Diet around conception and during pregnancy--effects on fetal and neonatal outcomes

The impact of folic acid supplementation on gestational and long term health: Critical temporal windows, benefits and risks

Highlights

Associations between FA supplementation in pregnancy and effects on offspring's NTDs, allergy/respiratory problems, cancer and behaviour problems as been studied.There is growing concern about the effects of excessive FA supplementation, whether in terms of doses or times of exposure.FA supplementation in the periconceptional period is protective against NTDs while in later periods it could be deleterious.A daily dose of 0.4 mg FA in the periconceptional period seems to be effective and safe.

Abstract

Maternal folic acid (FA) supplementation is one of the most popular nutritional interventions during pregnancy for its protective effect against neural tube defects (NTDs).The purposes of this review are: (a) to gather the current evidence regarding supplementation of maternal diet with FA and (b) to problematize the available literature in terms of dosages, critical temporal windows, and its potential benefits and risks.The expression (pregnancy OR fetus OR offspring OR mother) AND ("folic acid" AND supplementation) was searched on PubMed database, filtering for articles published from 2005 to 2014. Publications referring to FA supplementation during the periconceptional period or pregnancy in which there was a conclusion about the effects of isolated FA supplementation on pregnant woman, pregnancy or offspring were included. Of the initial 1182 papers, 109 fulfilled the inclusion criteria.The majority of the publications reported FA supplementation outcomes on offspring's health, with emphasis in NTDs, allergy/respiratory problems, cancer and behaviour problems. Some inconsistency is observed on the impact of FA supplementation on different outcomes, except for NTDs. It is also visible an increased concern about the impact of excessive supplementation, either in terms of doses or exposure's duration.In conclusion, there is a growing interest in FA supplementation issues. The protective effect of FA supplementation over NTDs has been confirmed, being the periconceptional period a critical window, and it is frequently suggested that allergy/respiratory outcomes arise from (excessive) FA supplementation particularly later in pregnancy. Further research on critical doses and time of exposure should be conducted.

Maternal selenium-supplementation at various stages of periconception period: influence on murine blastocyst morphology and implantation status

BACKGROUND

Selenium is one of the trace minerals whose deficiency is known to lead to complications of female reproduction. The identified gaps in researches regarding selenium and pregnancy include optimizing the dosage of selenium supplementation, timing of supplementation, finding the best form and type of selenium, and selenium administration combined with other antioxidants. Hence, this study was conceptualized to address one of the identified gaps, that is, to find out the best timing of selenium administration around the time of pregnancy. Specifically, this study aimed to assess the effects of maternal Selenium-supplementation, administered at various stages of periconception period, on murine blastocyst morphology, percent occurrence of good quality blastocysts, and implantation status.

METHODS

ICR female mice were randomly assigned into the unsupplemented group (Group I) receiving basal diet without selenium, and treatment groups given with 3.0 μg selenium-supplement per day during pregestation only (Group II), pregestation-throughout-gestation (Group III) and gestation only (Group IV). Both blastocyst morphology and implantation status were assessed.

RESULTS

The morphometric measurements of blastocysts appeared to be unaffected by selenium-supplementation at different stages of periconception. Selenium-supplementation at pregestation only (Group II) and gestation only (Group IV) produced higher percent occurrence of good quality blastocysts and lower percent pre-implantation loss than Group III. Among all the treatment groups, Group III (Selenium-supplementation during pregestation-to-gestation) yielded the lowest quality blastocysts and highest percent pre-implantation loss.

CONCLUSION

Maternal selenium-supplementation during pregestation and gestation stages of the periconception period yielded a high percent occurrence of good quality blastocysts and pre-implantation success.

Parental heights and maternal education as predictors of length/height of children at birth, age 3 and 19 years, independently on diet: the ELSPAC study

BACKGROUND/OBJECTIVES

Little is currently known about the relationship between the parental diet during pregnancy and the growth of the child from early childhood until early adulthood. This study was designed to examine whether the dietary patterns of the parents during a pregnancy and of the respective child at 3 years are associated with the length/height-for-age z-score of child at birth, 3 years of age and at 19 years of age.

SUBJECTS/METHODS

Dietary patterns of pregnant women and their partners, and offspring at 3 years that were enroled in the 1990-1991 period in the Czech part of the European Longitudinal Study of Pregnancy and Childhood. Multivariable linear regression models were used to estimate the relationship between the dietary patterns of parents (835 child-mother-father trios) during pregnancy and the length/height-for-age z-score of their offspring at birth, 3 years and 19 years.

RESULTS

The maternal health-conscious food pattern was found to predict lower child height at 3 years, but not at birth nor at 19 years of age. An increase in the health-conscious pattern score of the maternal diet was associated with significantly lower height-for-age z-score at 3 years; however, the observed effect lost its significance after the adjustment for diet of the child at 3 years.

CONCLUSIONS

After full adjustment, the only significant predictors of the height-for-age z-score of the child at 3 years were the heights of both parents and maternal education. More research into the association of maternal diet in pregnancy and height of child is necessary.

Vegetable Consumption and Selected Nutrient Intakes of Women of Childbearing Age

OBJECTIVE

To examine intake of selected nutrients and vegetable consumption of women of childbearing age (WCBA) from 19-50 years of age, across race/ethnicities, and annual household incomes.

DESIGN

Dietary data from the National Health and Nutrition Examination Survey 2009-2012 and the Food Pattern Equivalents Database 2009-2012.

PARTICIPANTS

The study sample included 3,058 WCBA who were non-Hispanic white (NHW), non-Hispanic black (NHB), Mexican American (MA), and of other races/ethnicities (ORE) with annual household incomes of < $25,000, $25,000-75,000 or > $75,000.

VARIABLES MEASURED

Average daily consumption of vegetables and mean intakes of nutrients of concern from foods, including potassium (K), dietary fiber (DF), calcium, magnesium, iron, vitamin C, and folates.

ANALYSIS

The analysis compared mean vegetable consumption and nutrient intake from food to current recommendations across race/ethnicity and household income categories.

RESULTS

On average, WCBA consumed 1.43 cup equivalents/d of total vegetables and NHB WCBA consumed fewer vegetables than did NHW (P < .01), MA (P < .01), and ORE (P < .01) WCBA. Mean consumption of starchy vegetables, including white potatoes (WP), by WCBA was also below the recommended 5-6 cups of starchy vegetables per week. Average intake of K was 2,364 mg, or about half of the recommended 4,700 mg. Mean DF intake, 15.4 g, was about 60% of the recommended 25 g. In general, NHB WCBA consumed fewer vegetables than did NHW (P < 0.01), MA (P < 0.01), and ORE (P < 0.01) WCBA. On average, WCBA in households with incomes < $25,000 consumed fewer vegetables and had lower intakes of K, DF, calcium, and iron than did WCBA with household incomes > $75,000 (P < .05).

CONCLUSIONS AND IMPLICATIONS

These results showed that WCBA had low vegetable consumption, including starchy vegetables, compared with recommendations in the Dietary Guidelines for Americans, 2015-2020. Potassium and DF intakes were low among WCBA, but especially so for NHB WCBA and WCBA with limited financial resources. Government-sponsored food assistance programs should consider policies that encourage WCBA to consume more vegetables, including starchy vegetables, such as WP and lima beans that are rich in K and an important source of DF.

Maternal protein intake during pregnancy and linear growth in the offspring

BACKGROUND

Observational and experimental evidence demonstrates that protein intake in infancy programs linear growth. To our knowledge, few studies have examined prenatal maternal protein intake.

OBJECTIVE

Our objective was to examine associations of maternal protein intake during pregnancy with offspring linear growth.

DESIGN

We analyzed data from 1961 mother-child pairs in Project Viva. We assessed first- and second-trimester diet with the use of food-frequency questionnaires and analyzed protein intake as grams per kilogram prepregnancy weight per day. We used research measures of offspring length at birth and in infancy (∼6 mo), early childhood (∼3 y), and midchildhood (∼7 y), as well as clinical growth measures obtained from after birth through midchildhood. We calculated sex-specific birth length z scores for gestational age with the use of international reference data. We used mixed models with repeated length measures to predict individual length gain velocities for birth to <6 mo and 6 mo to 7 y of age, then used these velocities as outcomes in adjusted linear regression models with maternal protein intake as the main predictor.

RESULTS

Mean (range) second-trimester protein intake was 1.4 g · kg-1 · d-1 (0.3-3.1 g · kg-1 · d-1). After adjusting for maternal sociodemographics, gestational weight gain, maternal and paternal height, and (for postdelivery outcomes) child sex, gestational age, and breastfeeding duration, each 1-SD (0.36 g · kg-1 · d-1) increment in second-trimester protein intake corresponded to a -0.10 (95% CI: -0.18, -0.03) change in birth length z score, a -0.03 cm/mo (95% CI: -0.05, -0.01 cm/mo) change in slope of length growth from birth to <6mo, and a -0.09 cm/y (95% CI: -0.14, -0.05 cm/y) change in slope of length growth from 6 mo to midchildhood. Results were similar for first-trimester intake.

CONCLUSIONS

In a population with relatively high protein intake during pregnancy, higher protein intake was associated with shorter offspring birth length and slower linear growth into midchildhood. Results suggest that higher protein intake during pregnancy does not increase fetal and child growth and may even reduce early length growth. Project Viva was registered at clinicaltrials.gov as NCT02820402.

Use of micronutrient supplements among pregnant women in Alberta: results from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort

Maternal nutrient intake in the prenatal period is an important determinant of fetal growth and development and supports maternal health. Many women, however, fail to meet their prenatal nutrient requirements through diet alone and are therefore advised to consume nutrient supplements. The purpose of this study was to describe the use of natural health products (NHP) by pregnant women in each trimester of pregnancy. Women (n = 599) participating in the first cohort of the Alberta Pregnancy Outcomes and Nutrition (APrON) study completed an interviewer-administered supplement intake questionnaire during each trimester of pregnancy. NHP use was high, with >90% taking multivitamin/mineral supplements, and nearly half taking at least one additional single-nutrient supplement. Compliance with supplementation guidelines was high for folic acid (>90%), vitamin D (∼70%) and calcium (∼80%), but low for iron (<30%) and for all four nutrients together (≤11%). On average, women met or exceeded the recommended dietary allowance for folic acid, vitamin D and iron from NHPs alone, with median daily intakes of 1000 μg, 400 IU and 27 mg, respectively. The median calcium intake was 250 mg d(-1) . Up to 26% of women exceeded the tolerable upper intake level for folic acid and up to 19% did so for iron at some point of their pregnancy. Findings highlight the need to consider both dietary and supplemental sources of micronutrients when assessing the nutrient intakes of pregnant women.

Prenatal dietary load of Maillard reaction products combined with postnatal Coca-Cola drinking affects metabolic status of female Wistar rats

Aim

To assess the impact of prenatal exposure to Maillard reaction products (MRPs) -rich diet and postnatal Coca-Cola consumption on metabolic status of female rats. Diet rich in MRPs and consumption of saccharose/fructose sweetened soft drinks is presumed to impose increased risk of development of cardiometabolic afflictions, such as obesity or insulin resistance.

Methods

At the first day of pregnancy, 9 female Wistar rats were randomized into two groups, pair-fed either with standard rat chow (MRP-) or MRPs-rich diet (MRP+). Offspring from each group of mothers was divided into two groups and given either water (Cola-) or Coca-Cola (Cola+) for drinking ad libitum for 18 days. Oral glucose tolerance test was performed, and circulating markers of inflammation, oxidative stress, glucose and lipid metabolism were assessed.

Results

MRP+ groups had higher weight gain, significantly so in the MRP+/Cola- vs MRP-/Cola-. Both prenatal and postnatal intervention increased carboxymethyllysine levels and semicarbazide-sensitive amine oxidase activity, both significantly higher in MRP+/Cola + than in MRP-/Cola-. Total antioxidant capacity was lower in MRP+ groups, with significant decrease in MRP+/Cola + vs MRP-/Cola+. Rats drinking Coca-Cola had higher insulin, homeostatic model assessment of insulin resistance, heart rate, advanced oxidation of protein products, triacylglycerols, and oxidative stress markers measured as thiobarbituric acid reactive substances compared to rats drinking water, with no visible effect of MRPs-rich diet.

Conclusion

Metabolic status of rats was affected both by prenatal and postnatal dietary intervention. Our results suggest that combined effect of prenatal MRPs load and postnatal Coca-Cola drinking may play a role in development of metabolic disorders in later life.

The association between portion size, nutrient intake and gestational weight gain: a secondary analysis in the WATCH study 2006/7

BACKGROUND

Excessive gestational weight gain (GWG) is associated with adverse maternal-child health outcomes. Managing energy intake and GWG versus optimising nutrient intake can be challenging. The present study aimed to examine the relationships between dietary portion size, GWG and nutrient intakes during pregnancy. It is hypothesised that, after adjustment for potential confounders, portion size would be positively associated with both GWG and nutrient intakes during pregnancy.

METHODS

Prospective data were obtained for 179 Australian women from the Women and Their Children's Health Study. A validated food frequency questionnaire was used at 18-24 and 36-40 weeks of gestation to quantify diet and portion size during the previous 3 months of pregnancy. Nutrient intakes were compared with Australian Nutrient Reference Values (NRVs). GWG was measured up to 36 weeks and compared with the Institute of Medicine weight gain recommendations (WtAdh).

RESULTS

In multivariate regression models, portion size factor (PSF) was positively associated with GWG in women with high socio-economic status (SES; β = 0.20, P = 0.04) and those with an overweight/obese pre-pregnancy body mass index (BMI) (β = 0.28, P = 0.04). PSF uniquely accounted for 8.2% and 3.7% of the variability in GWG for women with high SES and overweight/obese pre-pregnancy BMIs, respectively. Nutrient intakes and PSF were similar regardless of WtAdh. Women achieved NRVs for calcium and zinc in all PSF categories. Most of the women with large PSF still failed to achieve the NRVs for folate (95.7%), iron (89.6%) and fibre (85.5%).

CONCLUSIONS

All women require advice on quality food choices during pregnancy to optimise health outcomes. Targeting portion size alone is insufficient to manage GWG but may prove to be a valuable tool in pregnant women of high SES and/or those who are overweight/obese pre-pregnancy.

Assessment of Pre-Pregnancy Dietary Intake with a Food Frequency Questionnaire in Alberta Women

PURPOSE

Pre-pregnancy is an under-examined and potentially important time to optimize dietary intake to support fetal growth and development as well as maternal health. The purpose of the study was to determine the extent to which dietary intake reported by non-pregnant women is similar to pre-pregnancy dietary intake reported by pregnant women using the same assessment tool.

METHODS

The self-administered, semi-quantitative food frequency questionnaire (FFQ) was adapted from the Canadian version of the Diet History Questionnaire, originally developed by the National Cancer Institute in the United States. Pregnant women (n = 98) completed the FFQ which assessed dietary intake for the year prior to pregnancy. Non-pregnant women (n = 103) completed the same FFQ which assessed dietary intake for the previous year. Energy, macronutrients, and key micronutrients: long-chain omega-3 fatty acids, folate, vitamin B6, vitamin B12, calcium, vitamin D and iron were examined.

RESULTS

Dietary intake between groups; reported with the FFQ; was similar except for saturated fat; trans fat; calcium; and alcohol. Pregnant women reported significantly higher intakes of saturated fat; trans fat; and calcium and lower intake of alcohol in the year prior to pregnancy compared to non-pregnant women who reported intake in the previous year.

CONCLUSIONS

Despite limitations; a FFQ may be used to assist with retrospective assessment of pre-pregnancy dietary intake.

The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review

Background

There is growing evidence that preconception care may have an important role in preventing short and long term adverse health consequences for women and their offspring. This is particularly the case for women with chronic health conditions due to the rising prevalence of chronic disease in global populations. With this in mind, this paper presents an integrative systematic review of contemporary research outlining the use of preconception services and practices by women with chronic health conditions.

Methods

A search was conducted through PubMed, CINAHL, AMED, and Maternity and Infant Care databases which identified 672 papers examining preconception care and preconception services for women with chronic health conditions. Fourteen papers which were written in English, presented original research, and reported on the prevalence or nature of use of preconception care by women with chronic health conditions were included in the review. Critical appraisal of study quality and thematic categorical grouping of identified papers was undertaken.

Results

Current research evidence, as identified through this review, examines three major topic areas: the prevalence of preconception care practices, use of services and characteristics of users; knowledge of the value and impact of preconception care and availability of preconception services for women with chronic health conditions; and women’s attitudes, approaches and experiences of preconception care and preconception services. Prevalence estimates of engagement with preconception care range between 18.1% and 45%, with most studies focusing on women with type 1 or 2 diabetes. Significant gaps in women’s knowledge of preconception care for women with chronic health conditions were also identified. Women with chronic health conditions reported experiencing emotional distress as a result of their engagement with preconception care services. They also commonly described feeling a need to employ discipline to comply with preconception care programs, and experiencing a fear of pregnancy complications.

Conclusion

Future research requires a broad and sophisticated approach to research design and analysis, improved consideration of temporal changes to women’s health behaviour, representative samples to more effectively inform health policy, and a deeper understanding of women’s motivations, attitudes and perceptions of preconception care to assist in the development of tailored preconception health services.

Impact of singlehood during pregnancy on dietary intake and birth outcomes- a study in the Norwegian Mother and Child Cohort Study

Background

Little attention has been given to the impact of singlehood during pregnancy. The aim of this study was to examine the impact of marital status on diet during pregnancy and pregnancy outcome.

Methods

The study population comprised 62,773 women participating in the Norwegian Mother and Child Cohort Study. Marital status was categorised into singles living alone, singles living with parents and married/cohabiting (reference group). Participants answered a general health questionnaire in gestational week 15–17 and a food frequency questionnaire in gestational week 22. We used nonparametric tests to compare dietary intakes by marital status, and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for infants being small for gestational age (SGA), large for gestational age (LGA), and preterm delivery (defined as delivery before gestational week 37).

Results

Single women living with parents had lower intakes of fruits and vegetables, higher intake of total energy, higher proportion of energy from added sugar, and lower intake of fibre than the reference group. Singles living alone also had a higher intake of added sugar. In both of the single groups, daily smoking was more prevalent than in women living with a partner. In analyses adjusted for maternal age, pre-pregnancy BMI, energy intake, energy contributed by protein, education, income, parity and nausea, single women living alone had increased risk of SGA with OR = 1.27 (95% CI: 1.05, 1.55). When smoking was included among the confounding variables, the association was no longer significant. Likewise, singles living alone had increased risk of preterm delivery, with OR = 1.32 (95% CI: 1.01, 1.72) in a partly adjusted model, but the association did not remain significant in a model fully adjusted for confounding variables.

Conclusions

Single mothers had lower dietary quality and included more smokers than women who lived with a partner. Single mothers living alone had higher prevalence of SGA and preterm delivery, but the associations with adverse pregnancy outcomes were confounded by other variables. This study shows that single mothers should be given special attention during antenatal care and counselling.

Maternal dietary patterns and preterm delivery: results from large prospective cohort study

OBJECTIVE

To examine whether an association exists between maternal dietary patterns and risk of preterm delivery.

DESIGN

Prospective cohort study.

SETTING

Norway, between 2002 and 2008.

PARTICIPANTS

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).

MAIN OUTCOME MEASURE

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).

RESULTS

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).

CONCLUSION

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.

Nutritional programming of insulin resistance: causes and consequences

Strong evidence indicates that adverse prenatal and early postnatal environments have a significant long-term influence on risk factors that result in insulin resistance, type 2 diabetes (T2D), and cardiovascular disease later in life. Here we discuss current knowledge of how maternal and neonatal nutrition influence early growth and the long-term risk of developing insulin resistance in different organs and at the whole-body level. Accumulating evidence supports a role for epigenetic mechanisms underlying this nutritional programming, consisting of heritable changes that regulate gene expression which in turn shapes the phenotype across generations. Deciphering these molecular mechanisms in key tissues and discovering key biological markers may provide valuable insight towards the development of effective intervention strategies.

Can exercise training rescue the adverse cardiometabolic effects of low birth weight and prematurity?

Being born preterm and/or small for gestational age are well-established risk factors for cardiometabolic disease in adulthood. Physical activity has the potential to mitigate against the detrimental cardiometabolic effects of low birth weight from two perspectives: (i) maternal exercise prior to and during pregnancy; and (ii) exercise during childhood or adulthood for those born small or prematurely. Evidence from epidemiological birth cohort studies suggests that the effects of moderate-intensity physical activity during pregnancy on mean birth weight are small, but reduce the risk of either high or low birth weight infants. In contrast, vigorous and/or high-intensity exercise during pregnancy has been associated with reduced birth weight. In childhood and adolescence, exercise ability is compromised in extremely low birth weight individuals (< 1000 g), but only marginally reduced in those of very low to low birth weight (1000-2500 g). Epidemiological studies show that the association between birth weight and metabolic disease is lost in physically fit individuals and, consistently, that the association between low birth weight and metabolic syndrome is accentuated in unfit individuals. Physical activity intervention studies indicate that most cardiometabolic risk factors respond to exercise in a protective manner, independent of birth weight. The mechanisms by which exercise may protect low birth weight individuals include restoration of muscle mass, reduced adiposity and enhanced β-cell mass and function, as well as effects on both aerobic and anaerobic muscle metabolism, including substrate utilization and mitochondrial function. Vascular and cardiac adaptations are also likely important, but are less well studied.

Listeria monocytogenes and diet during pregnancy; balancing nutrient intake adequacy v. adverse pregnancy outcomes

OBJECTIVE

To evaluate the impact of adherence to public health recommendations on Listeria monocytogenes food safety to limit exposure to potential food sources on micronutrient intakes of pregnant women and whether more frequent consumption of 'high-risk' foods increases risk for adverse pregnancy outcomes.

DESIGN

A cohort study in women assessing Listeria exposure from an FFQ based on consumption of potential Listeria-containing food sources, the Listeria Food Exposure Score (LFES). Pregnancy status was defined as pregnant, trying to conceive, had a baby within the previous 12 months, or other. Nutrient intakes were compared with Nutrient Reference Values and self-reported pregnancy outcome history three years later.

SETTING

Australia.

SUBJECTS

Women aged 25-30 years (n 7486) participating in the Australian Longitudinal Study on Women's Health.

RESULTS

There were weak positive correlations (r = 0.13-0.37, P < 0.001) between LFES and all nutrients, with fibre, folate, Fe and vitamin E intakes consistently below the Nutrient Reference Values in every quintile of LFES. Women in the highest quintile of LFES reported 19 % more miscarriages (rate ratio = 1.19; 95 % CI 1.02, 1.38) than those in the lowest quintile, after adjusting for important confounding factors.

CONCLUSIONS

More frequent consumption of foods potentially containing L. monocytogenes is associated with higher nutrient intakes, but an increased risk of miscarriage. L. monocytogenes pregnancy recommendations require review and should include the list of 'risky' food items in addition to low-risk alternatives that would adequately replace nutrient intakes which may be reduced through avoidance strategies.

Stress, depression, social support, and eating habits reduce diet quality in the first trimester in low-income women: a pilot study

Maternal diet quality influences birth outcomes. Yet, little research exists that assesses women's diet quality during the first trimester of pregnancy, a crucial time of placental and fetal development. This cross-sectional study, describing diet quality and its relationship with stress, depression, social support, and eating habits in the first trimester, may identify low-income women needing intensive dietary intervention. Seventy-one low-income women completed validated instruments measuring stress, depression, social support, and eating habits; had their height and weight measured; received training on portion-size estimation; and completed three 24-hour dietary recalls (1 weekend day and 2 nonconsecutive weekdays) from July 2009 to February 2010. Comparative and correlational analyses were done. Women with diet quality scores below the median (n=35) had more depression (9.6±5.1 vs 6.7±5.1) and stress (22.1±5.4 vs 19.3±4.8) and less control over meal preparation (5.0±1.5 vs 4.2±1.5) and support from others (52.0±12.0 vs 57.4±7.2) than did women with high diet quality scores (n=36). Diet quality was negatively related to depression (r=-0.41), stress (r=-0.35), skipping meals (r=-0.41), and control over meal preparation (r=-0.33), and positively related to support from others (r=0.38). Low-income women experiencing life stressors represent an at-risk group for low diet quality and may need intensive dietary intervention before and during pregnancy. More research designed to improve diet quality in low-income pregnant women is needed.

A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum

BACKGROUND

Ensuring adequate dietary intake during pregnancy has important implications for optimising maternal and fetal health. It is not known whether diet quality is altered over pregnancy and the post-partum period.

OBJECTIVE

The aim of this study was to perform a comprehensive assessment of diet quality in overweight and obese women during pregnancy and early post-partum.

DESIGN

In a prospective cohort study, n=301 overweight or obese pregnant women completed a food frequency questionnaire at study entry (10-20 weeks gestation), 28 weeks gestation, 36 weeks gestation and 4 months post-partum for assessment of macronutrient and micronutrient intake and diet quality by the Healthy Eating Index (HEI).

RESULTS

Energy, macronutrient and dietary sources of micronutrients did not alter across pregnancy or post-partum. The HEI was of below average quality in 31.0% of women at baseline. This decreased from week 28 (P<0.001) and was maintained at a lower level post-partum such that HEI levels were lower compared with study entry (53.3±12.7 versus 56.7±10.1, P<0.001). The HEI decrease occurred in association with decreases in the milk, meat and unsaturated oil components, and increases in the proportion of energy from solid fats, alcohol and added sugars (P<0.001), and was independently predicted by the socioeconomic index for areas score (β=-0.011, s.e.=0.011, P=0.031).

CONCLUSION

We report for the first time that dietary quality decreases across pregnancy and is maintained at this reduced level in the early post-partum period in overweight and obese women. Dietary interventions aimed at improving diet quality should be targeted to early pregnancy and post-partum.

Systematic review and meta-analysis of energy and macronutrient intakes during pregnancy in developed countries

Research reporting diet during pregnancy in nationally representative samples is limited. This review summarizes the dietary intakes of pregnant women in developed countries and compares them with national recommendations. A systematic search without date limits was conducted. All studies reporting the macronutrient intakes of pregnant women were considered, irrespective of design. Two authors independently identified the studies to be included and assessed the methodological quality. Nutritional adequacy was summarized, with confounding factors considered. Meta-analysis data are reported for developed countries collectively, by geographical region, and by dietary methodology. Energy and macronutrient intakes of pregnant women do not match national recommendations. Energy and fiber intakes were consistently below recommendations, while total fat and saturated fat intakes were generally above recommendations and carbohydrate and polyunsaturated fat intakes were below to borderline low compared with recommendations. A mismatch between dietary practices and macronutrient recommendations in pregnant women is widespread and not well quantified. The implications of these practices are unknown until further research compares maternal diet with short-term and long-term maternal and offspring health outcomes.

Maternal nutrition and birth outcomes: effect of balanced protein-energy supplementation

The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. Maternal malnutrition is a key contributor to poor fetal growth, low birthweight (LBW) and short- and long-term infant morbidity and mortality. This review summarised the evidence on association of maternal nutrition with birth outcomes along with review of effects of balanced protein-energy supplementation during pregnancy. A literature search was conducted on PubMed, WHOLIS, PAHO and Cochrane library. Only intervention studies were considered for inclusion and data were combined by meta-analyses if available from more than one study. Sixteen intervention studies were included in the review. Pooled analysis showed a positive impact of balanced protein-energy supplementation on birthweight compared with control [mean difference 73 (g) [95% confidence interval (CI) 30, 117]]. This effect was more pronounced in undernourished women compared with adequately nourished women. Combined data from five studies showed a reduction of 32% in the risk of LBW in the intervention group compared with control [relative risk (RR) 0.68 [95% CI 0.51, 0.92]]. There was a reduction of 34% in the risk of small-for-gestational-age babies in the intervention compared with the control group [RR 0.66 [95% CI 0.49, 0.89]]. The risk of stillbirth was also reduced by 38% in the intervention group compared with control [RR 0.62 [95% CI 0.40, 0.98]]. In conclusion, balanced protein-energy supplementation is an effective intervention to reduce the prevalence of LBW and small-for-gestational-age births, especially in undernourished women.

Effect of women's nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review

Current understanding of biologic processes indicates that women's nutritional status before and during early pregnancy may play an important role in determining early developmental processes and ensuring successful pregnancy outcomes. We conducted a systematic review of the evidence for the impact of maternal nutrition before and during early pregnancy (<12 weeks gestation) on maternal, neonatal and child health outcomes and included 45 articles (nine intervention trials and 32 observational studies) that were identified through PubMed and EMBASE database searches and examining review articles. Intervention trials and observational studies show that periconceptional (<12 weeks gestation) folic acid supplementation significantly reduced the risk of neural tube defects. Observational studies suggest that preconceptional and periconceptional intake of vitamin and mineral supplements is associated with a reduced risk of delivering offspring who are low birthweight and/or small-for-gestational age (SGA) and preterm deliveries (PTD). Some studies report that indicators of maternal prepregnancy size, low stature, underweight and overweight are associated with increased risks of PTD and SGA. The available data indicate the importance of women's nutrition prior to and during the first trimester of pregnancy, but there is a need for well-designed prospective studies and controlled trials in developing country settings that examine relationships with low birthweight, SGA, PTD, stillbirth and maternal and neonatal mortality. The knowledge gaps that need to be addressed include the evaluation of periconceptional interventions such as food supplements, multivitamin-mineral supplements and/or specific micronutrients (iron, zinc, iodine, vitamin B-6 and B-12) as well as the relationship between measures of prepregnancy body size and composition and maternal, neonatal and child health outcomes.

Relationships among maternal nutrient intake and placental biomarkers during the 1st trimester in low-income women

PURPOSE

Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester.

METHODS

A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy.

RESULTS

The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024].

CONCLUSIONS

Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.

Food aversions and cravings during early pregnancy: association with nausea and vomiting

The prospective cohort study examined whether Ecuadorian women with early pregnancy nausea and vomiting (NVP) are more likely to develop food aversions and cravings, and if so, whether the specific foods identified as aversive or craved are the same as those predicted by the popular maternal-embryo protection hypothesis (MEPH). Consistent with MEPH predictions, women with NVP were more likely to report increased odor sensitivity and aversions for some predicted "toxic" foods and more likely to crave fruits. However, other hypothesis predictions were not supported. The relationship of food aversions and cravings with NVP appears more complicated than that explained by the MEPH.

Does access to fast food lead to super-sized pregnant women and whopper babies?

Rise in the availability of fast-food restaurants has been blamed, at least partly, for the increasing obesity in the U.S. The existing studies of obesity have focused primarily on children, adolescents, and adults, and this paper extends the literature by raising a little-studied question and using nationally representative data to answer it. It examines the relationship between the supply of fast-food restaurants and weight gain of pregnant women and their newborns. I study prenatal weight gain because excessive weight gain has been linked to postpartum overweight/obesity and I study both tails of the birthweight distribution because the origin of obesity may be traced to the prenatal period and both tail outcomes have been associated with obesity later in life. I merge the 1998 and 2004 Natality Detail Files with the Area Resource File, and County Business Patterns, which provide data on the number of fast-food restaurants in the metropolitan area where the mother resides. The empirical model includes an extensive list of MSA characteristics and MSA fixed effects to control for factors that may be correlated with both health outcomes and restaurants' location decision. Results reveal that the fast-food and weight gain relationship is robust to the inclusion of these controls but these controls greatly mitigate the fast food-infant health relationship. Greater access to fast-food restaurants is positively related to mothers' probability of excessive weight gain but it does not share a statistically significant relationship with birthweight. These relationships hold in all the socioeconomic and demographic subgroups studied.

Predictors of dietary quality in low-income pregnant women: a path analysis

BACKGROUND

Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester.

OBJECTIVE

The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women.

METHOD

A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy.

RESULTS

The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (β = .36) and a direct (β = -.23) and indirect effect on dietary quality (β = -.30). Poor eating habits had a direct effect on dietary quality (β = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (β = .39) and nutritional knowledge (β = .18) and an indirect effect on dietary quality (total effect, β = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables.

DISCUSSION

Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Disparities exist between National food group recommendations and the dietary intakes of women

BACKGROUND

Preconception and pregnancy dietary intakes can influence the health of future generations. In this study we compared the food intakes of reproductive-aged women by pregnancy status, to current Australian recommendations.

METHODS

Data are from the Australian Longitudinal Study on Women's Health, younger cohort aged 25-30 years in 2003, with self-reported status as pregnant (n = 606), trying to conceive (n = 454), given birth in the last 12 months (n = 829) or other (n = 5597). Diet was assessed using a validated 74-item food frequency questionnaire. Food group servings and nutrient intakes were compared to the Australian Guide to Healthy Eating (AGHE) and Australian Nutrient Reference Values (NRVs).

RESULTS

No women met all AGHE food group recommendations. Highest adherence rates [mean (95% CI) servings/day] were for meat [85%, 1.9(1.8-1.9)], fruit [44%, 2.1(2.1-2.2)] and dairy [35%, 1.8(1.8-1.9)], with < 14% meeting remaining recommendations. Women who achieved NRVs (folate, iron, calcium, zinc, fibre) for pregnancy, breastfeeding and adult life stages were 1.5%, 3.3% and 13.7%, respectively. Compared to AGHE, women consumed more servings of fruit (4.9 vs 4.0;P = 0.034) and dairy (3.4 vs 2.0;P = 0.006) to achieve pregnancy NRVs; more dairy (2.9 vs 2.0;P = 0.001), less fruit (3.9 vs 5.0;P < .001) and vegetables (3.4 vs 7.0;P < .001) to achieve breastfeeding NRVs; more fruit (3.6 vs 3.0;P < .001), dairy (2.5 vs 2.0;P < .001), meat (1.8 vs 1.5;P = 0.015), less vegetables (3.6 vs 5.0;P < .001) to achieve adult NRVs.

CONCLUSIONS

The AGHE does not align with contemporary diets of Australian women or enable them to meet all NRVs. Current tools to guide food consumption by women during pregnancy require revision.

Effect of balanced protein energy supplementation during pregnancy on birth outcomes

Background

The nutritional status of the mother prior to and during pregnancy plays a vital role in fetal growth and development, and maternal undernourishment may lead to adverse perinatal outcomes including intrauterine growth restriction (IUGR). Several macronutrient interventions had been proposed for adequate protein and energy supplementation during pregnancy. The objective of this paper was to review the effect of balanced protein energy supplementation during pregnancy on birth outcomes. This paper is a part of a series of reviews undertaken for getting estimates of effectiveness of an intervention for input to Lives Saved Tool (LiST) model.

Methods

A literature search was conducted on PubMed, Cochrane Library and WHO regional data bases to identify randomized trials (RCTs) and quasi RCTs that evaluated the impact of balanced protein energy supplementation in pregnancy. Balanced protein energy supplementation was defined as nutritional supplementation during pregnancy in which proteins provided less than 25% of the total energy content. Those studies were excluded in which the main intervention was dietary advice to pregnant women for increase in protein energy intake, high protein supplementation (i.e. supplementation in which protein provides at least 25% of total energy content), isocaloric protein supplementation (where protein replaces an equal quantity of non-protein energy content), or low energy diet to pregnant women who are either overweight or who exhibit high weight gain earlier in gestation. The primary outcomes were incidence of small for gestational age (SGA) birth, mean birth weight and neonatal mortality. Quality of evidence was evaluated according to the Child Health Epidemiology Reference group (CHERG) adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

Results

The final number of studies included in our review was eleven comprising of both RCTs and quasi-RCTs. Our meta-analysis indicates that providing pregnant females with balanced protein energy supplementation resulted in a significant reduction of 31 % in the risk of giving birth to small for gestational age infants (Relative risk (RR) =0.69, 95% Confidence interval (CI) 0.56 to 0.85). This estimate had been recommended for LiST as a proxy for reduction in IUGR. Pooled results for mean birth weight showed that balanced protein supplemented group gained more weight compared to control [Mean difference 59.89 g, 95 % CI 33.09-86.68]. This effect was more pronounced in malnourished women compared to adequately nourished women. There was no statistically significant effect of balanced protein energy supplementation on neonatal mortality (RR= 0.63, 95% CI 0.37 to 1.06).

Conclusion

Providing pregnant females with balanced protein energy supplementation leads to reduction in risk of small for gestational age infants, especially among undernourished pregnant women. Given these findings, we can recommend balanced protein energy supplementation as an intervention among undernourished women for inclusion in the LiST model with a point estimate of 31% [95% CI 15% to 44%] reduction in IUGR.

Predictors of measurement error in energy intake during pregnancy

Nutrition plays a critical role in maternal and fetal health; however, research on error in the measurement of energy intake during pregnancy is limited. The authors analyzed data on 998 women living in central North Carolina with singleton pregnancies during 2001-2005. Second-trimester diet was assessed by food frequency questionnaire. Estimated energy requirements were calculated using Institute of Medicine prediction equations, with adjustment for energy costs during the second trimester. Implausible values for daily energy intake were determined using confidence limits of agreement for energy intake/estimated energy requirements. Prevalences of low energy reporting (LER) and high energy reporting (HER) were 32.8% and 12.9%, respectively. In a multivariable analysis, pregravid body mass index was related to both LER and HER; LER was higher in both overweight (odds ratio = 1.96, 95% confidence interval: 1.26, 3.02; P = 0.031) and obese (odds ratio = 3.29, 95% confidence interval: 2.33, 4.65; P < 0.001) women than in normal-weight counterparts. Other predictors of LER included marriage and higher levels of physical activity. HER was higher among subjects who were underweight, African-American, and less educated and subjects who had higher depressive symptom scores. LER and HER are prevalent during pregnancy. Identifying their predictors may improve data collection and analytic methods for reducing systematic bias in the study of diet and reproductive outcomes.

Maternal dietary patterns during early pregnancy and the odds of childhood germ cell tumors: A Children's Oncology Group study

Maternal diet during pregnancy may be associated with cancer in offspring. Intake of individual foods, as well as dietary patterns, can be used when examining these relations. Here, the authors examined associations between maternal dietary intake patterns and pediatric germ cell tumors (GCTs) using principal components analysis and logistic regression. Mothers of 222 GCT cases aged less than 15 years who were diagnosed at a Children's Oncology Group institution between 1993 and 2001 and those of 336 frequency-matched controls completed a self-administered food frequency questionnaire of diet during early pregnancy. Four dietary patterns were identified: "Western," "fruits and vegetables," "protein," and "healthful." With adjustment for birth weight, parity, and vitamin use, the fruits and vegetables pattern was significantly associated with a lower odds for GCTs (odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.69, 0.99; 2 sided). Upon stratification, the fruits and vegetables pattern was significantly associated with a lower odds in males (OR = 0.66, 95% CI: 0.47, 0.92) but not females (OR = 0.91, 95% CI: 0.72, 1.14). A quantitative assessment of assumed nondifferential reporting error indicated no notable deviations from unadjusted odds ratio estimates. Results of this exploratory analysis suggest that maternal prenatal dietary patterns could be considered in future studies of GCTs in offspring.

Depression in Swedish women: relationship to factors at birth

Depression is a common and serious disorder that may have developmental origins. Birth-related factors have been related to childhood and adult occurrence of somatic as well as psychiatric disorders, but studies on the relationship between birth-related factors and depression are few and show mixed results. In addition, varying methods have been used to assess depression. Standardized clinical criteria to diagnose depression, combined with birth data collected from midwife records have not been used in most studies. Participants in the Prospective Population Study of Women in Sweden (803 women), born 1914, 1918, 1922 and 1930, provide information on birth factors and depression. Women participated from 1968 at mid-life ages of 38-60 years, to 2000, when they were age 78-92 years. Original birth records containing birth weight, length, head circumference, and gestational time, as well as social factors were obtained. Lifetime depression was diagnosed via multiple information sources. Symptoms were assessed using the Comprehensive Psychopathological Rating Scale and diagnoses were based on DSM-III-R criteria. Over their lifetime, 44.6% of women in this sample experienced depression. Birth weights ≤ 3500 g [odds ratio (OR), age-adjusted = 1.72; 95% CI 1.29-2.28, P < 0.001] and shorter gestational time (OR, age-adjusted = 1.13; 95% CI 1.04-1.24, P = 0.005) were independently associated with a higher odds of lifetime depression in a logistic regression model adjusted for age. Lower than median birth weights and shorter gestational time were related to lifetime depression in women. Both neurodevelopmental and environmental contributions to lifetime depression may be considered.

Dietary intake and nutritional adequacy prior to conception and during pregnancy: a follow-up study in the north of Portugal

Objective

To assess maternal diet and nutritional adequacy prior to conception and during pregnancy.

Design

Follow-up of a cohort of pregnant women with collection of questionnaire data throughout pregnancy and after delivery.

Setting

Antenatal clinics at two public hospitals in Porto, Portugal.

Subjects

Two hundred and forty-nine pregnant women who reported a gestational age below 13 weeks at the time they attended their first antenatal visit.

Results

Intakes of energy and macronutrients were within recommended levels for most women. Pregnancy was accompanied by increases in the dietary intake of vitamins A and E, riboflavin, folate, Ca and Mg, but declines in the intake of alcohol and caffeine. The micronutrients with higher inadequacy prevalences prior to pregnancy were vitamin E (83 %), folate (58 %) and Mg (19 %). These three micronutrients, together with Fe, were also those with the highest inadequacy prevalences during pregnancy (91 %, 88 %, 73 % and 21 %, respectively, for folate, Fe, vitamin E and Mg). Ninety-seven per cent of the women reported taking supplements of folic acid during the first trimester, but the median gestational age at initiation was 6·5 (interquartile range 5, 9) weeks. Self-reported prevalences of Fe and Mg supplementation were high, and increased throughout pregnancy.

Conclusion

The study identified low dietary intakes of vitamin E, folate and Mg both in the preconceptional period and during pregnancy, and low intake of Fe during pregnancy only. The low dietary intake of folate and the late initiation of supplementation indicate that current national guidelines are unlikely to be effective in preventing neural tube defects.

Dietary behaviour, food and nutrient intake of pregnant women in a rural community in Burkina Faso

The aim of this study was to assess potential changes in dietary habits during pregnancy in a rural community in Houndé district, Burkina Faso. In-depth interviews were performed on a random sample of 37 pregnant women in order to analyse specific perceptions and attitudes regarding food consumption during pregnancy. In addition to this, an interactive 24-h recall survey was used to compare the food intake of 218 pregnant and 176 non-pregnant women. The majority of interviewees reported dietary restrictions during pregnancy but no consistent pattern of avoided food types was found. Most of the mentioned 'forbidden' foods were in related to physical discomfort during gestation. Interviewees also admitted to ignoring culturally determined food prohibitions/prescriptions. No differences were observed in food intake, food choice and nutrient intake between the group of pregnant and non-pregnant women. During the third trimester of gestation women did not show any major differences in food and nutrient intake compared with women from the first/second trimester. The mean nutrient intakes were found to be insufficient compared with the recommended daily allowances, especially for pregnant women. In conclusion, pregnant women in this rural area of Burkina Faso do not seem to restrict their diet significantly during pregnancy. The additional nutritional requirements of pregnancy are not accounted for in their dietary practises.

Are muscular and cardiovascular fitness partially programmed at birth? Role of body composition

OBJECTIVE

To determine whether birth weight is associated with handgrip strength and cardiovascular fitness in adolescence and, if so, how these associations are influenced by current body composition.

STUDY DESIGN

A total of 1801 adolescents (983 females), age 13 to 18.5 years, from the AVENA (Alimentación y Valoración del Estado Nutricional de los Adolescentes Españoles [Food and Assessment of the Nutritional Status of Spanish Adolescents]) study were evaluated. Handgrip strength and cardiovascular fitness were assessed using the handgrip test and the 20-m shuttle run test, respectively.

RESULTS

Birth weight was positively associated with handgrip strength in females after controlling for current age, gestational age, breast-feeding, and adolescent body mass index (P = .002), body fat percentage (P < .001), or waist circumference (P = .005), but not after controlling for fat-free mass. The associations were similar yet weaker in males. Females with high birth weight (>90th percentile) had greater handgrip strength than those with normal (10th to 90th percentile) or low (<10th percentile) birth weight, after adjusting for body fat percentage (P = .004). All of the differences became nonsignificant after adjusting for adolescent fat-free mass. Birth weight was not associated with cardiovascular fitness.

CONCLUSIONS

High birth weight is associated with greater handgrip strength in adolescents, especially in females, yet these associations seem to be highly explained by fat-free mass.

Length of prenatal participation in WIC and risk of delivering a small for gestational age infant: Florida, 1996-2004

OBJECTIVE

To assess the association between length of prenatal participation in WIC and a marker of infant morbidity. By focusing on small for gestational age, we consider one of the possible pathways through which prenatal nutrition affects fetal growth.

DESIGN/METHODS

The study sample consists of 369,535 matched mother-infant pairs drawn from all singleton live births in Florida hospitals from 1996 to 2004. All subjects received WIC and Medicaid-funded prenatal services during pregnancy. We controlled for selection bias on observed variables using a generalized propensity scoring approach and performed separate analyses by gestational age category to control for simultaneity bias.

RESULTS

Ten percent increase in the percent of time in WIC was associated with 2.5% decrease (95% CI: 2.1-3.0%) in the risk of a full-term an SGA infant. The risk was also significantly decreased for very preterm and late preterm infants (29-33 and 34-36 weeks gestation) but not for extremely preterm infants (23-28 weeks gestation).

CONCLUSIONS

The observed small negative dose response relationship between percent of pregnancy spent in WIC and fetal growth restriction implies that longer participation in the program confers a small measure of protection against delivering an SGA infant.

Diet and pregnancy status in Australian women

OBJECTIVE

To investigate and report the diet quality of young Australian women by pregnancy status.

DESIGN

Pregnancy status was defined as pregnant (n 606), trying to conceive (n 454), had a baby in the last 12 months (n 829) and other (n 5597). The Dietary Questionnaire for Epidemiological Studies was used to calculate diet quality using the Australian Recommended Food Score (ARFS) methodology. Nutrient intakes were compared with the Nutrient Reference Values for Australia and New Zealand.

SETTING

A population-based cohort participating in the Australian Longitudinal Study on Women's Health (ALSWH).

SUBJECTS

A nationally representative sample of Australian women, aged 25 to 30 years, who completed Survey 3 of the ALSWH. The 7486 women with biologically plausible energy intake estimates, defined as >4.5 but <20.0 MJ/d, were included in the analyses.

RESULTS

Pregnancy status was not significantly predictive of diet quality, before or after adjusting for area of residence and socio-economic status. Pregnant women and those who had given birth in the previous 12 months had marginally higher ARFS (mean (se): 30.2 (0.4) and 30.2 (0.3), respectively) than 'other' women (29.1 (0.1)). No single food group accounted for this small difference. Across all pregnancy categories there were important nutrients that did not meet the current nationally recommended levels of intake, including dietary folate and fibre.

CONCLUSION

Women do not appear to consume a wider variety of nutritious foods when planning to become pregnant or during pregnancy. Many young Australian women are failing to meet key nutrient targets as nationally recommended.

Meeting report: atmospheric pollution and human reproduction

BACKGROUND

There is a growing body of epidemiologic literature reporting associations between atmospheric pollutants and reproductive outcomes, particularly birth weight and gestational duration.

OBJECTIVES

The objectives of our international workshop were to discuss the current evidence, to identify the strengths and weaknesses of published epidemiologic studies, and to suggest future directions for research.

DISCUSSION

Participants identified promising exposure assessment tools, including exposure models with fine spatial and temporal resolution that take into account time-activity patterns. More knowledge on factors correlated with exposure to air pollution, such as other environmental pollutants with similar temporal variations, and assessment of nutritional factors possibly influencing birth outcomes would help evaluate importance of residual confounding. Participants proposed a list of points to report in future publications on this topic to facilitate research syntheses. Nested case-control studies analyzed using two-phase statistical techniques and development of cohorts with extensive information on pregnancy behaviors and biological samples are promising study designs. Issues related to the identification of critical exposure windows and potential biological mechanisms through which air pollutants may lead to intrauterine growth restriction and premature birth were reviewed.

CONCLUSIONS

To make progress, this research field needs input from toxicology, exposure assessment, and clinical research, especially to aid in the identification and exposure assessment of feto-toxic agents in ambient air, in the development of early markers of adverse reproductive outcomes, and of relevant biological pathways. In particular, additional research using animal models would help better delineate the biological mechanisms underpinning the associations reported in human studies.

Dietary behaviors, physical activity, and cigarette smoking among pregnant Puerto Rican women

BACKGROUND

Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women.

OBJECTIVE

We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients.

DESIGN

Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings.

RESULTS

Approximately 13% of women met physical activity guidelines [>or=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9).

CONCLUSION

Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.

Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome

It is the position of the American Dietetic Association that women of child-bearing ages should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain; appropriate physical activity; consumption of a variety of foods in accordance with the Dietary Guidelines for Americans 2005; appropriate and timely vitamin and mineral supplementation; avoidance of alcohol, tobacco, and other harmful substances; and safe food handling. Pregnant women with inappropriate weight gain, hyperemesis, poor dietary patterns, phenylketonuria, certain chronic health problems, or a history of substance abuse should be referred to a registered dietitian for medical nutrition therapy. Prenatal weight gain within the Institute of Medicine recommended ranges has been associated with better pregnancy outcomes. Most pregnant women need 2,200 to 2,900 kcal a day, but prepregnancy body mass index, rate of weight gain, maternal age, and appetite must be considered when tailoring this recommendation to the individual. The consumption of more food to meet energy needs, and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy, are generally adequate to meet the needs for most nutrients. However, vitamin and mineral supplementation is appropriate for some nutrients and situations. This position paper also includes recommendations pertaining to use of alcohol, tobacco, caffeine, and illicit drugs.

A life course of adiposity and dementia

Adiposity, commonly measured as body mass index (BMI), may influence or be influenced by brain structures and functions involved in dementia processes. Adipose tissue changes in degree and intensity over the lifespan, and has been shown to influence brain development in relationship to early and late measures of cognitive function, intelligence, and disorders of cognition such as dementia. A lower BMI is associated with prevalent dementia, potentially due to underlying brain pathologies and correspondingly greater rates of BMI or weight decline observed during the years immediately preceding clinical dementia onset. However, high BMI during mid-life or at least approximately 5-10 years preceding clinical dementia onset may increase risk. The interplay of adiposity and the brain occurring over the course of the lifespan will be discussed in relationship to developmental origins, mid-life sequelae, disruptions in brain structure and function, and late-life changes in cognition and dementia. Characterizing the life course of adiposity among those who do and do not become demented enhances understanding of biological underpinnings relevant for understanding the etiologies of both dementia and obesity and their co-existence.

Maternal supply of omega-3 polyunsaturated fatty acids alter mechanisms involved in oocyte and early embryo development in the mouse

Despite the well-known benefits of omega-3 (n-3) polyunsaturated fatty acid (PUFA) supplementation on human health, relatively little is known about the effect of n-3 PUFA intake on fertility. More specifically, the aim of this study was to determine how oocyte and preimplantation embryo development might be influenced by n-3 PUFA supply and to understand the possible mechanisms underlying these effects. Adult female mice were fed a control diet or a diet relatively high in the long-chain n-3 PUFAs for 4 wk, and ovulated oocytes or zygotes were collected after gonadotropin stimulation. Oocytes were examined for mitochondrial parameters (active mitochondrial distribution, mitochondrial calcium and membrane potential) and oxidative stress, and embryo developmental ability was assessed at the blastocyst stage following 1) in vitro fertilization (IVF) or 2) culture of in vivo-derived zygotes. This study demonstrated that exposure of the oocyte during maturation in the ovary to an environment high in n-3 PUFA resulted in altered mitochondrial distribution and calcium levels and increased production of reactive oxygen species. Despite normal fertilization and development in vitro following IVF, the exposure of oocytes to an environment high in n-3 PUFA during in vivo fertilization adversely affected the morphological appearance of the embryo and decreased developmental ability to the blastocyst stage. This study suggests that high maternal dietary n-3 PUFA exposure periconception reduces normal embryo development in the mouse and is associated with perturbed mitochondrial metabolism, raising questions regarding supplementation with n-3 PUFAs during this period of time.

Food security, poverty, and human development in the United States

Access to food is essential to optimal development and function in children and adults. Food security, food insecurity, and hunger have been defined and a U.S. Food Security Scale was developed and is administered annually by the Census Bureau in its Current Population Survey. The eight child-referenced items now make up a Children's Food Security Scale. This review summarizes the data on household and children's food insecurity and its relationship with children's health and development and with mothers' depressive symptoms. It is demonstrable that food insecurity is a prevalent risk to the growth, health, cognitive, and behavioral potential of America's poor and near-poor children. Infants and toddlers in particular are at risk from food insecurity even at the lowest levels of severity, and the data indicate an "invisible epidemic" of a serious condition. Food insecurity is readily measured and rapidly remediable through policy changes, which a country like the United States, unlike many others, is fully capable of implementing. The food and distribution resources exist; the only constraint is political will.