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Sen S, Cherkerzian S, Herlihy M, Hacker MR, McElrath TF, Cantonwine DE, Fichorova R, Oken E, Meydani SN. Supplementation with antioxidant micronutrients in pregnant women with obesity: a randomized controlled trial. Int J Obes (Lond) 2024; 48:796-807. [PMID: 38396126 DOI: 10.1038/s41366-024-01472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND/OBJECTIVE Obesity increases maternal morbidity and adversely affects child health. Maternal inflammation may play a role in adverse outcomes. The objective of this study was to determine whether providing a higher dose of antioxidant micronutrients to pregnant women with obesity would raise concentrations of key antioxidant vitamins and impact inflammation and oxidative stress during pregnancy. SUBJECTS/METHODS This was a double-blind, randomized controlled trial. We recruited pregnant women with a body mass index (BMI) ≥ 30 kg/m2 at their initial prenatal visit ( < 13 weeks gestation) and collected blood and urine samples at baseline, 24-28 weeks, and 32-36 weeks to measure micronutrient concentrations (vitamin C, E, B6 and folate), markers of inflammation (C-reactive protein, interleukin-6, 8, and 1β) and oxidative stress (8-epi-PGF2α and malondialdehyde). We collected maternal and infant health data from enrollment to delivery as secondary outcomes. We enrolled 128 participants (64 in each arm), and 98 (49 in each arm) completed follow-up through delivery. INTERVENTION Both groups received a standard prenatal vitamin containing the recommended daily allowance of micronutrients in pregnancy. In addition, the intervention group received a supplement with 90 mg vitamin C, 30 αTU vitamin E, 18 mg vitamin B6, and 800 μg folic acid, and the control group received a placebo. RESULTS The intervention group had higher vit B6 (log transformed (ln), β 24-28 weeks: 0.76 nmol/L (95% CI: 0.40, 1.12); β 32-36 weeks: 0.52 nmol/L (95% CI: 0.17, 0.88)) than the control group. Vitamins C, E, erythrocyte RBC folate concentrations did not differ by randomization group. The intervention did not impact biomarkers of inflammation or oxidative stress. There were no differences in maternal or neonatal clinical outcomes by randomization group. CONCLUSIONS Higher concentrations of antioxidant vitamins during pregnancy increased specific micronutrients and did not impact maternal inflammation and oxidative stress, which may be related to dosing or type of supplementation provided. CLINICAL TRIAL REGISTRATION Clinical Trial Identification Number: NCT02802566; URL of the Registration Site: www. CLINICALTRIALS gov .
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Affiliation(s)
- Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- JM USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mary Herlihy
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele R Hacker
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas F McElrath
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - David E Cantonwine
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Raina Fichorova
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Oken
- Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Simin N Meydani
- JM USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Ter Borg S, Koopman N, Verkaik-Kloosterman J. An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review. Nutrients 2023; 15:3071. [PMID: 37447397 DOI: 10.3390/nu15133071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.
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Affiliation(s)
- Sovianne Ter Borg
- National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands
| | - Nynke Koopman
- National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands
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Purohit A, Oyeka CP, Khan SS, Toscano M, Nayak S, Lawson SM, Blumenthal RS, Sharma G. Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023; 12:129-137. [PMID: 37840644 PMCID: PMC10575259 DOI: 10.1007/s13669-023-00356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 10/17/2023]
Abstract
Purpose of review Obesity is a chronic disease that is becoming increasingly prevalent, and more individuals of reproductive age have obesity prior to becoming pregnant. Obesity in pregnancy is associated with short- and long-term adverse consequences for both the birthing person and their offspring which have been associated with increased long-term cardiovascular morbidity and mortality. The goal of this review is to discuss what is currently understood about the relationship between maternal obesity and adverse pregnancy outcomes (APOs), the association between APOs and future cardiovascular disease (CVD) risk, and what evidence-based interventions can be implemented to prevent adverse outcomes in this population. Recent findings Maternal obesity has been associated with an increased risk of APOs such as gestational diabetes, hypertensive disorders of pregnancy, and preterm birth as well as an increased risk of future CVD, such as metabolic syndrome, chronic hypertension, coronary heart disease, and stroke. The impact of maternal obesity also extends beyond the pregnant individual to the offspring, increasing the risk of fetal, neonatal, and infant mortality, as well as of congenital malformations, prematurity, and long-term health problems such as insulin resistance and childhood obesity. Prevention guidelines are incorporating the increased risk of adverse outcomes from maternal obesity into formalized risk assessments to guide both prenatal and postpartum care. It is becoming evident that a multidisciplinary cardio-obstetrics team is an important part of providing comprehensive care for pregnant individuals with obesity and other cardiovascular risk factors, including preexisting CVD and a history of prior APOs. There remains a need for further studies to better understand the mechanisms underlying the relationship between maternal obesity and APOs, as well as the racial and ethnic disparities that have been noted in the prevalence of APOs and associated CVD risk and mortality. Summary There is increasing awareness that obesity in pregnancy is associated with various short- and long-term adverse maternal and offspring outcomes. There are multiple screening and prevention strategies that may be implemented before, during, and after pregnancy to prevent these adverse outcomes.
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Affiliation(s)
- Aarti Purohit
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sadiya S. Khan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marika Toscano
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shriddha Nayak
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shari M. Lawson
- Johns Hopkins University School of Medicine Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | | | - Garima Sharma
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rak K, Styczyńska M, Godyla-Jabłoński M, Bronkowska M. Some Immune Parameters of Term Newborns at Birth Are Associated with the Concentration of Iron, Copper and Magnesium in Maternal Serum. Nutrients 2023; 15:nu15081908. [PMID: 37111127 PMCID: PMC10141145 DOI: 10.3390/nu15081908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The nutritional status of pregnant women is considered to affect fetal development and the health condition of newborns, including their immune system. We investigated the relationship between the concentrations of magnesium (Mg), calcium (Ca), zinc (Zn), iron (Fe) and copper (Cu) in maternal serum (MS) and the concentrations of IgG antibodies and antineutrophil cytoplasmatic auto-antibodies against lactoferrin (Lf-ANCA) in umbilical cord serum (UCS). IgG was considered as a promoter of immunity, and Lf-ANCA as an inhibitor. The examined group consisted of 98 pregnant women and their healthy term newborn children. The concentrations of mineral elements were measured by FAAS/FAES, while the concentrations of antibodies were determined by ELISA. Excessive MS Fe and insufficient MS Cu were related to insufficient UCS IgG and excessive UCS Lf-ANCA. The correlation analysis showed confirming results. Adequate UCS IgG and Lf-ANCA were related to MS Mg at the strictly lower limit of the reference values. The results obtained seem to suggest that an excess of Fe and a deficiency of Cu in pregnancy may adversely affect some immune parameters of newborns. Reference values for MS Mg are likely to require reconsideration. It would be advisable to monitor the nutritional status of pregnant women with minerals in order to support the immune capacity of newborns.
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Affiliation(s)
- Karolina Rak
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Marzena Styczyńska
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Michaela Godyla-Jabłoński
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Monika Bronkowska
- Institute of Health Sciences, Collegium Salutis Humanae, University of Opole, 45-060 Opole, Poland
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Hojeij B, Rousian M, Sinclair KD, Dinnyes A, Steegers-Theunissen RPM, Schoenmakers S. Periconceptional biomarkers for maternal obesity: a systematic review. Rev Endocr Metab Disord 2023; 24:139-175. [PMID: 36520252 PMCID: PMC10023635 DOI: 10.1007/s11154-022-09762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
Periconceptional maternal obesity is linked to adverse maternal and neonatal outcomes. Identifying periconceptional biomarkers of pathways affected by maternal obesity can unravel pathophysiologic mechanisms and identify individuals at risk of adverse clinical outcomes. The literature was systematically reviewed to identify periconceptional biomarkers of the endocrine, inflammatory and one-carbon metabolic pathways influenced by maternal obesity. A search was conducted in Embase, Ovid Medline All, Web of Science Core Collection and Cochrane Central Register of Controlled Trials databases, complemented by manual search in PubMed until December 31st, 2020. Eligible studies were those that measured biomarker(s) in relation to maternal obesity, overweight/obesity or body mass index (BMI) during the periconceptional period (14 weeks preconception until 14 weeks post conception). The ErasmusAGE score was used to assess the quality of included studies. Fifty-one articles were included that evaluated over 40 biomarkers. Endocrine biomarkers associated with maternal obesity included leptin, insulin, thyroid stimulating hormone, adiponectin, progesterone, free T4 and human chorionic gonadotropin. C-reactive protein was associated with obesity as part of the inflammatory pathway, while the associated one-carbon metabolism biomarkers were folate and vitamin B12. BMI was positively associated with leptin, C-reactive protein and insulin resistance, and negatively associated with Free T4, progesterone and human chorionic gonadotropin. Concerning the remaining studied biomarkers, strong conclusions could not be established due to limited or contradictory data. Future research should focus on determining the predictive value of the optimal set of biomarkers for their use in clinical settings. The most promising biomarkers include leptin, adiponectin, human chorionic gonadotropin, insulin, progesterone and CRP.
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Affiliation(s)
- Batoul Hojeij
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, 3015GD, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, 3015GD, The Netherlands
| | - Kevin D Sinclair
- School of Biosciences, Sutton Bonnington Campus, University of Nottingham, Leicestershire, LE12 6HD, UK
| | - Andras Dinnyes
- BioTalentum Ltd., Godollo, 2100, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, 6720, Hungary
- Department of Physiology and Animal Health, Institute of Physiology and Animal Nutrition, Hungarian University of Agriculture and Life Sciences, Godollo, 2100, Hungary
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, 3015GD, The Netherlands.
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St-Laurent A, Plante AS, Lemieux S, Robitaille J, MacFarlane AJ, Morisset AS. Higher Than Recommended Folic Acid Intakes is Associated with High Folate Status Throughout Pregnancy in a Prospective French-Canadian Cohort. J Nutr 2023; 153:1347-1358. [PMID: 36848988 DOI: 10.1016/j.tjnut.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Folate and vitamin B12 status during pregnancy are important for maternal and neonatal health. Maternal intake and prepregnancy body mass index (ppBMI) can influence biomarker status. OBJECTIVES This study aimed to, throughout pregnancy; 1) assess folate and B12 status including serum total folate, plasma total vitamin B12, and homocysteine (tHcy); 2) examine how these biomarkers are associated with intakes of folate and B12 and with ppBMI; and 3) determine predictors of serum total folate and plasma total vitamin B12. METHODS In each trimester (T1, T2, and T3), food and supplement intakes of 79 French-Canadian pregnant individuals were assessed by 3 dietary recalls (R24W) and a supplement use questionnaire. Fasting blood samples were collected. Serum total folate and plasma total vitamin B12 and tHcy were assessed by immunoassay (Siemens ADVIA Centaur XP). RESULTS Participants were 32.1 ± 3.7 y and had a mean ppBMI of 25.7 ± 5.8 kg/m2. Serum total folate concentrations were high (>45.3 nmol/L, T1: 75.4 ± 55.1, T2: 69.1 ± 44.8, T3: 72.1 ± 52.1, P = 0.48). Mean plasma total vitamin B12 concentrations were >220 pmol/L (T1: 428 ± 175, T2: 321 ± 116, T3: 336 ± 128, P < 0.0001). Mean tHcy concentrations were <11 μmol/L across trimesters. Most participants (79.6%-86.1%) had a total folic acid intake above the Tolerable Upper Intake Level (UL, >1000 μg/d). Supplement use accounted for 71.9%-76.1% and 35.3%-41.8% of total folic acid and vitamin B12 intakes, respectively. The ppBMI was not correlated with serum total folate (P > 0.1) but was weakly correlated with and predicted lower plasma total vitamin B12 in T3 (r = -0.23, P = 0.04; r2 = 0.08, standardized beta [sβ] = -0.24, P = 0.01). Higher folic acid intakes from supplements predicted higher serum total folate (T1: r2 = 0.05, sβ = 0.15, P = 0.04, T2: r2 = 0.28, sβ = 0.56, P = 0.01, T3: r2 = 0.19, sβ = 0.44, P < 0.0001). CONCLUSIONS Most pregnant individuals had elevated serum total folate concentrations, reflecting total folic acid intakes above the UL driven by supplement use. Vitamin B12 concentrations were generally adequate and differed by ppBMI and pregnancy stage.
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Affiliation(s)
- Audrey St-Laurent
- School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Laval University Research Center, Quebec City, Canada; NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada
| | - Anne-Sophie Plante
- School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Laval University Research Center, Quebec City, Canada
| | - Simone Lemieux
- School of Nutrition, Laval University, Quebec City, Canada; NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Laval University Research Center, Quebec City, Canada; NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada
| | - Amanda J MacFarlane
- Nutrition Research Division, Health Canada, Ottawa, Ontario, Canada; Agriculture, Food, and Nutrition Evidence Center, Texas A&M University, Fort Worth, Texas, USA
| | - Anne-Sophie Morisset
- School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Laval University Research Center, Quebec City, Canada; NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada.
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7
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Zhang J, Du Y, Che X, Xia S, Zhang L, Liu J. Central adiposity increases the odds for plasma folate deficiency among Chinese women of reproductive age. Front Public Health 2022; 10:1000542. [PMID: 36311613 PMCID: PMC9614314 DOI: 10.3389/fpubh.2022.1000542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 01/26/2023] Open
Abstract
Objective To explore the association between adiposity and plasma folate deficiency odds among women of reproductive age in China. Methods A cross-sectional survey on nutritional status among women of reproductive aged 18-30 years in 2005-2006 in China was conducted. General adiposity was defined as body mass index (BMI) ≥24 kg/m2, and central adiposity was defined as waist circumference >80 cm. A plasma folate concentration <10.5 nmol/L (measured through microbiological assay) was defined as plasma folate deficiency. Odds ratios (ORs) and 95% confidence intervals (CIs) for plasma folate deficiency were calculated using a logistic regression model, with adjustment for potential confounders. Results A total of 3,076 women of reproductive age were included in the final analysis. Compared to women with normal BMI and WC, women with both general and central adiposity had the highest odds for plasma folate deficiency (OR = 3.107, 95% CI: 1.819-5.307). Women with exclusively central adiposity had excess odds for plasma folate deficiency (WC > 80 cm, BMI <24 kg/m2; OR = 2.448, 95% CI: 1.144-5.241), which was higher than women with exclusively general adiposity (BMI ≥ 24 kg/m2, WC ≤ 80 cm; OR = 1.709, 95% CI: 1.259-2.319). The combined use of BMI and WC can detect more women (11.7%) at higher plasma folate deficiency odds than either used alone. Conclusions Women with central adiposity in normal weight have higher odds for plasma folate deficiency than those with general obesity only. Early screening for central adiposity among women of reproductive age would be meaningful to prevent folate deficiency and improve life-cycle health.
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Affiliation(s)
- Jinjuan Zhang
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yushan Du
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiaoyu Che
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuangbo Xia
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Le Zhang
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Rubini E, Schenkelaars N, Rousian M, Sinclair KD, Wekema L, Faas MM, Steegers-Theunissen RPM, Schoenmakers S. Maternal obesity during pregnancy leads to derangements in one-carbon metabolism and the gut microbiota: implications for fetal development and offspring wellbeing. Am J Obstet Gynecol 2022; 227:392-400. [PMID: 35452650 DOI: 10.1016/j.ajog.2022.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/01/2022]
Abstract
A healthy diet before and during pregnancy is beneficial in acquiring essential B vitamins involved in 1-carbon metabolism, and in maintaining a healthy gut microbiota. Each play important roles in fetal development, immune-system remodeling, and pregnancy-nutrient acquisition. Evidence shows that there is a reciprocal interaction between the one-carbon metabolism and the gut microbiota given that dietary intake of B vitamins has been shown to influence the composition of the gut microbiota, and certain gut bacteria also synthesize B vitamins. This reciprocal interaction contributes to the individual's overall availability of B vitamins and, therefore, should be maintained in a healthy state during pregnancy. There is an emerging consensus that obese pregnant women often have derangements in 1-carbon metabolism and gut dysbiosis owing to high intake of nutritiously poor foods and a chronic systemic inflammatory state. For example, low folate and vitamin B12 in obese women coincide with the decreased presence of B vitamin-producing bacteria and increased presence of inflammatory-associated bacteria from approximately mid-pregnancy. These alterations are risk factors for adverse pregnancy outcomes, impaired fetal development, and disruption of fetal growth and microbiota formation, which may lead to potential long-term offspring metabolic and neurologic disorders. Therefore, preconceptional and pregnant obese women may benefit from dietary and lifestyle counseling to improve their dietary nutrient intake, and from monitoring their B vitamin levels and gut microbiome by blood tests and microbiota stool samples. In addition, there is evidence that some probiotic bacteria have folate biosynthetic capacity and could be used to treat gut dysbiosis. Thus, their use as an intervention strategy for obese women holds potential and should be further investigated. Currently, there are many knowledge gaps concerning the relationship between one-carbon metabolism and the gut microbiota, and future research should focus on intervention strategies to counteract B vitamin deficiencies and gut dysbiosis in obese pregnant women, commencing with the use of probiotic and prebiotic supplements.
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Affiliation(s)
- Eleonora Rubini
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicole Schenkelaars
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kevin D Sinclair
- School of Biosciences, University of Nottingham, Nottingham, United Kingdom
| | - Lieske Wekema
- Division of Medical Biology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marijke M Faas
- Division of Medical Biology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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van Weelden W, Seed PT, Antoun E, Godfrey KM, Kitaba NT, Lillycrop KA, Dalrymple KV, Sobczyńska-Malefora A, Painter RC, Poston L, White SL, Flynn AC. Folate and vitamin B12 status: associations with maternal glucose and neonatal DNA methylation sites related to dysglycaemia, in pregnant women with obesity. J Dev Orig Health Dis 2022; 13:168-176. [PMID: 33972006 PMCID: PMC7612506 DOI: 10.1017/s2040174421000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recent studies implicate maternal gestational diabetes mellitus (GDM) in differential methylation of infant DNA. Folate and vitamin B12 play a role in DNA methylation, and these vitamins may also influence GDM risk. The aims of this study were to determine folate and vitamin B12 status in obese pregnant women and investigate associations between folate and vitamin B12 status, maternal dysglycaemia and neonatal DNA methylation at cytosine-phosphate-guanine sites previously observed to be associated with dysglycaemia. Obese pregnant women who participated in the UK Pregnancies Better Eating and Activity Trial were included. Serum folate and vitamin B12 were measured at the oral glucose tolerance test (OGTT) visit. Cord blood DNA methylation was assessed using the Infinium MethylationEPIC BeadChip. Regression models with adjustment for confounders were used to examine associations. Of the 951 women included, 356 (37.4%) were vitamin B12 deficient, and 44 (4.6%) were folate deficient. Two-hundred and seventy-one women (28%) developed GDM. Folate and vitamin B12 concentrations were not associated with neonatal DNA methylation. Higher folate was positively associated with 1-h plasma glucose after OGTT (β = 0.031, 95% CI 0.001-0.061, p = 0.045). There was no relationship between vitamin B12 and glucose concentrations post OGTT or between folate or vitamin B12 and GDM. In summary, we found no evidence to link folate and vitamin B12 status with the differential methylation of neonatal DNA previously observed in association with dysglycaemia. We add to the evidence that folate status may be related to maternal glucose homoeostasis although replication in other maternal cohorts is required for validation.
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Affiliation(s)
- Wenneke van Weelden
- Amsterdam University Medical Center – location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London
| | - Elie Antoun
- Human Development and Health, Faculty of Medicine, University of Southampton, UK
| | - Keith M. Godfrey
- Human Development and Health, Faculty of Medicine, University of Southampton, UK
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Negusse T. Kitaba
- Human Development and Health, Faculty of Medicine, University of Southampton, UK
| | - Karen A. Lillycrop
- Centre for Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK
| | - Kathryn V. Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London
| | - Agata Sobczyńska-Malefora
- Nutristasis Unit, Viapath, St. Thomas’ Hospital, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rebecca C. Painter
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London
| | - Sara L. White
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London
| | - Angela C. Flynn
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London
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Bodnar LM, Cartus AR, Kennedy EH, Kirkpatrick SI, Parisi SM, Himes KP, Parker CB, Grobman WA, Simhan HN, Silver RM, Wing DA, Perry S, Naimi AI. Use of a Doubly Robust Machine-Learning-Based Approach to Evaluate Body Mass Index as a Modifier of the Association Between Fruit and Vegetable Intake and Preeclampsia. Am J Epidemiol 2022; 191:1396-1406. [PMID: 35355047 PMCID: PMC9614933 DOI: 10.1093/aje/kwac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
The Dietary Guidelines for Americans rely on summaries of the effect of dietary pattern on disease risk, independent of other population characteristics. We explored the modifying effect of prepregnancy body mass index (BMI; weight (kg)/height (m)2) on the relationship between fruit and vegetable density (cup-equivalents/1,000 kcal) and preeclampsia using data from a pregnancy cohort study conducted at 8 US medical centers (n = 9,412; 2010-2013). Usual daily periconceptional intake of total fruits and total vegetables was estimated from a food frequency questionnaire. We quantified the effects of diets with a high density of fruits (≥1.2 cups/1,000 kcal/day vs. <1.2 cups/1,000 kcal/day) and vegetables (≥1.3 cups/1,000 kcal/day vs. <1.3 cups/1,000 kcal/day) on preeclampsia risk, conditional on BMI, using a doubly robust estimator implemented in 2 stages. We found that the protective association of higher fruit density declined approximately linearly from a BMI of 20 to a BMI of 32, by 0.25 cases per 100 women per each BMI unit, and then flattened. The protective association of higher vegetable density strengthened in a linear fashion, by 0.3 cases per 100 women for every unit increase in BMI, up to a BMI of 30, where it plateaued. Dietary patterns with a high periconceptional density of fruits and vegetables appear more protective against preeclampsia for women with higher BMI than for leaner women.
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Affiliation(s)
- Lisa M Bodnar
- Correspondence to Dr. Lisa M. Bodnar, 5129 Public Health, Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261 (e-mail: )
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11
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Kangalgil M, Şahinler A, Özçelik AÖ. Maternal micronutrient status and its association with sociodemographic, maternal, and dietary factors in a cross-sectional study. J Obstet Gynaecol Res 2022; 48:1328-1336. [PMID: 35332609 DOI: 10.1111/jog.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
AIM Maternal serum micronutrient status can have a significant impact on short- and long-term outcomes for mother and offspring. The aim of this study was to examine the associations of maternal serum folate, ferritin, and vitamin B12 status with maternal and dietary factors. METHODS This observational cross-sectional study was carried out with 165 healthy pregnant women at least 18 years of age with a singleton pregnancy. Maternal nutrient intake was determined by 24-hour dietary recall method and supplement records. Multivariable analyses using stepwise linear regression models were performed to associations of dietary intakes and maternal serum status. RESULTS There was a difference between the lowest and highest quartile of maternal serum folate, ferritin, and vitamin B12 status and maternal characteristics and dietary, and total intakes of nutrients (p < 0.05). Multivariable stepwise linear regression analysis showed the predictors of serum folate status were dietary folate equivalent, dietary folate, total vitamin B6 and iron intake. Primer predictors of serum ferritin and vitamin B12 status were dietary protein intake (p < 0.05). CONCLUSION Our findings support existing recommendations that folic acid supplementation should be prescribed to achieve optimal serum folate status during pregnancy. However, dietary protein intake is important to provide optimal maternal serum vitamin B12 and ferritin status.
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Affiliation(s)
- Melda Kangalgil
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Ayhan Şahinler
- Department of Obstetrics and Gynecology, Trabzon Numune Training and Research Hospital, Trabzon, Turkey
| | - Ayşe Özfer Özçelik
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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12
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Mayasari NR, Hu TY, Chao JCJ, Bai CH, Chen YC, Huang YL, Chang CC, Wang FF, Hadi H, Nurwanti E, Chang JS. Associations of the pre-pregnancy weight status with anaemia and the erythropoiesis-related micronutrient status. Public Health Nutr 2021; 24:6247-6257. [PMID: 34120669 PMCID: PMC11148615 DOI: 10.1017/s1368980021002627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron deficiency (ID) anaemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy BMI (pBMI) and erythropoiesis-related nutritional deficiencies. DESIGN Anthropometry, blood biochemistry and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion or a vitamin B12 deficiency. SETTING The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017-2019). PARTICIPANTS We included 1456 women aged 20 to 45 years with singleton pregnancies. RESULTS Among these pregnant women, 9·6 % were UW, and 29·2 % were either OW (15·8 %) or OB (13·4 %). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95 % CI) for OW subjects (0·6; 95 % CI (0·4, 0·9)) but increased odds for UW (1·2; 95 % CI (0·8, 2·0)) and OB subjects (1·2; 95 % CI (0·8, 1·8)). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight, OB pregnant women had 3·4-fold (3·4; 95 % CI (1·4, 8·1)) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0·3; 95 % CI (0·1, 1·2)). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, Fe and folate intakes, but positive relationship with fat intakes. CONCLUSION The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy.
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Affiliation(s)
- Noor Rohmah Mayasari
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei11031, Taiwan
| | - Tzu-Yu Hu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei11031, Taiwan
| | - Jane C-J Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei11031, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi Chun Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei11031, Taiwan
| | - Ya Li Huang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Fan-Fen Wang
- Department of Internal Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Hamam Hadi
- Alma Ata Graduate School of Public Health, Universitas Alma Ata, Yogyakarta, Indonesia
| | - Esti Nurwanti
- Department of Nutrition, Faculty of Health Sciences, University of Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei11031, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Chinese Taipei Society for the Study of Obesity (CTSSO), Taipei, Taiwan
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13
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Hieronimus B, Ensenauer R. Influence of maternal and paternal pre-conception overweight/obesity on offspring outcomes and strategies for prevention. Eur J Clin Nutr 2021; 75:1735-1744. [PMID: 34131301 PMCID: PMC8636250 DOI: 10.1038/s41430-021-00920-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
Overweight, obesity, and their comorbidities remain global health challenges. When established early in life, overweight is often sustained into adulthood and contributes to the early onset of non-communicable diseases. Parental pre-conception overweight and obesity is a risk factor for overweight and obesity in childhood and beyond. This increased risk likely is based on an interplay of genetic alterations and environmental exposures already at the beginning of life, although mechanisms are still poorly defined. In this narrative review, potential routes of transmission of pre-conceptional overweight/obesity from mothers and fathers to their offspring as well as prevention strategies are discussed. Observational evidence suggests that metabolic changes due to parental overweight/obesity affect epigenetic markers in oocytes and sperms alike and may influence epigenetic programming and reprogramming processes during embryogenesis. While weight reduction in overweight/obese men and women, who plan to become pregnant, seems advisable to improve undesirable outcomes in offspring, caution might be warranted. Limited evidence suggests that weight loss in men and women in close proximity to conception might increase undesirable offspring outcomes at birth due to nutritional deficits and/or metabolic disturbances in the parent also affecting gamete quality. A change in the dietary pattern might be more advisable. The data reviewed here suggest that pre-conception intervention strategies should shift from women to couples, and future studies should address possible interactions between maternal and paternal contribution to longitudinal childhood outcomes. Randomized controlled trials focusing on effects of pre-conceptional diet quality on long-term offspring health are warranted.
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Affiliation(s)
- Bettina Hieronimus
- Institute of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany
- Institute of Child Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany
| | - Regina Ensenauer
- Institute of Child Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany.
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14
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Taeubert MJ, Wiertsema CJ, Vermeulen MJ, Quezada-Pinedo HG, Reiss IK, Muckenthaler MU, Gaillard R. Maternal Iron Status in Early Pregnancy and Blood Pressure Throughout Pregnancy, Placental Hemodynamics, and the Risk of Gestational Hypertensive Disorders. J Nutr 2021; 152:525-534. [PMID: 34647596 PMCID: PMC8826859 DOI: 10.1093/jn/nxab368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In nonpregnant populations, higher serum ferritin, which reflects high iron stores, is associated with an increased risk of hypertension. We hypothesized that a dysregulated maternal iron status in early pregnancy may lead to impaired gestational hemodynamic adaptations, leading to an increased risk of gestational hypertensive disorders. OBJECTIVES We examined the associations of maternal iron status with maternal blood pressure, placental hemodynamic parameters, and the risks of gestational hypertensive disorders. METHODS In a population-based prospective cohort study among 5983 pregnant women, we measured maternal serum ferritin, transferrin saturation, serum iron, and transferrin concentrations at a median of 13.2 weeks gestation (95% range, 9.6-17.6). Maternal blood pressure was measured in early pregnancy, mid pregnancy, and late pregnancy, and placental hemodynamic parameters in mid pregnancy and late pregnancy were measured by ultrasound. Information on gestational hypertensive disorders was collected from medical records. We examined the associations of maternal early pregnancy iron status with maternal systolic and diastolic blood pressure, placental hemodynamic parameters, and the risks of gestational hypertensive disorders using linear and logistic regression models. RESULTS Higher maternal early pregnancy serum ferritin concentrations were associated with higher systolic and diastolic blood pressure throughout pregnancy in the basic models (P values < 0.05). After adjustment for maternal inflammation, sociodemographic and lifestyle factors, higher maternal early pregnancy serum ferritin concentrations were only associated with a higher early pregnancy diastolic blood pressure [0.27 (95% CI, 0.03-0.51) mmHg per SD score increase in serum ferritin] and with a higher mid pregnancy umbilical artery pulsatility index (P < 0.05). No associations with the risk of gestational hypertensive disorders were present. CONCLUSIONS No consistent associations were present of maternal iron status in early pregnancy with gestational hemodynamic adaptations or the risks of gestational hypertensive disorders. Further studies are needed to examine the potential role of iron metabolism in the development of gestational hypertensive disorders within higher-risk populations.
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Affiliation(s)
- Minerva J Taeubert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Pediatric Oncology, Hematology and Immunology, University Medical Center, Heidelberg, Germany
| | - Clarissa J Wiertsema
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hugo G Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K Reiss
- Department of Pediatrics, Sophia's Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martina U Muckenthaler
- Department of Pediatric Oncology, Hematology and Immunology, University Medical Center, Heidelberg, Germany
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15
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The effect of prepregnancy body mass index on maternal micronutrient status: a meta-analysis. Sci Rep 2021; 11:18100. [PMID: 34518612 PMCID: PMC8437962 DOI: 10.1038/s41598-021-97635-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
The relationship between prepregnancy body mass index (BMI) and maternal micronutrient status is inconsistent and has not received sufficient attention. This meta-analysis aimed to evaluate the effect of prepregnancy BMI on micronutrient levels in pregnant women. PubMed, Embase, Web of Science, and the Cochrane Library were searched for articles that contained information on micronutrient levels and prepregnancy BMI. A random-effects model was used to determine the association between prepregnancy BMI and maternal micronutrient status. Sixty-one eligible articles were eventually included, with 83,554 participants. Vitamin B12, folate, vitamin D, iron and ferritin were the main micronutrients evaluated in our meta-analysis. Prepregnancy obesity and overweight may lead to an increased risk of micronutrient deficiency, including vitamin B12, folate and vitamin D deficiency, while prepregnancy obesity or overweight may have no significant association with ferritin deficiency. Additionally, the results of the dose-response analyses demonstrated a possible significant inverse correlation between prepregnancy BMI and levels of micronutrient, except for iron and ferritin. Compared with women with normal weight, women who were overweight or obese prepregnancy have lower micronutrient concentrations and are more likely to exhibit micronutrient deficiency during pregnancy, which is harmful to both mothers and neonates.
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16
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Mattsson M, Murray DM, Hawkes CP, Kiely M, Ní Chaoimh C, McCarthy FP, Biesma R, Boland F. Body Mass Index Trajectories in the First 5 Years and Associated Antenatal Factors. Front Pediatr 2021; 9:622381. [PMID: 33681100 PMCID: PMC7933027 DOI: 10.3389/fped.2021.622381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The increasing prevalence of childhood obesity is an important public health issue and the development of obesity in early life and associated risk factors need to be better understood. The aim of this study was to identify distinct body mass index trajectories in the first 5 years of life and to examine their associations with factors identified in pregnancy, including metabolic parameters. Methods: BMI measurements from 2,172 children in Ireland enrolled in the BASELINE cohort study with BMI assessments at birth, 2, 6, and 12 months, and 2 and 5 years were analyzed. Growth mixture modeling was used to identify distinct BMI trajectories, and multivariate multinomial logistic regression was used to assess the association between these trajectories and antenatal factors. Results: Three distinct BMI trajectories were identified: normal (89.6%); rapid gain in the first 6 months (7.8%); and rapid BMI after 12 months (2.6%). Male sex and higher maternal age increased the likelihood of belonging to the rapid gain in the first 6 months trajectory. Raised maternal BMI at 15 weeks of pregnancy and lower cord blood IGF-2 were associated with rapid gain after 1 year. Conclusion: Sex, maternal age and BMI, and IGF-2 levels were found to be associated with BMI trajectories in early childhood departing from normal growth. Further research and extended follow-up to examine the effects of childhood growth patterns are required to understand their relationship with health outcomes.
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Affiliation(s)
- Molly Mattsson
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre M. Murray
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Colin P. Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Carol Ní Chaoimh
- Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Regien Biesma
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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17
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Vitamin B12 deficiency and altered one-carbon metabolites in early pregnancy is associated with maternal obesity and dyslipidaemia. Sci Rep 2020; 10:11066. [PMID: 32632125 PMCID: PMC7338455 DOI: 10.1038/s41598-020-68344-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Vitamin B12 (B12) is a micronutrient essential for one-carbon (1C) metabolism. B12 deficiency disturbs the 1C cycle and alters DNA methylation which is vital for most metabolic processes. Studies show that B12 deficiency may be associated with obesity, insulin resistance and gestational diabetes; and with obesity in child-bearing women. We therefore hypothesised that the associations between B12 deficiency, BMI and the metabolic risk could be mediated through altered 1C metabolites in early pregnancy. We explored these associations in two different early pregnancy cohorts in the UK (cohort 1; n = 244 and cohort 2; n = 60) with anthropometric data at 10-12 weeks and plasma/serum sampling at 16-18 weeks. B12, folate, total homocysteine (tHcy), methionine, MMA, metabolites of 1C metabolism (SAM, SAH) and anthropometry were measured. B12 deficiency (< 150 pmol/l) in early pregnancy was 23% in cohort 1 and 18% in cohort 2. Regression analysis after adjusting for likely confounders showed that B12 was independently and negatively associated with BMI (Cohort 1: β = - 0.260, 95% CI (- 0.440, - 0.079), p = 0.005, Cohort 2: (β = - 0.220, 95% CI (- 0.424, - 0.016), p = 0.036) and positively with HDL cholesterol (HDL-C) (β = 0.442, 95% CI (0.011,0.873), p = 0.045). We found that methionine (β = - 0.656, 95% CI (- 0.900, - 0.412), p < 0.0001) and SAH (β = 0.371, 95% CI (0.071, 0.672), p = 0.017) were independently associated with triglycerides. Low B12 status and alteration in metabolites in 1C metabolism are common in UK women in early pregnancy and are independently associated with maternal obesity and dyslipidaemia. Therefore, we suggest B12 monitoring in women during peri-conceptional period and future studies on the pathophysiological relationship between changes in 1C metabolites and its association with maternal and fetal outcomes on larger cohorts. This in turn may offer potential to reduce the metabolic risk in pregnant women and their offspring.
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18
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Edlow AG, Guedj F, Sverdlov D, Pennings JLA, Bianchi DW. Significant Effects of Maternal Diet During Pregnancy on the Murine Fetal Brain Transcriptome and Offspring Behavior. Front Neurosci 2019; 13:1335. [PMID: 31920502 PMCID: PMC6928003 DOI: 10.3389/fnins.2019.01335] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Maternal over- and undernutrition in pregnancy plays a critical role in fetal brain development and function. The effects of different maternal diet compositions on intrauterine programing of the fetal brain is a lesser-explored area. The goal of this study was to investigate the impact of two chowmaternal diets on fetal brain gene expression signatures, fetal/neonatal growth, and neonatal and adult behavior in a mouse model. METHODS Throughout pregnancy and lactation, female C57Bl/6J mice were fed one of two standard, commercially available chow diets (pellet versus powder). The powdered chow diet was relatively deficient in micronutrients and enriched for carbohydrates and n-3 long-chain polyunsaturated fatty acids compared to the pelleted chow. RNA was extracted from embryonic day 15.5 forebrains and hybridized to whole genome expression microarrays (N = 5/maternal diet group). Functional analyses of significantly differentially expressed fetal brain genes were performed using Ingenuity Pathways Analysis and Gene Set Enrichment Analysis. Neonatal behavior was assessed using a validated scale (N = 62 pellet-exposed and 31 powder-exposed). Hippocampal learning, locomotor behavior, and motor coordination were assessed in a subset of adults using fear conditioning, open field testing, and Rotarod tests (N = 16 pellet-exposed, 14 powder-exposed). RESULTS Comparing powdered to pelleted chow diets, neither maternal weight trajectory in pregnancy nor embryo size differed. Maternal powdered chow diet was associated with 1647 differentially expressed fetal brain genes. Functional analyses identified significant upregulation of canonical pathways and upstream regulators involved in cell cycle regulation, synaptic plasticity, and sensory nervous system development in the fetal brain, and significant downregulation of pathways related to cell and embryo death. Pathways related to DNA damage response, brain immune response, amino acid and fatty acid transport, and dopaminergic signaling were significantly dysregulated. Powdered chow-exposed neonates were significantly longer but not heavier than pelleted chow-exposed counterparts. On neonatal behavioral testing, powdered chow-exposed neonates achieved coordination- and strength-related milestones significantly earlier, but sensory maturation reflexes significantly later. On adult behavioral testing, powdered chow-exposed offspring exhibited hyperactivity and hippocampal learning deficits. CONCLUSION In wild-type offspring, two diets that differed primarily with respect to micronutrient composition had significant effects on the fetal brain transcriptome, neonatal and adult behavior. These effects did not appear to be mediated by alterations in gross maternal nutritional status nor fetal/neonatal weight. Maternal dietary content is an important variable to consider for investigators evaluating fetal brain development and offspring behavior.
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Affiliation(s)
- Andrea G. Edlow
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Faycal Guedj
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Deanna Sverdlov
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, United States
| | | | - Diana W. Bianchi
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States
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Obeid R, Holzgreve W, Pietrzik K. Folate supplementation for prevention of congenital heart defects and low birth weight: an update. Cardiovasc Diagn Ther 2019; 9:S424-S433. [PMID: 31737547 DOI: 10.21037/cdt.2019.02.03] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Women planning a pregnancy and pregnant women in the first trimester are recommended to use folate-containing supplements in order to prevent neural tube defects. The prevention of many cases of neural tube defects with folic acid is evident from meta-analysis, randomized controlled trials (RCTs), observational studies in humans and experimental evidence in animals. However, folate supplementation in pregnant women or a higher maternal folate status has been shown to be protective against other adverse birth outcomes such as congenital heart defects, low birth weight, and preterm birth. Additionally, infants and children with congenital heart defects often show disorders in folate metabolism (low folate, higher homocysteine, or low vitamin B12). Maternal genotype for several folate metabolizing genes has shown associations with the risk of having a child with congenital heart defect. There is some evidence that folate supplementation could have differential effects on sub-types of congenital heart defects, but it is not clear whether the prevention time window is the same as for neural tube defects. Some studies proposed a high dose of folic acid (in mg/d) to prevent congenital heart defects in women with a high global risk (such as those with diabetes or obesity). There are currently no RCTs to support that doses of folic acid in mg range are more effective than the currently recommended 400-800 µg/d taken at least 2-3 months before conception until the end of the first trimester.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | | | - Klaus Pietrzik
- Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms University, Bonn, Germany
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20
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Savard C, Lemieux S, Weisnagel SJ, Fontaine-Bisson B, Gagnon C, Robitaille J, Morisset AS. Trimester-Specific Dietary Intakes in a Sample of French-Canadian Pregnant Women in Comparison with National Nutritional Guidelines. Nutrients 2018; 10:E768. [PMID: 29899222 PMCID: PMC6024697 DOI: 10.3390/nu10060768] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 01/11/2023] Open
Abstract
Diet during pregnancy greatly impacts health outcomes. This study aims to measure changes in dietary intakes throughout trimesters and to assess pregnant women’s dietary intakes in comparison with current Canadian nutritional recommendations. Seventy-nine pregnant women were recruited and completed, within each trimester, three Web-based 24-h dietary recalls and one Web questionnaire on supplement use. Dietary intakes from food, with and without supplements, were compared to nutritional recommendations throughout pregnancy. Energy and macronutrient intakes remained stable throughout pregnancy. A majority of women exceeded their energy and protein requirements in the first trimester, and fat intakes as a percentage of energy intakes were above recommendations for more than half of the women in all trimesters. Supplement use increased dietary intakes of most vitamins and minerals, but 20% of women still had inadequate total vitamin D intakes and most women had excessive folic acid intakes. This study showed that pregnant women did not increase their energy intakes throughout pregnancy as recommended. Furthermore, although prenatal supplementation reduces the risk of inadequate intake for most micronutrients, there is still a risk of excessive folic acid and insufficient vitamin D intake, which needs further investigation.
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Affiliation(s)
- Claudia Savard
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada.
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada.
- Institute of Nutrition and Functional Foods, Laval University, Québec City, QC G1V 0A6, Canada.
| | - Simone Lemieux
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada.
- Institute of Nutrition and Functional Foods, Laval University, Québec City, QC G1V 0A6, Canada.
| | - S John Weisnagel
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada.
- Department of Medicine, Laval University, Québec City, QC G1V 0A6, Canada.
| | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada.
| | - Claudia Gagnon
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada.
- Institute of Nutrition and Functional Foods, Laval University, Québec City, QC G1V 0A6, Canada.
- Department of Medicine, Laval University, Québec City, QC G1V 0A6, Canada.
| | - Julie Robitaille
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada.
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada.
- Institute of Nutrition and Functional Foods, Laval University, Québec City, QC G1V 0A6, Canada.
| | - Anne-Sophie Morisset
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada.
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada.
- Institute of Nutrition and Functional Foods, Laval University, Québec City, QC G1V 0A6, Canada.
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