ArticlePDF AvailableLiterature Review

Abstract

Conclusion: In this review, we will summarise the recommendations for diet composition in pregnancy, focusing on both diet quality and quantity. What is Known • High food quality, together with adequate macro- and micronutrient intake in pregnancy, is crucial for the health status of the mother and child. What is New • Recent findings suggest that the diet could be beneficial or harmful in the context of the well-being of the whole future population. Most conditions that occur in adulthood originate in foetal life. • Moreover, some epigenetic events, modified by diet impact more than one generation.
REVIEW
Diet in pregnancymore than food
H. Danielewicz
1
&G. Myszczyszyn
2
&A. Dębińska
1
&A. Myszkal
2
&A. Boznański
1
&
L. Hirnle
2
Received: 8 July 2017 /Revised: 25 September 2017 /Accepted: 26 September 2017 /Published online: 3 November 2017
#The Author(s) 2017. This article is an open access publication
Abstract High food quality, together with adequate macro-
and micronutrient intake in pregnancy, is crucial for the health
status of the mother and child. Recent findings suggest that it
could also be beneficial or harmful in the context of the well-
being of the whole future population. According to the devel-
opmental origins of health and disease hypothesis, most con-
ditions that occur in adulthood originate in foetal life.
Moreover, some epigenetic events, modified inter alia by diet,
impact more than one generation. Still, the recommendations
in most countries are neither popularised nor very detailed.
While it seems to be important to direct diet trends towards
a healthier lifestyle, the methods of preventing specific disor-
ders like diabetes or asthma are not yet established and require
further investigation.
Conclusion: In this review, we will summarise the recom-
mendations for diet composition in pregnancy, focusing on
both diet quality and quantity.
What is Known
High food quality, together with adequate macro- and micronutrient
intake in pregnancy, is crucial for the health status of the mother and
child.
What is New
Recent findings suggest that the diet could be beneficial or harmful in
the context of the well-being of the whole future population. Most
conditions that occur in adulthood originate in foetal life.
Moreover, some epigenetic events, modified by diet impact more than
one generation.
Keywords Pregnancy .Maternal diet .Developmental
programming
Abbreviations
AAD Allergic airway disease
ADHD Attention-deficit hyperactivity disorder
ALA Alpha linolenic acid
BMI Body mass index
BPA Bisphenol A
DC Dendritic cell
DHA Docosahexaenoic acid
EPA Eicosapentaenoic acid
GPR20 G protein-coupled receptor 20
GWG Gestational weight gain
HELP Haemolysis, elevated liver enzymes and low plate-
let count
IL-1βInterleukin-1beta
Communicated by Mario Bianchetti
*H. Danielewicz
hanna.danielewicz@umed.wroc.pl
G. Myszczyszyn
grzegorz.myszczyszyn@gmail.com
A. Dębińska
aanowak@gmail.com
A. Myszkal
ammyszkal@gmail.com
A. Boznański
andrzej.boznanski@gmail.com
L. Hirnle
lidia.hirnle@gmail.com
1
1st Department of Pediatrics, Allergy and Cardiology, Wroclaw
Medical University, Chalubinskiego 2a 50-368, Wroclaw, Poland
2
1st Department of Obstetrics and Gynecology, Wroclaw Medical
University, Chalubinskiego 3 50-368, Wroclaw, Poland
Eur J Pediatr (2017) 176:15731579
DOI 10.1007/s00431-017-3026-5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
IL-6 Interleukin-6
IL-8 Interleukin-8
IOM Institute of Medicine
IUGR Intrauterine growth retardation
LBW Low birth weight
LPS Lipopolysaccharide
NF-κB Nucleic factor kappa B
NPPA Natriuretic peptide A
RDA Recommended dietary allowances
RvD Resolvin D
SCFA Short-chain fatty acid
SGA Small for gestational age
TLR Toll-like receptor
TNFαTumour necrosis factor alpha
Introduction
The substantial increase in the prevalence of common diseases
like asthma, atopy, obesity, hypertension and diabetes ob-
served over the past decades has directed attention to specific
changes in the environment as a possible cause of such an
unfavourable switch. Among environmental factors, the diet
is a crucial influencer of population health. According to the
developmental origins of health and disease hypothesis, most
conditions that occur in adulthood originate in foetal life.
Pregnancy is a specifically Bhot period^for the programming
of future condition. The relevance of the maternal diet to se-
rious pregnancy outcomes such as preeclampsia, hyperten-
sion, preterm birth and fertility hasalso been revealed [23,26].
In this narrative review, we will summarise the recommen-
dations for diet composition in pregnancy and existing devel-
opmental theories, focusing on both diet quality and quantity.
The aim of this review is to give the interpretative synthesis of
the current knowledge and highlight the developmental aspect
of maternal diet.
The literature search was provided via PubMed database with
the following search terms: Bdiet in pregnancy recommendation^,
Bspecific micro- or macronutrient and pregnancy^,Bspecific preg-
nancy outcome^,Bdiet in pregnancy and atopy/asthma^,
Bdevelopmental origin of disease^focusing on both more recent
reviews limited to specific aspects of diet and original papers.
Composition of the maternal dietquality
Specific recommendations exist for different types of nutrients in
pregnancy. They differ in some points according to both the
eating tradition and nutrition status of the population. WHO an-
tenatal standards paper provides 39 recommendations related to 5
types of interventions. The healthy eating and physically active
styleoflifeispromotedtoprevent excessive gestational weight
gain (GWG). In the undernourished population, balanced energy
and protein intake are recommended to prevent LBW, SGA, and
stillbirths. Doses of iron and folate supplementation are given
with possible daily or intermittent routine. Supplementation of
vitamin A is suggested to be restricted only to areas where vita-
min A deficiency is a substantial public health problem.
Recommendation of calcium supplementation is limited to pop-
ulation with low-calcium intake. Vitamin B6, zinc, multi-nutrient
supplements and vitamin D supplementation are not advocated
as routine procedure. Avoiding of caffeine is suggested for wom-
en with high consumption [40]. Canadian consensus highlights
the need of the uptake of nutrient-dense and energy-appropriate
food with moderate increase of energy intake during pregnancy.
Particular concern is given to GWG, adequate folate, iron, cho-
line, omega-3 fatty acid and iodine input, as well as avoiding or
limiting specific food which contains bacteria or methyl mercury
and alcohol [25]. German National Consensus is quite detailed in
different aspects of diet in pregnancy. In the first paragraph, the
difference between slightly increase of energy needs in compar-
ison to a much greater increase of vitamin and minerals is
highlighted. According to these requirements, nutrient-dense
food eating, regular meals and regular exercises together with
moderate GWG are recommended. The specific concerns exist
for obese pregnant women for whom the standards of care and
weight lose still are not well established, vegetarian nutrition with
possible supplementation of iron and DHA and vegan where
specific medical counselling is required due to diet deficiency
of many nutrients [16]. Italian Consensus differs a little in the
points according to energy input and protein intake during preg-
nancy, where specific amounts are recommended in the particular
periods. The emphasis is put on the protein and fat composition,
iron supplementation, as well as iodine and calcium adequate
provision [17]. Standards of nutrition for Polish population,
reflecting WHO and EFSA recommendations, contain tables
for different groups according to age, sex and pregnancy status
for both micro- and macronutrients together with energy require-
ments and expenditure [7,14]. Similar tables are published by
Institute of Medicine [13,31]. Further in the text, the nutrient
requirements during pregnancy are described in details and
summarised in Table 1. Apart from the recommendations, there
is substantial body of reviews concerning specific aspects of
maternal nutrition. In the last 2 years, we identified important
papers in the subject relating to diet and fertility, interventions
for diabetic or obese pregnant women, metabolic consequences
of excessive GWG, the impact of the diet rich in polyphenols, the
use of probiotics and prebiotics, the maternal microbiome and the
development of neonatal immune system, the benefits of
Mediterranean diet and the epigenetic programming.
Macronutrients
Protein
Both the quantity and the composition of protein are important
in the context of diet quality. In a rat model, protein deficiency
1574 Eur J Pediatr (2017) 176:15731579
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
in pregnancy results in decreased birth weight, decreased heart
weight, increased heart rate and increased systolic blood pres-
sure [2]. In general, animal protein is of higher quality than
vegetable protein, suggesting that meat should be the main
source of protein in pregnancy, but mixing different types of
vegetables increases the quality of plant protein substantially.
Nevertheless, it should also be considered that specific
types of plant diets, such as vegetarian and vegan diets, are
associated with microelement and mineral deficiencies and
unfavourable pregnancy outcomes. In this context, a vegetar-
ian diet can result in vitamin B12 and iron deficiency, as well
as low birth weight, whereas a vegan diet can lead to inade-
quate intake of DHA, zinc and iron, as well as an increased
risk of preeclampsia and inadequate brain development.
However, still a well-balanced ovo-lacto vegetarian diet usu-
ally enables good nutrient status in pregnancy, when supple-
mented with vitamin D, folic acid, iodine, iron, vitamin B12
and zinc, and, in cases of a fish-free diet, with DHA [19].
In contrast, consumption of red meat, which was recently
revealed to be associated with cancer risk, raises some con-
cerns over pregnancy and protein requirements, but till now,
there are no any evidences that this diet can negatively impact
childshealth[24].
Fat
Fat in the diet of pregnant woman is important mainly in
context of fatty acid composition, mainly that of DHA and
eicosapentaenoic acid (EPA). Omega-3 fatty acids are benefi-
cial for brain development and proper functioning of the ret-
ina. In many studies, maternal serum DHA concentration has
been associated with neuronal development and plasticity,
receptor-mediated signalling, membrane fluidity and the for-
mation of second messengers. This type of fatty acid also
impacts modulation of inflammation by affecting Toll-like
receptors (TLRs), related to adequate response to bacteria
and other microorganisms. DHA also plays a role as a precur-
sor of the anti-inflammatory lipid mediator RvD, which pre-
vents the formation of proinflammatory arachidonic acid
products, thus indicating the anti-inflammatory function of
these molecules [33].
Carbohydrates
Carbohydrates are an essential component of a healthy diet.
However, increased caloric intake associated with increased
fat and carbohydrate consumption with adequate protein has
been associated with neonatal adiposity, which is obviously
unfavourable [28]. Additionally, a preconception diet rich in
saturated fat, carbohydrates and take-away food has been as-
sociated with poor asthma control during pregnancy, thus af-
fecting child well-being [8]. Moreover, changing the maternal
eating pattern by decreasing carbohydrate load and increasing
physical activity could impact the inflammation status associ-
ated with obesity in pregnant women [32]. Similarly, modify-
ing the protein/carbohydrate ratio can decrease the expected
GWG [18].
Tab le 1 Micro- and macronutrients intake during pregnancy
summary of the recommendations
Energy No additional input I trimester
340 kcal/day II trimester
452 kcal/day III trimester [31]
69 kcal/day I trimester
266360 kcal/day II trimester
437496 kcal/day III trimester [17]
10% increase in late pregnancy260 kcal/day [16]
GWG BMI < 18.5 kg/m
2
GWG 12.518 kg
BMI 18.524.9 kg/m
2
GWG 11.516 kg
BMI 2529.9 kg/m
2
GWG 711.5 kg
BMI > 30 kg/m
2
GWG 59kg[25,40]
Protein 1035% of energy, 71 g/day [13]
Additional 1 g/day I trimester
8 g/day II trimester
26 g/day III trimester [17]
RDA 1.1 g/kg/day [25]
RDA 1.2 g/kg/day [14]
Carbohydrates 4565% of energy, 175 g/day
Fat 2035% of energy [13]
Additional 814 g/d II trimester
1118 g/day III trimester [14]
n-6 13 g/day, 510% [13]
n-3 1.4 g/day, 0.61.2% [13]
EPA 250 mg/day
DHA 100200 mg/day [14,16]
DHA 6001000 mg in risk groups [7]
Fibre 28 g/day [13,31]
Iron Supplementation 3060 mg/day [40]
RDA 27 mg/day [14,31]
Iodine RDA 220 mcg/day [14,31]
Supplementation 100150 mcg/day [16]
Supplementation 200 mcg/day [7]
None additional supplementation [40]
Folate RDA 600 mcg/day [31]
Supplementation 0.4 mg/day [7,16,40]
Calcium RDA 1.01.3 g/day [31]
Supplementation 1.52 g/day in risk population (low
calcium intake) [40]
Vitamin D RDA 5 mcg (200 IU)/day [31]
RDA 15 mcg (600 IU)/day [17]
At least 600 IU/day RDA, 15002000 IU/day to
maintain the level above 30 ng/ml [11]
None additional supplementation in general [40]
Additional supplementation in risk groups 2000 IU/day
[7]
Eur J Pediatr (2017) 176:15731579 1575
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Fibre
The main role of fibre is to modulate gut microbiome. A high-
fibre diet has been shown to prevent asthma by epigenetic
switch and by impacting the gut microbiota. In a mouse mod-
el, a diet differing only in fibre amount with the same fat,
protein, carbohydrates, energy and weight gain impacts the
development of allergic airway disease (AAD; a model of
human asthma). The mechanism is believed to be related to
the specific microbiota and level of short-chain fatty acids
(SCFAs) in faeces and serum. Specifically, SCFAs (acetate,
propionate and butyrate) regulate acetylation of Foxp3 and
Treg development and thus have an anti-inflammatory effect
but also affect epithelial integrity. The SCFA propionate also
impacts dendritic cell (DC) biology and the ability to promote
the T helper 2 (Th2) response and regulates NPPA gene ex-
pression in the lungs. All these phenomena happen only in
foetal life, possibly in the early stages of development, but
even later in pregnancy has some impact, where the high-
fibre diet has been shown to correlate with fewer GP visits
in the first year of life due to cough and wheezing [37].
Micronutrients
Iron
Iron is one of the most important micronutrients. The usual
absorption from plants is low and could be further decreased
by phytates and polyphenols, which are present in some plant-
based products. The absorption of haem iron from meat is
much higher.
Inadequate iron intake during pregnancy is associated with
cardiovascular risk to the offspring in adulthood. In animal
models, maternal iron deficiency has been associated with
obesity, hypertension and adverse cardiovascular outcomes
[1,29].
Iodine
Iodine is another very important micronutrient. Iodine defi-
ciency has been revealed to be associated with postpartum
hyperthyroidism, perinatal mortality and neonatal hypothy-
roidism. Inadequate iodine intake during pregnancy causes
an increased risk of spontaneous abortion, higher mortality,
birth defects, neurological disorders and brain damage [10].
Fish and shellfish, fruits, vegetables, milk, eggs and meat are
the main source of iodine from the usual diet.
Calcium and vitamin D
The main source of calcium is milk and milk products (50%),
cereals (11%) and vegetables (11%). It is crucial for bone
metabolism but also related to birth weight, risk of preterm
labour and appropriate blood pressure [12].
Early studies concerning vitamin D in pregnancy
showed an association with preeclampsia and caesarean
section but also glucose tolerance, abnormal foetal
grown pattern, preterm birth and reproductive failure.
In the first weeks of pregnancy, the level of the vitamin
D metabolite 1,25(OH)D3 increases 23-fold, regardless
of the level of intake, but the significance of this phe-
nomenon is unknown. This mechanism could possibly
maintain the required level during pregnancy if precon-
ception stores were normal. Below adequate levels of
25(OH)D3 (< 20 ng/ml) are related to adverse outcomes
later in life, such as asthma, multiple sclerosis, neuro-
logical disorders and autoimmune conditions.
The main dietary sources of vitamin D are cod liver oil and
fish. Smaller amounts are present in eggs, butter and cheese;
however, the most important contributor to the general level is
skin production upon exposure to UV radiation and additional
supplementation [21].
Folates
Folates are extremely important for the prevention of neural
tube defects. The RDA increases by up to 50% in pregnancy,
and the recommended supplementation dose is 400800 μg
from 2 months prior to conception onward, which is essential
in the first trimester and could be continued after the 12th
week of pregnancy [39].
BPA
Environmental exposure to harmful substances in pregnancy,
especially those present in the diet, raises concerns. BPA is
used for different types of food packaging and as food addi-
tives and has now become the focus of interest. Exposure to
this substance has been associated with adiposity, energy bal-
ance [38] and neurogenesis [22] and thus can be related to
obesity and neurological disorders such as ADHD, anxiety,
depression and sexual dimorphic behaviours.
Composition of the maternal dietquantity
Gestational weight gain
According to US epidemiological data, 69% of the popu-
lation is overweight and 35% is obese. This change in
prevalence is related to changes in lifestyle, but some
prenatal events are also important. Gestational weight
gain GWG has been shown to be a predictor of pregnancy
complications and future health problems in the child [15,
30]. GWG is strongly associated with birth weight and
values exceeding 4000 g are associated with a 2-fold
1576 Eur J Pediatr (2017) 176:15731579
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greater risk of obesity later in life. Excess intake of calo-
ries during pregnancy has been associated with miscar-
riage, diabetes and preeclampsia in mothers and obesity
and type 2 diabetes in children. This diabetic effect seems
to be transgenerational. The mechanism is possibly related
to placental gene-expression changes [35].
Surprisingly, opposite effect was described by Barker and
colleagues who observed that nutritional insufficiency in the
foetal period reflected by LBW or SGA is also related to
glucose intolerance, diabetes, hypertension and coronary dis-
ease later in life [3]. These observations are the basis of the so-
called thirsty phenotype hypothesis, which reflects the chang-
es in the metabolism as it increases efficiency. The values for
appropriate GWG are given in Table 1.
Metabolic programming, cardiovascular risk and cortisol
metabolism
A substantial number of studies have proven the causa-
tive relationship between birth weight, weight catch-up
and cardio-metabolic risk reflected by alternation in liver
and pancreatic functions [36]. BFatty liver^in normal-
weight offspring could be both a result of a high-fat
maternal diet or protein restriction. Later in life, both
poor weight gain and accelerated weight gain in the first
months of infancy increase the risk of non-alcoholic fatty
liver disease (NAFLD) [27]. What is more, maternal pro-
tein restriction in animal models modifies the offsprings
islet cell ontogeny and the number of beta cells [5,34].
In humans, LBW is associated with pancreatic beta cell
hyperplasia, and SGA causes a reduction of beta cell
number. Consequently, SGA or LBW results in insulin
resistance or diabetes in adulthood. Rapid weight catch-
up during early infancy in children with LBW increases
the risk of unfavourable metabolic events [4].
On the other hand, altering the foetal neuroendocrine
environment specifically by impacting on the ACTH/
cortisol level affects brain development. The foetus could
be protected against increased levels of maternal cortisol
by the placental enzyme 11β-HSD. This barrier, howev-
er, is disrupted by obstetric complications like pre-
eclampsia and preterm birth as well as IUGR (intrauter-
ine growth retardation), medication and diet. In an ani-
mal model, a maternal high-fat diet could increase anxi-
ety in offspring by the interplay with serotonin, dopa-
mine and HPA (hypothalamic-pituitary-adrenal) axis. In
this model, also maternal anxiety, reflected by increased
levels of cortisol, has been shown to cause impaired
cognition, deficits in learning and memory, sex-atypical
behaviours, heightened emotionality and general anxiety.
It also impacts reactivity to stress and sensitivity to nic-
otine and other addictive substances. Rats prenatally
stressed react with a faster, stronger and prolonged
cortisol response later in life. In humans, a relationship
between maternal stress in the third trimester and lower
scores in attention and reactivity in newborns has been
shown in some of them, as has a relation to Bayley
Scales of Infant Development (BSID) and mental/motor
development at 8 months. Data from epidemiological
studies suggest links between maternal obesity and met-
abolic complications with neurological disorders like
ADHD, ASD, schizophrenia, anxiety and depression [6,
20].
Atopy and asthma programming
Perhaps not surprisingly, because food allergy is usually the
first manifestation of atopy in life, atopy and asthma are con-
ditions associated strongly with the maternal diet. Different
diets have been studied in relation to this conditions risk. A
diet focused on avoiding the main allergens was shown not to
be related to atopic outcome in offspring. A holistic diet rich in
a variety of foods is believed to be beneficial. Specifically, a
diet rich in fish oil and PUFAs, probiotics, antioxidants and
vitamins has been shown to be protective. Folate, a known
methyl donor impacting methylation status, at specific doses
has the reverse effect, due to the epigenetic mechanism.
Specifically, high doses of folic acid (5 mg/day) in late
pregnancy are an established risk factor for allergy. In contrast,
nicotinamide, another methyl donor, decreases the risk of ec-
zema at 12 months. Its main sources are vitamin B3 and tryp-
tophan [9].
Conclusion
Here, we tried to answer questions concerning pregnan-
cy: What to eat? How much eat? Why is it important?
Recommendations proposed by different authorities are
based on the solid knowledge. However, there are some
differencespopulation specific, they depend on the eat-
ing customs and tradition, and interventions which have
been already introduced for the whole population. Some
concerns exist for adequate folate supplementation, ap-
propriate dose of DHA and iodine. Still, it seems to be
difficult for ordinary pregnant woman to design proper
diet. Novel electronic applications could be helpful; how-
ever, the algorithm should be approved by local health
authorities. Hopefully healthy eating becomes trendy
nowadays, which is the promise of good health for future
population.
Authorscontributions H. Danielewicz: preparing the manuscript, re-
view of the literature, final approval. Grzegorz Myszczyszyn: review of
the literature, final approval, Anna Dębińska: review of the literature,
final approval, Anna Myszkal: review of the literature, final approval,
Eur J Pediatr (2017) 176:15731579 1577
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Andrzej Boznański: review of the lietrature, consulting, final approval,
Lidia Hirnle: review of the literature, consulting, final approval.
Funding This study was funded by National Science Center, Poland,
DEC-2015/19/B/NZ5/00041.
Compliance with ethical standards
Conflict of interest Author Hanna Danielewicz has received a speaker
honorarium from GPharmaadministrator of Allergy and Pulmonology
2016 Conferenceactivity outside submitted work. Grzegorz
Myszczyszyn declares that he has no conflict of interest. Anna
Dębińska declares that she has no conflict of interest. Anna Myszkal
declares that she has no conflict of interest. Lidia Hirnle declares that
she has no conflict of interest. Andrzej Boznański declares that he has
no conflict of interest.
Ethical approval This article does not contain any studies with human
participants performed by any of the authors.
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appro-
priate credit to the original author(s) and the source, provide a link to the
Creative Commons license, and indicate if changes were made.
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... Over the past decades, nutrition has been revealed as a critical determinant of population health, especially because of the clear connection between specific environmental changes and the increased prevalence of noncommunicable diseases [1]. According to the 'fetal programming' hypothesis, an appropriate diet during pregnancy is considered fundamental for the health of both mother and child [2,3]. Moreover, the results of both clinical and research studies have associated maternal diet with adverse pregnancy outcomes, e.g., deficiencies in macro-and micronutrients can affect maternal health, pregnancy outcome, and neonatal wellbeing [2]. ...
... According to the 'fetal programming' hypothesis, an appropriate diet during pregnancy is considered fundamental for the health of both mother and child [2,3]. Moreover, the results of both clinical and research studies have associated maternal diet with adverse pregnancy outcomes, e.g., deficiencies in macro-and micronutrients can affect maternal health, pregnancy outcome, and neonatal wellbeing [2]. ...
... The average EIrep/RMR ratio was 0.93 ± 0.32, indicating that 42.2% of participants were low energy reporters (LERs). Energy derived from protein (17.9%) was within the recommended interval (10-35% of energy), carbohydrates intake (45.8%) was closer to the lower limit of the recommendations (45-65% of energy), while total fats intake (38.4%) was slightly higher than the recommended reference (20-35% of energy) [2,26]. FFQ Na-to-K ratio positively correlated with higher daily soups and sauces intake (r = 0.475, p < 0.001), cereals and cereal products intake (r = 0.454, p < 0.001), as well as fats and oils intake (r = 0.291, p = 0.022), but negatively correlated with daily fruit (r = −0.336, ...
Article
Full-text available
This study aimed to investigate diet quality in healthy pregnant women based on the Na-to-K ratio from 24 h urine sample and food frequency questionnaire (FFQ), to compare dietary micro- and macronutrient intake with current nutritional recommendations (RDA), and to investigate whether gestational weight gain (GWG) is associated with Na-to-K ratio and diet quality during pregnancy in general. Sixty-four healthy pregnant women between 37 and 40 weeks of gestation participated in the study. Participants’ GWG, body composition, molar 24 h urine Na-to-K ratio, and FFQ data on average daily total energy, food groups, and micro-/macronutrient intake were obtained. A Na-to-K ratio of 2.68 (1.11–5.24) does not meet nutrition quality and is higher than the WHO recommendations due to excessive sodium and insufficient potassium intake. FFQ Na-to-K ratio was associated with a higher daily intake of soups, sauces, cereals, fats, and oils and a low intake of fruit and non-alcoholic beverages. A total of 49% of pregnant women exhibited excessive GWG, which was attributed to the increase in adipose tissue mass. GWG was not associated with total energy but may be the result of insufficient physical activity during pregnancy. Daily intake of vitamin D, vitamin E, folate, niacin, riboflavin, calcium, iron, and zinc was suboptimal compared to RDA.
... [7][8] The contribution of maternal nutrition and pregnancy outcome is a complex problem influenced by biological, socio-economic, demographic, populations, morbidity, healthcare costs and services. [9][10][11] Maternal behavior is one factor that contributes to a mother's health status. Commonly, maternal behavior is related to dietary patterns and lifestyle, such as activity, smoking, medication and traditional herbs, drinking alcohol. ...
... The inclusion criteria were as follows; 1) doing pregnancy examination at the study site, 2) in the second and third trimester, 3) in normal health (no secondary infection) based on the medical record, 4) never having low-birthweight or stunted (<48 cm), 5) aged between 18-35 years, 6) the height between 150-165 cm, 7) having BMI (body mass index) of 18.5-25.0, 8) having experienced urinary tract infection, 9) having experienced vomiting, nausea, and diarrhea in the first trimester, 10) having planning to delivery in the study site, 11) signing the informed consent, 12) being willing to comply with the study procedures, and 13) never doing caesarean delivery. Meanwhile, the schema of collecting subjects was as follows: ...
Article
Full-text available
p> Background: Maternal behaviour during pregnancy is closely related to the condition of the fetus. Malnutrition in pregnant women can cause Low Birth Weight Babies (LBW) and also a decrease in the level of intelligence. The prevalence of stunting in 2021 decreased by 1.6 from 2019, that shows from 27.7% to 24.4%. Objectives: This study aims to determine the impact of nutritional status and maternal behaviour on infant growth in West Jakarta. Methods: This study was a cross-sectional, starting on July 2017 until January 2018. A total of 66 subjects of pregnant women aged 18-35 years chosen to take part in the study from their 37th weeks of pregnancy to delivery. Drinking alcohol, traditional herbs, medicines, and smoking are indicators of maternal behaviour. Maternal IGF-1 concentrations, body weight, body length, and infant heart rate were indicators of infant growth. Chi-Square test and Independent T-Test were used for the statistical analysis. Results: The subjects showed a mean of 26.0±4.8 years old, body height of 154.0±4.9 cm, body weight in third pregnancy of 66.4±11.3 kg, BMI of 22.6±3.7 kg/m<sup>2</sup>, MUAC of 27.2±3.3 cm, and body temperature of 36.2±1.3°C. Maternal behaviour and nutrional status did not significantly affect infant growth (p≥0.05). However, MUAC was a factor that affected to heart rate in infants (p<0.05). Conclusions: Nutritional status is one of indicator that affects to infant growth; therefore, pregnant women need to more attention to keep their nutritional status, nutritional intake and healthy living behaviour during pregnancy.</p
... Developmental adaptations of progeny to nutritional signals from the mother are a normal part of development and adaptation to the future environment. Especially, the first 1000 days of life are claimed to be crucial for linking maternal nutrition to metabolic traits in offspring and in creating long-term health implications in children [1][2][3]. ...
... At the beginning of pregnancy and before labor, the height and weight of the mothers were measured with the digital column scale, equipped with a stadiometer. It served for body mass index (BMI) assessment according to the standard formula: BMI = body mass (kg)/height (cm) 2 . At labor, the neonate's height, weight, head circumference, and chest circumference were measured. ...
Article
Full-text available
Essential fatty acids (EFA) and long-chain polyunsaturated fatty acids (LC PUFA) are considered the most valuable bioactive fatty acids (FA) of the greatest importance for the mother’s and child’s health (e.g., placentation process, labor course, development of the central nervous system, visual acuity, cognitive functions), which results in dietary recommendations concerning EFA and LC PUFA intake in the diet of pregnant women. In this study, we aimed to evaluate the frequency of different food products consumption and ‘omega’ dietary supplements usage in groups of pregnant women. We also measured n-3 and n-6 FA content in serum samples of pregnant women and their children with the GC-FID technique, estimated the efficacy of applied supplementation, and compared the usefulness of different dietary supplements dedicated for pregnant women. ‘Omega’ dietary supplements effectively increased LC PUFA in the maternal blood (EPA, p = 0.0379; DHA p < 0.0001; n-3 PUFA, p < 0.0001), which penetrated the umbilical cord (EPA, p = 0.0131; DHA, p = 0.0288). If fish and seafood consumption is not enough, dietary supplements of the highest quality may provide sufficient LC PUFA without apprehension of MetHg contamination. ‘Omega’ dietary supplementation seems the most efficient way of providing an optimal supply of LC PUFA for the developing child from the earliest stages of development, which will bring advantages in the child’s future life and its health.
... And it becomes more beneficial if mother starts taking folic acid before getting pregnant. 4 Immunization during pregnancy is a simple and effective way to protect the mother and child from certain infections via transfer of antibodies from the mother to the fetus. Vaccination of pregnant women can protect mother against vaccine-preventable infections, and in so doing potentially protect the fetus. ...
Article
Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers. Antenatal / prenatal care can be defined as the care provided by trained health-care professionals to pregnant women and adolescent girls in order to make sure the best health conditions for both mother and baby throughout the pregnancy. The components of ANC include: risk identification, prevention and management of pregnancy-related or concurrent diseases, and health education and health promotion. 1 According to Indian government guidelines, every pregnant should make use of 3 or more antenatal care visits along with 90 or more IFA tablets and 2 or more TT injections. According to joint WHO and MOD meeting report, birth defects account for 7% of all neonatal mortality and 3.3 million under five deaths. The prevalence of birth defects in India is 6-7% which translates to around 1.7 million birth defects annually. Objectives: The main objective of the study was to find out the knowledge level of the subjects on pregnancy care, to educate the community subjects on pregnancy care and to Evaluate Pregnancy Information leaflet on pregnancy care Methodology: A questionnaire-based interview was executed on 100 study subjects in Mangalore region. Study duration was 6 months. Ethical approval was obtained from Ethics Committee of Srinivas Institute of Medical Science and Research Center. The study population included in the study were adults above 18 years of age, who can understand English/Malayalam and belonging to the family with one or more pregnancy either in past, present or to be in future. Data was analyzed with the help of excel 17 and SPSS 20. Result and Discussion: In our study, survey was carried out on 100 subjects of Mangalore region All the study subjects were female. Out of 100 subjects 58 participants were in between 31 years to 50 Years of age while 19 participants were in 18-30 Years age group. The subjects in the present study do not have adequate knowledge regarding antenatal care, folic acid supplementation, TT injection and dietary change, irrespective to their educational level. The study found that 75% of the subjects were not aware of the antenatal care and about 100% were unknown regarding the necessity of antenatal check- up. ANC visit should be an essential part of the antenatal care but our study found that about 13% of the study subjects were not going for check- up. On pharmacist intervention and proper counselling, in our follow up interview we found that unawareness has reduced to 17%, while 84% realized the need for check-up. Conclusion: In our study we found that the respondents do not have adequate knowledge regarding antenatal care, folic acid supplementation, TT injection and dietary change. The age, literacy of the mother significantly influences antenatal care and ANC service utilization. To improve effective utilization of ANC services we need to raise awareness through counselling, improve the quality of ANC service, along with effective monitoring and evaluation. Pharmacist plays a major role in increasing awareness among mothers in pregnancy and further emphasizing the importance of ANC. Keywords: Antenatal care, Knowledge, Awareness.
... 1,2 During pregnancy, a healthy diet favors good fetal development and women's health and well-being, in addition to preventing the onset of diseases such as gestational diabetes, hypertension, and excessive weight gain, and is associated with better health conditions in childhood and adult life. 3,4 For this reason, many countries have invested in the development of advices, recommendations, and guidelines to support adequate nutrition to ensure healthy pregnancy and delivery. [5][6][7][8] Pregnancy can be a window of opportunity for dietary interventions, since pregnant women tend to change their diet due to their new condition and in favor of the fetus health. ...
Article
Full-text available
Objective To develop and validate a protocol for the use of the Dietary Guidelines for the Brazilian Population (DGBP) in the individual dietary advice for pregnant women assisted in primary healthcare (PHC). Methods Methodological study that involved the elaboration of a protocol in six steps: definition of the format, definition of the instrument to evaluate food consumption, systematization of evidence on food and nutrition needs of pregnant women, extraction of DGBP recommendations, development of messages of dietary guidelines and content, and face validity. The analyses of the validation steps were carried out by calculating the Content Validity Index (CVI) and thematic content analysis. Results As products of the steps, the protocol structure was defined and the dietary advice for pregnant women were elaborated, considering physiological changes, food consumption, nutritional and health needs, and socioeconomic conditions of this population. The protocol was well evaluated by experts and health professionals in terms of clarity, relevance (CVI > 0.8), and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with Brazilian pregnant women. Conclusion The instrument developed fills a gap in clinical protocols on dietary advice for pregnant women focused on promoting a healthy diet, contributing to a healthy pregnancy. In addition, it demonstrates potential to contribute to the qualification of PHC professionals and to the implementation of the DGBP recommendations.
... Thus, a healthy pregnancy and optimal perinatal outcomes require a balanced diet. These types of diets are rich in fruits and vegetables, whole grains and legumes, and rich monounsaturated fats, while avoiding simple sugars, meats, and processed products as well as trans and saturated fats [45]. Furthermore, restrictive-type diets are detrimental to the health of both the mother and the newborn. ...
Article
Full-text available
In order to better understand the implications of physical activity and nutrition in child development, we conducted the present narrative with the aim to analyze the physical activity and nutritional patterns related to maturation and development. To reach our study objective, a consensus and critical review were conducted by analyzing primary sources such as academic research and secondary sources such as databases, web pages, and bibliographic indexes following procedures of previous critical narrative reviews. We employed the MedLine (Pubmed), Cochrane (Wiley), PsychINFO, Embase, and CinAhl databases to search the MeSH-compliant keywords of exercise, physical activity, nutrition, maturation, development, child, neonatal, infantry, and cognitive development. We used manuscripts published from 1 January 2012 to 1 September 2022, although previous studies were included to explain some information in several points of the review. We found that physical activity and nutrition are basic pillars for the correct development and maturation of the child. Factors associated with development as a species such as breastfeeding, the correct intake of micro and macronutrients, and the performance of both passive and active physical activity will modulate the correct motor and cognitive development in preschool age, childhood, and adolescence.
... Here is the other significant advice that may be the risk factors during pregnancy. [17] [20] Hence to avoid all these below-mentioned: ...
Article
Full-text available
Two or more miscarriages or biochemical pregnancy losses are treated as recurrent pregnancy loss (RPL). Conditions like immune deficiency, thrombophilia, endocrine dysfunction, and obesity have all been linked to an increased likelihood of miscarriage. There is currently no documented treatment for repeated miscarriages; hence, diet and drug aspects must be implemented nationally or internationally. Databases like Google Scholar, the Directory of Open Access Journals (DOAJ), Semantic Scholar, etc., were used to find publications relevant to this study's objectives. From the Indian perspective, a pregnant woman's daily calorie intake should increase by 350, with an additional 9.5 g of protein in the second and 22.0 g in the third trimester. Prenatal folic acid supplementation has been linked to managing proper birth weight and reduced rates of congenital disabilities. During pregnancy, a woman's ideal weight gain is around 10 kilograms, which is the case for women who eat healthily. Limiting salt intake is necessary to prevent hypertension or preeclampsia during pregnancy. Coffee, tea, and other caffeinated drinks should be used in moderation. Vegetables like papaya, cabbage, pumpkin, milk derivatives, sugar cane, and fruits like bananas, mangoes, pineapple, avocados, etc., are the most taboo foods in developing countries like India and Africa. The widespread avoidance of these foods during pregnancy can be attributed to myths that they contribute to foetal obesity, evil eye, abortion, and other delivery difficulties. In rural India, pregnant women are primarily not adequately informed about the significance of eating a healthy, well-rounded diet. To ensure maternal dietary diversity, even modest; well-targeted awareness-raising programs should go a long way. Hence expected mothers should get compulsory nutritional guidance on what to eat and how much from experts like dietitians, physicians, or other experienced mothers through personal meetings or social media platforms to minimize recurrent pregnancy loss.
... Bireylerin beslenme tedavisinde ağırlık kazanımı hedefleri gebelik öncesi beden kütle indeksi (BKİ) değeri ile toplam/haftalık ağırlık kazanımı değerleri temel alınarak bireye özgü olmalıdır. GDM tanısı alan bireylerde zayıflık, hafif şişmanlık ve obezite sınıflandırılması tekil ya da çoğul gebelik olmasına bağlı olarak da değişiklik göstermektedir ( Tablo (Danielewicz et al., 2017). Ulusal Tıp Enstitüsü obez olmayan gebelerde gebelik öncesi ağırlıklarına göre ayarlanan ikinci ve üçüncü trimesterde enerji ihtiyacının sırasıyla 340 kkal/gün ve 452 kkal/gün olarak önermektedir (IOM/NRC, 2010). ...
... Specific dietary choices like vegan or vegetarian diets are associated with mineral &microelement deficiencies and unfavorable outcomes during pregnancy. A vegan diet can lead to inadequate intake of zinc, iron and DHA, as well as increased risk of inadequate brain development & preeclampsia, whereas a vegetarian diet can result in iron and vitamin B12 deficiency [20]. In our study, there was a nearly equal preference for vegetarian & non-vegetarian diet. ...
Article
Full-text available
Objective: The objective of the present study was to assess the nutritional status during pregnancy, survey the prescribed nutritional supplements, and monitor the adherence to prescribed nutritional supplements & to assess the attitude/experience of subjects towards supplement use. Methods: This was a prospective study. A data collection form was used to collect demographic data, Biochemical, clinical, obstetrics, nutritional supplements and dietary data. The adherence to the supplements by using 24-h recall method was noted, and the attitude towards supplement use was assessed. Results: The study was conducted over a period of six months in a tertiary care hospital in Pimpri- Chinchwad which comprised of 193 subjects. There was not much difference in the mean age of the pregnant women attending antenatal care at the hospital, which figured up to 29.93 years. The nutritional status of the study population was assessed and was classified on the basis of BMI and MUAC. BMI measurements revealed that out of 193 subjects studied, 5(2.5%) were underweight, 78(40%) had normal nutritional status, 75(38.8%) were overweight, and 35(18%) were obese. MUAC measurements show 19(9.8%) had moderate malnutrition (MUAC190-230mm), and 174(90.1%) had normal nutritional status (MUAC>230mm). FIGO analysis showed that an average of 47.33 out of 193 required assessment of nutritional status in detail. Out of the 193 subjects studied, combination therapy with Calcium & Vitamin D3 193(100%) was the most commonly prescribed nutritional supplement, followed by combination of Folic acid & iron 151(78.23%), and monotherapy with iron & folic acid respectively 42(21.7%) Adherence to the oral nutritional supplements was measured by a 24-h recall method, 11(6%) of the population reported skipping the prescribed supplements on the previous day. Out of 193 participants surveyed, 67(34.7%) reported they tend to skip the nutritional supplements sometimes. Reported barriers to adherence were forgetfulness (55%), followed by metallic taste (26%), fear of ADRs (9%), gastric ADRs (5%), and inconvenience in taking them along with other medications (5%). Conclusion: The findings of our study reveal that many pregnant women continue to have compromised nutritional status, despite the fact that there exist recommendations and ways for treating under nutrition, lack of sufficient dietary intake of the nutrients, weight management during pregnancy for avoiding post-pregnancy complications.
... A diet during pregnancy that is comprised of high-quality food, supplying essential macro and micro-nutrients, is crucial to the health status of the mother and the child [13]. However, maternal food sources and food preparation (e.g., organic foods, pre-made foods) are likely heavily determined by socio-economic status and maternal age [14]. ...
Article
Full-text available
This study examined the relationship between maternal food source and preparation during pregnancy and the duration of breastfeeding among 751 mother–child dyads in the United States. The data collected from the Environmental influences on Child Health Outcomes (ECHO) Program included twelve cohorts of mothers (age ≥ 18) who delivered infant(s). Three categories of maternal food source and preparation including, High, Moderate, or Low Food Source Quality were derived from the mother report. The mean duration of breastfeeding differed strongly across the three categories. The High Food Source Quality group breastfed an average of 41 weeks, while shorter durations were observed for the Moderate (26 weeks) and Low (16 weeks) Food Source Quality groups. Cox proportional hazards models were used to estimate the relative hazard of time to breastfeeding cessation for each participant characteristic. The full model adjusted for clustering/cohort effect for all participant characteristics, while the final model adjusted for the subset of characteristics identified from variable reduction modeling. The hazard of breastfeeding cessation for those in the High Food Source Quality group was 24% less than the Moderate group (RH = 0.76; 95% CI, 0.63–0.92). Pregnant women in the High Food Source Quality group breastfed longer than the Moderate and Low groups. We encourage more detailed studies in the future to examine this relationship longitudinally.
Article
Full-text available
The perinatal period is a window of heightened plasticity that lays the groundwork for future anatomic, physiologic, and behavioral outcomes. During this time, maternal diet plays a pivotal role in the maturation of vital organs and the establishment of neuronal connections. However, when perinatal nutrition is either lacking in specific micro- and macronutrients or overloaded with excess calories, the consequences can be devastating and long lasting. The brain is particularly sensitive to perinatal insults, with several neurologic and psychiatric disorders having been linked to a poor in utero environment. Diseases characterized by learning and memory impairments, such as autism, schizophrenia, and Alzheimer disease, are hypothesized to be attributed in part to environmental factors, and evidence suggests that the etiology of these conditions may date back to very early life. In this review, we discuss the role of the early-life diet in shaping cognitive outcomes in offspring. We explore the endocrine and immune mechanisms responsible for these phenotypes and discuss how these systemic factors converge to change the brain's epigenetic landscape and regulate learning and memory across the lifespan. Through understanding the maternal programming of cognition, critical steps may be taken toward preventing and treating diseases that compromise learning and memory.
Chapter
Full-text available
Background: Iodine is an essential nutrient required for the biosynthesis of thyroid hormones, which are responsible for regulating growth, development and metabolism. Iodine requirements increase substantially during pregnancy and breastfeeding. If requirements are not met during these periods, the production of thyroid hormones may decrease and be inadequate for maternal, fetal and infant needs. The provision of iodine supplements may help meet the increased iodine needs during pregnancy and the postpartum period and prevent or correct iodine deficiency and its consequences. Objectives: To assess the benefits and harms of supplementation with iodine, alone or in combination with other vitamins and minerals, for women in the preconceptional, pregnancy or postpartum period on their and their children's outcomes. Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register (14 November 2016), and the WHO International Clinical Trials Registry Platform (ICTRP) (17 November 2016), contacted experts in the field and searched the reference lists of retrieved studies and other relevant papers. Selection criteria: Randomized and quasi-randomized controlled trials with randomisation at either the individual or cluster level comparing injected or oral iodine supplementation (such as tablets, capsules, drops) during preconception, pregnancy or the postpartum period irrespective of iodine compound, dose, frequency or duration. Data collection and analysis: Two review authors independently assessed trial eligibility, risk of bias, extracted data and conducted checks for accuracy. We used the GRADE approach to assess the quality of the evidence for primary outcomes.We anticipated high heterogeneity among trials, and we pooled trial results using random-effects models and were cautious in our interpretation of the pooled results. Main results: We included 14 studies and excluded 48 studies. We identified five ongoing or unpublished studies and two studies are awaiting classification. Eleven trials involving over 2700 women contributed data for the comparisons in this review (in three trials, the primary or secondary outcomes were not reported). Maternal primary outcomesIodine supplementation decreased the likelihood of the adverse effect of postpartum hyperthyroidism by 68% (average risk ratio (RR) 0.32; 95% confidence interval (CI) 0.11 to 0.91, three trials in mild to moderate iodine deficiency settings, 543 women, no statistical heterogeneity, low-quality evidence) and increased the likelihood of the adverse effect of digestive intolerance in pregnancy by 15 times (average RR 15.33; 95% CI 2.07 to 113.70, one trial in a mild-deficiency setting, 76 women, very low-quality evidence).There were no clear differences between groups for hypothyroidism in pregnancy or postpartum (pregnancy: average RR 1.90; 95% CI 0.57 to 6.38, one trial, 365 women, low-quality evidence, and postpartum: average RR 0.44; 95% CI 0.06 to 3.42, three trials, 540 women, no statistical heterogeneity, low-quality evidence), preterm birth (average RR 0.71; 95% CI 0.30 to 1.66, two trials, 376 women, statistical heterogeneity, low-quality evidence) or the maternal adverse effects of elevated thyroid peroxidase antibodies (TPO-ab) in pregnancy or postpartum (average RR 0.95; 95% CI 0.44 to 2.07, one trial, 359 women, low-quality evidence, average RR 1.01; 95% CI 0.78 to 1.30, three trials, 397 women, no statistical heterogeneity, low-quality evidence), or hyperthyroidism in pregnancy (average RR 1.90; 95% CI 0.57 to 6.38, one trial, 365 women, low-quality evidence). All of the trials contributing data to these outcomes took place in settings with mild to moderate iodine deficiency. Infant/child primary outcomesCompared with those who did not receive iodine, those who received iodine supplements had a 34% lower likelihood of perinatal mortality, however this difference was not statistically significant (average RR 0.66; 95% CI 0.42 to 1.03, two trials, 457 assessments, low-quality evidence). All of the perinatal deaths occurred in one trial conducted in a severely iodine-deficient setting. There were no clear differences between groups for low birthweight (average RR 0.56; 95% CI 0.26 to 1.23, two trials, 377 infants, no statistical heterogeneity, low-quality evidence), neonatal hypothyroidism/elevated thyroid-stimulating hormone (TSH) (average RR 0.58; 95% CI 0.11 to 3.12, two trials, 260 infants, very low-quality evidence) or the adverse effect of elevated neonatal thyroid peroxidase antibodies (TPO-ab) (average RR 0.61; 95% CI 0.07 to 5.70, one trial, 108 infants, very low-quality evidence). All of the trials contributing data to these outcomes took place in areas with mild to moderate iodine deficiency. No trials reported on hypothyroidism/elevated TSH or any adverse effect beyond the neonatal period. Authors' conclusions: There were insufficient data to reach any meaningful conclusions on the benefits and harms of routine iodine supplementation in women before, during or after pregnancy. The available evidence suggested that iodine supplementation decreases the likelihood of postpartum hyperthyroidism and increases the likelihood of the adverse effect of digestive intolerance in pregnancy - both considered potential adverse effects. We considered evidence for these outcomes low or very low quality, however, because of study design limitations and wide confidence intervals. In addition, due to the small number of trials and included women in our meta-analyses, these findings must be interpreted with caution. There were no clear effects on other important maternal or child outcomes though these findings must also be interpreted cautiously due to limited data and low-quality trials. Additionally, almost all of the evidence came from settings with mild or moderate iodine deficiency and therefore may not be applicable to settings with severe deficiency.More high-quality randomised controlled trials are needed on iodine supplementation before, during and after pregnancy on maternal and infant/child outcomes. However, it may be unethical to compare iodine to placebo or no treatment in severe deficiency settings. Trials may also be unfeasible in settings where pregnant and lactating women commonly take prenatal supplements with iodine. Information is needed on optimal timing of initiation as well as supplementation regimen and dose. Future trials should consider the outcomes in this review and follow children beyond the neonatal period. Future trials should employ adequate sample sizes, assess potential adverse effects (including the nature and extent of digestive intolerance), and be reported in a way that allows assessment of risk of bias, full data extraction and analysis by the subgroups specified in this review.
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