Nutrient Requirements during Pregnancy and Lactation

The Importance of Natural Antioxidants in Female Reproduction

Oxidative stress (OS) has an important role in female reproduction, whether it is ovulation, endometrium decidualization, menstruation, oocyte fertilization, or development andimplantation of an embryo in the uterus. The menstrual cycle is regulated by the physiological concentration of reactive forms of oxygen and nitrogen as redox signal molecules, which trigger and regulate the length of individual phases of the menstrual cycle. It has been suggested that the decline in female fertility is modulated by pathological OS. The pathological excess of OS compared to antioxidants triggers many disorders of female reproduction which could lead to gynecological diseases and to infertility. Therefore, antioxidants are crucial for proper female reproductive function. They play a part in the metabolism of oocytes; in endometrium maturation via the activation of antioxidant signaling pathways Nrf2 and NF-κB; and in the hormonal regulation of vascular action. Antioxidants can directly scavenge radicals and act as a cofactor of highly valuable enzymes of cell differentiation and development, or enhance the activity of antioxidant enzymes. Compensation for low levels of antioxidants through their supplementation can improve fertility. This review considers the role of selected vitamins, flavonoids, peptides, and trace elements with antioxidant effects in female reproduction mechanisms.

Improving Dietary Zinc Bioavailability Using New Food Fortification Approaches: A Promising Tool to Boost Immunity in the Light of COVID-19

Zinc is a powerful immunomodulatory trace element, and its deficiency in the body is closely associated with changes in immune functions and viral infections, including SARS-CoV-2, the virus responsible for COVID-19. The creation of new forms of zinc delivery to target cells can make it possible to obtain smart chains of food ingredients. Recent evidence supports the idea that the optimal intake of zinc or bioactive compounds in appropriate supplements should be considered as part of a strategy to generate an immune response in the human body. Therefore, controlling the amount of this element in the diet is especially important for populations at risk of zinc deficiency, who are more susceptible to the severe progression of viral infection and disease, such as COVID-19. Convergent approaches such as micro- and nano-encapsulation develop new ways to treat zinc deficiency and make zinc more bioavailable.

[Hematologic and nutritional states are associated with the development of preeclampsia in a Mexican population]

Introduction

Introduction: nutrient and trace element deficiency are risk factors for the development of preeclampsia; these nutrients induce changes in the hematologic state, which can be used to prevent complications during pregnancy. Objective: this research will analyze the nutritional and hematological status during the 3 trimesters of gestation in pregnant women with preeclampsia to evaluate its association with gestational alterations. Method: a cross-sectional, descriptive, and analytic study was conducted on 78 pregnant women who attended a prenatal control clinic, 11 of whom were diagnosed with preeclampsia. The hematological parameters were determined through hematometry. To get the nutritional intake profile of the pregnant women, a frequency of food consumption questionnaire was used. Results: the normotensive group´s arterial pressure (PA) was significantly lower than that of pregnant women with preeclampsia. The hematological profile changed during pregnancy, and platelet value was much higher in preeclamptic women. The nutritional status of pregnant women in the third trimester consumed more macronutrients and micronutrients than in the first and second trimesters, and this pattern was observed in pregnant women with preeclampsia. When compared to pregnant women with preeclampsia, normotensive women received more minerals and vitamins. Conclusion: hematological values are modified during each trimester of gestation, and pregnant women with preeclampsia had high platelet values compared to normotensive women. Our data show a greater intake of minerals and vitamins in normotensive pregnant women as compared to those who developed preeclampsia; therefore, it is recommended that pregnant women be provided with nutritional guidance in order to prevent pregnant complications.

Mobile Phone-Based Nutrition Education Targeting Pregnant and Nursing Mothers in Sri Lanka

INTRODUCTION

A woman's nutrition during pregnancy and nursing affects the mother and the growing child. Similarly, the first two years of a child's life are critical to their growth and development and are facilitated by optimum nutrition. Women's nutrition-related knowledge, attitudes, and practices influence household food and nutrition security. Mobile health (mHealth) is a potentially effective health intervention in pandemic situations when physical gatherings are restricted.

OBJECTIVES

To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas.

METHOD

This intervention was evaluated using a before and after within-subjects design. The intervention included 19 messages over four weeks sent via mobile phone, covering nutrition themes such as pregnancy care, infant and young child-feeding, diet, family care for mother and child, and cash management. The intervention was evaluated based on a quantitative survey using a structured interviewer-administered questionnaire and qualitative interviews using a semi-structured questionnaire. The study population was pregnant and nursing mothers. The objective of the qualitative interviews was to identify how respondents used messages and how satisfied they were with the project. The outcome measures were awareness/knowledge, attitudes, social norms, self-efficacy, behaviour intentions, and practices of pregnant and nursing mothers. Trained enumerators collected data using a mobile phone.

RESULTS

A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = -18.70, p < 0.01) and attitudes (t = -2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers' practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses.

CONCLUSION AND RECOMMENDATIONS

The mobile intervention improved participants' knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.

Prevalence of harmful traditional practices during pregnancy and associated factors in Southwest Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the prevalence of harmful traditional practices during pregnancy and associated factors in Southwest Ethiopia.

DESIGN

A community-based cross-sectional study.

SETTING

Southwest Ethiopia.

PARTICIPANTS

667 women who were pregnant at the time of the study or gave birth 2 years prior to the study have participated.

OUTCOME OF THE STUDY

Harmful traditional practices during pregnancy (yes/no). Harmful traditional practices during pregnancy include abdominal massage, herbal intake or food taboos done on/by pregnant women without health professionals' instruction.

RESULTS

The prevalence of harmful traditional practices in the study area was 37%, 95% CI (33.4% to 40.8%). The most commonly practised activities were abdominal massage (72.9%), intake of herbs (63.9%) and food taboos (48.6%). Monthly income (AOR=3.13, 95% CI (1.83 to 5.37), p<0.001), having had no history of child death (AOR=2.74, 95% CI (1.75 to 4.29), p<0.001), women with no formal education (AOR=4.81, 95% CI (2.50 to 9.23), p<0.001), women who had antenatal care (ANC) visits during their last pregnancy (AOR=0.24, 95% CI (0.10 to 0.59), p=0.002) and being multipara (AOR=0.47, 95% CI (0.27 to 0.80), p=0.003) were significantly associated with harmful traditional practices during pregnancy.

CONCLUSION

Our study showed that more than one-third of women in Southwest Ethiopia practised harmful traditional practices while they were pregnant. The practices were more common among primiparas, women who had lower educational and financial status, women with no ANC visits, and women with no history of child death. Health education should be given to the community about the complications of harmful traditional practices during pregnancy.

Effects of vitamin D supplementation during pregnancy on bone health and offspring growth: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Whether vitamin D supplementation during pregnancy is beneficial to bone health and offspring growth remains controversial. Moreover, there is no universal agreement regarding the appropriate dose and the time of commencement of vitamin D supplementation during pregnancy.

OBJECTIVE

We aimed to systematically review the effects of vitamin D supplementation during pregnancy on bone development and offspring growth.

METHODS

A literature search for randomized controlled trials (RCTs) was performed in 7 electronic databases to identify relevant studies about the effects of vitamin D supplementation during pregnancy on bone development and offspring growth from inception to May 22, 2022. A Cochrane Risk Assessment Tool was used for quality assessment. Vitamin D supplementation was compared with placebo or standard supplements. The effects are presented as the mean differences (MDs) with 95% CIs. The outcomes include bone mineral content (BMC), bone mineral density (BMD), bone area (BA), femur length (FL) and humeral length (HL); measurement indicators of growth, including length, weight and head circumference; and secondary outcome measures, including biochemical indicators of bone health, such as the serum 25(OH)D concentration. Additionally, subgroup analyses were carried out to evaluate the impact of different doses and different initiation times of supplementation with vitamin D.

RESULTS

Twenty-three studies with 5390 participants met our inclusion criteria. Vitamin D supplementation during pregnancy was associated with increased humeral length (HL) (MD 0.13, 95% CI 0.06, 0.21, I2 = 0, P = 0.0007) during the fetal period (third trimester). Vitamin D supplementation during pregnancy was associated with a significantly increased length at birth (MD 0.14, 95% CI 0.04, 0.24, I2 = 24%, P = 0.005) and was associated with a higher cord blood 25(OH)D concentration (MD 48.74, 95% CI 8.47, 89.01, I2 = 100%, P = 0.02). Additionally, subgroup analysis revealed that birth length was significantly higher in the vitamin D intervention groups of ≤1000 IU/day and ≥4001 IU/day compared with the control group. Prenatal (third trimester) vitamin D supplementation was associated with a significant increase in birth length, while prenatal (second trimester) vitamin D supplementation was associated with a significant increase in birth weight.

CONCLUSION

Vitamin D supplementation during pregnancy may be associated with increased humeral length (HL) in the uterus, increased body length at birth and higher cord blood 25(OH)D concentration. Evidence of its effect on long-term growth in children is lacking. Additional rigorous high-quality, long-term and larger randomized trials are required to more fully investigate the effects of vitamin D supplementation during pregnancy.

Optimizing Maternal Nutrition: The Importance of a Tailored Approach

Improving nutritional status during pregnancy is a global interest. Frequently, women either fail to meet or exceed nutrient recommendations. Current strategies to improve maternal nutrition focus on a "one-size-fits-all" approach and fail to consider individual factors that affect the mother's overall nutritional status. The objectives of this review were to determine the importance of key nutrients for optimal maternal and fetal health, to explore to what extent current recommendations consider individual factors, and to explore novel strategies to close the gap between current guidelines and real-world challenges through more personalized approaches. This review intercalated different nutritional guidelines and recent scientific publications and research initiatives related to maternal nutrition. Based on that, an overview of current recommendations, challenges related to present approaches, and perspectives for future directions are described. Current guidelines are not optimally supporting adequate nutrient intake and health of expectant mothers and their offspring. Existing recommendations are not consistent and do not sufficiently take into account how interindividual variation leads to differences in nutrient status. Personalized nutrition offers women the opportunity to improve their health by using strategies that are tailored to their unique nutritional needs. Such strategies can include personalized supplementation, holistic lifestyle interventions, digital and application-based technologies, and dietary assessment through blood biomarker and genetic analysis. However, these approaches warrant further investigation and optimization. More personalized approaches have the potential to optimize mothers' and their offspring's health outcomes more appropriately to their nutritional needs before, during, and after pregnancy. Moving away from a generalized "one-size-fits-all" approach can be achieved through a variety of means. Future aims should be to provide supporting evidence to create customized subpopulation-based or individualized recommendations, improve nutrition education, and develop novel approaches to improve adherence to dietary and lifestyle interventions.

Nutrition recommendations for a healthy pregnancy and lactation in women with overweight and obesity - strategies for weight loss before and after pregnancy

A healthy eating pattern is recommended for all life stages and is central to achieving optimal pregnancy outcomes and successful lactation. The preconception period is a critical window of time during which good nutritional status benefits both the mother and the offspring. The ongoing overweight and obesity epidemic, especially in conjunction with poor nutritional status, presents maternal and infant health risks. Preconception and postpartum weight loss are routinely recommended in clinical practice. In this review, we discuss the nutritional recommendations for healthy weight loss during these periods. Unhealthy weight loss during preconception and for lactating women, can cause adverse maternal consequences that can impact the offspring.

Facile bimetallic co-amplified electrochemical sensor for folic acid sensing based on CoNPs and CuNPs

Folic acid (FA) is essential for human health, particularly for pregnant women and infants. In this work, a glassy carbon electrode (GCE) was modified by a bimetallic layer of Cu/Co nanoparticles (CuNPs/CoNPs) as a synergistic amplification element by simple step-by-step electrodeposition, and was used for sensitive detection of FA. The proposed CuNPs/CoNPs/GCE sensor was characterized by differential pulse voltammetry (DPV), electrochemical impedance spectroscopy (EIS) and field emission scanning electron microscopy (FESEM). Then, under optimal conditions, a linear relationship was obtained in the wide range of 110.00-1750.00 μM for the detection of FA with a limit of detection (LOD) of 34.79 μM (S/N = 3). The sensitivity was calculated as 0.096 μA μM^-1 cm^-2. Some interfering compounds including glucose (Glc), biotin, dopamine (DA), and glutamic acid (Glu) showed little effect on the detection of FA by amperometry (i-t). Finally, the average recovery obtained was in a range of 91.77-110.06%, with a relative standard deviation (RSD) less than 8.00% in FA tablets, indicating that the proposed sensor can accurately and effectively detect the FA content in FA tablets.

Vitamin A Nutritional Status of Urban Lactating Chinese Women and Its Associated Factors

We aimed to investigate dietary vitamin A (DVA) intake, serum vitamin A (SVA) concentrations, and breast milk vitamin A (BMVA) concentrations of urban lactating Chinese women and explore the associated factors. We recruited 326 lactating women from ten cities in China and collected their dietary information, blood samples, and breast milk samples. SVA and BMVA were assessed with high-performance liquid chromatography. Mann–Whitney U tests, Kruskal–Wallis H tests, Chi-square tests, Spearman correlation tests, and multiple regression analyses were conducted. The median (25th, 75th) of DVA, SVA and BMVA were 372.36 (209.12, 619.78) μg RAE/day, 1.99 (1.71, 2.35) μmol/L, and 1.67 (1.13, 2.15) μmol/L, respectively. Only 3.1% of lactating women met the recommended nutrient intake of Vitamin A (VA), and 20.6% had a BMVA level below 1.05 μmol/L. Compared to underweight or normal weight women, overweight or obese lactating women had lower DVA and BMVA but higher SVA (p = 0.022; p = 0.030; p = 0.003). Multiparous women had a higher risk of inadequate BMVA (p = 0.023) than primiparous women. SVA and BMVA were positively associated with DVA, especially for lactating women not using VA supplements (β = 0.174, 95%CI = 0.025, 0.324, p = 0.022; β = 0.501, 95%CI = 0.208, 0.795, p = 0.001). There was no association between SVA and BMVA (β = 0.165, 95%CI = −0.037, 0.366, p = 0.109). In conclusion, VA nutritional status among Chinese urban lactating women needs more attention, especially for those who are obese, overweight, or higher parity. Increased DVA may contribute to increased BMVA.

Caffeine, Paraxanthine, Theophylline, and Theobromine Content in Human Milk

This study aimed to assess the content of caffeine and its metabolites—paraxanthine, theophylline, and theobromine—in breast milk according to selected factors. Samples of human milk were collected from 100 women living in the east–northeast region of Poland. Information on the consumption of beverages and foods containing caffeine was collected using a 3 day food record. The determination of caffeine and its metabolite content was performed using liquid chromatography–mass spectrometry (LC–MS/MS). This study research showed that more caffeine was found in the milk of women living in cities, with secondary education, aged 34–43, and also in milk from the 3rd and 4th lactation periods (p ≤ 0.05). Factors such as place of residence, level of education, age, and stage of lactation influenced the nutritional choices of breastfeeding women, which had an impact on the level of caffeine and its metabolites in breast milk. A positive correlation was found between the consumption of caffeine with food and drinks and its level in human milk.

Iodine Supplementation in Pregnancy in an Iodine-Deficient Region: A Cross-Sectional Survey

Iodine deficiency is a common problem in pregnant women and may have implications for maternal and child health. Iodine supplementation during pregnancy has been recommended by several scientific societies. We undertook a cross-sectional survey to assess the efficacy of these recommendations in a European iodine-deficient region. Urinary iodine concentrations (UIC) were determined in pregnant women before (n = 203) and after (n = 136) the implementation of guidelines for iodine supplementation in pregnancy. Iodine supplementation (200 μg/day) reduced the proportion of pregnant women with severe iodine deficiency (37.4% to 18.0%, p = 0.0002). The median UIC increased from 67.6 µg/L to 106.8 µg/L but remained below the recommended target level (>150 µg/L) for pregnant women. In conclusion, iodine supplementation in pregnant women improved iodine status in this iodine-deficient region but was insufficient to achieve recommended iodine levels in pregnancy. Additional measures, such as the adjustment of the dose or timing of supplementation, or universal salt iodization, may be needed.

Beliefs and Norms Associated with the Use of Ultra-Processed Commercial Milk Formulas for Pregnant Women in Vietnam

Commercial milk formula for pregnant women (CMF-PW) is an expensive, ultra-processed food with a high concentration of sugar, the consumption of which may be linked to negative health outcomes. However, CMF-PWs are promoted as beneficial for pregnant women and lactating mothers as well as their children. To date, little is known about the factors associated with the use of CMF-PW among pregnant women. We performed this analysis to examine the association between the use of CMF-PW and related beliefs and norms among pregnant women in Vietnam. We interviewed 268 pregnant women in their second and third trimesters from two provinces and one municipality representing diverse communities in Vietnam. Multinomial (polytomous) logistic regression, structural equation modeling (SEM), and propensity score matching (PSM) analysis were used to examine associations between beliefs and social norms related to CMF-PW and reported consumption, characterized as occasional, recent, and never during the current pregnancy. Overall, 64.6% of pregnant women reported using CMF-PW during the current pregnancy and 34.7% consumed CMF-PW on the day prior to the interview. Strong beliefs that CMF-PW will make a child smart and healthy (53.7%) and the perception that use of CMF-PW is common (70.9%) were associated with increased use on the previous day (beliefs: aOR: 3.56; 95% Confidence Interval (95% CI): 1.65, 7.71; p < 0.01 and social norms aOR: 2.29; 95% CI: 1.13, 4.66; p < 0.05). SEM and PSM analyses confirmed these findings for both occasional and regular CMF-PW use. Results are consistent with observations of CMF-PW product labels and marketing tactics in Vietnam. The prevalent use of CMF-PW in Vietnam is associated with the belief that these products make children smart and healthy and the perceived social norm that most mothers use these products, which mirrors marketing messages and approaches employed by the CMF industry.