Physiology of pregnancy and nutrient metabolism

Fructose consumption during pregnancy and lactation induces fatty liver and glucose intolerance in rats

Nutritional insults during pregnancy and lactation are health risks for mother and offspring. Both fructose (FR) and low-protein (LP) diets are linked to hepatic steatosis and insulin resistance in nonpregnant animals. We hypothesized that dietary FR or LP intake during pregnancy may exacerbate the already compromised glucose homeostasis to induce gestational diabetes and fatty liver. Therefore, we investigated and compared the effects of LP or FR intake on hepatic steatosis and insulin resistance in unmated controls (CTs) and pregnant and lactating rats. Sprague-Dawley rats were fed a CT, or a 63% FR, or an 8% LP diet. Glucose tolerance test at day 17 of the study revealed greater (P < .05) blood glucose at 10 (75.6 mg/dL vs 64.0 ± 4.8 mg/dL) minutes and 20 (72.4 mg/dL vs 58.6 ± 4.0 mg/dL) minutes after glucose dose and greater area under the curve (4302.3 mg∙dL(-1)∙min(-1) vs 3763.4 ± 263.6 mg∙dL(-1)∙min(-1)) for FR-fed dams compared with CT-fed dams. The rats were euthanized at 21 days postpartum. Both the FR- and LP-fed dams had enlarged (P < .05) livers (9.3%, 7.1% body weight vs 4.8% ± 0.2% body weight) and elevated (P < .05) liver triacylglycerol (216.0, 130.0 mg/g vs 19.9 ± 12.6 mg/g liver weight) compared with CT-fed dams. Fructose induced fatty liver and glucose intolerance in pregnant and lactating rats, but not unmated CT rats. The data demonstrate a unique physiological status response to diet resulting in the development of gestational diabetes coupled with hepatic steatosis in FR-fed dams, which is more severe than an LP diet.

Available versus digestible amino acids – new stable isotope methods

The nutritive value of food protein sources is dependent on the amino acid composition and the bioavailability of the nutritionally indispensable amino acids. Traditionally the methods developed to determine amino acid bioavailability have focused on intestinal absorption or digestibility, which is calculated as the percent of amino acid intake that does not appear in digesta or faeces. Traditional digestibility based methods do not always account for gut endogenous amino acid losses or absorbed amino acids which are unavailable due to the effect of heat processing and the presence of anti-nutritional factors, though methods have been developed to address these issues. Furthermore, digestibility based methods require the use of animal models, thus there is a need to developin vivomethods that can be applied directly in human subjects to identify the proportion of dietary amino acids which is bioavailable, or metabolically available to the body for protein synthesis following digestion and absorption. The indicator amino acid oxidation (IAAO) method developed in our laboratory for humans has been systematically applied to determine almost all indispensable amino acid requirements in adult humans. Oxidation of the indicator amino acid is inversely proportional to whole body protein synthesis and responds rapidly to changes in the bioavailability of amino acids for metabolic processes. Using the IAAO concept, we developed a newin vivomethod in growing pigs, pregnant sows and adult humans to identify the metabolic availability of amino acids in foods. The stable isotope based metabolic availability method is suitable for rapid and routine analysis in humans, and can be used to integrate amino acid requirement data with dietary amino acid availability of foods.

Maternal zinc intakes and homeostatic adjustments during pregnancy and lactation

Zinc plays critical roles during embryogenesis, fetal growth, and milk secretion, which increase the zinc need for pregnancy and lactation. Increased needs can be met by increasing the dietary zinc intake, along with making homeostatic adjustments in zinc utilization. Potential homeostatic adjustments include changes in circulating zinc, increased zinc absorption, decreased zinc losses, and changes in whole body zinc kinetics. Although severe zinc deficiency during pregnancy has devastating effects, systematic reviews and meta-analysis of the effect of maternal zinc supplementation on pregnancy outcomes have consistently shown a limited benefit. We hypothesize, therefore, that zinc homeostatic adjustments during pregnancy and lactation improve zinc utilization sufficiently to provide the increased zinc needs in these stages and, therefore, mitigate immediate detrimental effects due to a low zinc intake. The specific questions addressed are the following: How is zinc utilization altered during pregnancy and lactation? Are those homeostatic adjustments influenced by maternal zinc status, dietary zinc, or zinc supplementation? These questions are addressed by critically reviewing results from published human studies on zinc homeostasis during pregnancy and lactation carried out in different populations worldwide.

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.

Serum retinol is associated with stage of pregnancy and the acute phase response in pregnant women in Guinea-Bissau

Vitamin A deficiencies in pregnancy may impair the health of the mother and the growth, development, and later health of her offspring. However, the understanding of the variability of micronutrient status markers during pregnancy is limited. We measured serum retinol and β-carotene and the acute phase proteins C-reactive protein (CRP) and α(1)-antichymotrypsin (ACT) in 738 pregnant women in a cross-sectional study in Guinea-Bissau, West Africa. Gestational age ranged from 7 to 42 wk (mean ± SD = 23 ± 7 wk). The serum retinol concentration was 1.03 ± 0.33 μmol/L (mean ± SD) whereas serum β-carotene was 1.40 (0.85, 2.13) μmol/L [median (25, 75 percentile)]. Vitamin A deficiency (serum retinol <0.70 μmol/L) was observed in 13.8% of individuals. Serum CRP was elevated (>3 mg/L) in 51.6% of individuals and ACT (>0.3 g/L) in 66.3%. Gestational age >20 wk (β = -0.11; P < 0.001) as well as elevated serum CRP (β = -0.16; P < 0.001) and ACT (β = -0.80; P = 0.004) were associated with lower serum retinol. Based on this large cross-sectional study, we suggest that serum retinol and its conventional cutoff may be underestimating the vitamin A status in late pregnancy and in populations with high prevalence of infections. However, prospective cohort studies measuring the serum concentration of retinol during and after pregnancy and inflammation are needed to describe the physiological behavior of serum retinol and thereby to improve the assessment of vitamin A status.

Can we modify the intrauterine environment to halt the intergenerational cycle of obesity?

Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.

Maternal intake of fatty acids during pregnancy and allergies in the offspring

Fatty acids (FA) are known to have a number of immunological effects and, accordingly, may play a role in the development of allergic diseases. We investigated the effect of maternal intake of FA during pregnancy on the risk of allergic rhinitis, wheeze and atopic eczema in children aged 5 years. The present study analysed data from the Finnish Type 1 Diabetes Prediction and Prevention Nutrition Study, a population-based birth cohort study with a 5-year follow-up. Complete information on maternal diet (assessed by a validated FFQ) and International Study of Asthma and Allergies in Childhood-based allergic outcomes was available for 2441 children. Cox proportional regression and logistic regression were used for the analyses. After adjusting for potential confounding variables, high maternal consumption of butter and butter spreads (hazard ratio (HR) 1.33; 95 % CI 1.03, 1.71) and higher ratio of n-6:n-3 FA (HR 1.37; 95 % CI 1.07, 1.77) during pregnancy were associated with an increased risk of allergic rhinitis in the offspring by 5 years of age. High maternal intakes of total PUFA (HR 0.71; 95 % CI 0.52, 0.96) and α-linolenic FA (HR 0.73; 95 % CI 0.54, 0.98) were associated with a decreased risk of allergic rhinitis. However, these results lost their significance after adjustment for multiple comparisons. Overall, our data suggest that maternal consumption of butter, the ratio of n-6:n-3 FA and intake of PUFA and α-linolenic FA during pregnancy may be potential determinants of allergic rhinitis in the offspring.

Electrophoretic serum protein fraction profile during the different physiological phases in Comisana ewes

The aim of this study was to evaluate the influence of different physiological phases on serum total proteins and their fractions of ten Comisana ewes housed in Mediterranean area. From each animal, blood samples were collected at different physiological phases: late pregnancy, post-partum, early, mid-, end lactation and dry period. On all samples serum total proteins were determined by the biuret method, and albumin, α-globulins, β(1) -globulins, β(2) -globulins and γ-globulins concentrations were assessed using an automated system. One-way repeated measures analysis of variance was applied to determine the significant effect of different physiological phases on the parameters studied. During the late pregnancy and post-partum, total proteins, β1- and β2-globulins and γ-globulins showed the highest values. Starting from post-partum, α-globulins increased to reach their peaks in mid-lactation. Early lactation was characterized by low γ-globulins values. The increase in serum albumin concentration and the drop in some globulin fractions determined the significant increase in albumin/globulin ratio. The obtained results contributed to improve the knowledge on electrophoretic profile during the different physiological phases in ewes, confirming that pregnancy and lactation periods affect the protein metabolism. Particularly, serum protein fractions pattern could give information about dehydration, plasma volume expansion and hepatic function, which occur during the different physiological phases. Dynamics of the protein profile - from pregnancy to dry period - which are provided by our results, could be considered as guidelines for the management strategies to guarantee the nutritional needs of these animals during the different physiological phases and to avoid a decline of productive performance and consequently an economic loss.

Maternal vitamin D during pregnancy and its relation to immune-mediated diseases in the offspring

Vitamin D deficiency during pregnancy is fairly common in many parts of the world. However, currently there is no consensus on the optimal vitamin D intake during pregnancy. Vitamin D is known to be of great importance for the homeostatic functions within the immune system. Maternal vitamin D status during pregnancy may therefore affect the developing immune system of the fetus, thus contributing to the later development of immune-mediated diseases. This chapter introduces the basics of vitamin D during pregnancy and discusses the role of maternal vitamin D intake in the development of asthma, allergic diseases, autoimmune diseases, cancer, and infections in the offspring. So far, the strongest observational evidence underlines the potential of maternal vitamin D intake during pregnancy to influence the likelihood of asthma and allergic outcomes in the offspring. Somewhat conflicting findings imply that there might be critical time windows of exposure to adequate vitamin D levels during pregnancy. More research is needed in order to fully understand the contribution of maternal vitamin D status during pregnancy to the progress of immune-mediated diseases.

Evidence-based risk assessment and recommendations for physical activity clearance: pregnancy1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process

Recommendations for physical activity during pregnancy have progressed significantly in the last 30 years and continue to evolve as an increasing body of scientific evidence becomes available. In addition, there is an increasing number of women who wish to either maintain physical fitness levels during the prenatal period or initiate exercise for a healthier lifestyle during pregnancy. As such, consistent evaluation of the risks associated with exercise during pregnancy is warranted for maternal and fetal well-being. The primary purpose of this systematic review was to evaluate the scientific information available regarding maternal and fetal responses as it relates to the occurrence of adverse exercise-related events in pregnant women without contraindications to exercise. A systematic and evidence-based approach was used to analyze critically the level of evidence for risks associated with acute and chronic exercise during pregnancy in healthy pregnant women. All articles were screened according to standardized evaluation criteria developed by a panel of experts. A total of 74 investigations that involved 3766 pregnant women were included in the analysis. Of the 74 studies, only 35 studies documented the presence or absence of adverse events. The serious adverse event rate for these studies was 1.4 per 10 000 h of exercise. The adverse event rate increased to 6.8 per 10 000 h of exercise when including the occurrence of more mild events and exercise-related fetal bradycardia and tachycardia. Previously inactive or active women (without contraindications) are at a low risk for adverse fetal or maternal events if they participate in routine physical activity during pregnancy.

Prediction of nutritive intake energy and substrates of Czech pregnant women

OBJECTIVE

Equations linking nutritional intake of energy and substrates (NIES) to anthropometry during pregnancy are currently unknown. The aim of this longitudinal study was to determine the predictive equations for NIES as an expression of dietary patterns.

METHODS

In total, 152 randomly recruited healthy pregnant Czech women (non-smokers, non-users of long-term medications or abusers of alcohol or drugs, normoglycemic, euthyroid, and non-anemic) were divided into two cohorts: group 1 (n = 31) was used for the determination of equations for NIES during pregnancy, and group 2 (n = 121) for cross-validation of these equations. In both study groups, anthropometry was measured and resting energy expenditure obtained by indirect calorimetry after 12 h of fasting during four phases of pregnancy. NIES was evaluated from self-reported dietary intake records over 7 d.

RESULTS

Strong relations were found between NIES and anthropometric parameters, especially the difference between pregnancy body weight and ideal body weight. By correlation analysis and linear regression, new predictive equations were derived for NIES during pregnancy using the difference between pregnancy body weight and ideal body weight. A high concordance was observed between values from the predictive equations and the actual assessed values of NIES in group 2.

CONCLUSION

The proposed equations for nutritional intake of energy, protein, and fats have a reasonable prediction power during pregnancy in relation to physiologic birth outcome.

Micronutrients, birth weight, and survival

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

Pirâmide alimentar para gestantes eutróficas de 19 a 30 anos

Objetivo O objetivo deste estudo foi desenvolver uma pirâmide alimentar adaptada para as gestantes eutróficas na faixa etária de 19 a 30 anos, fundamentada nas diretrizes do guia alimentar para a população bra-sileira. Métodos A construção da pirâmide alimentar foi baseada em dois planos alimentares (2.188kcal referentes ao primeiro trimestre gestacional e 2.502kcal para o segundo e terceiro trimestres gestacionais) calculados segundo reco-mendações para esse grupo. Resultados A distribuição percentual dos macronutrientes no plano alimentar proposto para o primeiro trimestre é de: 12% de proteínas, 62% de carboidratos e 26% de lipídeos. No segundo e terceiro trimestres gestacionais os percentuais obtidos são de: 11% para proteínas, 60% para carboidratos e 29% para lipídeos. As porções e os equivalentes foram estabelecidos a partir de adaptações do total energético de cada alimento obtido por Philippi et al. e disponível no guia alimentar para a população brasileira. Os alimentos estão organizados em oito grupos na pirâmide alimentar, independentemente do período gestacional, variando apenas a quantidade de porções recomendada. Conclusão Espera-se que a pirâmide alimentar desenvolvida seja útil aos profissionais de saúde na atenção pré-natal, favoreça a orientação alimentar e nutricional e contribua para promover a adequação do estado de nutrição e saúde da gestante eutrófica, além de contribuir também para reduzir a ocorrência de baixo peso ao nascer, prematuridade e macrossomia.

Pre- and postnatal health: evidence of increased choline needs

Choline, a micronutrient found in food, serves as the starting material for several important metabolites that play key roles in fetal development, particularly the brain. Although human beings' requirement for choline is unknown, an Adequate Intake level of 425 mg/day was established for women with upward adjustments to 450 and 550 mg/day during pregnancy and lactation, respectively. The importance of choline in human development is supported by observations that a human fetus receives a large supply of choline during gestation; pregnancy causes depletion of hepatic choline pools in rats consuming a normal diet; human neonates are born with blood levels that are three times higher than maternal blood concentrations; and large amounts of choline are present in human milk. The development of the central nervous system is particularly sensitive to choline availability with evidence of effects on neural tube closure and cognition. Existing data show that the majority of pregnant (and presumably lactating) women are not achieving the target intake levels and that certain common genetic variants may increase requirements for choline beyond current recommendations. Because choline is not found in most varieties of prenatal vitamins (or regular multivitamins), increased consumption of choline-rich foods may be needed to meet the high pre- and postnatal demands for choline.

Blood copper, zinc, calcium, and magnesium levels during different duration of pregnancy in Chinese

Concentrations of various trace elements are altered during pregnancy with changes in the mother's physiology and the requirements of growing fetus. The aim of the present longitudinal study was to learn the changes of trace element copper (Cu), zinc (Zn), calcium (Ca), and magnesium (Mg) of normal pregnant woman during different durations of pregnancy and establish the reference values of changes of statistical significance. Blood samples were obtained from 128 normal pregnant women during early (10-14th week), mid (20-24th week), and late (30-34th week) pregnancy and 6-12th week postpartum and 120 healthy unpregnant healthy women. The full blood concentrations of chosen elements were measured by means of an atomic absorption spectrophotometer. Changes on levels of Cu, Ca, and Mg during all the three durations of pregnancy and Zn during mid and late pregnancy and postpartum were of statistical significance and new reference values of them were set in the present study. These new reference values will be helpful in assessing the health status of pregnant women with a socioeconomic and racial background similar to those of our study participants and give treatments to them promptly.

Perinatal depression: prevalence, risks, and the nutrition link--a review of the literature

The purpose of this review is to examine the role of nutrition in perinatal depression. Perinatal (maternal) depression refers to major and minor episodes during pregnancy (termed antenatal) and/or within the first 12 months after delivery (termed postpartum or postnatal). Prevalence of antenatal depression can be as high as 20%, while approximately 12% to 16% of women experience postpartum depression. These are probably conservative estimates, as cases of maternal depression are underreported or underdiagnosed. Risk factors for depression include genetic predisposition and environmental factors, as well as a number of social, psychological, and biological factors. One biological factor given increasing consideration is inadequate nutrition. Credible links between nutrient deficiency and mood have been reported for folate, vitamin B-12, calcium, iron, selenium, zinc, and n-3 fatty acids. For maternal depression, the nutrient that has received the most attention from nutrition researchers has been the n-3 essential fatty acids. Numerous studies, such as randomized controlled trials, cohort studies, and ecological studies, have found a positive association between low n-3 levels and a higher incidence of maternal depression. In addition, nutrient inadequacies in pregnant women who consume a typical western diet might be much more common than researchers and clinicians realize. A number of studies have reported inadequate intakes of n-3, folate, B vitamins, iron, and calcium in pregnant women. Depletion of nutrient reserves throughout pregnancy can increase a woman's risk for maternal depression.

Extreme maternal underweight and feto-infant morbidity outcomes: a population-based study

OBJECTIVE

We sought to estimate the association between severity of maternal pre-pregnancy underweight and feto-infant morbidity outcomes.

METHODS

Missouri maternally linked cohort records from 1989 to 1997 inclusive were analysed. Using pre-pregnancy maternal body mass index (BMI), we classified study participants into: Normal (18.5-24.9) [referent group], mild thinness (17.0-18.5), moderate thinness (16.0-16.9) and severe thinness (<16.0). We estimated the association between pre-pregnancy underweight, underweight subtypes and feto-infant morbidity outcomes using adjusted odds ratios to approximate relative risks with correction for intra-cluster correlations.

RESULTS

Fetal growth curve trajectories for the two groups became divergent as from 30 gestational weeks. Underweight mothers were at increased risk for low birthweight (OR = 1.82; 95% CI = 1.77-1.88), very low birthweight (OR = 1.41; 95% CI = 1.31-1.51), small for gestational age (OR = 1.80; 95% CI = 1.76-1.84), preterm (OR = 1.37; 95% CI = 1.33-1.40) and very preterm (OR = 1.42; 95% CI = 1.34-1.50). These risk estimates increased in a dose-effect fashion with increasing severity of underweight status except for very preterm (p for trend < 0.01).

CONCLUSION

Pre-pregnancy underweight is a risk factor for a spectrum of feto-infant morbidity outcomes, with risk estimates being most pronounced among extremely underweight mothers.

Assessment of dietary intake among pregnant women in a rural area of western China

BACKGROUND

Adequate maternal nutrient intake during pregnancy is important to ensure satisfactory birth outcomes. There are no data available on the usual dietary intake among pregnant women in rural China. The present study describes and evaluates the dietary intake in a cohort of pregnant women living in two counties of rural Shaanxi, western China.

METHODS

1420 pregnant women were recruited from a trial that examined the effects of micronutrient supplementation on birth outcomes. Dietary information was collected at the end of their trimester or after delivery with an interviewed-administrated semi-quantitative food frequency questionnaire (FFQ). Nutrients intake was calculated from the FFQ and compared to the Estimated Average Requirements (EAR). The EAR cut-offs based on the Chinese Nutrition Society Dietary Reference Intakes (DRIs) were used to assess the prevalence of inadequate dietary intakes of energy, protein, calcium, zinc, riboflavin, vitamin C and folate. Mann-Whitney U and Kruskal Wallis tests were used to compare nutrient intakes across subgroups.

RESULTS

The mean nutrient intakes assessed by the FFQ was similar to those reported in the 2002 Chinese National Nutrition and Health Survey from women living in rural areas except for low intakes of protein, fat, iron and zinc. Of the participants, 54% were at risk of inadequate intake of energy. There were high proportions of pregnant women who did not have adequate intakes of folate (97%) and zinc (91%). Using the "probability approach", 64% of subjects had an inadequate consumption of iron.

CONCLUSION

These results reveal that the majority of pregnant women in these two counties had low intakes of nutrients that are essential for pregnancy such as iron and folate.

TRIAL REGISTRATION

ISRCTN08850194.

Brain development, environment and sex: what can we learn from studying graviperception, gravitransduction and the gravireaction of the developing CNS to altered gravity?

As man embarks on space exploration and contemplates space habitation, there is a critical need for basic understanding of the impact of the environmental factors of space, and in particular gravity, on human survival, health, reproduction and development. This review summarizes our present knowledge on the effect of altered gravity on the developing CNS with respect to the response of the developing CNS to altered gravity (gravireaction), the physiological changes associated with altered gravity that could contribute to this effect (gravitransduction), and the possible mechanisms involved in the detection of altered gravity (graviperception). Some of these findings transcend gravitational research and are relevant to our understanding of the impact of environmental factors on CNS development on Earth.

Pediatric Obesity: It's Time for Prevention before Conception Can Maternal Obesity Program Pediatric Obesity?

Global increases in obesity have led public health experts to declare this disease a pandemic. Although prevalent in all ages, the dire consequences associated with maternal obesity have a pronounced impact on the long-term health of their children as a result of the intergenerational effects of developmental programming. Previously, fetal under-nutrition has been linked to the predisposition to pediatric obesity explained by the adiposity rebound and ‘catch-up’ growth that occurs when a child born to a nutrient deprived mother is exposed to the obesogenic environment of present day. Given the recent increase in maternal overweight/obesity (OW/OB) our attention has shifted from nutrient restriction to overabundance and excess during pregnancy. Consideration must now be given to interventions that could mitigate pregravid body mass index (BMI), attenuate gestational weight gain (GWG) and reduce postpartum weight retention (PPWR) in an attempt to prevent the downstream signaling of pediatric obesity and halt the intergenerational cycle of weight related disease currently plaguing our world. Thus, this paper will briefly review current research that best highlights the proposed mechanisms responsible for the development of child OW/OB and related sequalae (e.g. type II diabetes (T2D) and cardiovascular disease (CVD)) resulting from maternal obesity.

Dynamic changes in lipids and proteins of maternal, fetal, and pup blood and milk during perinatal development in CD and Wistar rats

An understanding of the physiological factors that regulate perinatal dosimetry is essential to improve the ability of physiologically based (PB) pharmacokinetic (PK) models to predict chemical risks to children. However, the impact of changing maternal/offspring physiology on PK during gestation and lactation remains poorly understood. This research determined lipid and protein changes in blood, milk and amniotic fluid of CD and Wistar dams, fetuses and neonates to improve the precision of perinatal PBPK modeling. Samples were collected from time-mated CD dams, fetuses, and pups on gestation day (GD) 18 and 20 (sperm positive = GD 0) or lactation day 0 (day of birth), 1, 3, 5, 10, 15, and 20 (n > or = 5 per time point). Fewer time points were sampled in Wistar rats, which showed similar patterns to CDs. Relative to nonpregnant dams, maternal serum protein levels (albumin, total protein and globulin) each decreased by approximately 20% during late gestation, whereas maternal serum lipids (triglycerides, low density lipoproteins, and phospholipids) increased up to fourfold. These physiological changes can impact maternal PK of both protein-bound and lipophilic chemicals. During lactation, triglycerides in milk were greater than 100-fold higher than maternal serum, favoring the disposition of lipophilic chemicals into milk and potentially increasing neonatal rodent exposure during critical stages of postnatal development. Serum protein levels in pups were two- to threefold lower than adults at birth, which may increase the bioavailability of protein-bound compounds. These data will aid in the interpretation of perinatal toxicity studies and improve the accuracy of predictive perinatal PBPK models.

Serum zinc, copper, selenium, calcium, and magnesium levels in pregnant and non-pregnant women in Gondar, Northwest Ethiopia

Pregnant women in developing countries are vulnerable to multiple micronutrient deficiencies. Studies assessing serum levels of the micronutrients and magnitude of their deficiencies are very scarce in African subjects. This study was aimed at determining serum levels of micronutrients in 375 pregnant (42 HIV seropositive) and 76 non-pregnant women (20 HIV seropositive) who visited the University of Gondar Hospital, Gondar, Ethiopia. Serum concentrations of zinc,\ copper, selenium, calcium, and magnesium were determined using an inductively coupled plasma mass spectrometer. Irrespective of HIV serostatus, pregnant women had significantly higher serum concentrations of copper and copper/zinc ratio and significantly lower magnesium compared to those in non-pregnant women (P < 0.05). Except for selenium, which was significantly lower in HIV-seropositive pregnant women (P < 0.05), the mean serum concentrations of zinc, copper, calcium, and magnesium were not significantly different between pregnant women by HIV serostatus. The prevalence of deficiency in zinc, magnesium, selenium, and calcium in the pregnant women, irrespective of their HIV serostatus, was 66.7%, 25.6%, 21.9%, and 9.3%, respectively. The magnitude of deficiency in zinc, magnesium, and selenium was significantly higher in HIV seropositive pregnant women (76.2%, 52.4%, and 45.2%) than that in HIV-seronegative pregnant women (65.5%, 22.2%, and 18.9%) and in HIV-seronegative non-pregnant women (42.9%, 8.1%, and 30.4%; P < 0.05). Deficiency in one, two, three, or four mineral elements was observed in 44.8%, 14.4%, 9.9%, and 5.1% of the pregnant women, respectively. Only 25.9% of the pregnant women and 44.7% of the non-pregnant women were not deficient in any of the micronutrients. The high prevalence of micronutrient deficiencies in pregnant and non-pregnant women in Gondar, Ethiopia warrants the need for strategies on prevention and control of the deficiencies.

Coronary nitric oxide production controls cardiac substrate metabolism during pregnancy in the dog

The aim of this study was to examine the role of nitric oxide (NO) in the control of cardiac metabolism at 60 days of pregnancy (P60) in the dog. There was a basal increase in diastolic coronary blood flow during pregnancy and a statistically significant increase in cardiac output (55 +/- 4%) and in cardiac NOx production (44 +/- 4 to 59 +/- 3 nmol/min, P < 0.05). Immunohistochemistry of the left ventricle showed an increase in endothelial nitric oxide synthase staining in the endothelial cells at P60. NO-dependent coronary vasodilation (Bezold-Jarisch reflex) was increased by 20% and blocked by N(G)-nitro-l-arginine methyl ester (l-NAME). Isotopically labeled substrates were infused to measure oleate, glucose uptake, and oxidation. Glucose oxidation was not significantly different in P60 hearts (5.4 +/- 0.5 vs. 6.2 +/- 0.4 micromol/min) but greatly increased in response to l-NAME injection (to 19.9 +/- 0.9 micromol/min, P < 0.05). Free fatty acid (FFA) oxidation was increased in P60 (from 5.3 +/- 0.6 to 10.4 +/- 0.5 micromol/min, P < 0.05) and decreased in response to l-NAME (to 4.5 +/- 0.5 micromol/min, P < 0.05). There was an increased oxidation of FFA for ATP production but no change in the respiratory quotient during pregnancy. Genes associated with glucose and glycogen metabolism were downregulated, whereas genes involved in FFA oxidation were elevated. The acute inhibition of NO shifts the heart away from FFA and toward glucose metabolism despite the downregulation of the carbohydrate oxidative pathway. The increase in endothelium-derived NO during pregnancy results in a tonic inhibition of glucose oxidation and reliance on FFA uptake and oxidation to support ATP synthesis in conjunction with upregulation of FFA metabolic enzymes.

Role of nitric oxide in the coupling of myocardial oxygen consumption and coronary vascular dynamics during pregnancy in the dog

We examined the ability of cardiac endothelial nitric oxide synthase (eNOS) to couple myocardial oxygen consumption (MV̇o2) and oxygen delivery during pregnancy. Awake dogs were studied using echocardiography before and at 40 days, 50 days, and 60 days (60D) of pregnancy and at ∼14 days postpartum. Left ventricular eNOS, phosphorylated eNOS, and copper, zinc-superoxide dismutase (CuZnSOD or SOD-1) were determined by immunoblotting. MV̇o2 of left ventricular tissue samples was measured in vitro in response to increasing doses of bradykinin, enalapril maleate, and amlodipine. We examined the changes in passive diameter and flow-dependant arteriolar dilation of coronary arterioles. Echocardiography indicated increases in cardiac output (∼60%) during pregnancy. Myocardial eNOS (21 ± 4%), phosphorylated eNOS (19 ± 3%), and SOD-1 (61 ± 2.7%) protein levels were significantly increased at 60D. Bradykinin, enalapril maleate, and amlodipine (10−4 mol/l) decreased MV̇o2 in a nitric oxide-dependant manner (by 24 ± 1.3% in controls and 34 ± 2.2% at 60D; by 21 ± 1.1% in controls and 29 ± 1.1 at 60D; and by 22 ± 2.5% in controls and 26 ± 1.0% at 60D, respectively). Arterioles from pregnant dogs showed increased flow-dependant dilation in response to increased shear stress and larger passive diameter. Nitrite production was stimulated by bradykinin and carbachol in microvessels in vitro; pregnancy enhanced nitrite release. Myocardial eNOS, phosphorylated eNOS, and SOD-1 protein expression are increased during pregnancy, and this increase is associated with enhanced nitric oxide-dependant control of MV̇o2. Thus increases in eNOS and SOD-1 promote the coupling of oxygen delivery and efficiency in the heart during pregnancy.

Dietary calcium supplementation to lower blood lead levels in pregnancy and lactation

Pregnancy and lactation are states known to be accompanied by physiologically up regulated bone resorption in response to the calcium demands of the developing fetus and nursing infant. The role of calcium supplements in altering maternal responses to fetal demand for calcium is not fully understood. Exposure to the toxicant lead is known to pose a major hazard to fetal neurodevelopment and growth. Since >95% of maternal lead is stored in the bone, mobilization of cumulative maternal lead stores into the circulation represents an endogenous source of exposure, which may pose a significant hazard for the fetus and infant. Maternal dietary calcium supplementation has been associated with reductions in lead levels in both animal and human studies when administered during pregnancy and lactation. Therefore, supplementation of the maternal diet with calcium may represent an important secondary prevention strategy aimed not only at reducing circulating levels of lead in the mother but also at reducing lead exposure to the developing fetus and nursing infant.

Lactating Women Restricting Milk Are Low on Select Nutrients

OBJECTIVE

Currently there are no recommendations for vitamin/mineral supplementation for lactating women but supplementation may be important, particularly for those women who choose to restrict milk intake during lactation. The objective of this study was to assess nutrient adequacy for lactating women and compare their dietary intake, including supplements, between those who restrict milk and those who do not.

METHODS

A cohort of 175 healthy exclusively breast-feeding women (19-45 yrs) recruited from prenatal classes were divided into milk restrictors (RS) defined as milk intake < or = 250 ml/day and non-restrictors (NRS) (>250 ml/day) and followed for six months postpartum. Participants provided repeated 24-hr dietary recalls, detailed use of vitamin/mineral supplements and reasons for restricting milk.

STATISTICAL ANALYSES

Observed intakes were adjusted to remove day-to-day variability. Nutrient intakes were estimated for macronutrients and vitamins C, D, thiamin, riboflavin, niacin, and minerals, calcium and zinc, with and without vitamin/mineral supplements. Chi-square was used to compare the number of RS and NRS with intakes less than the Estimated Average Requirement (EAR).

RESULTS

Milk restriction was practiced by 23% of the sample. Sixty per cent of RS reported protein intakes <EAR compared to 38% of NRS (chi(2) = 6.22, p < 0.05). Prior to supplementation, mean levels of calcium and vitamin D intakes for RS were below the adequate intake level (AI) and lower than NRS estimated intakes (p < 0.05). Following supplementation, mean levels of these nutrients reached AI for both groups. RS remained lower than NRS. RS had lower energy intakes than NRS (p < 0.05) but no difference in weight loss at 6 months was noted. A higher proportion of RS were below the EAR for thiamin, riboflavin and zinc.

CONCLUSIONS

Milk restriction compromised protein and nutrient intakes in lactating women who restricted milk to <250 mL. Vitamin/mineral supplements helped exclusively breastfeeding milk restrictors improve their vitamin D and calcium intakes. Milk restriction is not recommended during lactation and where unavoidable, nutrients provided by milk should be compensated for by other foods or supplements.

Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study

The aim of this study was to assess the impact of dietary counselling combined with the provision of food products on food and nutrient intake in pregnant women. We carried out a prospective cohort study of healthy and atopic pregnant women (n 209), who were randomized into dietary intervention and control groups. The intervention group received dietary counselling and food products to modify the fat composition of their diet to meet current recommendations. Three-day food records were collected during each trimester of pregnancy. Women in the intervention group consumed more vegetables, fruits, soft margarines and vegetable oils and less butter than those in the control group during the course of pregnancy (P < 0·05). The main distinction between the groups in nutrient intake over the pregnancy was attributable to a higher energy intake (% energy) of PUFA by 0·5 %energy (95 % CI 0·1, 0·8) and to a lower intake of SFA by 0·8 % energy (95 % CI − 1·4, − 0·4) in the intervention group. Dietary intake of vitamin E was 1·4 mg (95 % CI 0·6, 2·2), folate 20·9 μg (95 % CI 0·8, 41·0) and ascorbic acid 19·8 mg (95 % CI 3·5, 36·0) higher in the intervention group compared to the controls, while no differences in other nutrients were detected. Dietary counselling combined with the provision of food products during pregnancy is of importance in modifying food and nutrient intake, with potential health benefits.

Maternal smoking is associated with decreased 5-methyltetrahydrofolate in cord plasma

BACKGROUND

Maternal-fetal folate transport via the placenta has been shown to be concentrative. Exposure to cigarette smoke is associated with decreased maternal folate status through altered dietary intakes and possibly through nondietary mechanisms such as increased folate turnover. The effect of maternal smoking on fetal folate status has not been documented.

OBJECTIVE

The objective was to determine the effect of maternal smoking on plasma 5-methyltetrahydrofolic acid (5-MTHFA) concentrations in umbilical cord blood.

DESIGN

African American women were recruited from an antenatal clinic in Detroit, MI. Plasma 5-MTHFA concentrations were measured in maternal-umbilical cord pairings (n = 58). The participants completed a structured interview to determine demographic characteristics, including smoking.

RESULTS

Concentrations of 5-MTHFA were significantly higher in venous cord plasma (16.8 +/- 7.5 ng/mL) than in maternal plasma (13.0 +/- 7.5 ng/mL) but remained associated (r = 0.60, P < 0.001) with each other. Cigarettes smoked by the mothers was negatively associated (r = -0.31, P = 0.019) with venous cord 5-MTHFA concentrations and remained so after control for maternal plasma 5-MTHFA and other variables. Venous cord plasma 5-MTHFA was significantly lower in smoking (15.1 +/- 7.6 ng/mL; n = 32) than in nonsmoking (19.0 +/- 7.0 ng/mL; n = 26) mothers.

CONCLUSIONS

Cord plasma 5-MTHFA concentrations were elevated relative to maternal blood, as expected, because the placenta is capable of concentrative folate transport to the fetus. The negative effect of maternal smoking on infant, but not on maternal, 5-MTHFA status indicates that maternal smoking may impair folate transport to the fetus.

A systematic review of dietary assessments of pregnant adolescents in industrialised countries

Adolescent pregnancy is a major public health challenge for many industrialised countries and is associated with significant medical, nutritional, social and economic risk for mothers and their infants. Despite this, relatively little is known about the nutrient intakes of adolescents during pregnancy. The aim of this study is to review the current evidence relating to the dietary assessment of pregnant adolescents living in industrialised countries. Nine papers were identified that fulfilled the inclusion criteria, seven of which were conducted in the USA. Mean nutrient intakes were compared with the most recent US dietary reference intakes (DRI) for pregnant adolescents. Despite the poor quality of the majority of studies, there appeared to be some consensus to suggest that the nutrient intakes of pregnant adolescents were below the DRI for energy, iron, folate, calcium, vitamin E and magnesium, nutrients which are recognised to be vital for fetal growth and development during pregnancy. Modest differences were observed in nutrient intake between trimesters and age groups. Current research is limited by sampling and measurement bias, and research is urgently required to address these limitations. Further consideration should also be made of the influence of age and of role of socio-economic support on pregnant adolescents' nutrient intake. The achievement of improved nutrition in pregnancy among adolescents requires multidisciplinary collaborations of adolescent health care providers, academics, professional organisations, policy makers, industry and service users. Only once this is achieved can adolescent nutrition, and adolescent nutrition in pregnancy, be significantly and sustainably optimised.

Seasonal variation of nutrient intake in pregnancy: effects on infant measures and possible influence on diseases related to season of birth

OBJECTIVES

To determine, firstly, if there was any seasonal effect on nutrient intake during pregnancy and birth measures, secondly, if there was any relationship between maternal nutrient intake and infant birth measures according to season and thirdly, to consider the hypothesis that seasonal change in nutrient intake during pregnancy might affect health in later life of some women's offspring.

DESIGN

Pilot study to determine number of days required to characterize group intake followed by a prospective cohort study.

SETTING

Patients attending a city ante-natal clinic in the lower North Island, New Zealand.

SUBJECTS

A total of 214 healthy mostly European pregnant women volunteers, entering the second trimester of pregnancy, of whom 10 miscarried and seven withdrew.

METHODS

Subjects were visited in months 4 and 7 of pregnancy, and months 2, 6 and 12 after birth. Height, weight and skinfolds were measured and questionnaires to determine personal details administered at these times. Subjects recorded 8 days of weighed diets in both the fourth and seventh month. Health records were used to supply infant measures.

RESULTS

Significant (P</=0.05) seasonal variations in fat, carbohydrate, vitamin C and D, B vitamins, beta-carotene, sodium, potassium, calcium, phosphorous, sulfur, sodium, chloride, zinc and selenium intakes were found. No significant 'main effect' difference in gestational age, infant birthweight, and head circumference was found with season. However, there were significant interactions (P</=0.05) for each birth season between birth measures and specific maternal nutrients at months 4 and 7 of pregnancy.

CONCLUSION

The significant seasonal variations in nutrient intake in pregnant women, and significant influence of nutrient intake on birth measures in different seasons, suggests seasonal nutrient variation may also affect fetal development at a cellular level. This supports our hypothesis that the development of conditions related to season of birth, including schizophrenia, multiple sclerosis, type I diabetes and longevity, may be influenced by seasonal variation in nutrient intake during pregnancy.

The relationship between parity and overweight varies with household wealth and national development

BACKGROUND

Recent studies support a positive relationship between parity and overweight among women of developing countries; however, it is unclear whether these effects vary by household wealth and national development. Our objective was to determine whether the association between parity and overweight [body mass index (BMI) > or =25 kg/m(2)] in women living in developing countries varies with levels of national human development and/or household wealth.

METHODS

We used data from 28 nationally representative, cross-sectional surveys conducted between 1996 and 2003 (n = 275 704 women, 15-49 years). The relationship between parity and overweight was modelled using logistic regression, controlling for several biological and sociodemographic factors and national development, as reflected by the United Nations' Human Development Index. We also modelled the interaction between parity and national development, and the three-way interaction between parity, household wealth and national development.

RESULTS

Parity had a weak, positive association with overweight, which varied by household wealth and national development. Among the poorest women and women in the second tertile of household wealth, parity was positively related to overweight only in the most developed countries. Among the wealthiest women, parity was positively related to overweight regardless of the level of national development.

CONCLUSIONS

As development increases, the burden of parity-related overweight shifts to include poor as well as wealthy women. In the least-developed countries, programmes to prevent parity-related overweight should target wealthy women, whereas such programmes should be provided to all women in more developed countries.

Country development and the association between parity and overweight

INTRODUCTION

Parity is associated with overweight and obesity in developed countries and has been related to maternal depletion in poor developing countries. However, the literature from developing countries is limited and may not represent current stages of development.

METHODS

We analyzed data from 50 Demographic and Reproductive Health Surveys conducted between 1992 and 2003. We examined the association between parity (proxied by number of live births) and overweight (body mass index (BMI)> or =25 kg/m(2)) in relation to level of country wealth and development.

RESULTS

The odds ratio (OR) for overweight comparing women with at least four live births to women with one live birth was >1.0 in 38 of the 50 countries studied. The median OR was >1.0 in all regions studied and highest in North Africa/West Asia, where all countries had OR >1.0. Country wealth and development were both positively associated with the ORs.

CONCLUSIONS

The importance of parity as a predictor of overweight increases with national economic development and wealth. Policy implications might include the development and implementation of programs to prevent excessive gestational weight gain and promote postpartum weight loss via dietary change and physical activity, concomitant with exclusive breastfeeding.

Maternal obesity, metabolism, and pregnancy outcomes

About one third of all pregnant women in the United States are obese. Maternal obesity at conception alters gestational metabolic adjustments and affects placental, embryonic, and fetal growth and development. Neural tube defects and other developmental anomalies are more common in infants born to obese women; these defects have been linked to poor glycemic control. Preeclampsia, a gestational disorder occurring more frequently in obese women, appears to be due to a subclinical inflammatory state that impairs early placentation and development of its blood supply. Fetal growth and development during the last half of pregnancy depends on maternal metabolic adjustments dictated by placental hormones and the subsequent oxygen and nutrient supply. Maternal obesity affects these metabolic adjustments as well. Basal metabolic rates are significantly higher in obese women, and maternal fat gain is lower, possibly in response to altered leptin function. The usual increase in insulin resistance seen in late pregnancy is enhanced in obese mothers, causing marked postprandial increases in glucose, lipids, and amino acids and excessive fetal exposure to fuel sources, which in turn increases fetal size, fat stores, and risk for disease postnatally. Impaired glucose tolerance, gestational diabetes, and hyperlipidemia are more common among obese mothers. To date, little attention has been given to the role of diet among obese women in preventing these problems. However, studies of women with impaired glucose tolerance show that replacing refined carbohydrates and saturated fat with complex, low-glycemic carbohydrates and polyunsaturated fatty acids improves metabolic homeostasis and pregnancy outcomes. Thus, current dietary guidelines regarding the amount and type of carbohydrates and fat for nonpregnant women seem appropriate for pregnant women as well.

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

Substrate supply to the fetus is a major regulator of prenatal growth. Maternal nutrition influences the availability of nutrients for transfer to the fetus. Animal experiments demonstrate that restriction of maternal protein or energy intake can retard fetal growth. Effects of maternal nutrition vary with the type and timing of the restriction and the species studied. Maternal undernutrition before conception and/or in early pregnancy can alter fetal physiology in late gestation, and influence postnatal function, often without measurable effects on birth size. In contrast, to date, observational and intervention studies in humans provide limited support for a major role of maternal nutrition in determining birth size, except where women are quite malnourished. However, recent studies report associations between newborn size and the balance of macronutrients in women's diets in Western settings. Associations between maternal dietary composition and adult blood pressure of the offspring are also reported in human populations. Most studies in women have focused on dietary content or supplementation during mid-late pregnancy. Further investigation of how maternal dietary composition, before conception and throughout pregnancy, affects fetal physiology and health of the baby will increase the understanding of how maternal diet and nutritional status influence fetal, neonatal and longer-term outcomes.

Influence of Endurance Exercise and Diet on Human Placental Development and Fetal Growth

The delivery of oxygen and substrate to the maternal-fetal interphase is the major maternal environmental stimulus which either up- or down-regulates feto-placental growth. During pregnancy, sustained exercise sessions cause an intermittent reduction in oxygen and substrate delivery to the interphase that may exceed 50% during the exercise but, it is probable that regular bouts of sustained exercise or exercise training may improve oxygen and substrate delivery at rest. The type of maternal carbohydrate intake (low- versus high-glycemic sources) and food intake frequency also influence substrate availability through their effects on maternal blood glucose levels and insulin sensitivity. As a result, different exercise regimens and/or different types of carbohydrate intake modify feto-placental growth. The magnitude and direction of the effect is determined by their average 24-h effect on oxygen and substrate availability at different time-points in pregnancy. In general, exercise in early and mid pregnancy stimulates placental growth while the relative amount of exercise in late pregnancy determines its effect on late fetal growth. Low-glycemic food sources in the diet decrease growth rate and size at birth while high-glycemic food sources increase it. Thus, it may be possible to improve pregnancy outcomes in both healthy, low-risk women and a variety of high-risk populaces by simply modifying maternal physical activity and dietary carbohydrate intake during pregnancy.

Isotopic evidence for breastfeeding and possible adult dietary differences from Late/Sub-Roman Britain

Historical documents indicate that breastfeeding and weaning practices have fluctuated in England through history. In order to obtain evidence for general breastfeeding patterns in Late/Sub-Roman Britain, stable carbon and nitrogen isotope values were measured in juvenile and adult skeletons (n = 87) from the cemetery of Queenford Farm, Dorchester-on-Thames, Oxfordshire. As the site contained few individuals between 0-1.5 years of age, it was not possible to determine the initial timing for the introduction of weaning foods. Between ages 2-4 years, the mean +/- SD delta(13)C results (-20.2 +/- 0.3 per thousand) are significantly more negative (t = -4.03, P < 0.001) compared to adult females (-19.7 +/- 0.3 per thousand). This is interpreted as evidence of a different diet being fed to children during weaning. After age 2, the delta(15)N values gradually decline, indicating complete cessation of breastfeeding by 3-4 years. Among adults, stature (males = 1.68 +/- 0.06 m; females = 1.58 +/- 0.07 m) and sexual dimorphism (106) were low, suggesting that the population was possibly under environmental stress. The delta(13)C results for adults are similar, but females show a small but statistically significantly (t = -2.86, P < 0.01) lower mean delta(15)N value (9.9 +/- 0.9 per thousand) compared to males (10.6 +/- 0.5 per thousand). These lower female delta(15)N values possibly reflect the different physiology of the sexes (pregnancy and/or lactation) or the reduced consumption of animal/fish protein by women, and this may have been influenced by individual preference, family needs, or societal values of the era.

A comparison of the dietary and total intake of micronutrients in a group of pregnant Greek women with the Dietary Reference Intakes

OBJECTIVE

We compared the dietary and total (diet and supplement) intake of micronutrients with the Dietary Reference Intakes (DRIs) from the USA in a population of pregnant Greek women.

METHODS

Two hundred pregnant women participated in a nutritional survey, 98 in the second trimester and 102 in the third trimester in a random sampling. To examine dietary intake we used two questionnaires, the nutritional questionnaire for pregnant women from the California Department of Health Services, and a semi-quantitative questionnaire (Walter Willet) with modifications for use in Greece. Dietary intake analysis was performed using the Diet Analysis Plus software, Version 3, ESHA Research. Statistical analysis was performed with Minitab for Windows, Release 12. A simple complementary questionnaire concerning demographic and socio-economic features was also completed.

RESULTS

The average total intake of vitamins A, B(1), B(2), B(3), B(6), B(12) and C, calcium and phosphorus was higher than the respective DRIs. Folic acid and iron intake exceed the highest values specified for pregnancy. Vitamin E and zinc was lower than the DRIs, while vitamin D, magnesium and thiamin did not differ.

CONCLUSIONS

The results of our study suggest that in a Greek population, sufficient micronutrients appear to be received in adequate amount from diet, except for folic acid and iron, which also had to be taken in the form of nutritional supplements.

Pregnancy increases urinary loss of carnitine and reduces plasma carnitine in Korean women

This study compared plasma and urinary carnitine concentrations in pregnant and non-pregnant Korean women. The subjects were fifty pregnant women and thirty non-pregnant women aged 24-28 years. During the first trimester, dietary carnitine intakes in the pregnant women were much lower than in non-pregnant women (70.00 (SD 29.22) micromol/d), but over the course of pregnancy carnitine intake increased from 44.64 (SD 24.84) micromol/d during the first trimester to 96.11 (SD 36.56) micromol/d during the third trimester. Pregnant women had a significantly lower plasma carnitine concentration than non-pregnant women. Plasma concentrations of non-esterified carnitine, acid-soluble acylcarnitine and total carnitine were significantly lower during the second and third trimesters than the first. Plasma acid-insoluble acylcarnitine levels, which tended to be higher in the non-pregnant women compared with the pregnant women, increased significantly as gestation proceeded. The urinary excretion of non-esterified carnitine, acid-soluble acylcarnitine and total carnitine was significantly higher in the pregnant women during the first and second trimesters than in non-pregnant women and decreased significantly as gestation proceeded. We found that there was a significant decrease in plasma carnitine level even though dietary carnitine intake increased as gestation proceeded. The low urinary excretion of carnitine in late pregnancy may be caused by an increased demand during pregnancy.

Maternal--neonatal serum selenium and copper levels in Greeks and Albanians

AIM

To evaluate selenium (Se) and copper (Cu) concentrations in Greek and Albanian immigrant mothers and in the cord blood of their newborns.

SUBJECTS AND METHODS

From 1118 Greek and 820 Albanian mothers and from the cord blood of their neonates blood was obtained for Se and Cu measurement. Se and Cu concentrations were determined in sera with graphite furnace atomic absorption spectroscopy (GFAAAS) and atomic absorption spectrometry, respectively. In all, 30 days' nutrient intakes were evaluated in both groups.

RESULTS

Animal protein, Se and Cu intakes were poor in the Albanians vs the Greeks (P < 0.001). Se concentrations in the Greek mothers (68.3 +/- 8.5 microg/l) and in their newborns (37.02 +/- 8.9 microg/l) were found higher as compared with those in Albanian mothers (37.4 +/- 9.9 microg/l) and in their newborns (34.3 +/- 9.1 microg/l) (P < 0.001). Cu levels were also found higher (P < 0.001) in the Greek mothers (1687 +/- 353 microg/l) and in their neonates (449 +/- 87 microg/l) compared with those in the Albanian mothers (959 +/- 318 microg/l) and in their newborns (229 +/- 67 microg/l). Additionally, 31.5% of neonates born to Albanian women with Se concentrations less than 28 microg/l had higher Se levels (P < 0.01) than their mothers.

CONCLUSIONS

The low Se and Cu levels evaluated in the Albanian mothers and their newborns could be related to their poor animal protein intake which could be the consequence of their low socioeconomic status. As an effective preventive measure, accurate dietetic strategies to assess the requirements of pregnant immigrant women for trace elements may be planned in Greece.

Status of plasma folate after folic acid fortification of the food supply in pregnant African American women and the influences of diet, smoking, and alcohol consumption

BACKGROUND

African American women and socioeconomically challenged women are at risk of compromised folate status and, thus, of folate-related birth defects. Data are limited on circulating folate concentrations in pregnant African American women after folic acid fortification of the food supply was implemented.

OBJECTIVE

The objective was to determine the influence of smoking and alcohol consumption on plasma 5-methyltetrahydrofolic acid (5-MTHFA) concentrations in pregnant African American women.

DESIGN

Alcohol consumption, smoking exposure, and other characteristics of pregnant African American women reporting to an inner-city antenatal clinic were assessed. At 24 wk of gestation, blood samples and food-frequency intake data were collected. Plasma 5-MTHFA concentrations were determined by liquid chromatography-mass spectrometry for 116 subjects and examined in a correlational study design.

RESULTS

Dietary folate and markers of alcohol consumption were positively associated, whereas exposure to smoke was negatively associated with plasma 5-MTHFA. More than one-half of the participants in this population failed to meet the recommended dietary allowance for dietary folate equivalents of 600 microg/d during pregnancy.

CONCLUSIONS

Most inner-city African American women are not meeting the recommended dietary allowance for dietary folate during pregnancy, and smoking may further compromise their folate status. Programs to reduce smoking and raise awareness about the importance of folate and multivitamin supplementation during pregnancy need to target this population.

Comparison of bloodstream fatty acid composition from African-American women at gestation, delivery, and postpartum

Our aim was to examine the docosahexaenoic acid (DHA; 22:6n-3) status of pregnant African-American women reporting to the antenatal clinic at Wayne State University in a longitudinal study design. Fatty acid compositions of plasma and erythrocyte total lipid extracts were determined and food frequency surveys were administered at 24 weeks of gestation, delivery, and 3 months postpartum for participants (n = 157). DHA (mean +/- SD) in the estimated total circulating plasma was similar at gestation (384 +/- 162 mg) and delivery (372 +/- 155 mg) but was significantly lower at 3 months postpartum (178 +/- 81 mg). The relative weight percentage of DHA and docosapentaenoic acid n-6 (DPAn-6; 22:5n-6) decreased postpartum, whereas their respective metabolic precursors, eicosapentaenoic acid (EPA; 20:5n-3) and arachidonic acid (AA; 20:4n-6), increased. Similar results were found in erythrocytes. Dietary intake of DHA throughout the study was estimated at 68 +/- 75 mg/day. The relative amounts of circulating DHA and DPAn-6 were increased during pregnancy compared with 3 months postpartum, possibly via increased synthesis from EPA and AA. The low dietary intake and blood levels of DHA in this population compared with others may not support optimal fetal DHA accretion and subsequent neural development.