Article

A vegetable, fruit, and white rice dietary pattern during pregnancy is associated with a lower risk of preterm birth and larger birth size in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

October 2016
American Journal of Clinical Nutrition 104(5)

DOI:10.3945/ajcn.116.133892

Authors:

Jamie Violet de Seymour

Massey University

Marjorelee Colega

Agency for Science, Technology and Research (A*STAR)

Ling-Wei Chen

National Taiwan University

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Background: Maternal dietary patterns during pregnancy have been shown to influence infant birth outcomes. However, to our knowledge, only a few studies have examined the associations in Asian populations. Objective: We characterized maternal dietary patterns in Asian pregnant women and examined their associations with the risk of preterm birth and offspring birth size. Design: At 26-28 wk of gestation, 24-h recalls and 3-d food diaries were collected from the women in the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort. Dietary patterns were derived from exploratory factor analysis. Gestational age was determined by a dating ultrasound scan in the first trimester, and infant birth anthropometric measurements were obtained from hospital records. Associations were assessed by logistic and linear regressions with adjustment for confounding factors. Results: Three maternal dietary patterns were identified: vegetable, fruit, and white rice (VFR); seafood and noodle (SfN); and pasta, cheese, and processed meat (PCP). Of 923 infants, 7.6% were born preterm, 13.4% were born small for gestational age, and 14.7% were born large for gestational age. A greater adherence to the VFR pattern (per SD increase in VFR score) was associated with a lower risk of preterm births (OR: 0.67; 95% CI: 0.50, 0.91), higher ponderal index (β: 0.26 kg/m(3); 95% CI: 0.06, 0.45 kg/m(3)), and increased risk of a large-for-gestational-age birth (RR: 1.31; 95% CI: 1.06, 1.62). No associations were observed for the SfN and PCP patterns in relation to birth outcomes. Conclusions: The VFR pattern is associated with a lower incidence of preterm birth and with larger birth size in an Asian population. The findings related to larger birth size warrant further confirmation in independent studies. This trial was registered at clinicaltrials.gov as NCT01174875.

Supplementary Material

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October 2016

Airu Chia · Jamie Violet de Seymour · Marjorelee Colega · Ling-Wei Chen · M.F.F. Chong

Maternal dietary patterns as predictors of neonatal body composition in Ethiopia: the IABC birth cohort study

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Full-text available

Apr 2025

Background Malnutrition during pregnancy is associated with adverse birth outcomes, but the importance of maternal diet during pregnancy for neonatal body composition remains inconclusive. This study investigated the role of maternal diet during pregnancy for neonatal body composition in the Ethiopian iABC birth cohort. Methods The data stemmed from the first visit at birth comprising 644 mother-child pairs. Shortly after delivery, the diet of the last week of pregnancy was assessed by a non-quantitative and non-validated 18-items food frequency questionnaire. Multiple imputation was used to handle missing data. Twin births and implausible values were excluded from analysis (n = 92). The Dietary Diversity Score (0–9 points) was constructed and exploratory dietary patterns were derived via principal component analysis. Neonatal fat mass and fat-free mass were assessed by air-displacement plethysmography. The associations of maternal Dietary Diversity Score and exploratory dietary patterns with gestational age, neonatal anthropometric measures and body composition were investigated using multiple-adjusted linear regression analysis. Results In this cohort (n = 552), mean ± standard deviation (SD) mother’s age was 24.1 ± 4.6 years and the median maternal Dietary Diversity Score was 6 (interquartile range = 5–7). An ‘Animal-source food pattern’ and a ‘Vegetarian food pattern’ were identified. The mean ± SD birth weight was 3096 ± 363 g and gestational age was 39.0 ± 1.0 weeks. Maternal adherence to the Animal-source food pattern, but not Vegetarian food pattern, was related to birth weight [79.5 g (95% confidence interval (CI): -14.6, 173.6)]. In the adjusted model, adherence to the Animal-source food pattern was associated with higher neonatal fat-free mass [53.1 g (95% CI: -20.3, 126.6)], while neonates of women with high compared to low adherence to Dietary Diversity Score and Vegetarian food pattern had higher fat mass [19.4 g (95% CI: -7.4, 46.2) and 33.5 g (95% CI: 2.8, 64.1), respectively]. Conclusions In this Ethiopian population, maternal diet during pregnancy was associated with neonatal body composition. The analysis of body composition adds important detail to the evaluation of maternal dietary habits for the newborn constitution.

Association of Maternal Dietary Patterns With Birth Weight and the Mediation of Gestational Weight Gain: A Prospective Birth Cohort

Article

Full-text available

Nov 2021

The associations among maternal diet, birth weight, and gestational weight gain are still inconclusive. This study aimed to investigate the associations between maternal dietary patterns and birth weight, and further explore whether GWG mediates these associations. A total of 3,334 pregnant women who completed a validated semi-quantitative food frequency questionnaire from the Tongji Maternal and Child Health Cohort were included. Dietary patterns were extracted by using principal component analysis. Regression models and mediation analyses were performed to explore the associations between dietary patterns and birth weight and the effects of GWG on these associations. Five dietary patterns were identified: “Beans-vegetables,” “Fish-meat-eggs,” “Nuts-whole grains,” “Organ-poultry-seafood” and “Rice-wheat-fruits.” Only women following the “Beans-vegetables” pattern had heavier newborns ( β = 47.39; 95% CI: 12.25, 82.54). Women following the “Beans-vegetables” pattern had significantly lower GWG ( β = −0.7; 95% CI: −1.15, −0.25) and had a 16% lower risk of excessive GWG and 11% higher odd of adequate GWG. The association between the “Beans-vegetables” pattern and birth weight was negatively mediated by GWG. A dietary pattern enriched in beans and vegetables is beneficial for effectively controlling GWG and increasing birth weight. GWG serves. Clinical Trial Registry: This trial was registered at ClinicalTrials.gov (NCT03099837).

Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies

Article

Jan 2021

The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as “healthy,” “unhealthy,” or “mixed.” No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges’ g: 0.15; P = 0.01), and birth weight (Hedges’ g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and “prudent” dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.

Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

Article

Full-text available

May 2019

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics. SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in SECOST between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs. RESULTS: Three DPs were identified at each time point and designated DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), DP 7-9 (second trimester) and DP 10-12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11. CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.

Maternal Dietary Patterns and Birth Outcomes: A Systematic Review and Meta-Analysis

Article

Full-text available

Apr 2019

Findings on the relations of maternal dietary patterns during pregnancy and risk of preterm birth and offspring birth size remain inconclusive. We aimed to systematically review and quantify these associations.We searched MEDLINE, Embase, CENTRAL, and CINAHL up to December 2017. Three authors independently conducted a literature search, study selection, data extraction, and quality assessment. Summary effect sizeswere calculated with random effects models and studies were summarized narratively if results could not be pooled. We included 36 studies and pooled results from 25 observational studies (167,507 participants). Two common dietary patterns—“healthy” and “unhealthy”—were identified. Healthy dietary patterns—characterized by high intakes of vegetables, fruits, wholegrains, low-fat dairy, and lean protein foods—were associated with lower risk of preterm birth (OR for top compared with bottom tertile: 0.79; 95% CI: 0.68, 0.91; I2 = 32%) and a weak trend towards a lower risk of small-forgestational- age (OR: 0.86; 95% CI: 0.73, 1.01; I2 = 34%). Only statistically data-driven healthy dietary patterns, and not dietary index-based patterns, were associated with higher birth weight (mean difference: 67 g; 95% CI: 37, 96 g; I2 = 75%). Unhealthy dietary patterns—characterized by high intakes of refined grains, processedmeat, and foods high in saturated fat or sugar—were associatedwith lower birthweight (mean difference:−40 g; 95% CI:−61,−20 g; I2 =0%) and a trend towards a higher risk of pretermbirth (OR: 1.17; 95% CI: 0.99, 1.39; I2 =76%). Data fromobservational studies indicate that greater adherence to healthy dietary patterns during pregnancy is significantly related to lower risk of preterm birth. No consistent associations with birth weight and small- or large-for-gestational-age were observed.

Dietary patterns before and during pregnancy and birth outcomes: a systematic review

Article

Mar 2019

Background: Maternal diet before and during pregnancy could influence fetal growth and birth outcomes. Objective: Two systematic reviews aimed to assess the relationships between dietary patterns before and during pregnancy and 1) gestational age at birth and 2) gestational age- and sex-specific birth weight. Methods: Literature was searched from January, 1980 to January, 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using predetermined inclusion and exclusion criteria. Data were extracted from included articles and risk of bias was assessed. Data were synthesized qualitatively, a conclusion statement was drafted for each question, and evidence supporting each conclusion was graded. Results: Of the 9103 studies identified, 11 [representing 7 cohorts and 1 randomized controlled trial (RCT)] were included for gestational age and 21 (representing 19 cohorts and 2 RCTs) were included for birth weight. Limited but consistent evidence suggests that certain dietary patterns during pregnancy are associated with a lower risk of preterm birth and spontaneous preterm birth. These protective dietary patterns are higher in vegetables; fruits; whole grains; nuts, legumes, and seeds; and seafood (preterm birth, only), and lower in red and processed meats, and fried foods. Most of the research was conducted in healthy Caucasian women with access to health care. No conclusion can be drawn on the association between dietary patterns during pregnancy and birth weight outcomes. Although research is available, the ability to draw a conclusion is restricted by inconsistency in study findings, inadequate adjustment of birth weight for gestational age and sex, and variation in study design, dietary assessment methodology, and adjustment for key confounding factors. Insufficient evidence exists regarding dietary patterns before pregnancy for both outcomes. Conclusions: Maternal dietary patterns may be associated with a lower preterm and spontaneous preterm birth risk. The association is unclear for birth weight outcomes.

The association between ultra-processed food and common pregnancy adverse outcomes: a dose-response systematic review and meta-analysis

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Full-text available

May 2024

Objectives Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the relationship between ultra-processed foods (UPFs) consumption and common adverse pregnancy outcomes including gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants. UPFs are described as formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers, and other cosmetic additives. Examples include savory snacks, reconstituted meat products, frozen meals that have already been made, and soft drinks. Methods A comprehensive search was performed using the Scopus, PubMed, and Web of Science databases up to December 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using a random-effects model. Results Our analysis (encompassing 54 studies with 552,686 individuals) revealed a significant association between UPFs intake and increased risks of GDM (RR = 1.19; 95% CI: 1.10, 1.27; I² = 77.5%; p < 0.001; studies = 44; number of participants = 180,824), PE (RR = 1.28; 95% CI: 1.03, 1.59; I² = 80.0%; p = 0.025; studies = 12; number of participants = 54,955), while no significant relationships were found for PTB, LBW and SGA infants. Importantly, a 100 g increment in UPFs intake was related to a 27% increase in GDM risk (RR = 1.27; 95% CI: 1.07, 1.51; I² = 81.0%; p = 0.007; studies = 9; number of participants = 39,812). The non-linear dose-response analysis further indicated a positive, non-linear relationship between UPFs intake and GDM risk Pnonlinearity = 0.034, Pdose-response = 0.034), although no such relationship was observed for PE (Pnonlinearity = 0.696, Pdose-response = 0.812). Conclusion In summary, both prior to and during pregnancy, chronic and excessive intake of UPFs is associated with an increased risk of GDM and PE. However, further observational studies, particularly among diverse ethnic groups with precise UPFs consumption measurement tools, are imperative for a more comprehensive understanding.

Preterm Birth and Its Association with Maternal Diet, and Placental and Neonatal Telomere Length

Article

Full-text available

Nov 2023

Preterm birth (PTB), a multi-causal syndrome, is one of the global epidemics. Maternal nutrition, but also neonatal and placental telomere length (TL), are among the factors affecting PTB risk. However, the exact relationship between these factors and the PTB outcome, remains obscure. The aim of this review was to investigate the association between PTB, maternal nutrition, and placental-infant TL. Observational studies were sought with the keywords: maternal nutrition, placental TL, newborn, TL, and PTB. No studies were found that included all of the keywords simultaneously, and thus, the keywords were searched in dyads, to reach assumptive conclusions. The findings show that maternal nutrition affects PTB risk, through its influence on maternal TL. On the other hand, maternal TL independently affects PTB risk, and at the same time PTB is a major determinant of offspring TL regulation. The strength of the associations, and the extent of the influence from covariates, remains to be elucidated in future research. Furthermore, the question of whether maternal TL is simply a biomarker of maternal nutritional status and PTB risk, or a causative factor of PTB, to date, remains to be answered.

Vegetarian diets during pregnancy: effects on the mother’s health. A systematic review

Article

Nov 2020

While interest in vegetarian nutrition has been steadily increasing, some aspects have not yet been consistently investigated. A topic requiring evidence-based confirmation is the adoption of a vegetarian diet during pregnancy and lactation. Maternal diet is correlated not only with the fetus’ and infant’s health, but it appears relevant for that of the mother as well. Not only is an adequate delivery of nutrients to the fetus and infant mandatory, but the increased physiological needs of the maternal body require an adequate supply of nutrients and can represent harmful stress events that may lead to well-defined pathological conditions. In this review, we aim to systematically investigate the state-of-the-art of vegetarian diets during pregnancy and lactation, focusing on maternal nutritional status and pregnancy outcomes. Data are scarce, often inconsistent and not homogeneous for many of the topics we considered, mainly because only a few studies were performed in developed countries, whereas other studies derived from developing countries, where vegetarianism can be a proxy indicator of malnutrition. For this reason, we did not find sufficient data to provide evidence-based information and recommendations. To date, the available literature does not clearly support a negative impact on the mother’s health and pregnancy outcomes, but, analogously with the findings in the vegetarian adult population, the improvement of the quality of the studies might facilitate finding more information on the possible positive impact of well-planned vegetarian diets in pregnancy and lactation. More epidemiological and interventional studies are warranted, in order to address the question as to whether vegetarian nutrition represents an advantage for the mother or poses nutritional issues that need further attention.

Influences of the perinatal diet on maternal and child health: Insights from the GUSTO study

Article

Dec 2019

Maternal and child health are intrinsically linked. With accumulating evidence over the past two decades supporting the developmental origins of health and diseases hypothesis, it is now widely recognised that nutrition in the first 1000 d sets the foundation for long-term health. Maternal diet before, during and after pregnancy can influence the developmental pathways of the fetus and lead to health consequences later in life. While maternal and infant mortality rates have declined significantly in the past two decades, the growing burden of obesity and chronic non-communicable diseases in women of reproductive age and children is on a rapid rise worldwide, in developed and developing countries. A key contributory factor is malnutrition, which is a consequence of consuming poor quality diets. Suboptimal macronutrient balance and micronutrient inadequacies can lead to undesirable maternal body composition and metabolism, in turn influencing the health of the mother and leading to longer-term metabolic and cognitive health consequences in the infant. The GUSTO (Growing Up in Singapore Towards healthy Outcomes) study, a mother–offspring multi-ethnic cohort study in Singapore, has contributed to this body of evidence over the past 10 years. This review will illustrate how nutritional epidemiological research through a birth cohort has illuminated the importance and urgency of maternal and child nutrition and health in a modern, industrialised setting. It underscores the importance of a number of critical nutrients during pregnancy, in combination with healthy dietary patterns and appropriate meal timing, for optimal maternal and child health.

Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras

Article

Full-text available

Feb 2025

Objective: To investigate the sociodemographic, maternal, and gestational factors associated with the dietary total antioxidant capacity in pregnant Brazilian women. Methods: A cross-sectional study with 2,232 pregnant women aged 18 years old or older, in the first, second, and third trimesters of pregnancy, from eleven cities in the five Brazilian regions. A semi-structured questionnaire was applied to assess socioeconomic, demographic, and health data, and a 24-hour dietary recall (R24h) was used to assess food consumption and analyze the dietary total antioxidant capacity (DTAC), estimated using the ferric reducing antioxidant power (FRAP) method. Results: The median of DTAC was 5.32 mmol/day. Aracaju, Sergipe (SE) had the highest median of DTAC (6.44 mmol/day) and Palmas, Tocantins (TO) had the lowest (4.71 mmol/day). Pregnant women aged 20 to 34 years (OR 1.86; 95%CI 1.26-2.76), 35 years old or older (OR 3.68; 95%CI 2.21-6.14) and who were in the second trimester of pregnancy (OR 1.50; 95%CI 1.11-2.01) were more likely to be above the median DTAC. While pregnant women with higher education had a 67% lower chance of being above the median DTAC (OR 0.67; 95%CI 0.48-0.92). Conclusion: The study demonstrated that there are differences in antioxidant consumption in different cities in Brazil and that associated factors such as age, education, and gestational trimester can impact the intake of foods rich in antioxidants. The profile found draws attention to the importance of an adequate diet rich in antioxidants during prenatal care. Keywords: Antioxidants; Pregnancy; Oxidative stress; Food consumption; Sociodemographic factors

Maternal dietary practices during pregnancy and obesity of neonates: a machine learning approach towards hierarchical and nested relationships in a Tibet Plateau cohort study

Article

Sep 2024
BRIT J NUTR

Studies on obesity and risk factors from a life-course perspective among residents in the Tibet Plateau with recent economic growth and increasing obesity are important and urgently needed. The birth cohort in this area provides a unique opportunity to examine the association between maternal dietary practice and neonatal obesity. The study aims to detect the prevalence of obesity among neonates, associated with maternal diet and other factors, supporting life-course strategies for obesity control. A cohort of pregnant women was enrolled in Tibet Plateau and followed till childbirth. Dietary practice during pregnancy was assessed using the Chinese FFQ – Tibet Plateau version, food items and other variables were associated with the risk for obesity of neonates followed by logistic regression, classification and regression trees (CART) and random forest. Of the total 1226 mother–neonate pairs, 40·5 % were Tibetan and 5·4 % of neonates with obesity. Consuming fruits as a protective factor for obesity of neonates with OR (95 % CI) = 0·61 (0·43, 0·87) from logistic regression; as well as OR = 0·20 (0·12, 0·35) for consuming fruits (≥ weekly) from CART. Removing fruit consumption to avoid overshadowing effects of other factors, the following were influential from CART: maternal education (more than middle school, OR = 0·22 (0·13, 0·37)) and consumption of Tibetan food (daily, OR = 3·44 (2·08, 5·69). Obesity among neonates is prevalent in the study population. Promoting healthy diets during pregnancy and strengthening maternal education should be part of the life-course strategies for obesity control.

Maternal dietary patterns during pregnancy and birth weight: a prospective cohort study

Article

Full-text available

Aug 2024
Nutr J

Background Existing data on maternal dietary patterns and birth weight remains limited and inconsistent, especially in non-Western populations. We aimed to examine the relationship between maternal dietary patterns and birth weight among a cohort of Chinese. Methods In this study, 4,184 mother-child pairs were included from the Iodine Status in Pregnancy and Offspring Health Cohort. Maternal diet during pregnancy was evaluated using a self-administered food frequency questionnaire with 69 food items. Principal component analysis was used to identify dietary patterns. Information on birth weight and gestational age was obtained through medical records. Adverse outcomes of birth weight were defined according to standard clinical cutoffs, including low birth weight, macrosomia, small for gestational age, and large for gestational age. Results Three maternal dietary patterns were identified: plant-based, animal-based, and processed food and beverage dietary patterns, which explained 23.7% variance in the diet. In the multivariate-adjusted model, women with higher adherence to the plant-based dietary patten had a significantly higher risk of macrosomia (middle tertile vs. low tertile: odds ratio (OR) 1.45, 95% CI 1.00-2.10; high tertile vs. low tertile: OR 1.55, 95% CI 1.03–2.34; P-trend = 0.039). For individual food groups, potato intake showed positive association with macrosomia (high tertile vs. low tertile: OR 1.72, 95% CI 1.20–2.47; P-trend = 0.002). Excluding potatoes from the plant-based dietary pattern attenuated its association with macrosomia risk. No significant associations was observed for the animal-based or processed food and beverage dietary pattern with birth weight outcomes. Conclusions Adherence to a plant-based diet high in carbohydrate intake was associated with higher macrosomia risk among Chinese women. Future studies are required to replicate these findings and explore the potential mechanisms involved.

Effects of prepregnancy dietary patterns on infant birth weight: a prospective cohort study

Article

Full-text available

Oct 2023

Background Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns. Objectives This study aimed to explore the effects between prepregnancy dietary patterns on birth weight. Methods This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother–Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI). Results Four dietary patterns were identified based on 15 food groups. These patterns were named as “cereals–vegetables–fruits,” “vegetables–poultry–aquatic products,” “milk–meat–eggs,” and “nuts–aquatic products–snacks.” After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the “cereals–vegetables–fruits” pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the “nuts–aquatic products–snacks” pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, “cereals–vegetables–fruits” pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480). Conclusions An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy.

Dietary patterns before and during pregnancy and small for gestational age in Japan: a prospective birth cohort study

Article

Full-text available

Sep 2022
Nutr J

Background Although small for gestational age (SGA) is a serious problem worldwide, the association of dietary patterns before and during pregnancy with SGA risk is unclear. We evaluated this association among Japanese pregnant women using three methods: reduced rank regression (RRR) and partial least squares (PLS), methods for extracting dietary patterns that can explain the variation of response variables, and principal component analysis (PCA), a method for extracting dietary patterns of the population. Methods Between July 2013 and March 2017, 22,493 pregnant women were recruited to the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a population-based prospective birth cohort study in Japan. Information on dietary intake was obtained using food frequency questionnaires, and dietary patterns were extracted using RRR, PLS, and PCA. Information on birth weight was obtained from obstetric records, and the birth weight SD score and SGA were defined by the method of the Japan Pediatric Society. The associations of dietary patterns with birth weight SD score and SGA risk were investigated using multiple linear regression and multiple logistic regression, respectively. Results A total of 17,728 mother-child pairs were included. The birth weight SD score was 0.15 ± 0.96, and the prevalence of SGA was 6.3%. The dietary patterns extracted by RRR and PLS were similar and characterized by a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages in both pre- to early pregnancy and from early to mid-pregnancy. Higher adoption of the RRR and PLS patterns in both periods was associated with an increased birth weight SD score and lower risk of SGA. In contrast, the PCA1 pattern was not associated with birth weight SD score or SGA risk in either period. Although the PCA2 pattern was associated with increased birth weight SD score from early to mid-pregnancy, no other associations with birth weight SD score or SGA risk were observed. Conclusions The dietary pattern with a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages before and during pregnancy was associated with a decreased SGA risk in Japan.

Associations of maternal dietary patterns during pregnancy and fetal intrauterine development

Article

Full-text available

Sep 2022

Dietary pattern is excellent in reflecting an individual's eating conditions. Longitudinal data on fetal growth can reflect the process of intrauterine growth. We aimed to evaluate the associations between maternal dietary patterns and intrauterine parameters in middle and late pregnancy. The present study was conducted within Jiangsu Birth Cohort (JBC) study. Dietary information was assessed with a food frequency questionnaire (FFQ) in the second and third trimester of gestation. B-ultrasound scans were performed to obtain fetal intrauterine parameters, including head circumference (HC), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW). Exploratory factor analysis was used to extract dietary patterns. Multiple linear regression and linear mixed-effects model (LMM) were used to investigate the association between maternal dietary patterns and fetal growth. A total of 1,936 pregnant women were eligible for the study. We observed inverse associations of maternal “Vegetables and fish” and “Snack and less eggs” patterns during mid-pregnancy with fetal HC Z-score, respectively (“Vegetables and fish”: β = −0.09, 95% CI −0.12, −0.06; “Snack and less eggs”: β = −0.05, 95% CI −0.08, −0.02). On the contrary, “Animal internal organs, thallophyte and shellfish” pattern in the second trimester was associated with increased HC Z-scores (β = 0.04, 95% CI 0.02, 0.06). Consistently, score increase in “Vegetables and fish” pattern in the third trimester was inversely associated with the Z-scores of HC (β = −0.05, 95% CI −0.09, −0.02), while “Meat and less nuts” pattern was positively correlated with the Z-scores of HC (β = 0.04, 95% CI 0.02, 0.07). As compared to the fetus whose mothers at the lowest tertile of “Snack and less eggs” pattern in both trimesters, those whose mothers at the highest tertile demonstrated 1.08 fold (RR = 2.10, 95% CI 1.34–3.28) increased risk of small HC for gestational age (GA). No correlation was observed between maternal dietary patterns and other intrauterine parameters. Our results suggested the effects of maternal dietary patterns on fetal growth, particularly HC. These findings highlighted the adverse impact of unhealthy dietary pattern on fetal growth, might provide evidence for strategies to prevent intrauterine dysplasia and dietary guidelines during pregnancy.

The effect of dietary fiber supplement on prevention of gestational diabetes mellitus in women with pre-pregnancy overweight/obesity: A randomized controlled trial

Article

Full-text available

Aug 2022

Objective: To investigate the effect of dietary fiber intake during pregnancy on the prevention of gestational diabetes mellitus (GDM) in women who are overweight/obese prior to pregnancy. Methods: This randomized controlled trial was conducted in Shanghai General Hospital from June 2021 to March 2022. A total of 98 women who reported BMI≥24 kg/m² prior to pregnancy were recruited before their 20th gestational week, and randomly (simple random allocation) assigned to the fiber supplement group (12 g of dietary fiber power twice daily) and the control group (standard prenatal care) from 20 to 24⁺⁶ gestational weeks. Both groups received nutrition education and dietary advice during the study. GDM diagnosis was performed by an oral glucose tolerance test (OGTT) at 25–28 weeks’ gestation. Data are presented as means with SD, as medians with IQR, or as counts with percentages as appropriate. Comparisons were conducted using a t-test, Mann-Whitney U test, and χ² test, respectively. Results: The incidence of GDM was significantly reduced in the fiber supplement group compared with the control group: 8.3 vs. 24.0% (χ² = 4.40, p = 0.036). At OGTT, the mean fasting plasma glucose in the fiber supplement group was significantly lower than before the intervention (4.57 ± 0.38 mmol/L vs. 4.41 ± 0.29 mmol/L, p < 0.01) but not in the control group (4.48 ± 0.42 mmol/L vs. 4.37 ± 0.58 mmol/L, p = 0.150). Compared with the control group, the TG and TG/HDL-C ratio levels in the intervention group were significantly higher than those in the control group (2.19 ± 0.54 mmol/L vs. 2.70 ± 0.82 mmol/L and 1.19 ± 0.49 vs.1.63 ± 0.63, respectively, all P＜0.05). The body weight gain was significantly lower in the fiber supplement group than the control group (1.99 ± 1.09 kg vs. 2.53 ± 1.20kg, p = 0.022). None of the women randomized to the fiber supplement group experienced preterm birth (<37 weeks gestation) compared with 12.0% in the control group (p = 0.040). Excessive weight gain (total weight gain >11.5 kg for overweight, and >9.0 kg for obesity) occurred in 46.7% of women in the fiber supplement group compared with 68.0% in the control group (p = 0.035). There were no differences in other maternal and neonatal outcomes. Conclusion: Increased dietary fiber intake in pregnant women who were overweight/obese prior to pregnancy may reduce the risk of GDM, excessive weight gain, and preterm birth, but it did not improve blood lipids.

An Investigation of the Relationship Between Dietary Patterns in Early Pregnancy and Maternal/Infant Health Outcomes in a Chinese Cohort

Article

Full-text available

Apr 2022

Background Studies assessing links between maternal diet and pregnancy outcomes have focused predominantly on individual nutrients or foods. However, nutrients are typically consumed in combinations of foods or beverages (i.e., dietary patterns). Taking into account the diet as a whole appreciates that nutrient absorption and metabolism are influenced by other nutrients and the food matrix. Objective The aim of this study was to investigate the relationship between dietary pattern consumption in early pregnancy and pregnancy/infant outcomes, including gestational diabetes mellitus, gestational weight gain, preeclampsia, placental weight, gestational age at delivery, small-for-gestational-age, large-for-gestational-age, macrosomia, measures of infant body composition, and scores on two main indices of the Bayley Scales of Infant Development [Mental Development Index (MDI) and the Psychomotor Development Index (PDI)] at 12 months. Design Our study included 1,437 participants from a mother-infant cohort in Chongqing, China. Maternal diet was assessed using a 96-item food frequency questionnaire at 11–14 weeks gestation. Dietary patterns were constructed using principal component analysis. Multivariate regressions were performed to assess associations between maternal dietary pattern scores and pregnancy and infant outcomes, adjusting for confounders. Results Two dietary patterns were derived: a pattern high in pasta, sweetened beverages, and oils and condiments (PSO-based dietary pattern) and a pattern high in fish, poultry, and vegetables (FPV-based dietary pattern). Higher scores on the PSO-based dietary pattern were associated with lower infant standardized scores on the PDI of the Bayley Scales of Infant Development, β (95% confidence interval) = −1.276 (−2.392, −0.160); lower placental weight, β (95% CI) = −6.413 (−12.352g, −0.473); and higher infant's tricep skinfold thickness at 6 weeks of age. β (95% CI) = 0.279 (0.033, 0.526). Higher scores on the FPV-based dietary pattern were associated with higher gestational weight gain between visit 1 (11–14 week's gestation) and 3 (32–34 week's gestation). β (95% CI) = 25.612 (13.255, 37.969). No significant associations were observed between dietary pattern scores and the remaining pregnancy/infant outcomes investigated or MDI scores on the Bayley Scales of Infant Development. This was the first study to investigate the association between dietary patterns in early pregnancy and infant neurocognition in a Chinese cohort.

Cohort Profile: The Chongqing Longitudinal Twin Study (LoTiS)

Article

Jan 2022
INT J EPIDEMIOL

Why was the cohort set up? The Fetal Programming Hypothesis/Fetal Origins of Adult Disease Hypothesis (FOAD), first proposed in the 1980s,¹ stated that a suboptimal intrauterine environment has potential to negatively affect fetal developmental in a manner that ultimately results in excess risk of disease in adulthood. This hypothesis covers many medical biosystems but is particularly relevant to metabolic and cardiovascular morbidity and mortality in adulthood. After considerable supporting evidence arising from both direct animal experimentation and observational human studies, the FOAD theory gradually evolved to that of the Developmental Origins of Health and Diseases’ (DOHaD), still widely used today.² Current knowledge around the molecular processes potentially having roles in DOHaD-related phenomena strongly implicates the interaction between both genetic and environmental influences over time. Such complex genomic and epigenetic factors are particularly prevalent in outbred and diverse human populations, making exploration of non-communicable disease (NCD) aetiology challenging, often requiring very large cohorts commencing early in life, with detailed exposure and outcome data plus multiple biospecimens.

Influencing mechanisms of lifestyle and dietary factors on chronic diseases among community residents: updated evidence in Shanghai, China

Article

Full-text available

Oct 2021

Objectives This study aimed to determine the risk factors for chronic diseases and identify the potential influencing mechanisms from the perspectives of lifestyle and dietary factors. The findings could provide updated and innovative evidence for the prevention and control of chronic diseases. Design A cross-sectional study. Setting Shanghai, China. Participants 1,005 adults from Yangpu district of Shanghai participated in the study, and responded to questions on dietary habits, lifestyle, and health status. Results Residents suffering from chronic diseases accounted for 34.99% of the respondents. Logistic regression analysis showed that age, diet quality, amount of exercise and tea drinking were related to chronic diseases. Age>60 and overeating (diet balance index total score >0, DBI_TS) had negative additive interaction on the occurrence of chronic disease, while overexercise (Physical activity index>17.1, PAI) and tea drinking had negative multiplicative interaction and negative additive interaction on the occurrence of chronic disease. Diet quality, physical activity, tea drinking was an incomplete mediator of the relationship between types of medical insurance residents participating in and chronic diseases. Conclusions The residents in Yangpu District of Shanghai have a high prevalence of chronic diseases. Strengthening access of residents to health education and interventions to prevent chronic diseases and cultivating healthy eating and exercise habits of residents are crucial. The nutritional environment of the elderly population should be considered, the reimbursement level of different types of medical insurance should be designed reasonably to improve the accessibility of medical and health services and reduce the risk of chronic diseases.

Within-Case Analysis of the US' Hitech

Chapter

Full-text available

Aug 2021

Grain consumption before and during pregnancy and birth weight in Japan: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

Article

Full-text available

Feb 2022

Studies have reported the effects of grain consumption on human health, but the association between maternal grain consumption before and during pregnancy and birth weight remains unclear. We evaluated the association between maternal grain consumption before and during pregnancy and birth weight/low birth weight (LBW). Grain consumption was calculated using two semi-quantitative food frequency questionnaires (FFQs). The two FFQs evaluated consumption from pre- to early pregnancy and then from early to mid-pregnancy, respectively. Information concerning birth weight was obtained from birth records, and multivariable analyses for birth weight and LBW risk were conducted after adjusting for potential confounders. In total, 17,610 pregnant women (age, 31.8 ± 4.9 years; smoked during pregnancy, 16.1%; gestation period, 38.5 ± 2.5 weeks; first childbirth, 45.5%) and their singleton and term new-borns (birth weight, 3061.8 ± 354.1 g; LBW, 5.4%) were included in the analysis. Women in the highest quartile of grain consumption from pre- to early pregnancy had heavier new-borns (β = 22.3; 95% confidence interval (CI): 5.8–38.9) but did not have a significantly lower LBW risk (odds ratio [OR]: 0.87; 95% CI: 0.71–1.07) than women in the lowest quartile. Women in the highest quartile of grain consumption from early to mid-pregnancy also had heavier new-borns (β = 24.1; 95% CI: 7.1–41.1) but did not have a significantly lower LBW risk (OR: 0.85; 95% CI: 0.69–1.05) than women in the lowest quartile. Grain consumption before and during pregnancy was positively associated with birth weight.

Identification and reproducibility of dietary patterns assessed with a food frequency questionnaire among women planning pregnancy

Article

Mar 2021

Objective To identify a posteriori dietary patterns among women planning pregnancy and assess the reproducibility of these patterns in a subsample using two dietary assessment methods. Design A semi-quantitative Food Frequency Questionnaire (FFQ) was administered to women enrolled in the S-PRESTO study. Dietary patterns from the FFQ were identified using exploratory factor analysis (EFA). In a subsample of women (n=289), 3-day food diaries (3DFD) were also completed and analyzed. Reproducibility of the identified patterns was assessed using confirmatory factor analysis (CFA) in the subsample and goodness of fit of the CFA models were examined using several fit indices. Subsequently, EFA was conducted in the subsample and dietary patterns of the FFQ and the 3DFD were compared. Setting Singapore Participants 1007 women planning pregnancy (18 to 45 years) Results Three dietary patterns were identified from the FFQ: the ‘Fish, poultry/meat and noodles’ pattern was characterised by higher intakes of fish, poultry/meat and noodles in soup; ‘Fast food and sweetened beverages’ pattern was characterised by higher intakes of fast food, sweetened beverages and fried snacks; ‘Bread, legumes and dairy’ pattern was characterised by higher intakes of buns/ethnic breads, nuts/legumes and dairy products. The comparative fit indices from the CFA models were 0.79 and 0.34 for the FFQ and 3DFD of the subsample, respectively. In the subsample, three similar patterns were identified in the FFQ while only two for the 3DFD. Conclusions Dietary patterns from the FFQ are reproducible within this cohort, providing a basis for future investigations on diet and health outcomes.

Relationship between the quality of the pregnant woman’s diet and birth weight: a prospective cohort study

Article

Full-text available

Dec 2021

Background Birth weight is a relevant predictor of childhood health outcomes. Studies investigating the association between modifiable risk factors, as the maternal diet quality, and birth weight are needed. We aimed to investigate the association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) score and birth weight. Methods This is a prospective cohort that includes 547 Brazilian mother–child pairs. Dietary recalls and a food frequency questionnaire were obtained during pregnancy. Information on birth weight, sex, and gestation duration were obtained from the Live Birth Information System (SINASC). Results On total, 3.8% of the newborns were classified as low birth weight (LBW), 6.0% with macrosomia, 10.2% small for gestational age (SGA), and 11.2% large for gestational age (LGA). The mean (SD) IQDAG score was 70.1 (11.8). Adjusted logistic regression models showed that women in the third tertile of the IQDAG score presented a lower risk of having LGA babies [OR 0.44 (95% CI 0.22, 0.90), p-trend = 0.02] compared to the first tertile. Women in the third tertile of omega-3 intake presented a lower risk of giving birth to LGA infants [OR 0.33 (95% CI 0.15, 0.69), p-trend = 0.00] and LBW infants [OR 0.18 (95% CI 0.04, 0.83), p-trend = 0.02] when compared to the first tertile. There was also a lower SGA trend among the children of women in the third tertile of omega-3 intake [OR 0.43 (95% CI 0.17, 1.07), p-trend = 0.03] compared to the first tertile. Conclusion A better diet quality and higher omega-3 intake are protective factors for LGA babies, and increased maternal omega-3 intake reduce the risk of LBW and LGA, and may be a protective factor against the birth of SGA infants.

Association Between Maternal Dietary Pattern and Infant Birth Weight: a Structural Equation Modelling Analysis

Preprint

Full-text available

Feb 2021

Background: The mother’s diet during pregnancy is associated with maternal and child health. However, there are few studies with moderation analysis on maternal dietary patterns and infant birth weight. We aim to analyse the association between dietary patterns during pregnancy and birth weight. Methods: A cohort study was performed with pregnant women in Bahia, Brazil. A food frequency questionnaire was used to evaluate dietary intake. Birth weight was measured by a prenatal service team. Statistical analyses were performed using factor analysis with a principal component extraction technique and structural equation modelling. Results: Four patterns of dietary consumption were identified for each trimester of the pregnancy evaluated. Adherence to the "Meat, Eggs, Fried Snacks and Processed foods” dietary pattern (pattern 1) and the "Sugars and Sweets" dietary pattern (pattern 4) in the third trimester directly reduced birth weight, by 98.42 g (Confidence interval (CI) 95%: 24.26, 172.59) and 92,03g (CI 95%: 39.88, 165.30), respectively. Insufficient dietary consumption in the third trimester increases maternal complications during pregnancy, indirectly reducing birth weight by 145 g (CI 95%: -21.39, -211.45). Conclusion: Inadequate dietary intake in the third trimester appears to have negative results on birth weight, directly and indirectly.

Investigation on Dietary Behavior Changes in 658 Pregnant Women Before and During Pregnancy in China

Preprint

Full-text available

Nov 2020

Background The extra dietary care women receive after pregnancy, coupled with the effect of their own physiological response during pregnancy, can cause some changes in their dietary habits compared with those before pregnancy. Current studies have mostly focused on detailed foods and specific dietary patterns; less attention has been given to changes in food flavor, cooking methods, and meal frequency before and after pregnancy. This study aimed to investigate these changes in pregnant women in TaiYuan City, China and analyze some possible related factors. Methods A total of 658 pregnant women were asked about their frequency of daily meals, choice of eating at home or out, personal preference for different tastes (salty, spicy, and sweet), cooking methods (frying, braising, sautéing, steaming, and stewing), specific food choices, and other changes in dietary habits before and after pregnancy through a questionnaire. SPSS 24.0 was used for all data statistical analyses. P<0.05 was considered statistically significant. Results The choice of salty, spicy, and sweet tastes changed, and the proportion of women who chose lighter flavors after pregnancy increased (P < 0.001). A positive correlation was found between the choice of lighter salty taste and parity (r = 0.142, P = 0.035), that is, pregnant women with more parity were likely to choose a lighter salty taste after pregnancy. By contrast, a negative correlation was found between the choice of lighter spicy taste and age (r = -0.115, P = 0.048), implying that younger pregnant women were likely to choose a lighter spicy taste after pregnancy. In the traditional Chinese cooking methods, compared with pre-pregnancy, the number of pregnant women who chose frying, braising, and sautéing decreased, whereas that of steaming and stewing increased (P < 0.001).Compared with pre-pregnancy, the number of meals every day of pregnant women increased (from 2.85 to 3.09) (P < 0.001), and the frequency of eating at home every week increased (from 4.82 to 5.52) (P < 0.001). Conclusion Overall differences were found in the eating habits of 658 pregnant women before and after pregnancy. Pregnant women with more parity were likely to choose a lighter salty taste, and younger pregnant women were likely to choose a lighter spicy taste.

Dietary patterns of Chinese women of childbearing age during pregnancy and their relationship to the neonatal birth weight

Article

Full-text available

Aug 2020
Nutr J

Objective: To examine the type of maternal dietary patterns during pregnancy and the distribution characteristics of children's birth weight and the association between dietary patterns and neonatal birth weight in China. Methods: Data were derived from a cross-sectional program named "The prevalence and risk factors of birth defects in Shaanxi Province" in July to November in 2013. A stratified multistage random sampling method was used to select women and their children. The mother's diet during pregnancy was investigated using semi-quantitative food frequency questionnaire (FFQ) to collect the frequency and amount of food consumption, and the newborn birth weight as well as related social demographic information was collected at the same time. In our study, 0-1 year old children and their mothers with complete dietary survey data were selected as research objects. The main dietary patterns were identified according to factor analysis, and latent class analysis (LCA) was used to investigate the social demographic factors affecting dietary patterns. The logistic regression model was used to assess the association between birth weight and maternal dietary patterns during pregnancy by establishing three adjusting models and the data were stratified for further analysis by urban-rural and regions. Results: A total of 15,980 participants were involved in this study. Four dietary patterns were identified: "vegetarian pattern", "balance pattern", "traditional pattern" and "processing pattern". Compared with moderate tertile, women in the highest tertile of adherence to vegetarian pattern increased the risk of low birth weight in offspring in rural areas (OR = 1.61, 95%CI:1.06-2.93) and middle region (OR = 1.75, 95%CI:1.18-2.62), and the traditional pattern had greater odds of lower birth weight in the middle region (OR = 1.55, 95%CI:1.05-3.75). The processing pattern was found a protective factor for the occurrence of low birth weight in rural areas (OR = 0.98, 95%CI:0.43-0.99) but was a risk factor for low birth weight in the southern region (OR = 8.83, 95%CI:1.22-15.16). The balance pattern was a protective factor for the occurrence of low birth weight in the northern region(OR = 0.35, 95%CI:0.14-0.83). Conclusion: The vegetarian and traditional pattern may be positively related to a higher risk of low birth weight while the balanced pattern may keep birth weight of offspring within the appropriate range. Health education of balanced diet and individual nutrition guidance during pregnancy should be strengthened, to make the dietary structure during pregnancy are more reasonable, reduce the occurrence of adverse birth weight of newborns.

Maternal plasma metabolic markers of neonatal adiposity and associated maternal characteristics: The GUSTO study

Article

Full-text available

Jun 2020

Infant adiposity may be related to later metabolic health. Maternal metabolite profiling reflects both genetic and environmental influences and allows elucidation of metabolic pathways associated with infant adiposity. In this multi-ethnic Asian cohort, we aimed to (i) identify maternal plasma metabolites associated with infant adiposity and other birth outcomes and (ii) investigate the maternal characteristics associated with those metabolites. In 940 mother-offspring pairs, we performed gas chromatography-mass spectrometry and identified 134 metabolites in maternal fasting plasma at 26–28 weeks of gestation. At birth, neonatal triceps and subscapular skinfold thicknesses were measured by trained research personnel, while weight and length measures were abstracted from delivery records. Gestational age was estimated from first-trimester dating ultrasound. Associations were assessed by multivariable linear regression, with p-values corrected using the Benjamini-Hochberg approach. At a false discovery rate of 5%, we observed associations between 28 metabolites and neonatal sum of skinfold thicknesses (13 amino acid-related, 4 non-esterified fatty acids, 6 xenobiotics, and 5 unknown compounds). Few associations were observed with gestational duration, birth weight, or birth length. Maternal ethnicity, pre-pregnancy BMI, and diet quality during pregnancy had the strongest associations with the specific metabolome related to infant adiposity. Further studies are warranted to replicate our findings and to understand the underlying mechanisms.

Dietary total antioxidant capacity during pregnancy and birth outcomes

Article

Full-text available

Feb 2021
EUR J NUTR

PurposeTo investigate the effect of maternal dietary total antioxidant capacity (DTAC) and main food sources on the risk of preterm birth (PB) and offspring birth size.Methods Cohort study that included 733 Brazilian mother–child pairs. Two 24 h dietary recalls were obtained during pregnancy and the usual intake was estimated through the Multiple Source Method. Data of the offspring were extracted from the national live births information system. Adjusted multivariable logistic regression models were used to investigate the relationship that energy-adjusted DTAC and food sources have with the outcomes.ResultsIn total, 9.7% of the children were PBs, 6.0% were born with low birth weight (LBW), 6.7% with macrosomia, 9.3% were small for gestational age (SGA) and 16.4% large for gestational age (LGA). The mean energy-adjusted DTAC ± SD was 4.7 ± 2.1 mmol. The adjusted OR (95%CI) of PB for each increasing tertile of maternal DTAC were 0.71 (0.41, 1.30) and 0.54 (0.29, 0.98), when compared with the lowest intake. For LBW, these were 0.25 (0.09, 0.65) and 0.63 (0.28, 1.41). A likelihood of lower odds for PB was found for a higher intake of fruits [0.66 (0.39, 1.09)]. Women with a higher consumption of milk were less likely to have a child with LBW [0.48 (0.23, 1.01)], and children whose mothers reported a higher intake of beans had lower odds of being born LGA [0.61 (0.39, 0.93)].Conclusion The data suggest that a higher intake of foods with antioxidant activity during pregnancy might reduce the chance of adverse birth outcomes.

Modeling Differential Effects of Maternal Dietary Patterns across Severity Levels of Preterm Birth Using a Partial Proportional Odds Model https://rdcu.be/b3fGG

Article

Full-text available

Mar 2020

Aweke Abebaw Mitku

Preterm birth is a common cause of death worldwide of children under the age of five years. This condition is linked with short and long term neonatal morbidity and mortality. Maternal nutrition during pregnancy has a profound effect on fetal growth and development and subsequently also on the incidence of preterm birth. The aim of this study was to assess the differential effect of dietary patterns of pregnant women across ordered levels of preterm birth. Dietary assessments were performed using a food frequency questionnaire, presented to 687 pregnant women, in the “Mother and Child in the Environment” birth cohort during the period of 2013 to 2017. Each pregnancy resulted in a live birth. Eight dietary patterns were extracted, using exploratory factor analysis. The partial proportional odds model was employed to model severity levels of preterm birth. The partial proportional odds model has been recognized to be a flexible approach since it allows the effect of predictor variables to vary across categories of the ordinal response variable of interest. Women with increased consumption of vegetable-rich foods showed a reduced risk of very to moderately preterm birth incidence (AOR = 0.73, 95% CI = (0.531, 0.981), p = 0.036). Lower odds of very/moderately preterm birth compared to late preterm or term birth were observed for women following “nuts and rice foods” dietary pattern (AOR = 0.25, 95% CI = (0.099, 0.621), p = 0.003). High dietary consumption of starch foods dietary pattern (AOR = 2.09, 95% CI = (1.158, 3.769), p = 0.014) was associated with the most severe level of preterm birth outcome incidence, i.e. very/moderately preterm birth. The partial proportional odds modeling allowed the description of the effect of maternal dietary patterns across the different severity levels of preterm birth.

Modeling Differential Effects of Maternal Dietary Patterns across Severity Levels of Preterm Birth Using a Partial Proportional Odds Model

Article

Full-text available

Mar 2020

Maternal, but not paternal or grandparental, caffeine intake is associated with childhood obesity and adiposity: The Lifeways Cross-Generation Cohort Study

Article

Jun 2019

Background Maternal caffeine intake is associated with adverse birth outcomes, but its long-term influence on offspring adiposity outcomes is not well studied. Furthermore, few studies have investigated paternal and grandparental caffeine intake in relation to offspring outcomes. Objective To study the associations between maternal, paternal, and grandparental caffeine intake and offspring childhood adiposity. Design The core study sample consists of 558 mother-child pairs from the Lifeways Study. Caffeine intake was derived from relevant food items in a self-administered validated food frequency questionnaire in early pregnancy. Children's body mass index (BMI) and waist circumference (WC) were measured at 5- and 9-y follow-up. Childhood overall and central obesity were defined as age- and sex-specific BMI z-score > International Obesity Task Force cut-off and WC z-score > 90th percentile, respectively. Multiple linear and logistic regressions were used to assess associations. Results Study mothers had a mean age of 30.8 y and a mean prepregnancy BMI (kg/m2) of 23.7. In adjusted models, maternal caffeine intake was associated with a higher offspring BMI z-score [β (95% CI): 0.13 (0.06, 0.21) for year 5 and 0.17 (0.04, 0.29) for year 9; per 100 mg/d increment in maternal caffeine intake], WC z-score [β (95% CI): 0.09 (0.01, 0.17) for year 5 and 0.19 (0.05, 0.32) for year 9], and a higher risk of offspring overall obesity [OR (95% CI): 1.32 (1.11, 1.57) for year 5 and 1.44 (1.10, 1.88) for year 9] and central obesity [1.28 (1.02, 1.60) for year 5 and 1.62 (1.12, 2.34) for year 9]. The influence was stronger for coffee caffeine than tea caffeine. No consistent associations were observed for paternal and grandparental caffeine intake. Conclusions Maternal antenatal, but not paternal or grandparental, caffeine intake is associated with higher offspring adiposity and obesity risk at age 5 and 9 y, with stronger associations observed for coffee caffeine. This prospective observational study was registered at the ISRCTN Registry as ISRCTN16537904.

Effects of Milk and Dairy Product Consumption on Pregnancy and Lactation Outcomes: A Systematic Review

Article

Full-text available

May 2018

Pregnancy and lactation are considered critical periods in a female's life. Thus, the maternal diet must provide sufficient energy and nutrients to meet the mother's higher than usual requirements as well as the needs of the growing fetus. The maternal diet must enable the mother to provide stores of nutrients required for adequate fetal development, and good health and quality of life in infancy and later adulthood. Among the food and beverage groups, milk and dairy products can play a very important role in achieving these targets due to their high nutrient density and bioavailability, as well as their availability and widespread consumption. The objective of this study was to evaluate the influence of maternal milk and dairy consumption on pregnancy and lactation outcomes in healthy women. This report mainly focuses on the effects of the mother's intake of dairy products on infant birth weight and length, fetal femur length, head circumference, gestational weight gain, preterm birth, spontaneous abortion, breast milk consumption, and human milk nutritional value. A systematic review of available studies published up to May 2018 was conducted. A preliminary broad search of the literature yielded 5,695 citations. Four of the investigators independently selected studies for inclusion according to predefined eligibility criteria. Thirty-seven full-text articles were evaluated for potential inclusion, and 17 studies were finally included. Six were prospective cohort studies, 3 were intervention studies, 3 were retrospective cohort studies, 3 were cross-sectional studies, and 2 were case-control studies. Although the number and types of studies prevent definite conclusions, there appears to be a trend that maternal milk intake during pregnancy is positively associated with infant birth weight and length. The lack of studies prevents any conclusions being drawn related to preterm deliveries, spontaneous abortion, and lactation.

Dialysis or a Plant-Based Diet in Advanced CKD in Pregnancy? A Case Report and Critical Appraisal of the Literature

Article

Full-text available

Jan 2019

Pregnancy is increasingly reported in chronic kidney disease (CKD), reflecting higher awareness, improvements in materno-foetal care, and a more flexible attitude towards “allowing” pregnancy in the advanced stages of CKD. Success is not devoid of problems and an important grey area regards the indications for starting dialysis (by urea level, clinical picture, and residual glomerular filtration rate) and for dietary management. The present case may highlight the role of plant-based diets in dietary management in pregnant CKD women, aimed at retarding dialysis needs. The case. A 28-year-old woman, affected by glomerulocystic disease and unilateral renal agenesis, in stage-4 CKD, was referred at the 6th week of amenorrhea: she weighed 40 kg (BMI 16.3), was normotensive, had no sign of oedema, her serum creatinine was 2.73 mg/dL, blood urea nitrogen (BUN) 35 mg/dL, and proteinuria 200 mg/24 h. She had been on a moderately protein-restricted diet (about 0.8 g/kg/real body weight, 0.6 per ideal body weight) since childhood. Low-dose acetylsalicylate was added, and a first attempt to switch to a protein-restricted supplemented plant-based diet was made and soon stopped, as she did not tolerate ketoacid and aminoacid supplementation. At 22 weeks of pregnancy, creatinine was increased (3.17 mg/dL, BUN 42 mg/dL), dietary management was re-discussed and a plant-based non-supplemented diet was started. The diet was associated with a rapid decrease in serum urea and creatinine; this favourable effect was maintained up to the 33rd gestational week when a new rise in urea and creatinine was observed, together with signs of cholestasis. After induction, at 33 weeks + 6 days, she delivered a healthy female baby, adequate for gestational age (39th centile). Urea levels decreased after delivery, but increased again when the mother resumed her usual mixed-protein diet. At the child’s most recent follow-up visit (age 4 months), development was normal, with normal weight and height (50th–75th centile). In summary, the present case confirms that a moderate protein-restricted diet can be prescribed in pregnancies in advanced CKD without negatively influencing foetal growth, supporting the importance of choosing a plant-based protein source, and suggests focusing on the diet’s effects on microcirculation to explain these favourable results.

Anthropometric indices of the newborns related with some lifestyle parameters of women during pregnancy in Tirgu Mures region - a pilot study

Article

Full-text available

Jan 2018
PROG NUTR

Objective: We aim to study possible associations between lifestyle, socio-economic aspects, education and dietary habits during pregnancy and both the incidence of premature deliveries and anthropometric characteristics of newborns in different ethnic Romanian populations. Methods: This is a cross-sectional, questionnaire-based retrospective study applied on puerperal women from Tirgu-Mures, Romania. Anova and Kruskall Wallis were the statistical tests used. Results: Deficient intake of dairy products was found in the Romani women (69.50%), of red meat in Romanians (23.20%), of white meat in Hungarians (83.40) and Romanians (77.50%), of fish and eggs in Romani (91.30%) and Hungarian women (89.6%), of vegetables in Hungarian (93.80%) and the Romani women (91.3%) and of whole grain cereals in Romanian (93.40%) and Hungarian (95.50%) women. The water intake below the daily needs was found in 49.30% of Romanian women, 47.60% of Hungarian women and 100% of Romani women. An increased consumption of tobacco (p<0.0032) and alcohol (p<0.0169) was observed in the Romani women group. The level of education (p<0.0001) and the income (p< 0.0001) was significantly lower in the Romani women. The group of Romani women had a higher risk for a premature birth (p<0.0013). Conclusions: The Romani pregnant women presented a deficient diet and an inappropriate lifestyle for pregnancy. A group of Romani women who had newborns with a smaller birth weight and premature births was identified.

Factors associated with the dietary total antioxidant capacity of pregnant Brazilian women

Article

Full-text available

Feb 2025

Objective To investigate the sociodemographic, maternal, and gestational factors associated with the dietary total antioxidant capacity in pregnant Brazilian women. Methods A cross-sectional study with 2,232 pregnant women aged 18 years old or older, in the first, second, and third trimesters of pregnancy, from eleven cities in the five Brazilian regions. A semi-structured questionnaire was applied to assess socioeconomic, demographic, and health data, and a 24-hour dietary recall (R24h) was used to assess food consumption and analyze the dietary total antioxidant capacity (DTAC), estimated using the ferric reducing antioxidant power (FRAP) method. Results The median of DTAC was 5.32 mmol/day. Aracaju, Sergipe (SE) had the highest median of DTAC (6.44 mmol/day) and Palmas, Tocantins (TO) had the lowest (4.71 mmol/day). Pregnant women aged 20 to 34 years (OR 1.86; 95%CI 1.26-2.76), 35 years old or older (OR 3.68; 95%CI 2.21-6.14) and who were in the second trimester of pregnancy (OR 1.50; 95%CI 1.11-2.01) were more likely to be above the median DTAC. While pregnant women with higher education had a 67% lower chance of being above the median DTAC (OR 0.67; 95%CI 0.48-0.92). Conclusion The study demonstrated that there are differences in antioxidant consumption in different cities in Brazil and that associated factors such as age, education, and gestational trimester can impact the intake of foods rich in antioxidants. The profile found draws attention to the importance of an adequate diet rich in antioxidants during prenatal care.

Impact of Maternal Macronutrient Intake on Large for Gestational Age Neonates’ Risk Among Women with Gestational Diabetes Mellitus: Results from the Greek BORN2020 Cohort

Article

Full-text available

Jan 2025

Background/Objectives: The effect of maternal macronutrient composition on the risk of large for gestational age (LGA) neonates among women with gestational diabetes mellitus (GDM) is not well understood. This study aimed to investigate these associations in a pregnant cohort in Northern Greece, considering both pre-pregnancy and early pregnancy dietary intake, and stratifying women by pre-pregnancy body mass index (BMI). Methods: From a total of 797 eligible pregnant women, the 117 (14.7%) who developed GDM (and thus were included in the study) completed the validated Food Frequency Questionnaires (FFQs). Macronutrient intake was assessed for the six months before pregnancy and until mid-gestation, prior to the oral glucose tolerance test. Data were compared with European Food Safety Authority (EFSA) guidelines, and participants were stratified by pre-pregnancy BMI (normal vs. overweight/obese). Multivariate logistic regression was used to estimate adjusted odds ratios (aORs) for LGA risk. Results: In normal-BMI women with GDM, higher dietary fiber (aOR = 1.39) and vegetable protein (aOR = 1.61) intake before pregnancy were both significantly associated with an increased risk of LGA. During early pregnancy, the elevated risk from vegetable protein persisted (aOR = 1.51). Among overweight/obese women, no significant pre-pregnancy associations were observed. However, during early pregnancy, a higher percentage of total carbohydrate intake was linked to increased LGA risk (aOR = 1.11), while maintaining saturated fatty acids “as low as possible” reduced the odds of LGA (aOR = 0.71). Elevated vegetable protein intake also increased LGA risk (aOR = 1.61). Conclusions: Maternal macronutrient intake prior to and during early pregnancy may influence LGA risk in GDM, with distinct patterns according to pre-pregnancy BMI. These findings underscore the importance of tailoring dietary recommendations—especially regarding fiber, vegetable protein, carbohydrates, and saturated fat—to mitigate the risk of LGA in women with GDM.

Trimester-specific associations of maternal dietary patterns with preterm birth: China Medical University birth cohort study

Article

Aug 2023

The trimester-specific associations of maternal dietary patterns with preterm birth (PTB) are unclear. In a prospective prebirth cohort study, we aimed to examine the critical time window of maternal prenatal dietary patterns and the risk of PTB. We assessed prenatal dietary intake among 1500 pregnant women with validated food frequency questionnaires during the 1st, 2nd and 3rd trimester, respectively. We used logistic regression models and generalized estimating equation models to examine the trimester-specific associations and longitudinal associations between maternal dietary patterns in relation to risk of PTB and PTB subtypes. The incidence rate of PTB was 11.9% (179 out of 1500 pregnant women) in the present study. We observed that maternal adherence to a fish-seafood pattern in the 1st trimester was associated with higher risk of PTB [tertile 3 (T3) vs. tertile 1 (T1): OR = 2.29, 95% CI: 1.32-3.96] and iatrogenic preterm birth (IPTB) (T3 vs. T1: OR = 2.26, 95% CI: 1.21-4.20), while a fish-seafood pattern in the 2nd trimester was associated with lower risk of PTB (T3 vs. T1: OR = 0.49, 95% CI: 0.25-0.93). Maternal adherence to a dairy-egg pattern in the 2nd or 3rd trimester was associated with higher risks of PTB and IPTB. No dietary patterns were associated with spontaneous preterm birth. Our findings provide new evidence that specific dietary patterns during different trimesters may have different and even inverse health effects on pregnant women. This supports the necessity of guiding the maternal diet according to different periods of pregnancy to prevent PTB.

A Vegetables, Oils, and Fruit Dietary Pattern in Late Pregnancy is Linked to Reduced Risk of Adverse Birth Outcomes in a Predominantly Low-Income Hispanic/Latina Pregnancy Cohort

Article

Full-text available

Sep 2022

Background Studies examining diet and its link to birth outcomes among socioeconomically disadvantaged populations in the U.S. are scarce. Objectives We aimed to identify prenatal dietary patterns, examine their relationships with birth outcomes, and evaluate the variation of these associations by maternal diabetes status (none, gestational [GDM], pre-existing). Methods Women in the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study (n = 465)—an ongoing, prospective pregnancy cohort of predominantly low-income Hispanic/Latina women in Los Angeles—completed up to two 24-hour dietary recalls in the third trimester of pregnancy. We identified prenatal dietary patterns (DPs) via factor analysis and evaluated their associations with birth weight and gestational age at birth (GA) z-scores, separately, using linear regression and premature birth, small-for-gestational age (SGA), and large-for-gestational-age (LGA) using logistic regression adjusting for relevant covariates. We additionally tested interaction terms between prenatal DPs and maternal diabetes status in separate models. We adjusted for multiple comparisons using false discovery rate. Results We identified two dietary patterns: (1) solid fats, refined grains, and cheese (SRC) and (2) vegetables, oils, and fruit (VOF). Comparing highest-to-lowest quartiles, the VOF DP was significantly associated with greater birth weight (β = 0.40, 95% CIs: 0.10, 0.70; Ptrend = 0.011), GA (β = 0.32, 95% CIs: 0.03, 0.61; Ptrend = 0.036) and lower odds of premature birth (OR = 0.31, 95% CIs: 0.10, 0.95; Ptrend = 0.049) and SGA (OR = 0.18, 95% CIs: 0.06, 0.58; Ptrend= 0.028). Only among women with GDM, a 1-SD score increase in the SRC prenatal DP was significantly associated with lower birth weight (β = -0.20, 95% CIs -0.39, -0.02; Pinteraction = 0.040). Conclusions Among low-income Hispanic/Latina pregnant women, greater adherence to the VOF prenatal DP may lower the risk of premature birth and SGA. Greater adherence to the SRC DP, however, may adversely affect newborn birth weight among mothers with GDM but future research is needed to verify our findings.

Equal Weighting of the Healthy Eating Index-2010 Components May Not be Appropriate for Pregnancy

Article

May 2022

Background Adherence to the Dietary Guidelines for Americans is often assessed using the Healthy Eating Index (HEI). The HEI total score reflects overall diet quality, with all aspects equally important. Using the traditional weighting scheme for the HEI, all components are generally weighted equally in the total score. However, there is limited empirical basis for applying the traditional weighting for pregnancy specifically. Objective We aimed to assess associations between the 12 HEI-2010 component scores and select pregnancy outcomes. Methods The Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be was a prospective pregnancy cohort (U.S. multi-center, 2010–2013). Participants enrolled in the study between 6 and 13 weeks’ gestation. A food frequency questionnaire assessed usual dietary intake 3 months prior to pregnancy (n = 7,880). Scores for the HEI-2010 components were assigned using pre-specified standards based on densities (standard units per 1,000 kcal) of relevant food groups for most components, a ratio (poly-and monounsaturated to saturated) for Fatty Acids, and the contribution to total energy for Empty Calories. Using log binomial regression, we estimated risk differences between each component score and small-for-gestational age (SGA) birth, preterm birth, preeclampsia, and gestational diabetes, controlling for total energy and scores for the other HEI-2010 components. Results Higher scores for Greens/Beans and Total Vegetables were associated with fewer cases of SGA birth, preterm birth, and preeclampsia. For instance, every 1-unit increase in Greens/Beans score was associated with 1.2 fewer SGA infants (95% CI 0.7 to 1.7), 0.7 fewer preterm births (95% CI 0.3 to 1.1), and 0.7 fewer preeclampsia cases (95% CI 0.2 to 1.1) per 100 deliveries. For gestational diabetes, associations were null. Conclusions Vegetable-rich diets were associated with fewer cases of SGA birth, preterm birth, and preeclampsia, controlling for overall diet quality. Examination of the equal weighting of the HEI components (and underlying guidance) is needed for pregnancy.

Maternal diet, nutritional status and infant birth weight in Malaysia: a scoping review

Article

Full-text available

Apr 2022

Background Women’s diet and nutritional status during pregnancy are important in influencing birth outcomes. We conducted a systematic scoping review of the best available evidence regarding dietary intake of Malaysian pregnant women, and the associations of maternal diet, anthropometry, and nutrition-related co-morbidities with the infant’s birth weight (IBW). The study objectives were to examine: (1) the adequacy of micronutrient intake among pregnant women; and (2) the association of maternal factors (anthropometry, diet, plasma glucose and blood pressure) during pregnancy with IBW. Methods Eleven search engines such as Proquest, EbscoHost, Scopus, Cochrane Library, Science Direct, Wiley Online Library, PubMed, Google Scholar, MyJournal, BookSC and Inter Library Loan with Medical Library Group were extensively searched to identify the primary articles. Three reviewers independently screened the abstracts and full articles based on the inclusion and exclusion criteria. Extracted data included details about the population characteristics, study methods and key findings related to the review objectives. Seventeen studies published from 1972 to 2021 were included, following the PRISMA-ScR guideline. Results Studies showed that maternal micronutrient intakes including calcium, iron, vitamin D, folic acid, and niacin fell short of the national recommendations. Increased maternal fruit intake was also associated with increased birth weight. Factors associated with fetal macrosomia included high pre-pregnancy body mass index (BMI), excess gestational weight gain (GWG) and high blood glucose levels. Low pre-pregnancy BMI, inadequate GWG, intake of confectioneries and condiments, and high blood pressure were associated with low birth weight. Conclusion This review identified several factors such as the mother’s food habits, comorbidities, BMI and gestational weight gain as the determinants of low birth weight. This implies that emphasis should be given on maternal health and nutrition for the birth outcome.

Are pre- and early pregnancy lifestyle factors associated with the risk of preterm birth? A secondary cohort analysis of the cluster-randomised GeliS trial

Article

Full-text available

Mar 2022

Background Maternal lifestyle is discussed as a modifiable determinant in the prevention of preterm birth. However, previous research on associations between individual lifestyle factors and preterm birth risk is inconclusive. In this secondary analysis, we investigated the associations between several modifiable antenatal lifestyle factors and the odds of preterm birth. Methods This secondary cohort analysis used data from the cluster-randomised controlled “healthy living in pregnancy” (GeliS) trial. Data were collected from early pregnancy to birth with maternity records, validated questionnaires and birth protocols. Women with complete datasets for all covariates were eligible for analysis. Multivariate logistic regression models, adjusted for recognised risk factors, were fitted to determine whether dietary quality, assessed with a healthy eating index (HEI), physical activity (PA) levels and antenatal anxiety/distress influenced the odds of preterm birth. Moreover, the combined association between pre-pregnancy body mass index (BMI) and HEI on the odds of preterm birth was explored. The independent associations of individual dietary components and types of PA on prematurity were assessed by adjusted logistic regression models. Results Overall, 1738 women were included in the analysis. A low HEI significantly increased the odds of preterm birth (OR 1.54 (CI 1.04 – 2.30), p = 0.033), while no associations with either low PA levels or antenatal anxiety/distress were observed. BMI significantly interacted with HEI on the association with prematurity ( p = 0.036). Energy % from protein and the intake of average portions of vegetables and cereals were significantly negatively associated with the odds of preterm birth. There was no significant evidence of an association between different types of PA and prematurity. Conclusions This cohort analysis revealed that low dietary quality in early pregnancy may increase the chance of giving birth prematurely, while healthier dietary choices may help to prevent preterm birth. More research on pre- and early pregnancy modifiable lifestyle factors is warranted. Trial registration This trial is registered with the Clinical Trial Registry ClinicalTrials.gov ( NCT01958307 ). Registration date 09 October 2013, retrospectively registered.

Associations between Maternal Dietary Patterns and Infant Birth Weight in the NISAMI Cohort: A Structural Equation Modeling Analysis

Article

Full-text available

Nov 2021

The mother's diet during pregnancy is associated with maternal and child health. However, there are few studies with moderation analysis on maternal dietary patterns and infant birth weight. We aim to analyse the association between dietary patterns during pregnancy and birth weight. A prospective cohort study was performed with pregnant women registered with the prenatal service (Bahia, Brazil). A food frequency questionnaire was used to evaluate dietary intake. Birth weight was measured by a prenatal service team. Statistical analyses were performed using factor analysis with a principal component extraction technique and structural equation modelling. The mean age of the pregnant women was 27 years old (SD: 5.5) and the mean birth weight was 3341.18 g. It was observed that alcohol consumption (p = 0.05) and weight-gain during pregnancy (p = 0.05) were associated with birth weight. Four patterns of dietary consumption were identified for each trimester of the pregnancy evaluated. Adherence to the "Meat, Eggs, Fried Snacks and Processed foods" dietary pattern (pattern 1) and the "Sugars and Sweets" dietary pattern (pattern 4) in the third trimester directly reduced birth weight, by 98.42 g (Confidence interval (CI) 95%: 24.26, 172.59) and 92.03 g (CI 95%: 39.88, 165.30), respectively. It was also observed that insufficient dietary consumption in the third trimester increases maternal complications during pregnancy, indirectly reducing birth weight by 145 g (CI 95%: −21.39, −211.45). Inadequate dietary intake in the third trimester appears to have negative results on birth weight, directly and indirectly, but more studies are needed to clarify these causal paths, especially investigations of the influence of the maternal dietary pattern on the infant gut microbiota and the impacts on perinatal outcomes.

Capturing Value in Digital Health Eco-Systems: Validating Strategies for Stakeholders

Book

Full-text available

Aug 2021

Effects of Dietary Patterns during Pregnancy on Preterm Birth: A Birth Cohort Study in Shanghai

Article

Full-text available

Jul 2021

The objective of this study was to analyse representative dietary patterns during pregnancy in Shanghai and explore the effects of dietary patterns during pregnancy on preterm birth. Data were derived from the ‘Iodine Status in Pregnancy and Offspring Health Cohort’ (ISPOHC) study. Multistage, stratified random sampling was used to select survey participants from 16 districts in Shanghai, which were divided into five sampling areas; 40–70 pregnant women were selected from each area. A total of 4361 pregnant women and their offspring were involved in the study. The male-to-female ratio of the babies was 1.04:1, and the incidence of single preterm birth was 4.2%. Three dietary patterns were extracted by factor analysis: a ‘Vegetarian Pattern’, an ‘Animal Food Pattern’ (AFP), and a ‘Dairy and Egg Pattern’. These patterns explained 40.511% of the variance in dietary intake. Binary logistic regression, which was used to analyse the association between birth outcomes and scores measuring maternal dietary patterns, found only the AFP was a significant risk factor for preterm birth. Higher AFP scores were positively associated with preterm birth (Q2 vs. Q1 OR = 1.487, 95% CI: 1.002–2.207; Q3 vs. Q1 OR = 1.885, 95% CI: 1.291–2.754). After adjusting for other potential contributors, a higher AFP score was still a significant risk factor for preterm birth (Q2 vs. Q1 OR = 1.470, 95% CI: 0.990–2.183; Q3 vs. Q1 OR = 1.899, 95% CI: 1.299–2.776). The incidence of preterm birth was 4.2%. A higher score of AFP was significantly associated with a higher risk of preterm birth. The animal food intake of pregnant women should be reasonably consumed during pregnancy.

Role of maternal tryptophan metabolism in allergic diseases in the offspring

Article

May 2021

Background Nicotinamide (vitamin B3) is a metabolite of tryptophan and dietary precursor of enzymes involved in many regulatory processes, which may influence fetal immune development. Objective We examined whether maternal plasma concentrations of nicotinamide, tryptophan or nine related tryptophan metabolites during pregnancy were associated with risk of development of infant eczema, wheeze, rhinitis or allergic sensitization. Methods In the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study, we analysed the associations between maternal plasma levels of nicotinamide, tryptophan and tryptophan metabolites at 26-28 weeks gestation and allergic outcomes collected through interviewer-administered questionnaires at multiple timepoints and skin prick testing to egg, milk, peanut and mites at age 18 months. Multivariate analysis was undertaken adjusting for all metabolites measured, and separately adjusting for relevant demographic and environmental exposures. Analyses were also adjusted for multiple comparisons using the false discovery method. Results Tryptophan metabolites were evaluated in 976/1247 (78%) women enrolled in GUSTO. In multivariate analysis including all metabolites, maternal plasma 3-hydrokynurenine was associated with increased allergic sensitization at 18 months (AdjRR 2.6, 95% CI 1.3-5.2 for highest quartile) but the association with nicotinamide was not significant (AdjRR 1.8, 95% CI 0.9-3.6). In analysis adjusting for other exposures, both 3-hydrokynurenine and nicotinamide were associated with increased allergic sensitization (AdjRR 2.0, 95% CI 1.1-3.6 for both metabolites). High maternal plasma nicotinamide was associated with increased infant eczema diagnosis by 6 and 12 months, which was not significant when adjusting for all metabolites measured, but was significant when adjusting for relevant environmental and demographic exposures. Other metabolites measured were not associated with allergic sensitisation or eczema, and maternal tryptophan metabolites were not associated with offspring rhinitis and wheeze. Conclusions and Clinical Relevance Maternal tryptophan metabolism during pregnancy may influence the development of allergic sensitization and eczema in infants.

Maternal dietary pattern in early pregnancy is associated with gestational weight gain and hyperglycemia: A cohort study in South West of Iran

Article

Aug 2020

Background and aims Maternal dietary pattern could influence on fetal health outcome. Thus, this study was conducted to evaluate the relationship between maternal dietary pattern and Gestational Weight Gain (GWG) in each trimester and hyperglycemia amongst Arab pregnant women in south-west of Iran. Methods This longitudinally study was performed in urban healthcare centers of south-west of Iran. Among 610 candidates, 488 pregnant women were included in the final analysis. Consequently, two diet patterns were determined by principal component analysis and the association between GWG and blood glucose level was determined using quartile regression. Using generalized linear model, a model was adjusted for pre-pregnancy BMI, maternal age, income, and education levels. Results Two dietary patterns were identified as follows: “high fat –fast food” and “vegetable-fruits & protein” pattern. High adherence to “high fat –fast food” pattern was associated with higher GWG and hyperglycemia in 3rd trimester (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) respectively. High tendency to “vegetable-fruits & protein” pattern was inversely associated with development of hyperglycemia in 3rd trimester. Higher SES level was associated with low adherence to “high fat-fast food” pattern. Conclusion Findings of the study revealed that, higher adherence to high -fat diet is related to excessive GWG and hyperglycemia in late pregnancy.

Effects of maternal diets on preterm birth and low birth weight: A systematic review

Article

Nov 2019

Current evidence indicates that maternal diets before and during pregnancy could influence rates of preterm birth, low birth weight (LBW), and small for gestational age (SGA) births. However, findings have been inconsistent. This review summarised evidence concerning the effects of maternal diets before and during pregnancy on preterm birth, LBW, and SGA. Systematic electronic database searches were carried out using PubMed, EMBASE, Scopus, and Cochrane library using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The review included forty eligible articles, comprising mostly of prospective cohort studies, with five randomized controlled trials (RCT). The dietary patterns during pregnancy associated with a lower risk of preterm birth were commonly characterized by high consumption of vegetables, fruits, whole grains, fish, and dairy products. Those associated with a lower risk of SGA also had similar characteristics, including high consumption of vegetables, fruits, legumes, seafood/fish, and milk products. Results from a limited number of studies suggested there was a beneficial effect on the risk of preterm birth of pre-pregnancy diet quality characterized by a high intake of fruits and proteins and less intake of added sugars, saturated fats, and fast foods. The evidence was mixed for the relationship between maternal dietary patterns during pregnancy and LBW. These findings indicate that better maternal diet quality during pregnancy, characterized by a high intake of vegetables, fruits, whole grains, dairy, and protein diets, may have a synergistic effect on reducing the risk of preterm birth and SGA.

Maternal night-time eating and sleep duration in relation to length of gestation and preterm birth

Article

Aug 2019
CLIN NUTR

Background & aims: Maternal metabolic disturbance arising from inappropriate meal timing or sleep deprivation may disrupt circadian rhythm, potentially inducing pregnancy complications. We examined the associations of maternal night-time eating and sleep duration during pregnancy with gestation length and preterm birth. Methods: We studied 673 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal energy intake by time of day and nightly sleep duration were assessed at 26-28 weeks' gestation. Based on 24-h dietary recall, night-eating was defined as consuming >50% of total energy intake from 1900 to 0659 h. Short sleep duration was defined as <6 h night sleep. Night-eating and short sleep were simultaneously analyzed to examine for associations with a) gestation length using multiple linear regression, and b) preterm birth (<37 weeks' gestation) using logistic regression. Results: Overall, 15.6% women engaged in night-eating, 12.3% had short sleep and 6.8% delivered preterm. Adjusting for confounding factors, night-eating was associated with 0.45 weeks shortening of gestation length (95% CI -0.75, -0.16) and 2.19-fold higher odds of delivering preterm (1.01, 4.72). Short sleep was associated with 0.33 weeks shortening of gestation length (-0.66, -0.01), but its association with preterm birth did not reach statistical significance (1.81; 0.76, 4.30). Conclusions: During pregnancy, women with higher energy consumption at night than during the day had shorter gestation and greater likelihood of delivering preterm. Misalignment of eating time with day-night cycles may be a contributing factor to preterm birth. This points to a potential target for intervention to reduce the risk of preterm birth. Observations for nightly sleep deprivation in relation to gestation length and PTB warrant further confirmation.

Immune Tolerance Attenuates Gut Dysbiosis, Dysregulated Uterine Gene Expression and High-Fat Diet Potentiated Preterm Birth in Mice

Article

Feb 2019
AM J OBSTET GYNECOL

Background: Preterm delivery is associated with 85% of perinatal morbidity and mortality. While consumption of a high-fat diet leads to exaggerated pro-inflammatory responses and, in pregnant women, increased rates of spontaneous preterm birth, the underlying mechanisms remain unclear. Objective: We sought to elucidate the mechanisms by which maternal consumption of a high fat diet leads to a dysregulated immune response and, in turn, spontaneous preterm birth. Study design: We performed 16s rRNA sequencing of stool samples and compared the gut microbiomes of lipopolysaccharide induced pregnant mice maintained on a high fat diet vs. a normal control diet. Next we sequenced the uterine transcriptomes of the mice. To test the effect of dampening of the immune response on the microbiome, transcriptome and risk of spontaneous preterm birth, we induced immune tolerance with repetitive subclinical doses of endotoxin and performed 16s rRNA and uterine transcriptome sequencing on these immunotolerized mice as well. Results: High fat diet potentiates lipopolysaccharide-induced preterm birth via effects on the maternal gut microbiome and uterine transcriptome and reduces antioxidant capacity in a murine model. High fat diet consumption also increases the colonization of the gut by five immunogenic bacteria and decreases colonization by Lachnospiraceae_NK4A136_group. Uteri from high fat diet mice have increased expression of genes that stimulate the inflammatory-oxidative stress axis, autophagy/apoptosis and smooth muscle contraction. Repetitive endotoxin priming protects high fat diet dams from spontaneous preterm birth, increases colonization of the gut by Lachnospiraceae_NK4A136_group, decreases levels of immunogenic bacteria in the gut microbiome and reduces the number of dysregulated genes after high fat diet consumption from 994 to 74. Conclusions: High fat diet-potentiated spontaneous preterm birth is mediated by increased inflammation, oxidative stress and gut dysbiosis. Induction of immune tolerance via endotoxin priming reverses these effects and protects HFD dams from spontaneous preterm birth. Based on this work, the role of immunomodulation as a novel therapeutic approach to prevent preterm birth among women who consume high fat diets should be explored.

National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

Article

Full-text available

Jul 2013

National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low birthweight (<2500 g), in 138 countries of low and middle income in 2010. METHODS Small for gestational age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from the WHO Global Survey on Maternal and Perinatal Health (23 countries) were used to model the prevalence of term-SGA births. Prevalence of preterm-SGA infants was calculated from meta-analyses. FINDINGS In 2010, an estimated 32·4 million infants were born small for gestational age in low-income and middle-income countries (27% of livebirths), of whom 10·6 million infants were born at term and low birthweight. The prevalence of term-SGA babies ranged from 5·3% of livebirths in east Asia to 41·5% in south Asia, and the prevalence of preterm-SGA infants ranged from 1·2% in north Africa to 3·0% in southeast Asia. Of 18 million low-birthweight babies, 59% were term-SGA and 41% were preterm-SGA. Two-thirds of small-for-gestational-age infants were born in Asia (17·4 million in south Asia). Preterm-SGA babies totalled 2·8 million births in low-income and middle-income countries. Most small-for-gestational-age infants were born in India, Pakistan, Nigeria, and Bangladesh. INTERPRETATION The burden of small-for-gestational-age births is very high in countries of low and middle income and is concentrated in south Asia. Implementation of effective interventions for babies born too small or too soon is an urgent priority to increase survival and reduce disability, stunting, and non-communicable diseases. FUNDING Bill & Melinda Gates Foundation by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group (CHERG).

Associations of consumption of fruits and vegetables during pregnancy with infant birth weight or small for gestational age births: a systematic review of the literature

Article

Full-text available

Oct 2014

Maternal nutrition is recognized as one of the determinants of fetal growth. Consumption of fruits and vegetables is promoted as part of a healthful diet; however, intakes are typically lower than recommended levels. The purpose of this study was to systematically review results from studies examining the relationship between maternal consumption of fruits and vegetables during pregnancy with infant birth weight or risk for delivering a small for gestational age baby. A comprehensive search of PubMed and EMBASE was conducted and abstracts were screened using predefined criteria. Eleven relevant studies were identified and systematically reviewed, including six prospective cohort studies, three retrospective cohort studies, and two case–control studies. Seven studies were conducted in cohorts from highly developed countries. One prospective study from a highly developed area reported increased risk for small for gestational age birth by women with low vegetable intakes (odds ratio 3.1; 95% confidence interval 1.4–6.9; P=0.01); another large prospective study reported a 10.4 g increase in birth weight per quintile increase in fruit intake (95% confidence interval 6.9–3.9; P<0.0001) and increases of 8.4 or 7.7 g per quintile intake of fruits and vegetables (combined) or fruits, vegetables, and juice (combined), respectively. One retrospective study reported an association between low fruit intake and birth weight. In less developed countries, increased vegetable or fruit intake was associated with increased birth weight in two prospective studies. Overall, limited inconclusive evidence of a protective effect of increased consumption of vegetables and risk for small for gestational age birth, and increased consumption of fruits and vegetables and increased birth weight among women from highly developed countries was identified. Among women in less developed countries, limited inconclusive evidence suggests that increased consumption of vegetables or fruits may be associated with higher infant birth weight. The available evidence supports maternal consumption of a variety of fruits and vegetables as part of a balanced diet throughout pregnancy.

Cohort Profile: Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study

Article

Full-text available

Aug 2013
INT J EPIDEMIOL

Characterization of Dietary Patterns in the Danish National Birth Cohort in Relation to Preterm Birth

Article

Full-text available

Apr 2014
PLOS ONE

Dietary patterns better reflect eating habits as opposed to single dietary components. However, the use of dietary pattern analysis in nutritional epidemiology has been hampered by the complexity of interpreting and presenting multidimensional dietary data. This study extracts and visualizes dietary patterns from self-reported dietary data collected in mid-pregnancy (25th week of gestation) from nearly 60,000 mother-child pairs part of a prospective, longitudinal cohort (Danish National Birth Cohort) and further examines their associations with spontaneous and induced preterm birth (gestational age<259 days (<37 weeks)). A total of seven dietary patterns were extracted by principal component analysis, characterized and visualized by color-coded spider plots, and referred to as: Vegetables/Prudent, Alcohol, Western, Nordic, Seafood, Candy and Rice/Pasta/Poultry. A consistent dose-response association with preterm birth was only observed for Western diet with an odds ratio of 1.30 (95% CI: 1.13, 1.49) comparing the highest to the lowest quintile. This association was primarily driven by induced preterm deliveries (odds ratio = 1.66, 95% CI: 1.30, 2.11, comparing the highest to the lowest quintile) while the corresponding odds ratio for spontaneous preterm deliveries was more modest (odds ratio = 1.18, 95% CI: 0.99, 1.39). All based on adjusted analyses. In conclusion, this study presented a simple and novel framework for visualizing correlation structures between overall consumption of foods group and their relation to nutrient intake and maternal characteristics. Our results suggest that Western-type diet, high in meat and fats and low in fruits and vegetables, is associated with increased odds of induced preterm birth.

Maternal Dietary Patterns and Preterm Delivery: Results From Large Prospective Cohort Study

Article

Full-text available

Mar 2014
Br Med J

To examine whether an association exists between maternal dietary patterns and risk of preterm delivery. Prospective cohort study. Norway, between 2002 and 2008. 66 000 pregnant women (singletons, answered food frequency questionnaire, no missing information about parity or previously preterm delivery, pregnancy duration between 22+0 and 41+6 gestational weeks, no diabetes, first enrolment pregnancy). Hazard ratio for preterm delivery according to level of adherence to three distinct dietary patterns interpreted as "prudent" (for example, vegetables, fruits, oils, water as beverage, whole grain cereals, fibre rich bread), "Western" (salty and sweet snacks, white bread, desserts, processed meat products), and "traditional" (potatoes, fish). After adjustment for covariates, high scores on the "prudent" pattern were associated with significantly reduced risk of preterm delivery hazard ratio for the highest versus the lowest third (0.88, 95% confidence interval 0.80 to 0.97). The prudent pattern was also associated with a significantly lower risk of late and spontaneous preterm delivery. No independent association with preterm delivery was found for the "Western" pattern. The "traditional" pattern was associated with reduced risk of preterm delivery for the highest versus the lowest third (hazard ratio 0.91, 0.83 to 0.99). This study showed that women adhering to a "prudent" or a "traditional" dietary pattern during pregnancy were at lower risk of preterm delivery compared with other women. Although these findings cannot establish causality, they support dietary advice to pregnant women to eat a balanced diet including vegetables, fruit, whole grains, and fish and to drink water. Our results indicate that increasing the intake of foods associated with a prudent dietary pattern is more important than totally excluding processed food, fast food, junk food, and snacks.

Effect of Maternal Glycemia on Neonatal Adiposity in a Multiethnic Asian Birth Cohort

Article

Full-text available

Nov 2013
J CLIN ENDOCR METAB

Context: Gestational hyperglycemia increases the risk of obesity and diabetes in offspring later in life. Objective: We examined the relationship between gestational glycemia and neonatal adiposity in a multiethnic cohort of Singaporean neonates. Design: A prospective mother-offspring cohort study recruited 1247 pregnant mothers (57.2% Chinese, 25.5% Malay, 17.3% Indian) and performed 75-g, 2-hour oral glucose tolerance tests at 26-28 weeks' gestation; glucose levels were available for 1081 participants. Neonatal anthropometry (birth weight, length, triceps, and subscapular skinfolds) was measured, and percentage body fat (%BF) was derived using our published equation. Associations of maternal glucose with excessive neonatal adiposity [large for gestational age; %BF; and sum of skinfolds (∑SFT)>90th centile] were assessed using multiple logistic regression analyses. Results: Adjusting for potential confounders we observed strong positive continuous associations across the range of maternal fasting and 2-hour glucose in relation to excessive neonatal adiposity; each 1 SD increase in fasting glucose was associated with 1.31 [95% confidence interval (CI) 1.10-1.55], 1.72 (95% CI 1.31-2.27) and 1.64 (95% CI 1.32-2.03) increases in odds ratios for large for gestational age and %BF and ∑SFT greater than the 90th centile, respectively. Corresponding odds ratios for 2-hour glucose were 1.11 (95% CI 0.92-1.33), 1.55 (95% CI 1.10-2.20), and 1.40 (95% CI 1.10-1.79), respectively. The influence of high maternal fasting glucose on neonatal ∑SFT was less pronounced in Indians compared with Chinese (interaction P=.005). Conclusions: A continuous relationship between maternal glycemia and excessive neonatal adiposity extends across the range of maternal glycemia. Compared with Chinese infants, Indian infants may be less susceptible to excessive adiposity from high maternal glucose levels.

Body fat in Singaporean infants: Development of body fat prediction equations in Asian newborns

Article

Full-text available

Apr 2013

Background/objectives: Prediction equations are commonly used to estimate body fat from anthropometric measurements, but are population specific. We aimed to establish and validate a body composition prediction formula for Asian newborns, and compared the performance of this formula with that of a published equation. Subjects/methods: Among 262 neonates (174 from day 0, 88 from days 1-3 post delivery) from a prospective cohort study, body composition was measured using air-displacement plethysmography (PEA POD), with standard anthropometric measurements, including triceps and subscapular skinfolds. Using fat mass measurement by PEA POD as a reference, stepwise linear regression was utilized to develop a prediction equation in a randomly selected subgroup of 62 infants measured on days 1-3, which was then validated in another subgroup of 200 infants measured on days 0-3. Results: Regression analyses revealed subscapular skinfolds, weight, gender and gestational age were significant predictors of neonatal fat mass, explaining 81.1% of the variance, but not triceps skinfold or ethnicity. By Bland-Altman analyses, our prediction equation revealed a non-significant bias with limits of agreement (LOA) similar to those of a published equation for infants measured on days 1-3 (95% LOA: (-0.25, 0.26) kg vs (-0.23, 0.21) kg) and on day 0 (95% LOA: (-0.19, 0.17) kg vs (-0.17, 0.18) kg). The published equation, however, exhibited a systematic bias in our sample. Conclusions: Our equation requires only one skinfold site measurement, which can significantly reduce time and effort. It does not require the input of ethnicity and, thus, aid its application to other Asian neonatal populations.

National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications

Article

Full-text available

Jun 2012
LANCET

Preterm birth is the second largest direct cause of child deaths in children younger than 5 years. Yet, data regarding preterm birth (<37 completed weeks of gestation) are not routinely collected by UN agencies, and no systematic country estimates nor time trend analyses have been done. We report worldwide, regional, and national estimates of preterm birth rates for 184 countries in 2010 with time trends for selected countries, and provide a quantitative assessment of the uncertainty surrounding these estimates. METHODS: We assessed various data sources according to prespecified inclusion criteria. National Registries (563 datapoints, 51 countries), Reproductive Health Surveys (13 datapoints, eight countries), and studies identified through systematic searches and unpublished data (162 datapoints, 40 countries) were included. 55 countries submitted additional data during WHO's country consultation process. For 13 countries with adequate quality and quantity of data, we estimated preterm birth rates using country-level loess regression for 2010. For 171 countries, two regional multilevel statistical models were developed to estimate preterm birth rates for 2010. We estimated time trends from 1990 to 2010 for 65 countries with reliable time trend data and more than 10,000 livebirths per year. We calculated uncertainty ranges for all countries. FINDINGS: In 2010, an estimated 14·9 million babies (uncertainty range 12·3-18·1 million) were born preterm, 11·1% of all livebirths worldwide, ranging from about 5% in several European countries to 18% in some African countries. More than 60% of preterm babies were born in south Asia and sub-Saharan Africa, where 52% of the global livebirths occur. Preterm birth also affects rich countries, for example, USA has high rates and is one of the ten countries with the highest numbers of preterm births. Of the 65 countries with estimated time trends, only three (Croatia, Ecuador, and Estonia), had reduced preterm birth rates 1990-2010. INTERPRETATION: The burden of preterm birth is substantial and is increasing in those regions with reliable data. Improved recording of all pregnancy outcomes and standard application of preterm definitions is important. We recommend the addition of a data-quality indicator of the per cent of all live preterm births that are under 28 weeks' gestation. Distinguishing preterm births that are spontaneous from those that are provider-initiated is important to monitor trends associated with increased caesarean sections. Rapid scale up of basic interventions could accelerate progress towards Millennium Development Goal 4 for child survival and beyond. FUNDING: Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme; March of Dimes; the Partnership for Maternal Newborn and Childe Health; and WHO, Department of Reproductive Health and Research.

Does famine influence sex ratio at birth? Evidence from the 1959-1961 Great Leap Forward Famine in China

Article

Full-text available

Mar 2012
Proc Biol Sci

Shige Song

The current study examined the long-term trend in sex ratio at birth between 1929 and 1982 using retrospective birth histories of 310 101 Chinese women collected in a large, nationally representative sample survey in 1982. The study identified an abrupt decline in sex ratio at birth between April 1960, over a year after the Great Leap Forward Famine began, and October 1963, approximately 2 years after the famine ended, followed by a compensatory rise between October 1963 and July 1965. These findings support the adaptive sex ratio adjustment hypothesis that mothers in good condition are more likely to give birth to sons, whereas mothers in poor condition are more likely to give birth to daughters. In addition, these findings help explain the lack of consistent evidence reported by earlier studies based on the 1944-1945 Dutch Hunger Winter or the 1942 Leningrad Siege.

Maternal dietary patterns in pregnancy and fetal growth in Japan: the Osaka Maternal and Child Health Study

Article

Full-text available

Sep 2011
BRIT J NUTR

Maternal nutritional status during pregnancy is an important determinant of fetal growth. Although the effects of several nutrients and foods have been well examined, little is known about the relationship of overall maternal diet in pregnancy to fetal growth, particularly in non-Western populations. We prospectively examined the relationship of maternal dietary patterns in pregnancy to neonatal anthropometric measurements at birth and risk of small-for-gestational-age (SGA) birth among 803 Japanese women with live-born, singleton, term deliveries. Maternal diet in pregnancy was assessed using a validated, self-administered diet history questionnaire. Dietary patterns from thirty-three predefined food groups (g/4184 kJ) were extracted by cluster analysis. The following three dietary patterns were identified: the 'meat and eggs' (n 326), 'wheat products', with a relatively high intake of bread, confectioneries and soft drinks (n 303), and 'rice, fish and vegetables' (n 174) patterns. After adjustment for potential confounders, women in the 'wheat products' pattern had infants with the significantly lowest birth weight (P = 0·045) and head circumference (P = 0·036) among those in the three dietary patterns. Compared with women in the 'rice, fish and vegetables' pattern, women in the 'wheat products' pattern had higher odds of having a SGA infant for weight (multivariate OR 5·2, 95 % CI 1·1, 24·4), but this was not the case for birth length or head circumference. These results suggest that a diet high in bread, confectioneries, and soft drinks and low in fish and vegetables during pregnancy might be associated with a small birth weight and an increased risk of having a SGA infant.

Maternal Nutrition and Birth Outcomes

Article

Full-text available

Mar 2010
EPIDEMIOL REV

In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

Maternal dietary patterns in pregnancy and the association with small-for-gestational-age infants

Article

Full-text available

Mar 2010
BRIT J NUTR

Maternal nutritional status before and during pregnancy is important for the growth and development of the fetus. The effects of pre-pregnancy nutrition (estimated by maternal size) are well documented. There is little information in today's Western society on the effect of maternal nutrition during pregnancy on the fetus. The aim of the study was to describe dietary patterns of a cohort of mothers during pregnancy (using principal components analysis with a varimax rotation) and assess the effect of these dietary patterns on the risk of delivering a small-for-gestational-age (SGA) baby. The study was a case-control study investigating factors related to SGA. The population was 1714 subjects in Auckland, New Zealand, born between October 1995 and November 1997, about half of whom were born SGA ( < or = 10th percentile for sex and gestation). Maternal dietary information was collected using FFQ after delivery for the first and last months of pregnancy. Three dietary patterns (traditional, junk and fusion) were defined. Factors associated with these dietary patterns when examined in multivariable analyses included marital status, maternal weight, maternal age and ethnicity. In multivariable analysis, mothers who had higher 'traditional' diet scores in early pregnancy were less likely to deliver a SGA infant (OR = 0.86; 95 % CI 0.75, 0.99). Maternal diet, particularly in early pregnancy, is important for the development of the fetus. Socio-demographic factors tend to be significantly related to dietary patterns, suggesting that extra resources may be necessary for disadvantaged mothers to ensure good nutrition in pregnancy.

Women's Dietary Patterns Change Little from Before to During Pregnancy

Article

Full-text available

Sep 2009
J NUTR

Principal component analysis (PCA) is a popular method of dietary patterns analysis, but our understanding of its use to describe changes in dietary patterns over time is limited. Using a FFQ, we assessed the diets of 12,572 nonpregnant women aged 20-34 y from Southampton, UK, of whom 2270 and 2649 became pregnant and provided complete dietary data in early and late pregnancy, respectively. Intakes of white bread, breakfast cereals, cakes and biscuits, processed meat, crisps, fruit and fruit juices, sweet spreads, confectionery, hot chocolate drinks, puddings, cream, milk, cheese, full-fat spread, cooking fats and salad oils, red meat, and soft drinks increased in pregnancy. Intakes of rice and pasta, liver and kidney, vegetables, nuts, diet cola, tea and coffee, boiled potatoes, and crackers decreased in pregnancy. PCA at each time point produced 2 consistent dietary patterns, labeled prudent and high-energy. At each time point in pregnancy, and for both the prudent and high-energy patterns, we derived 2 dietary pattern scores for each woman: a natural score, based on the pattern defined at that time point, and an applied score, based on the pattern defined before pregnancy. Applied scores are preferred to natural scores to characterize changes in dietary patterns over time because the scale of measurement remains constant. Using applied scores, there was a very small mean decrease in prudent diet score in pregnancy and a very small mean increase in high-energy diet score in late pregnancy, indicating little overall change in dietary patterns in pregnancy.

International Tables of Glycemic Index

Article

Full-text available

Nov 1995

The glycemic index (GI) is a ranking of foods based on their glycemic effect compared with a standard food. It has been used to classify carbohydrate foods for various applications, including diabetes, sports, and appetite research. The purpose of these tables is to bring together all of the published data on the GIs of individual foods for the convenience of users. In total, there are almost 600 separate entries, including values for most common Western foods, many indigenous foods, and pure sugar solutions. The tables show the GI according to both the glucose and white bread (the original reference food) standard, the type and number of subjects tested, and the source of the data. For many foods there were two or more published values, so the mean +/- SEM was calculated and is shown together with the original data. These tables reduce unnecessary repetition in the testing of individual foods and facilitate wider application of the GI approach.

Maternal nutrition in early and late pregnancy in relation to placental and fetal growth

Article

Full-text available

Mar 1996

To assess how nutrient intakes of mothers in early and late pregnancy influence placental and fetal growth. Prospective observational study. Princess Anne Maternity Hospital, Southampton. 538 mothers who delivered at term. Placental and birth weights adjusted for the infant's sex and duration of gestation. Mothers who had high carbohydrate intakes in early pregnancy had babies with lower placental and birth weights. Low maternal intakes of dairy and meat protein in late pregnancy were also associated with lower placental and birth weights. Placental weight fell by 49 g(95% confidence interval 16 g to 81 g; P=0.002) for each log g increase in intake of carbohydrate in early pregnancy and by 1.4 g (0.4 g to 2.4 g; P=0.005) for each g decrease in intake of dairy protein in late pregnancy. Birth weight fell by 165 g (49 g to 282 g; P=0.005) for each log g increase in carbohydrate intake in early pregnancy and by 3.1 g (0.3 g to 6.0 g; P=0.03) for each g decrease in meat protein intake in late pregnancy. These associations were independent of the mother's height and body mass index and of strong relations between the mother's birth weight and the placental and birth weights of her offspring. These findings suggest that a high carbohydrate intake in early pregnancy suppresses placental growth, especially if combined with a low dairy protein intake in late pregnancy. Such an effect could have long term consequences for the offspring's risk of cardiovascular disease.

Influence of maternal nutrition on outcome of pregnancy: prospective cohort study

Article

Full-text available

Sep 1999

To investigate the relations of maternal diet and smoking during pregnancy to placental and birth weights at term. Prospective cohort study. Setting: District general hospital in the south of England. 693 pregnant nulliparous white women with singleton pregnancies who were selected from antenatal booking clinics with stratified random sampling. Birth and placental weights at term. Placental and birth weights were unrelated to the intake of any macronutrient. Early in pregnancy, vitamin C was the only micronutrient independently associated with birth weight after adjustment for maternal height and smoking. Each ln mg increase in vitamin C was associated with a 50.8 g (95% confidence interval 4.6 g to 97.0 g) increase in birth weight. Vitamin C, vitamin E, and folate were each associated with placental weight after adjustment for maternal characteristics. In simultaneous regression, however, vitamin C was the only nutrient predictive of placental weight: each ln mg increase in vitamin C was associated with a 3.2% (0.4 to 6.1) rise in placental weight. No nutrient late in pregnancy was associated with either placental or birth weight. Concern over the impact of maternal nutrition on the health of the infant has been premature. Maternal nutrition, at least in industrialised populations, seems to have only a small effect on placental and birth weights. Other possible determinants of fetal and placental growth should be investigated.

A Low Protein Diet Alters the Balance of Islet Cell Replication and Apoptosis in the Fetal and Neonatal Rat and Is Associated with a Reduced Pancreatic Expression of Insulin-Like Growth Factor-II 1

Article

Full-text available

Nov 1999

A programmed turnover of pancreatic beta cells occurs in the neonatal rat involving a loss of beta cells by apoptosis, and their replacement by islet cell replication and neogenesis. The timing of apoptosis is associated with a loss of expression of a survival factor, insulin-like growth factor-II (IGF-II), in the pancreatic islets. Offspring from rats chronically fed a low protein isocalorific diet (LP) exhibit a reduced pancreatic beta cell mass at birth and a reduced insulin secretion in later life. This study therefore investigated the impact of LP on islet cell ontogeny in the late fetal and neonatal rat, and any associated changes in the presence of IGFs and their binding proteins (IGFBPs). Pregnant Wistar rats were fed either LP (8% protein) or normal (C) (20% protein) chow from shortly after conception until the offspring were 21 days postnatal (PN). Bromo-deoxyuridine (BrdU) was administered 1 h before rats were killed and pancreata removed from animals between 19.5 days fetal life and postnatal day 21. Offspring of rats given LP diet had reduced birthweight, pancreatic beta cell mass, and pancreas insulin content, with smaller islets compared with control fed animals, which persisted to weaning. Histological analysis showed that islets from pups given LP diet had a lower nuclear labeling index with BrdU in the beta cells, although, paradoxically, more beta cells showed immunoreactivity for proliferating cell nuclear antigen (PCNA). Because PCNA is present in G1 as well as S phase of the cell cycle, we quantified the number of beta cells immunopositive for cyclin D1, a marker of G1, and NEK2, an indicator of cells in G2 and mitosis. More beta cells in islets from LP-fed animals contained cyclin D1, but less contained NEK2 than did those in controls. This suggests that the beta cell cycle may have a prolonged G1 phase in LP-fed animals in vivo. Offspring of rats given C diet had a low rate of islet cell apoptosis detected by the TUNEL method in fetal and neonatal life (1-2%), with a transient increase to 8% at PN day 14. Offspring of rats receiving LP diet demonstrated a significantly greater level of islet cell apoptosis at every age, rising to 15% at PN 14. IGF-II mRNA was quantified in whole pancreas and was significantly reduced in LP-fed animals at ages up to PN day 10. IGF-II immunoreactivity within the islets of LP-fed rats was also less apparent, but no changes were seen in immunoreactive IGF-I or IGFBPs-2 to -5. These findings show that LP diet changes the balance of beta cell replication and apoptosis in fetal and neonatal neonatal life, which may involve an altered length of beta cell cycle, and contribute to the smaller islet size and impaired insulin release seen in later life. A reduced pancreatic expression of IGF-II may contribute to the lower beta cell proliferation rate and increased apoptosis seen in the fetus and neonate after feeding LP diet.

Intake of Micronutrient-Rich Foods in Rural Indian Mothers Is Associated with the Size of Their Babies at Birth: Pune Maternal Nutrition Study1

Article

Full-text available

Apr 2001

One third of the Indian babies are of low birth weight (<2.5 kg), and this is attributed to maternal undernutrition. We therefore examined the relationship between maternal nutrition and birth size in a prospective study of 797 rural Indian women, focusing on macronutrient intakes, dietary quality and micronutrient status. Maternal intakes (24-h recall and food frequency questionnaire) and erythrocyte folate, serum ferritin and vitamin C concentrations were measured at 18 ± 2 and 28 ± 2 wk gestation. Mothers were short (151.9 ± 5.1 cm) and underweight (41.7 ± 5.1 kg) and had low energy and protein intakes at 18 wk (7.4 ± 2.1 MJ and 45.4 ± 14.1 g) and 28 wk (7.0 ± 2.0 MJ and 43.5 ± 13.5 g) of gestation. Mean birth weight and length of term babies were also low (2665 ± 358 g and 47.8 ± 2.0 cm, respectively). Energy and protein intakes were not associated with birth size, but higher fat intake at wk 18 was associated with neonatal length (P < 0.001), birth weight (P < 0.05) and triceps skinfold thickness (P < 0.05) when adjusted for sex, parity and gestation. However, birth size was strongly associated with the consumption of milk at wk 18 (P < 0.05) and of green leafy vegetables (P < 0.001) and fruits (P < 0.01) at wk 28 of gestation even after adjustment for potentially confounding variables. Erythrocyte folate at 28 wk gestation was positively associated with birth weight (P < 0.001). The lack of association between size at birth and maternal energy and protein intake but strong associations with folate status and with intakes of foods rich in micronutrients suggest that micronutrients may be important limiting factors for fetal growth in this undernourished community.

Maternal Energy Stores and Diet Composition During Pregnancy Program Adolescent Blood Pressure

Article

Full-text available

Sep 2001
CIRCULATION

Fetal undernutrition is hypothesized to program blood pressure (BP) later in life. Human epidemiological studies that use birth weight as a proxy for fetal malnutrition fail to identify specific aspects of maternal nutrition responsible for programming. We examined how maternal nutrition during pregnancy and infant birth weight relate to systolic and diastolic BP (SBP and DBP) in 2026 Filipino adolescents. Data were collected prospectively during the Cebu (Philippines) Longitudinal Health and Nutrition Survey. Women were assessed at approximately 30 weeks gestation, and children were followed from birth through adolescence. Regression models were used to examine how the mothers' total energy intake, percentage of energy from protein and fat, triceps skinfold thickness during pregnancy, and infant birth weight relate to adolescent BP, controlling for current age, height, and body mass index and other potential confounders. Maternal triceps skinfold thickness was significantly inversely related to SBP among boys and to DBP in boys and girls. Maternal nutrition variables attenuated but did not eliminate an inverse birth weight-SBP relationship in boys. SBP was significantly inversely related to the mothers' percent of dietary energy from protein in boys. Among girls, SBP and DBP were inversely related to the mothers' percentage of calories from fat. There was no evidence of confounding of these relationships by current diet, maturation status, physical activity, or socioeconomic status. Maternal diet composition and energy stores in the form of subcutaneous fat have long-term effects on offspring BP in adolescence.

National, Regional, and Worldwide Estimates of Preterm Birth Rates in the Year 2010 With Time Trends Since 1990 for Selected Countries: A Systematic Analysis and Implications

Article

Sep 2013
Obstet Anesth Digest

Comments on "Adjustment for total energy intake in epidemiologic studies"

Article

Apr 1997

Willett et al [Am J Clin Nutr 1997;65(suppl): 1220S-8S] reviewed the case for energy adjustment in the analysis of nutritional studies and argued strongly for basing the main analysis on an energy-adjustment statistical model. They recommended focusing attention on a statistical association that represents the change in disease incidence associated with the substitution of energy from a specific nutrient for energy from other nutrient sources, while keeping total energy intake constant. Although we agree with many of the points made in their paper, we recommend assessing and reporting associations representing not only the substitution but also the addition of energy from the specific nutrient. For these ''addition'' associations, it is especially important to check for confounding with measures of body size and physical activity. Restricting analyses to substitution associations will confine investigators to estimating the relative effects of one nutrient to another and will preclude investigating the effects of increased intake of a specific nutrient.

Maternal Dietary Patterns during the Second Trimester Are Associated with Preterm Birth

Article

Jun 2015
J NUTR

Preterm birth is one of the leading causes of neonatal morbidity in the United States. Despite decades of research, the etiology is largely unknown. The purpose of our study was to examine the association between maternal dietary patterns during pregnancy and preterm birth. This prospective cohort study used data from the PIN (Pregnancy, Infection, and Nutrition) study (n = 3143). Dietary intake was assessed at 26-29 wk of gestation by using a food-frequency questionnaire, and patterns were derived by using factor analysis and the Dietary Approaches to Stop Hypertension (DASH) diet. Associations between dietary patterns and preterm birth were assessed by logistic regression. Four dietary patterns were identified from the factor analysis characterized by high intakes of the following: 1) fruits, vegetables, low-fat dairy, high-fiber and fortified cereals, nonfried chicken and fish, and wheat bread; 2) beans, corn, French fries, hamburgers or cheeseburgers, white potatoes, fried chicken, mixed dishes, and ice cream; 3) collard greens, coleslaw or cabbage, red and processed meats, cornbread or hushpuppies, whole milk, and vitamin C-rich drinks; and 4) shellfish, pizza, salty snacks, and refined grains. Increased odds of preterm birth were found for a diet characterized by a high consumption of collard greens, coleslaw or cabbage, red meats, fried chicken and fish, processed meats, cornbread or hushpuppies, eggs or egg biscuits, gravy, whole milk, and vitamin C-rich drinks such as Kool-Aid (Kraft Foods) and Hi-C (Minute Maid Co.) (adjusted OR for quartile 4 vs. quartile 1: 1.55; 95% CI: 1.07, 2.24). Greater adherence to the DASH diet was associated with decreased odds of preterm birth compared with women in the lowest quartile (adjusted OR for quartile 4 vs. quartile 1: 0.59; 95% CI: 0.40, 0.85). Diet quality during pregnancy is associated with preterm birth; thus, preconceptional and early prenatal dietary counseling promoting healthy dietary intake could improve pregnancy outcomes. © 2015 American Society for Nutrition.

Maternal Glucose Concentration Influences Fetal Growth, Gestation, and Pregnancy Complications

Article

Sep 2001
AM J EPIDEMIOL

Theresa O. Scholl

Using 1990–1995 data, the authors examined the influence of post-challenge maternal glucose concentration on pregnancy outcome in 1,157 nondiabetic US gravidas. After control for potential confounding variables and comparing gravidas with lower glucose concentrations (<99 mg/dl) with the others, they found that mean birth weight increased by 50 g and 200 g with glucose concentrations of 99–130 mg/dl and >130 mg/dl, respectively. Increased maternal glucose concentration also was associated with an increased risk of large-for-gestation fetuses (p for trend < 0.001) and a decreased risk of fetal growth restriction (p for trend < 0.05). The association between glucose and gestation was inverse and significantly shortened when glucose concentrations were higher. Maternal complications increased twofold or more with high glucose concentrations and included cesarean section and clinical chorioamnionitis. Chorioamnionitis in combination with high maternal glucose concentration increased the risk of very preterm delivery almost 12-fold. These observations extend Pedersen's hypothesis—that high concentrations of maternal glucose give rise to increased nutrient transfer to the fetus and increase fetal growth, beyond the model of maternal diabetes (Acta Endocrinol 1954;16:330–42). They raise the question of whether higher, but seemingly normal maternal glucose concentration predisposes to or is a marker for placental inflammation and infection.

Maternal Protein Intake during Pregnancy Is Not Associated with Offspring Birth Weight in a Multiethnic Asian Population

Article

May 2015
J NUTR

Maternal diet during pregnancy can influence fetal growth. However, the relation between maternal macronutrient intake and birth size outcomes is less clear. We examined the associations between maternal macronutrient intake during pregnancy and infant birth size. Pregnant women (n = 835) from the Singapore GUSTO (Growing Up in Singapore Towards healthy Outcomes) mother-offspring cohort were studied. At 26-28 wk of gestation, the macronutrient intake of women was ascertained with the use of 24 h dietary recalls and 3 d food diaries. Weight, length, and ponderal index of their offspring were measured at birth. Associations were assessed by substitution models with the use of multiple linear regressions. Mean ± SD maternal energy intake and percentage energy from protein, fat, and carbohydrates per day were 1903 ± 576 kcal, 15.6% ± 3.9%, 32.7% ± 7.5%, and 51.6% ± 8.7% respectively. With the use of adjusted models, no associations were observed for maternal macronutrient intake and birth weight. In male offspring, higher carbohydrates or fat with lower protein intake was associated with longer birth length (β = 0.08 cm per percentage increment in carbohydrates; 95% CI: 0.04, 0.13; β = 0.08 cm per percentage increment in fats; 95% CI: 0.02, 0.13) and lower ponderal index (β = -0.12 kg/m(3) per percentage increment in carbohydrates; 95% CI: -0.19, -0.05; β = -0.08 kg/m(3) per percentage increment in fats; 95% CI: -0.16, -0.003), but this was not observed in female offspring (P-interaction < 0.01). Maternal macronutrient intake during pregnancy was not associated with infant birth weight. Lower maternal protein intake was significantly associated with longer birth length and lower ponderal index in male but not female offspring. However, this finding warrants further confirmation in independent studies. This trial was registered at clinicaltrials.gov as NCT01174875. © 2015 American Society for Nutrition.

Dietary patterns: From nutritional epidemiologic analysis to national guidelines

Article

Apr 2015
AM J CLIN NUTR

The effect of prenatal dietary intake on birth weight

Article

Feb 2001
NUTR RES

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 (

Diet, exercise, and feto-placental growth

Article

Mar 1996
J Soc Gynecol Investig

J. F. Clapp

Background and Objective: Evidence from multiple sources indicates that maternal blood glucose levels correlate directly with size at birth and that both diet and exercise alter them. The purpose of these preliminary studies was to test the hypothesis that the carbohydrate mix in a pregnant woman's diet modifies the primary effect of exercise on feto-placental growth through its effects on maternal blood glucose levels. Experimental Designs and Methods: A prospective randomized design was used to examine the effects of two isocaloric, high carbohydrate diets combined with regular exercise on maternal blood glucose levels and various indices of morphometric outcome in healthy pregnant women (n = 12). The diets differed only in the type of carbohydrate ingested. Those in one had low glycemic indices and those in the other had high glycemic indices. Results: During pregnancy, women on the low glycemic carbohydrate diet experienced no significant change in their glycemic response to mixed caloric intake while those who switched to the high glycemic carbohydrate diet experienced a 190 % increase in their response. The later was associated with larger placental size, increased birth weight, and greater maternal weight gain. Conclusion: These preliminary data indicate that the type of dietary carbohydrate in a physically active pregnant woman's diet influences her blood glucose profile which alters placental growth, size at birth, and weight gain.

Macrosomia in 23 developing countries: An analysis of a multicountry, facility-based, cross-sectional survey

Article

Jan 2013
LANCET

Background: Macrosomia is a risk factor for adverse delivery outcomes. We investigated the prevalence, risk factors, and delivery outcomes of babies with macrosomia in 23 developing countries in Africa, Asia, and Latin America. Methods: We analysed data from WHO's Global Survey on Maternal and Perinatal Health, which was a facility-based cross-sectional study that obtained data for women giving birth in 373 health facilities in 24 countries in Africa and Latin America in 2004-05, and in Asia in 2007-08. Facilities were selected by stratified multistage cluster sampling and women were recruited at admission for delivery. We extracted data from the medical records with a standardised questionnaire. We used logistic regression with random effects to assess the risk factors for macrosomia and the risks for caesarean section and adverse maternal and perinatal outcomes (assessed by a composite score) in babies with the disorder. Findings: Of 290,610 deliveries, we analysed data for 276,436 singleton livebirths or fresh stillbirths. Higher maternal age (20-34 years), height, parity, body-mass index, and presence of diabetes, post-term pregnancy, and male fetal sex were associated with a significantly increased risk of macrosomia. Macrosomia was associated with an increased risk of caesarean section because of obstructed labour and post-term pregnancy in all regions. Additionally, macrosomia was associated with an increased risk of adverse maternal birth outcomes in all regions, and of adverse perinatal outcomes only in Africa. Interpretation: Increasing prevalence of diabetes and obesity in women of reproductive age in developing countries could be associated with a parallel increase in macrosomic births. The effect and feasibility of control of diabetes and preconception weight on macrosomia should be investigated in these settings. Furthermore, increased institutional delivery in countries where rates are low could be crucial to reduce macrosomia-associated morbidity and mortality. Funding: None.

Diet in Pregnancy and the offspring's blood pressure 40 years later

Article

Aug 2005
BJOG-INT J OBSTET GY

Objective To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life. Design A follow up study of men and women born during 1948–1954 whose mothers had taken part in a survey of diet in late pregnancy. Setting Aberdeen, Scotland. Population Two hundred and fifty-three men and women born in Aberdeen Maternity Hospital. Main outcome measure Systolic and diastolic blood pressure. Results The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50 g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (P= 0.02)). At daily animal protein intakes above 50 g, lower Carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (P= 0.004)). These increases in blood pressure were associated with decreased placental size. Conclusion Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.

Fetal Programming and Metabolic Syndrome

Article

Feb 2011
ANNU REV PHYSIOL

Metabolic syndrome is reaching epidemic proportions, particularly in developing countries. In this review, we explore the concept-based on the developmental-origin-of-health-and-disease hypothesis-that reprogramming during critical times of fetal life can lead to metabolic syndrome in adulthood. Specifically, we summarize the epidemiological evidence linking prenatal stress, manifested by low birth weight, to metabolic syndrome and its individual components. We also review animal studies that suggest potential mechanisms for the long-term effects of fetal reprogramming, including the cellular response to stress and both organ- and hormone-specific alterations induced by stress. Although metabolic syndrome in adulthood is undoubtedly caused by multiple factors, including modifiable behavior, fetal life may provide a critical window in which individuals are predisposed to metabolic syndrome later in life.

Sex Differences in Birth Size and Intergenerational Effects of Intrauterine Exposure to Ramadan in Saudi Arabia

Article

Sep 2011
AM J HUM BIOL

In Europe, boys and girls have different body proportions at birth. We examined newborn babies in Saudi Arabia to determine the sex differences and whether fetal growth differed if the mother was in utero during Ramadan. We examined body size at birth among 967 babies (479 boys and 488 girls) born in Unizah, a small city in Saudi Arabia. Large head circumference was the strongest single predictor of male sex. In a simultaneous regression, female sex was predicted by small head circumference (P < 0.001), low birth weight (P = 0.002), and large chest circumference (P = 0.008). The mothers of boys were heavier in pregnancy than the mothers of girls and had a higher body mass index, 31.7 kg/m(2) compared to 30.2 (P < 0.001). The mothers of girls, however, were taller than the mothers of boys, 158.6 cm compared to 157.4 (P = 0.001). Compared to babies whose mothers were not in utero during Ramadan boys whose mothers were in mid gestation during Ramadan were 1.2 cm longer (P = 0.005) while girls had a 0.4 week shorter gestation period (P = 0.04). Our findings are consistent with other evidence that boys are more ready than girls to trade off visceral development in utero to protect somatic and brain growth. They also support the hypothesis that boys are more responsive to their mother's current diet than girls, who respond more to their mother's life time nutrition and metabolism. They provide the first evidence that changes in the life style of pregnant women during Ramadan affect more than one generation.

A global reference for fetal-weight and birthweight percentiles

Article

May 2011
LANCET

Definition of small for gestational age in various populations worldwide remains a challenge. References based on birthweight are deficient for preterm births, those derived from ultrasound estimates might not be applicable to all populations, and the individualised reference can be too complex to use in developing countries. Our aim was to create a generic reference for fetal weight and birthweight that overcame these deficiencies and could be readily adapted to local populations. We used the fetal-weight reference developed by Hadlock and colleagues and the notion of proportionality proposed by Gardosi and colleagues and made the weight reference easily adjustable according to the mean birthweight at 40 weeks of gestation for any local population. For application and validation, we used data from 24 countries in Africa, Latin America, and Asia that participated in the 2004-08 WHO Global Survey on Maternal and Perinatal Health (237,025 births). We compared our reference with that of Hadlock and colleagues (non-customised) and with that of Gardosi and colleagues (individualised). For every reference, the odds ratio (OR) of adverse perinatal outcomes (stillbirths, neonatal deaths, referral to higher-level or special care unit, or Apgar score lower than 7 at 5 min) for infants who were small for gestational age versus those who were not was estimated with multilevel logistic regression. OR of adverse outcomes for infants small for gestational age versus those not small for gestational age was 1·59 (95% CI 1·53-1·66) for the non-customised fetal-weight reference compared with 2·87 (2·73-3·01) for our country-specific reference, and 2·84 (2·71-2·99) for the fully individualised reference. Our generic reference for fetal-weight and birthweight percentiles can be easily adapted to local populations. It has a better ability to predict adverse perinatal outcomes than has the non-customised fetal-weight reference, and is simpler to use than the individualised reference without loss of predictive ability. None.

How Is Maternal Nutrition Related to Preterm Birth?

Article

Aug 2010
ANNU REV NUTR

Frank H Bloomfield

The incidence of preterm birth in developed countries is increasing, and in some countries, including the United States, it is almost as high as in developing countries. Demographic changes in women becoming pregnant can account for only a relatively small proportion of the increase. A significant proportion of spontaneous preterm birth continues to be of unknown cause. Experimental data from animal studies suggesting that maternal undernutrition may play a role in spontaneous, noninfectious, preterm birth are supported by observational data in human populations, which support a role for maternal prepregnancy nutritional status in determining gestation length. In addition, intakes or lack of specific nutrients during pregnancy may influence gestation length and thus the risk of preterm birth. As yet, the role of paternal nutrition in contributing to gestation length is unexplored.

Effect of maternal diet on the epigenome: Implications for human metabolic disease

Article

Feb 2011

Karen A Lillycrop

The rapid increase in the incidence of chronic non-communicable diseases over the past two decades cannot be explained solely by genetic and adult lifestyle factors. There is now considerable evidence that the fetal and early postnatal environment also strongly influences the risk of developing such diseases in later life. Human studies have shown that low birth weight is associated with an increased risk of CVD, type II diabetes, obesity and hypertension, although recent studies have shown that over-nutrition in early life can also increase susceptibility to future metabolic disease. These findings have been replicated in a variety of animal models, which have shown that both maternal under- and over-nutrition can induce persistent changes in gene expression and metabolism within the offspring. The mechanism by which the maternal nutritional environment induces such changes is beginning to be understood and involves the altered epigenetic regulation of specific genes. The demonstration of a role for altered epigenetic regulation of genes in the developmental induction of chronic diseases raises the possibility that nutritional or pharmaceutical interventions may be used to modify long-term cardio-metabolic disease risk and combat this rapid rise in chronic non-communicable diseases.

Micronutrients, Birth Weight, and Survival

Article

Apr 2010
ANNU REV NUTR

Parul Christian

Maternal micronutrient requirements during pregnancy increase to meet the physiologic changes in gestation and fetal demands for growth and development. Maternal micronutrient deficiencies are high and coexist in many settings, likely influencing birth and newborn outcomes. The only recommendation for pregnancy currently exists for iron and folic acid use. Evidence is convincing that maternal iron supplementation will improve birth weight and perhaps gestational length. In one randomized trial, iron supplementation during pregnancy reduced child mortality in the offspring compared with the control group. Few other single micronutrients given antenatally, including vitamin A, zinc, and folic acid, have been systematically shown to confer such a benefit. A meta-analysis of 12 trials of multiple micronutrient supplementation compared with iron-folic acid reveals an overall 11% reduction in low birth weight but no effect on preterm birth and perinatal or neonatal survival. Currently, data are unconvincing for replacing supplementation of antenatal iron-folic acid with multiple micronutrients.

Maternal Micronutrient Supplementation Study Group. Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation

Article

Dec 2009

Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes. This meta-analysis reports the effects on newborn size and duration of gestation of multiple micronutrient supplementation mainly compared with iron plus folic acid during pregnancy in recent randomized, controlled trials. Original data from 12 randomized, controlled trials in Bangladesh, Burkina Faso, China, Guinea-Bissau, Indonesia, Mexico, Nepal, Niger, Pakistan, and Zimbabwe, all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients to presumed HIV-negative women, were included. Outcomes included birthweight, other birth measurements, gestation, and incidence of low birthweight (LBW) (< 2500 g), small-for-gestational age birth (SGA, birthweight below the within-each-population 10th percentile), large-for-gestational age birth (LGA, birthweight above the within-each-population 90th percentile), and preterm delivery (< 37 weeks). Compared with control supplementation (mainly with iron-folic acid), multiple micronutrient supplementation was associated with an increase in mean birthweight (pooled estimate: +22.4 g [95% CI, 8.3 to 36.4 g]; p = .002), a reduction in the prevalence of LBW (pooled OR = 0.89 [95% CI, 0.81 to 0.97]; p = .01) and SGA birth (pooled OR = 0.90 [95% CI, 0.82 to 0.99]; p = .03), and an increase in the prevalence of LGA birth (pooled OR = 1.13 [95% CI, 1.00 to 1.28]; p = .04). In most studies, the effects on birthweight were greater in mothers with higher body mass index (BMI). In the pooled analysis, the positive effect of multiple micronutrients on birthweight increased by 7.6 g (95% CI, 1.9 to 13.3 g) per unit increase in maternal BMI (p for interaction = .009). The intervention effect relative to the control group was + 39.0 g (95% CI, +22.0 to +56.1 g) in mothers with BMI of 20 kg/m2 or higher compared with -6.0 g (95% CI, -8.8 to +16.8 g) in mothers with BMI under 20 kg/m2. There were no significant effects of multiple micronutrient supplementation on birth length or head circumference nor on the duration of gestation (pooled effect: +0.17 day [95% CI, -0.35 to +0.70 day]; p = .51) or the incidence of preterm birth (pooled OR = 1.00 [95% CI, 0.93 to 1.09]; p = .92). Compared with iron-folic acid supplementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10%. The effect was greater among women with higher BMI.

Boys Live Dangerously in the Womb

Article

May 2010
AM J HUM BIOL

The growth of every human fetus is constrained by the limited capacity of the mother and placenta to deliver nutrients to it. At birth, boys tend to be longer than girls at any placental weight. Boy's placentas may therefore be more efficient than girls, but may have less reserve capacity. In the womb boys grow faster than girls and are therefore at greater risk of becoming undernourished. Fetal undernutrition leads to small size at birth and cardiovascular disorders, including hypertension, in later life. We studied 2003 men and women aged around 62 years who were born in Helsinki, Finland, of whom 644 had hypertension: we examined their body and placental size at birth. In both sexes, hypertension was associated with low birth weight. In men, hypertension was also associated with a long minor diameter of the placental surface. The dangerous growth strategy of boys may be compounded by the costs of compensatory placental enlargement in late gestation. In women, hypertension was associated with a small placental area, which may reduce nutrient delivery to the fetus. In men, hypertension was linked to the mothers' socioeconomic status, an indicator of their diets: in women it was linked to the mothers' heights, an indicator of their protein metabolism. Boys' greater dependence on their mothers' diets may enable them to capitalize on an improving food supply, but it makes them vulnerable to food shortages. The ultimate manifestation of their dangerous strategies may be that men have higher blood pressures and shorter lives than women.

The effect of nutrition intake on outcome of pregnancy in smokers and non-smokers

Article

Jun 1991

The relationship between nutrient intake and pregnancy outcome (adjusted birth weight and gestational age) was investigated in randomly selected non-smokers ( n 97) and in heavy smokers (15 + cigarettes/d) ( n 72) booking for ante-natal care at a hospital in South London. Weighed dietary intakes (7 d) were obtained at 28 and 36 weeks gestation. Birth weight was adjusted for gestational age, maternal height, parity and sex of infant. Compared with non-smokers, intakes of micronutrients and fibre were lower in smokers at both 28 and 36 weeks, and smokers reduced their intakes more in late pregnancy. The babies of smokers had a lower adjusted birth weight but there was no difference in length of gestation between smokers and non-smokers. After controlling for smoking, social class and alcohol consumption, nutrient intakes at 28 weeks were found to have no effect on adjusted birth weight. However, intakes of protein, zinc, riboflavin and thiamin at 36 weeks, and the change in intakes of these nutrients (plus iron) between 28 and 36 weeks, had independent positive effects on birth weight. Some of the effect of smoking on birth weight appeared to be mediated through differences in nutrient intakes. Smoking explained 14.3% of the variance in birth weight in this population and a further 2.4–7.2 % was explained by change in nutrient intakes between 28 and 36 weeks. It is recommended that women in pregnancy do not reduce their dietary intakes in late pregnancy.

In utero analysis of fetal growth: A sonographic weight standard

Article

Nov 1991

Regression analysis was used to develop an in utero fetal weight model from a population of 392 predominantly middle-class white patients with certain menstrual histories. There was a gradual increase in fetal weight from 35 g at 10 weeks to 3,619 g at 40 weeks, with uniform variance of +/- 12.7% (1 standard deviation) throughout gestation. When tested against the estimated weights of 1,771 chromosomally normal fetuses between 14 and 21 weeks, the mean percent difference was 0.8% and the average absolute percent error was 3.3%. When compared with actual delivery data for 163 fetuses in the group, the mean percent difference was 0.8% and the average absolute percent error was 1.1%. These data are compared with other prenatal weight curves obtained at ultrasound and with data from several large postnatal weight studies.

Maternal Eating Patterns and Birth Weight of Mexican American Infants

Article

Feb 1995

Eating patterns of 549 Mexican American mothers were identified using dietary data from the United States Hispanic Health and Nutrition Examination Survey. These eating patterns were then used to investigate the relationship between maternal diet and infant birth weight. Principle components factor analysis was used to determine the structure of the maternal eating patterns. Seven distinct eating patterns were identified: nutrient dense, traditional, transitional, nutrient dilute, protein rich, high fat dairy, and mixed dishes. Stepwise multiple regression analysis was used to identify those eating patterns associated with birth weight. In addition to eating patterns, regression variables included body mass index, hemoglobin, gestational age at delivery, maternal age, infant gender, acculturation, marital status, income, education, and smoking during pregnancy. Regression results indicated that the nutrient dense (fruits, vegetables, low fat dairy, etc.) and protein rich (low fat meats, processed meats, and dairy desserts, etc.) eating patterns were associated with increased birth weight and that the transitional eating pattern (fats and oils, breads and cereals, high fat meats, sugar, etc.) was associated with decreased birth weight. Study findings suggest that the eating pattern methodology may be an appropriate tool for analyzing food frequency data in the investigation of diet and health relationships and for targeting dietary interventions.

An Adjustable Fetal Weight Standard

Article

Oct 1995

The monitoring of fetal weight is an important aspect of antenatal care. To construct an individually adjustable standard, we developed a model to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy. A formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight, and also defines the 90th and 10th centile curves as normal limits. We analyzed a birth weight database of 38 114 singleton, routine ultrasound‐dated pregnancies resulting in term deliveries. By stepwise multiple regression analysis, we derived coefficients for the factors that act as variables on term birth weight in our population. Apart from gestational age and sex, the maternal height, weight at first visit, ethnic group, parity and smoking all have significant and independent effects on birth weight. The variation due to ethnic group appears to be physiological in this population. Smoking is associated with a reduction in birth weight, which is independent of maternal physique and related to the number of cigarettes per day as reported at the first visit. We have developed a software program which calculates, on the basis of pregnancy variables entered at the first visit, an adjusted normal range for fetal size. This can be printed out as a chart and used for antenatal surveillance of growth. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology

Adjustment for total energy intake in epidemilogic studies

Article

May 1997

In epidemiologic studies, total energy intake is often related to disease risk because of associations between physical activity or body size and the probability of disease. In theory, differences in disease incidence may also be related to metabolic efficiency and therefore to total energy intake. Because intakes of most specific nutrients, particularly macronutrients, are correlated with total energy intake, they may be noncausally associated with disease as a result of confounding by total energy intake. In addition, extraneous variation in nutrient intake resulting from variation in total energy intake that is unrelated to disease risk may weaken associations. Furthermore, individuals or populations must alter their intake of specific nutrients primarily by altering the composition of their diets rather than by changing their total energy intake, unless physical activity or body weight are changed substantially. Thus, adjustment for total energy intake is usually appropriate in epidemiologic studies to control for confounding, reduce extraneous variation, and predict the effect of dietary interventions. Failure to account for total energy intake can obscure associations between nutrient intakes and disease risk or even reverse the direction of association. Several disease-risk models and formulations of these models are available to account for energy intake in epidemiologic analyses, including adjustment of nutrient intakes for total energy intake by regression analysis and addition of total energy to a model with the nutrient density (nutrient divided by energy).

Maternal birthweight and diet in prenancy in relation to the infant’s thinness at birth

Article

Jun 1997
Br J Obstet Gynaecol

To examine how maternal diet in pregnancy and parental body size and birthweight influence an infant's thinness at birth measured by a low ponderal index. An observational study of newborn infants and their parents. Southampton, England. Five hundred and thirty-eight infants born at term. Ponderal index at birth. Women who had a high intake of carbohydrate in early pregnancy and a low intake of dairy protein in late pregnancy tended to have infants that were thin at birth (P = 0.01 and P = 0.03, respectively, in a simultaneous analysis). Women who themselves had a low birthweight also tended to have thin infants, ponderal index falling from 28.3 kg/m3 to 26.2 kg/m3 as the women's birthweights decreased from more than 4.0 kg to 2.5 kg or less (P < 0.0001). Tall fathers had thin infants, but ponderal index was not related to the women's heights or the fathers' birthweights. These associations may reflect constraints on placental development imposed by a woman's nutrition in pregnancy and during her own intrauterine life. Effects of the father's height may be mediated through genetic influences on skeletal growth.

Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation

Article

Jul 1998

The classification of diabetes mellitus and the tests used for its diagnosis were brought into order by the National Diabetes Data Group of the USA and the second World Health Organization Expert Committee on Diabetes Mellitus in 1979 and 1980. Apart from minor modifications by WHO in 1985, little has been changed since that time. There is however considerable new knowledge regarding the aetiology of different forms of diabetes as well as more information on the predictive value of different blood glucose values for the complications of diabetes. A WHO Consultation has therefore taken place in parallel with a report by an American Diabetes Association Expert Committee to re-examine diagnostic criteria and classification. The present document includes the conclusions of the former and is intended for wide distribution and discussion before final proposals are submitted to WHO for approval. The main changes proposed are as follows. The diagnostic fasting plasma (blood) glucose value has been lowered to > or =7.0 mmol l(-1) (6.1 mmol l(-1)). Impaired Glucose Tolerance (IGT) is changed to allow for the new fasting level. A new category of Impaired Fasting Glycaemia (IFG) is proposed to encompass values which are above normal but below the diagnostic cut-off for diabetes (plasma > or =6.1 to <7.0 mmol l(-1); whole blood > or =5.6 to <6.1 mmol l(-1)). Gestational Diabetes Mellitus (GDM) now includes gestational impaired glucose tolerance as well as the previous GDM. The classification defines both process and stage of the disease. The processes include Type 1, autoimmune and non-autoimmune, with beta-cell destruction; Type 2 with varying degrees of insulin resistance and insulin hyposecretion; Gestational Diabetes Mellitus; and Other Types where the cause is known (e.g. MODY, endocrinopathies). It is anticipated that this group will expand as causes of Type 2 become known. Stages range from normoglycaemia to insulin required for survival. It is hoped that the new classification will allow better classification of individuals and lead to fewer therapeutic misjudgements.

Fetal Nutrition and adult disease

Article

Jun 2000

Recent research suggests that several of the major diseases of later life, including coronary heart disease, hypertension, and type 2 diabetes, originate in impaired intrauterine growth and development. These diseases may be consequences of "programming," whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on structure, physiology, and metabolism. Evidence that coronary heart disease, hypertension, and diabetes are programmed came from longitudinal studies of 25,000 UK men and women in which size at birth was related to the occurrence of the disease in middle age. People who were small or disproportionate (thin or short) at birth had high rates of coronary heart disease, high blood pressure, high cholesterol concentrations, and abnormal glucose-insulin metabolism. These relations were independent of the length of gestation, suggesting that cardiovascular disease is linked to fetal growth restriction rather than to premature birth. Replication of the UK findings has led to wide acceptance that low rates of fetal growth are associated with cardiovascular disease in later life. Impaired growth and development in utero seem to be widespread in the population, affecting many babies whose birth weights are within the normal range. Although the influences that impair fetal development and program adult cardiovascular disease remain to be defined, there are strong pointers to the importance of the fetal adaptations invoked when the maternoplacental nutrient supply fails to match the fetal nutrient demand.

Predicting Delivery Date by Ultrasound and Last Menstrual Period in Early Gestation

Article

Mar 2001
OBSTET GYNECOL

To compare last menstrual period and ultrasonography in predicting delivery date. We used ultrasound to scan 17,221 nonselected singleton pregnancies at 8-16 completed weeks. The last menstrual period (LMP) was considered certain in 13,541 and uncertain in 3680 cases. The duration of pregnancy from the scan to the day of spontaneous delivery was predicted by crown-rump length, biparietal diameter (BPD), and femur length (FL) using linear regression models, and the results were compared with estimates based on LMP. At all gestational ages, ultrasound was superior to certain LMP in predicting the day of delivery by at least 1.7 days. When deliveries before 37 weeks were excluded, crown-rump length measurement of 15-60 mm (corresponding to 8-12.5 weeks) had the lowest prediction error of 7.3 days. After that time, BPD (at least 21 mm) showed a similar error (7.3 days) and was more precise than crown-rump length. Femur length was slightly less accurate than crown-rump length or BPD. Regression models using a combination of any two or three ultrasonic variables did not improve accuracy of prediction. When ultrasound was used instead of certain LMP, the number of postterm pregnancies decreased from 10.3% to 2.7% (P <.001). Ultrasound was more accurate than LMP in dating, and when it was used the number of postterm pregnancies decreased. Crown-rump length of 15-60 mm was superior to BPD, but then BPD (at least 21 mm) was more precise. Combining more than one ultrasonic measurements did not improve dating accuracy.

The Nutritional Basis of the Fetal Origins of Adult Disease

Article

Mar 2001

Jane E Harding

Epidemiological observations linking size at birth with the risk of adult disease have now been extensively replicated and are widely accepted. It is hypothesized that such observations are the result of programming events in fetal life leading both to altered birth size and to permanent changes in structure and function which predispose to disease in adult life. Programming is a well-established biological phenomenon and there is good experimental evidence that nutrition can be an important and probably central programming stimulus. However, clear distinctions need to be drawn between maternal nutrition and size at birth on the one hand, and between fetal nutrition and fetal growth on the other. Maternal nutrition may bear little or no relationship to size at birth, but fetal nutrition is critically important in fetal growth. Many common assumptions about the relationship between body proportions and prenatal physiological events lack a sound experimental basis. Furthermore, important species differences in physiology, metabolism, placental structure and function necessitate cautious interpretation of animal experiments in their application to human situations. Details of these nutritional influences are likely to be very species dependent. Despite these caveats, it is clear that altered fetal nutrition can influence both fetal growth and later disease risk. There is indeed a nutritional basis for the fetal origins of adult disease.

Maternal nutrition during gestation and blood pressure in later life

Article

Feb 2001

To assess the link between maternal diet during pregnancy and blood pressure of the offspring. Follow-up study. A university hospital in Amsterdam, The Netherlands. People born at term as singletons between November 1943 and February 1947. Blood pressure at adult age. Adult blood pressure was not associated with protein, carbohydrate or fat intake during any period of gestation. We found, however, after adjustment for sex that the systolic blood pressure decreased by 0.6 mmHg (0.1-1.1) for every 1% increase in protein/carbohydrate ratio in the third trimester. This association was present both in people who had been exposed to the famine during gestation as well as in those who had not been exposed. The association between protein/carbohydrate ratio in the third trimester and adult blood pressure was furthermore independent of maternal weight gain and final weight, and birth weight [increase for every 1% increase in protein/carbohydrate ratio 0.6 mmHg (0.0-1.2)]. Adjustment for adult characteristics such as body mass index, smoking and socio-economic status did not affect the observed association appreciably [adjusted increase 0.5 mmHg (0.0-1.0)]. Adult blood pressure seems to be affected by small variations in the balance of macro-nutrients in the maternal diet during gestation rather than by relatively large variations in the absolute amounts.

Does Dietary Protein in Early Life Affect the Development of Adiposity in Mammals?

Article

Aug 2001

Cornelia C. Metges

This article examines the proposition that dietary protein in pre- and early postnatal life influences the development of adiposity in later life. In rodents, low protein intake during gestation can result in low birth weight and subsequently leads to various metabolic disturbances in adulthood, such as high blood pressure, impaired glucose tolerance and insulin resistance. The few controlled studies conducted in animals suggest that high protein or energy intake during gestation leads to low birth weights. Observational studies in humans have been inconclusive in establishing a relationship between dietary protein intake in pregnancy and effects on birth weight and adiposity of the offspring later in life. There is only weak epidemiological evidence linking high protein intake during early childhood and the development of obesity. By contrast, studies in domestic animals have found that higher levels of protein intake are often associated with lower rates of fat accretion. Additional studies are proposed to explore claims linking protein nutrition in early life to the postnatal development of obesity and disease in humans.

Maternal Glucose Concentration Influences Fetal Growth, Gestation, and Pregnancy Complications

Article

Oct 2001
AM J EPIDEMIOL

Using 1990-1995 data, the authors examined the influence of post-challenge maternal glucose concentration on pregnancy outcome in 1,157 nondiabetic US gravidas. After control for potential confounding variables and comparing gravidas with lower glucose concentrations (<99 mg/dl) with the others, they found that mean birth weight increased by 50 g and 200 g with glucose concentrations of 99-130 mg/dl and >130 mg/dl, respectively. Increased maternal glucose concentration also was associated with an increased risk of large-for-gestation fetuses (p for trend < 0.001) and a decreased risk of fetal growth restriction (p for trend < 0.05). The association between glucose and gestation was inverse and significantly shortened when glucose concentrations were higher. Maternal complications increased twofold or more with high glucose concentrations and included cesarean section and clinical chorioamnionitis. Chorioamnionitis in combination with high maternal glucose concentration increased the risk of very preterm delivery almost 12-fold. These observations extend Pedersen's hypothesis-that high concentrations of maternal glucose give rise to increased nutrient transfer to the fetus and increase fetal growth, beyond the model of maternal diabetes (Acta Endocrinol 1954;16:330-42). They raise the question of whether higher, but seemingly normal maternal glucose concentration predisposes to or is a marker for placental inflammation and infection.

A vegetable, fruit, and white rice dietary pattern during pregnancy is associated with a lower risk of preterm birth and larger birth size in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

Abstract

No full-text available

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