypes. Because of a negative impact of imbalance and antagonism among amino acids on nutrient intake and utilisation, care should be exercised in developing effective strategies of enteral or parenteral provision for maximum health benefits. Such measures should be based on knowledge about the biochemistry and physiology of amino acids, their roles in immune responses, nutritional and pathological states of individuals and expected treatment outcomes. New knowledge about the metabolism of amino acids in leucocytes is critical for the development of effective means to prevent and treat immunodeficient diseases. These nutrients hold great promise in improving health and preventing infectious diseases in animals and humans.
Chronic obstructive pulmonary disease (COPD) is a chronic lung problem that needs higher attention. Smoking and pollution are main causative agents of this health problem. Inflammation and Oxidative stress are the major markers of COPD and antioxidant enzyme status can be used as biomarker to assess various chronic diseases. Antioxidant defense system plays an important to control oxidative stress caused by free radicals and other reactive species (reactive oxygen species and reactive nitrogen species). In COPD subjects, permanent oxidative stress continuously produced in the body caused imbalanced response of endogenous antioxidant enzyme. So, this disease is major public health problem and life threatening. This is the time to generate some treatment and drugs to prevent and cure the chronic lung disease.
OBJECTIVE: To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies. METHODS: Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. FINDINGS: We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). CONCLUSION: Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care.
Although there are biological pathways that conceivably might link stress with preterm birth, studies attempting to demonstrate such a relationship have given conflicting results. For the most part, social support has notbeen found to reduce preterm births. The present study is a prospective examination of how such factors as life events, social support, depression, and anxiety related to pregnancy may be associated with birth before 37 weeks' gestation. The study cohort included 1962 women who gave birth in central North Carolina in the years 1996-2000. Participants, aged 16 years and older, were entered into the study at 24-29 weeks' gestation. Many subjects were African-American women, and about half were nulliparous. More than half were not married when entering the study. Low-income households were liberally represented in the study group. The incidence of preterm birth was 12%. Life events, social support, and depression were not associated with preterm birth in this study, but women having medium and high scores for self-rated pregnancy-related anxiety were at increased risk; risk ratios were 1.5 and 2.1, respectively. High scores on a scale of perceived racial discrimination also correlated with an increased risk of preterm birth (risk ratio, 1.4). Similar findings were obtained when alcohol or tobacco use was taken into account. Women with greater self-rated anxiety were more at risk of spontaneous than of medically indicated preterm birth. A risk ratio of 1.8 was associated with life events perceived as having had a negative impact. Among women with negative life events, pregnancy-related anxiety was associated with preterm birth triggered by either labor or ruptured membranes. The association between high levels of pregnancy-related anxiety and preterm birth was less marked when limited to women lacking comorbid medical conditions, but it persisted. These findings suggest that some psychosocial measures are in fact associated with preterm birth.
From 1940 to 1980, protein deficiency was implicated in depressed fetal growth and impaired infant development. Consequently, increasing protein intake in pregnancy was recommended. In 1980, a randomized controlled trial found high protein supplements to be associated with depressed birth weight in low-income pregnant women. The objective of this study was to assess the role of dietary protein during pregnancy in women consuming a self-selected diet. The relation between dietary protein intake and pregnancy outcome was explored in an observational, longitudinal study of low income, mostly urban women. Protein intake was estimated using the average of two 24-hour dietary recalls, the first generally completed between months 4 to 6 and the second in month 8 of pregnancy. Hierarchical multiple regression analyses were conducted, adjusted for maternal, infant and socio-demographic characteristics and for duration of gestation and maternal energy intake. This study found that mean protein intake ≥85 g/day was associated with a 71 g decrement in birth weight (n = 2163, p = 0.009) compared to intermediate (50–84.9 g/day) average protein intake. About 36% of the women studied reported mean intakes of ≥85 g protein daily during pregnancy, whereas only 12% had low protein intakes (
Our purpose was to investigate the roles of nitric oxide and prostaglandins in controlling parturition.
Pregnant rats on day 18 of gestation were injected intraperitoneally with prostaglandin F2 alpha, prostaglandin F2 alpha plus diethylenetriamine-nitric oxide (a donor of nitric oxide), prostaglandin F2 alpha plus diethylenetriamine without nitric oxide, or vehicle. Uterine nitrite production, nitric oxide synthase messenger ribonucleic acid and contractile response in vitro, and serum progesterone levels were measured. The labor and delivery of the rats also were monitored.
Exogenously administered prostaglandin F2 alpha significantly inhibited nitric oxide production by the uterus in a time-dependent manner with maximal effects observed 48 hours after prostaglandin F2 alpha treatment. Messenger ribonucleic acid for inducible nitric oxide synthase but not endothelial nitric oxide synthase messenger ribonucleic acid in the uterus was significantly inhibited by prostaglandin F2 alpha with maximal inhibition at 48 hours after prostaglandin F2 alpha injection. The serum progesterone concentration was substantially reduced by prostaglandin F2 alpha, and this reduction was partially reversed by administration of diethylenetriamine-nitric oxide but not diethylenetriamine without nitric oxide. Prostaglandin F2 alpha caused increases in contractile activity of the uterus in a dose-dependent manner. Diethylenetriamine-nitric oxide (10(-4) mol/L) blocked prostaglandin F2 alpha-induced contractions. Premature parturition was induced within 48 hours after prostaglandin F2 alpha injection in 100% of the animals. Coadministration of diethylenetriamine-nitric oxide completely prevented the preterm labor induced by prostaglandin F2 alpha.
Prostaglandin F2 alpha inhibited inducible nitric oxide synthase messenger ribonucleic acid and subsequent nitric oxide generation in the rat uterus. Nitric oxide can prevent prostaglandin F2 alpha-induced preterm labor, possibly by attenuating the fall in serum progesterone and blocking uterine contractions induced by prostaglandin F2 alpha administration.
Female rats were fed throughout pregnancy on diets which differed in the level of protein (90 or 180 g/kg) and the type of fat (100 g corn oil or 50 g corn oil + 50 g coconut oil or 10 g corn oil + 90 g coconut oil/kg) they contained. At birth they were transferred to standard laboratory chow. Thymocytes from neonates exhibited a strong proliferative response to the T-cell mitogen concanavalin A, whereas spleen lymphocytes did not. Lower protein intake during pregnancy impaired neonatal thymocyte proliferation by up to 80%. Thymic and spleen lymphocyte proliferation remained impaired at weaning for the offspring of dams fed the lower protein diet containing 100 or 50 g corn oil/kg. Lymphocytes from the offspring of dams fed the lower protein diet containing 90 g coconut oil/kg responded in a similar fashion to cells from the offspring of dams fed the diets containing 180 g protein/kg. Thus, the acquisition of lymphocyte responsiveness which was impaired at birth after prenatal exposure to a low protein diet could be overcome postnatally if the prenatal diet included a large amount of coconut oil and a small amount of corn oil. Spleen natural killer cell activity at weaning was lower following prenatal exposure to the low protein diet and was lower when coconut oil was included in the diet. Thus, some aspects of immune function are programmed in utero by factors related to the diet of the mother. The effects of the nutrients and other factors received during suckling and of the developmental changes in the immune system which occur postpartum appear unable to overcome the impact of the diet received in utero.
Objective To examine the impact of antenatal supplementationwithmultiple micronutrientsoriron and folic acid compared with folic acid alone on birth weight, duration of gestation, and maternal haemoglobin concentration in the third trimester. Design Cluster randomised double blind controlled trial. Setting Two rural counties in north west China. Participants 5828 pregnant women and 4697 live births. Interventions Villages were randomised for all pregnant women to take either daily folic acid (control), iron with folicacid,ormultiplemicronutrientswitharecommended allowance of 15 vitamins and minerals. Main outcome measures Birth weight, length, and head circumference measured within 72 hours after delivery. Neonatalsurvivalassessedatthesixweekfollow-upvisit. Results Birth weight was 42 g (95% confidence interval 7 to 78 g) higher in the multiple micronutrients group compared with the folic acid group. Duration of gestation was 0.23 weeks (0.10 to 0.36 weeks) longer in the iron- folic acid group and 0.19 weeks (0.06 to 0.32 weeks)
Iodine requirements are increased ≥ 50% during pregnancy. Iodine deficiency during pregnancy can cause maternal and fetal hypothyroidism and impair neurological development of the fetus. The consequences depend upon the timing and severity of the hypothyroidism; the most severe manifestation is cretinism. In moderate-to-severely iodine-deficient areas, controlled studies have demonstrated that iodine supplementation before or during early pregnancy eliminates new cases of cretinism, increases birthweight, reduces rates of perinatal and infant mortality and generally increases developmental scores in young children by 10-20%. Mild maternal iodine deficiency can cause thyroid dysfunction but whether it impairs cognitive and/or neurologic function in the offspring remains uncertain. Two meta-analyses have estimated that iodine-deficient populations experience a mean reduction in IQ of 12-13.5 points. In nearly all regions affected by iodine deficiency, salt iodisation is the most cost-effective way of delivering iodine and improving maternal and infant health.
Poor maternal zinc status has been associated with foetal loss, congenital malformations, intra-uterine growth retardation, reduced birth weight, prolonged labour and preterm or post-term deliveries. A meta-analysis completed in 2007 showed that maternal zinc supplementation resulted in a small but significant reduction in preterm birth. The purposes of this analysis are to update that previous review and expand the scope of assessment to include maternal, infant and child health outcomes. Electronic searches were carried out to identify peer-reviewed, randomised controlled trials where daily zinc supplementation was given for at least one trimester of pregnancy. The co-authors applied the study selection criteria, assessed trial quality and abstracted data. A total of 20 independent intervention trials involving more than 11,000 births were identified. The 20 trials took place across five continents between 1977 and 2008. Most studies assessed the zinc effect against a background of other micronutrient supplements, but five were placebo-controlled trials of zinc alone. The provided dose of supplemental zinc ranged from 5 to 50 mg/day. Only the risk of preterm birth reached statistical significance (summary relative risk 0.86 [95% confidence interval 0.75, 0.99]). There was no evidence that supplemental zinc affected any parameter of foetal growth (risk of low birth weight, birth weight, length at birth or head circumference at birth). Six of the 20 trials were graded as high quality. The evidence that maternal zinc supplementation lowers the risk of preterm birth was graded low; evidence for a positive effect on other foetal outcomes was graded as very low. The effect of zinc supplementation on preterm birth, if causal, might reflect a reduction in maternal infection, a primary cause of prematurity. While further study would be needed to explore this possibility in detail, the overall public health benefit of zinc supplementation in pregnancy appears limited.
Iron deficiency is the most common nutritional deficiency globally. Children and women of reproductive age are at a particular risk of iron deficiency. Anaemia during pregnancy is a specific risk factor for adverse maternal and perinatal outcomes. The objective of this review was to assess the impact of routine iron supplementation on maternal anaemia and perinatal outcomes. A literature search was conducted for published randomised and quasi-randomised trials on PubMed and the Cochrane Library. Only those studies were included in the review that assessed the preventive effect of iron supplementation during pregnancy. Data from selected studies were double abstracted in a standardised excel sheet. The studies were graded according to study design, limitations, intervention specifics and outcome effects. Meta-analyses were conducted where data were available from more than one study for an outcome. After screening 5209 titles, 30 studies were selected for inclusion in this review. Daily iron supplementation resulted in 69% reduction in incidence of anaemia at term in the intervention group compared with control [relative risk (RR) 0.31 [95% confidence interval (CI) 0.22, 0.44]] and 66% reduction in iron deficiency anaemia at term (RR 0.44 [95% CI 0.28, 0.68]; random model) compared with no intervention/placebo. The quality grade for these outcomes was that of 'moderate' level. Routine daily iron supplementation during pregnancy resulted in a significant reduction of 20% in incidence of low birthweight in the intervention group compared with control (RR 0.80 [95% CI 0.71, 0.90]). Preventive iron supplementation during pregnancy has a significant benefit in reducing incidence of anaemia in mothers and low birthweight in neonates.
The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. Maternal malnutrition is a key contributor to poor fetal growth, low birthweight (LBW) and short- and long-term infant morbidity and mortality. This review summarised the evidence on association of maternal nutrition with birth outcomes along with review of effects of balanced protein-energy supplementation during pregnancy. A literature search was conducted on PubMed, WHOLIS, PAHO and Cochrane library. Only intervention studies were considered for inclusion and data were combined by meta-analyses if available from more than one study. Sixteen intervention studies were included in the review. Pooled analysis showed a positive impact of balanced protein-energy supplementation on birthweight compared with control [mean difference 73 (g) [95% confidence interval (CI) 30, 117]]. This effect was more pronounced in undernourished women compared with adequately nourished women. Combined data from five studies showed a reduction of 32% in the risk of LBW in the intervention group compared with control [relative risk (RR) 0.68 [95% CI 0.51, 0.92]]. There was a reduction of 34% in the risk of small-for-gestational-age babies in the intervention compared with the control group [RR 0.66 [95% CI 0.49, 0.89]]. The risk of stillbirth was also reduced by 38% in the intervention group compared with control [RR 0.62 [95% CI 0.40, 0.98]]. In conclusion, balanced protein-energy supplementation is an effective intervention to reduce the prevalence of LBW and small-for-gestational-age births, especially in undernourished women.
▪ Abstract Vitamin C is an essential dietary nutrient required as a co-factor for many enzymes, and humans are among the few animals that lack the ability to synthesize the compound from glucose. The reduced form of the vitamin, ascorbic acid, is an especially effective antioxidant owing to its high electron-donating power and ready conversion back to the active reduced form. Concentrations of the vitamin in body tissues and fluids are regulated through interactions of intestinal absorption, cellular transport, and excretion. The amount of vitamin C needed to prevent scurvy is very small and easily obtained in nearly all Western diets. There is great interest in the clinical roles of vitamin C because of evidence that oxidative damage is a root cause of, or at least associated with, many diseases. Population studies show that individuals with high intakes of vitamin C have lower risk of a number of chronic diseases, including heart disease, cancer, eye diseases, and neurodegenerative conditions. However, these results may simply reflect a more healthful diet or lifestyle for individuals with a high vitamin C intake. At present, data from controlled clinical trials have not established that higher intakes of vitamin C alone will help prevent chronic degenerative diseases. However, the evidence that ascorbic acid acts as an important antioxidant in many body tissues is convincing. The new higher Recommended Dietary Allowance (RDA) for vitamin C of 75 mg for women and 90 mg for men is, for the first time, based on the vitamin's role as an antioxidant as well as protection from deficiency. In healthy people, amounts greater than the RDA do not appear to be helpful. Vitamin C nutriture may be more important for people with certain diseases or conditions. High intakes of the vitamin are generally well tolerated; a Tolerable Upper Level was recently set at 2 g based on gastrointestinal upset that sometimes accompanies excessive intakes.
The labeling of health claims that meet the significant scientific agreement (SSA) standard (authorized health claims) and qualified health claims on conventional foods and dietary supplements requires premarket approval by the US Food and Drug Administration (FDA). FDA conducts an evidence-based review to determine whether there is sufficient evidence to support an authorized or qualified health claim. An evidencebased review was conducted on the human intervention and observational studies evaluating the role of supplemental calcium in reducing the risk of hypertension, pregnancy-induced hypertension, and preeclampsia. This review provides FDA's evaluation of the current scientific evidence on the role of supplemental calcium in reducing the risk of these three end points. Based on this evidence-based review, the agency concluded that the relationship between calcium and risk of hypertension is inconsistent and inconclusive, and the relationship between calcium and risk of pregnancy-induced hypertension and preeclampsia is highly unlikely.
It has been reported that impaired oxidant/antioxidant status is involved in a variety of pregnancy complications. To elucidate the possible free radical mediated mechanism of preterm delivery due to lead exposure by determining the placental lead level and oxidant/antioxidant status in women with the preterm and full-term deliveries. Twenty-nine women with preterm deliveries (gestational age 28-37 weeks) and 31 women with full-term deliveries (gestational age >37 weeks) attending a local hospital of Lucknow, India were recruited. Placental lead level, thiobarbituric acid reactive species (TBARS) level, as an end product of lipid peroxidation, antioxidant molecule glutathione (GSH) level, and activity of antioxidant enzymes; superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione S-transferase (GST) were measured in the placental tissue. In the group with preterm delivery, significantly higher placental lead levels were recorded than in those of full-term (0.39μg/g vs. 0.27μg/g; p<0.05). TBARS was significantly higher while GSH was significantly lower in the placenta of women with the preterm deliveries as compared to the full-term deliveries (p<0.05 for each). Activity of antioxidant enzymes; SOD, CAT, GPx, and GR were significantly higher in the placenta of women having preterm deliveries than those of the full-term (p<0.05 for each). Furthermore, placental lead has significant positive correlations with TBARS (r=0.34, p<0.05), SOD (r=0.30, p<0.05) and CAT (r=0.41, p<0.05), and negative correlation with GSH (r=-0.31, p<0.05). There may be a number of plausible reasons for increased oxidative stress in preterm delivery. However, results of this pilot study suggest that lead-induced oxidative stress may be one of the underlying mechanism(s) of preterm delivery and emphasizes the importance of evaluating the impact of persistent environmental pollutants on adverse pregnancy outcome.
To estimate the association between maternal overweight and obesity on complications during pregnancy and delivery in Denmark.
A population-based study on a cohort consisting of all Danish women giving birth to a singleton from 2004 through June 30, 2010 (N = 403,092) was undertaken. Women were identified from the Danish Medical Birth Registry, which contains data on 99.8% of all deliveries in Denmark. Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases, 10th Revision.
The final study population consisted of 369,347 women, 20.9% being overweight (body mass index [BMI] 25-29.9), 7.7% obese (BMI 30-35), and 4% severely obese (BMI higher than 35). Overweight, obese, and severely obese women had more complications than did normal weight women. Adjusted odds ratios (ORs) were significantly increased as follows: for gestational diabetes mellitus, 3.5, 7.7, and 11.0 for each BMI category; for preeclampsia 1.9, 3, and 4.4. Planned and especially emergency cesarean delivery was significantly increased with increasing BMI (OR ranging from 1.2 to 2.1). The risk of giving birth to a macrosomic neonate (greater than 4,500 g) increased significantly with increasing BMI (1.6, 2.2, and 2.7), as did the risks of having a neonate with a low Apgar score (1.3, 1.4, and 1.9) and having a stillborn fetus (1.4, 1.6, and 1.9). For shoulder dystocia the risk was significantly increased in the unadjusted analysis, but the significance disappeared in the adjusted analysis. No statistically significance was seen for hemorrhage and thrombosis.
This study shows a significant increased risk of a wide variety of pregnancy, birth, and neonatal complications in overweight, obese, and severely obese women.
II.
Our knowledge of the mechanisms and regulation of intestinal absorption of water-soluble vitamins under normal physiological conditions, and of the factors/conditions that affect and interfere with theses processes has been significantly expanded in recent years as a result of the availability of a host of valuable molecular/cellular tools. Although structurally and functionally unrelated, the water-soluble vitamins share the feature of being essential for normal cellular functions, growth and development, and that their deficiency leads to a variety of clinical abnormalities that range from anaemia to growth retardation and neurological disorders. Humans cannot synthesize water-soluble vitamins (with the exception of some endogenous synthesis of niacin) and must obtain these micronutrients from exogenous sources. Thus body homoeostasis of these micronutrients depends on their normal absorption in the intestine. Interference with absorption, which occurs in a variety of conditions (e.g. congenital defects in the digestive or absorptive system, intestinal disease/resection, drug interaction and chronic alcohol use), leads to the development of deficiency (and sub-optimal status) and results in clinical abnormalities. It is well established now that intestinal absorption of the water-soluble vitamins ascorbate, biotin, folate, niacin, pantothenic acid, pyridoxine, riboflavin and thiamin is via specific carrier-mediated processes. These processes are regulated by a variety of factors and conditions, and the regulation involves transcriptional and/or post-transcriptional mechanisms. Also well recognized now is the fact that the large intestine possesses specific and efficient uptake systems to absorb a number of water-soluble vitamins that are synthesized by the normal microflora. This source may contribute to total body vitamin nutrition, and especially towards the cellular nutrition and health of the local colonocytes. The present review aims to outline our current understanding of the mechanisms involved in intestinal absorption of water-soluble vitamins, their regulation, the cell biology of the carriers involved and the factors that negatively affect these absorptive events.
In 1998, fortification of a large variety of cereal products with folic acid became mandatory in Canada. A multicentric study was carried out to assess the impact of this policy on the frequency of NTDs. The present analysis focused on spina bifida.
The study population included approximately 2 million livebirths, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces, from 1993 to 2002. Spina bifida cases were divided according to the upper limit of the defect: upper (cranial, cervical, or thoracic) and lower (lumbar or sacral) defects. Based on published results of red blood cell folate tests, the study period was divided into prefortification, partial fortification, and full fortification periods.
A total of 1,286 spina bifida cases were identified: 51% livebirths, 3% stillbirths, and 46% terminations. Prevalence decreased from 0.86/1,000 in the prefortification to 0.40 in the full fortification period, while the proportion of upper defects decreased from 32% to 13%. Following fortification, regional variations in the prevalence and distribution of sites almost disappeared.
Results confirmed the etiologic heterogeneity of spina bifida and the more pronounced effect of folic acid in decreasing the risk of the more severe clinical presentations.
The placenta is the organ that transports nutrients, respiratory gases, and wastes between the maternal and fetal systems. Consequently, placental blood flow and vascular development are essential components of normal placental function and are critical to fetal growth and development. Normal fetal growth and development are important to ensure optimum health of offspring throughout their subsequent life course. In numerous sheep models of compromised pregnancy, in which fetal or placental growth, or both, are impaired, utero-placental blood flows are reduced. In the models that have been evaluated, placental vascular development also is altered. Recent studies found that treatments designed to increase placental blood flow can 'rescue' fetal growth that was reduced due to low maternal dietary intake. Placental blood flow and vascular development are thus potential therapeutic targets in compromised pregnancies.
Suboptimal embryonic/fetal survival and growth remains a significant problem in mammals. Using a swine model, we tested the hypothesis that dietary L-arginine supplementation during gestation may improve pregnancy outcomes through enhancing placental growth and modulating hormonal secretions. Gestating pigs (Yorkshire×Landrace, n=108) were assigned randomly into two groups based on parity and body weight, representing dietary supplementation with 1.0% L-arginine-HCl or 1.7% L-alanine (isonitrogenous control) between days 22 and 114 of gestation. Blood samples were obtained from the ear vein on days 22, 40, 70 and 90 of gestation. On days 40, 70 and 90 of gestation, concentrations of estradiol in plasma were higher (P<0.05) in arginine-supplemented than in control sows. Moreover, arginine supplementation increased (P<0.05) the concentrations of arginine, proline and ornithine in plasma, but concentrations of urea or progesterone in plasma did not differ between the two groups of sows. Compared with the control, arginine supplementation increased (P<0.05) the total number of piglets by 1.31 per litter, the number of live-born piglets by 1.10 per litter, the litter birth weight for all piglets by 1.36 kg, and the litter birth weight for live-born piglets by 1.70 kg. Furthermore, arginine supplementation enhanced (P<0.05) placental weight by 16.2%. The weaning-to-estrus interval of sows was not affected by arginine supplementation during gestation. These results indicate that dietary arginine supplementation beneficially enhances placental growth and the reproductive performance of sows.