Relationship between dietary intake of cod liver oil in early pregnancy and birthweight

Dietary intake of carbohydrates in pregnant women with type 1 diabetes-A narrative review

In pregnant women with type 1 diabetes, a low but sufficient, intake of carbohydrates is important to aim for near normal glycemic control. However, knowledge about the carbohydrate intake in this group is limited. To assess the average quantity and quality of carbohydrate intake in pregnant women with type 1diabetes compared to healthy pregnant women and current dietary reference intakes. A narrative literature search was performed in PubMed, Embase, and Cochrane Library and by using a snow-ball search technique to identify papers published on studies conducted in industrialized countries within the last 20 years. Intakes of carbohydrate were assessed qualitatively in relation to the Dietary Reference Intakes recommended by the American Diabetes Association and quantitatively as mean intake of dietary fiber. Five observational studies including 810 pregnant women with type 1 diabetes and 15 observational studies with a total of 118,246 healthy pregnant women were identified. The mean total carbohydrate intake was within the Acceptable Macronutrient Distribution Range (45%-64% of energy intake) in both groups. In pregnant women with type 1 diabetes, the average total intake was 218 ± 19 g/day, which was 20% (53 g/day) lower than in healthy pregnant women. Mean intake of dietary fiber in women with diabetes was lower than the recommended adequate intake for healthy women. With the limitations of pronounced heterogeneity across the included studies, pregnant women with type 1 diabetes reported a mean total carbohydrate intake, which was lower than in healthy pregnant women but still within the recommended range.

Periconceptional use of cod liver oil, a vitamin D source, could decrease the risk of CHD in offspring

OBJECTIVE

To explore if there is association between vitamin D supplementation through cod liver oil ingestion around the periconceptional period and the risk of developing severe CHD in offspring. Furthermore, we would examine the interaction between vitamin D and folic acid supplementation in the association.

METHODS

A case-control study was conducted in Shanghai Children's Medical Center, in which, a total of 262 severe CHD cases versus 262 controls were recruited through June 2016 to December 2017. All children were younger than 2 years. To reduce potential selection bias and to minimise confounding effects, propensity score matching was applied.

RESULTS

After propensity score matching, vitamin D supplementation seemed to be associated with decreased odds ratio of severe CHD (odds ratio = 0.666; 95% confidence intervals: 0.449-0.990) in the multivariable conditional logistic analysis. Furthermore, we found an additive interaction between vitamin D and folic acid supplementation (relative excess risk due to interaction = 0.810, 95% confidence intervals: 0.386-1.235) in the association.

CONCLUSION

The results suggested that maternal vitamin D supplementation could decrease the risk of offspring severe CHD; moreover, it could strengthen the protective effect of folic acid. The significance of this study lies in providing epidemiological evidence that vitamin D supplementation around the periconceptional period could be a potential nutritional intervention strategy to meet the challenge of increasing CHD.

Omega-3 polyunsaturated fatty acid intake norms and preterm birth rate: a cross-sectional analysis of 184 countries

BACKGROUND

The preponderance of evidence now indicates that elevated long-chain omega-3 polyunsaturated fatty acid (LC omega-3 PUFA) intake is often associated with reduced risk of preterm birth (PTB). This conclusion is based on recent meta-analyses that include several studies that reported null findings. We probed the reasons for this heterogeneity across studies and its implications for PTB prevention using country-level data.

METHODS

We analysed the relationship between national PTB rates (<37 weeks of gestation) and omega-3 PUFA intake norms from 184 countries for the year 2010. To estimate the total LC omega-3 PUFA levels (eicosapentaenoic acid [EPA]/docosahexaenoic acid [DHA]) that these norms produce we utilised a metric that accounts for (1) seafood-based omega-3 intake (EPA/DHA) and (2) plant-based omega-3 intake (alpha-linolenic acid [ALA]), ~20% of which is converted to EPA/DHA in vivo. We then assessed the shape of the omega-3-PTB relationship with a penalised spline and conducted linear regression analyses within the linear sections of the relationship.

RESULTS

Penalised spline analyses indicated that PTB rates decrease linearly with increasing omega-3 levels up to ~600 mg/day. Income-adjusted linear regression analysis among the countries in this exposure range indicated that the number of PTBs per 100 live births decreases by 1.5 (95% CI 2.8 to 0.3) for each 1 SD increase in omega-3 intake norms (383 mg/day).

CONCLUSIONS

Taken with prior evidence for a causal association on the individual level, our findings indicate that omega-3 PUFA deficiency may be a widespread contributing factor in PTB risk. Consideration of baseline omega-3 PUFA levels is critical in the design of future interventions.

Maternal obesity is not associated with placental lipid accumulation in women with high omega-3 fatty acid levels

INTRODUCTION

Placentas of obese women have higher lipid content compared to lean women. We have previously shown that supplementation of overweight and obese women with omega-3 fatty acids decreases placental esterification pathways and total lipid content in a mid-western population (Ohio). We hypothesized that placental lipid accumulation and inflammation would be similar between lean and obese women living in a region of high omega-3 intake, such as Hawaii.

METHODS

Fifty-five healthy, normal glucose tolerant women from Honolulu Hawaii, dichotomized based on pre-pregnancy BMI into lean (BMI <25 kg/m2, n = 29) and obese (BMI >30 kg/m2, n = 26), were recruited at scheduled term cesarean delivery. Maternal plasma DHA levels were analyzed by mass spectrometry. Expression of key genes involved in fatty acid oxidation and esterification were measured in placental tissue using qPCR. Total lipids were extracted from placental tissue via the Folch method. TNF-α concentration was measured by enzyme-linked immunosorbent assay in placental lysates.

RESULTS

DHA levels were higher in lean women compared to obese women (P = 0.02). However, DHA levels in obese women in Hawaii were eight times higher compared to obese Ohioan women (P=<0.0001). Placental lipid content and expression of key genes involved in fatty acid oxidation and esterification were similar (P > 0.05) between lean and obese women in Hawaii. Furthermore, TNF-α placental lysates were not different between lean and obese women.

CONCLUSIONS

Though obese women in Hawaii have lower DHA levels compared to their lean counterparts, these levels remain over eight times as high as obese Ohioan women. These relatively high plasma omega-3 levels in obese women in Hawaii may suppress placental lipid esterification/storage and inflammation to the same levels of lean women, as seen previously in vitro.

The effect of fish oil supplementation on maternal and neonatal outcomes: a triple-blind, randomized controlled trial

OBJECTIVE

To evaluate the effect of fish oil supplementation on pregnancy outcomes in mother and newborn.

METHODS

This randomized, triple-blind, placebo-controlled trial was conducted on 150 pregnant women aged 18-35 years from Feburary 2014 to April 2015 in Tabriz, Iran. Participants were assigned to receive either 1000 mg fish oil supplements containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexanoic acid or placebo from week 20 of gestation to birth. The primary outcome measure was birth weight. Gestational duration, preterm labor low birth weight (LBW), length, head circumference, and maternal serum docosahexaenoic acid (DHA) and EPA level at 35-37 weeks were also examined. The statistical analysis was on an intention-to-treat basis.

RESULTS

Demographic characteristics were similar in both groups (P>0.05). The mean (SD) birth weight values in the fish oil and placebo groups were 3256 (362) g and 3172 (447) g, respectively (adjusted mean difference (MD)=84.1 g, 95% confidence interval [CI]=-24.8 to 193.2). Five (7.6%) neonates in the placebo versus no case in the fish oil group were born with LBW (P=0.02). The rate of preterm labor was lower in the fish oil group (adjusted OR=0.74, 95% CI=0.16-3.42). However, there were no statistically significant differences in the maternal outcomes (P>0.05) with the exception of the proportion of maternal serum DHA fatty acid at 35-37 weeks (P<0.001).

CONCLUSION

Although low dose fish oil supplementation increased birth weight, its effect was not statistically significant. The frequency of LBW was significantly reduced in the intervention group, but the observed reduction needs to be confirmed in future larger investigations using different doses of omega-3.

Effect of ω-3 supplementation on placental lipid metabolism in overweight and obese women

BACKGROUND

The placentas of obese women accumulate lipids that may alter fetal lipid exposure. The long-chain omega-3 fatty acids (n–3 FAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) alter FA metabolism in hepatocytes, although their effect on the placenta is poorly understood.

OBJECTIVE

We aimed to investigate whether n–3 supplementation during pregnancy affects lipid metabolism in the placentas of overweight and obese women at term.

DESIGN

A secondary analysis of a double-blind randomized controlled trial was conducted in healthy overweight and obese pregnant women who were randomly assigned to DHA plus EPA (2 g/d) or placebo twice a day from early pregnancy to term. Placental FA uptake, esterification, and oxidation pathways were studied by measuring the expression of key genes in the placental tissue of women supplemented with placebo and n–3 and in vitro in isolated trophoblast cells in response to DHA and EPA treatment.

RESULTS

Total lipid content was significantly lower in the placentas of overweight and obese women supplemented with n–3 FAs than in those supplemented with placebo (14.14 ± 1.03 compared with 19.63 ± 1.45 mg lipid/g tissue; P < 0.05). The messenger RNA expression of placental FA synthase (FAS) and diacylglycerol O-acyltransferase 1 (DGAT1) was negatively correlated with maternal plasma enrichment in DHA and EPA (P < 0.05). The expression of placental peroxisome proliferator–activated receptor γ (r = −0.39, P = 0.04) and its target genes DGAT1 (r = −0.37, P = 0.02) and PLIN2 (r = −0.38, P = 0.04) significantly decreased, with an increasing maternal n–3:n–6 ratio (representing the n–3 status) near the end of pregnancy. The expression of genes that regulate FA oxidation or uptake was not changed. Birth weight and length were significantly higher in the offspring of n–3-supplemented women than in those in the placebo group (P < 0.05), but no differences in the ponderal index were observed. Supplementation of n–3 significantly decreased FA esterification in isolated trophoblasts without affecting FA oxidation.

CONCLUSION

Supplementing overweight and obese women with n–3 FAs during pregnancy inhibited the ability of the placenta to esterify and store lipids. This trial was registered at clinicaltrials.gov as NCT00957476.

Maternal use of flaxseed oil during pregnancy and lactation prevents morphological alterations in pancreas of female offspring from rat dams with experimental diabetes

Nutritional recommendations have promoted the increased need to consume n-3 polyunsaturated fatty acids. Flaxseed is the richest dietary source of n-3 fatty acids among plant sources and is widely used for its edible oil. This study aimed to investigate whether maternal use of flaxseed oil has effects on pancreas morphology in the female offspring of diabetic mothers. Female Wistar rats (n = 12) were induced into diabetes by a high-fat diet and low dose of streptozotocin. After confirmation of the diabetes, rats were mated, and once pregnancy was confirmed, they were allocated into three groups (n = 6): high-fat group (HG); flaxseed oil group (FOG); and control group (CG) (non-diabetic rats). At weaning, female offspring (n = 6/group) received standard chow diet. The animals were euthanized at 180 days. Pancreas was collected for histomorphometric and immunohistochemistry analysis. HG showed hypertrophy of pancreatic islets (P < 0.0001), whereas FOG offspring had islets with smaller diameters compared to HG (P < 0.0001). HG offspring showed higher percentage of larger (P = 0.0061) and lower percentage of smaller islets (P = 0.0036). HG showed lower islet insulin immunodensity at 180 days (P < 0.0001), whereas FOG was similar to CG (P < 0.0001). Flaxseed oil reduced the damage caused by maternal hyperglycaemia, promoting normal pancreas histomorphometry and β-cell mass in female offspring.

Worldwide variation in human growth and the World Health Organization growth standards: a systematic review

OBJECTIVE

The World Health Organization (WHO) has established a set of growth curves for use as international standards in children up to age 5. The WHO's position is that all economically advantaged children who were breastfed as infants grow similarly. As a result, a single set of growth charts can be used to judge growth in any child, regardless of race or ethnicity. The goal of this study was to compare mean heights, weights and head circumferences from a variety of studies with the WHO's data.

DESIGN

We compared data from the WHO's Multicentre Growth Reference Study (MGRS) with data from studies performed in 55 countries or ethnic groups.

DATA SOURCES

PubMed, WHO Global Database on Child Growth and Malnutrition, SciELO, Google Scholar, Textbooks and Ministries of Statistics and Public Health.

ELIGIBILITY CRITERIA

Large recent studies (1988-2013) of economically advantaged groups, including comparisons with cohorts of breastfed children wherever possible.

RESULTS

Height varied somewhat among different national and ethnic groups. Means were generally within 0.5 of an SD of the MGRS means. Weight varied more than height, but the low MGRS means were seen as endorsing slenderness in the midst of an obesity epidemic. The mean head circumference varied widely. In many groups, means were consistently 0.5-1 SD above the MGRS mean. Head size in breastfed children at any age examined was far closer to local norms than to the MGRS means.

CONCLUSIONS

Height and weight curves may not be optimal fits in all cases. The differences between national or ethnic group head circumference means were large enough that using the WHO charts would put many children at risk for misdiagnosis of macrocephaly or microcephaly. Our findings indicate that the use of a single international standard for head circumference is not justified.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (# CRD42013003675).

Effect of birth year on birth weight and obesity in adulthood: comparison between subjects born prior to and during the great depression in Iceland

Background

Many epidemiological studies have linked small size at birth to adverse adult health outcomes but the relative influence of environmental exposures is less well established.

Methods

The authors investigated the impact of prenatal environmental exposure by comparing 2750 participants born before (1925–1929) and during (1930–1934) the Great Depression in Reykjavik, Iceland. Calendar year served as proxy for environmental effects. Anthropometric measurements at birth and school-age (8–13 years) were collected from national registries. Participants were medically examined as adults (33–65 years).

Results

Mean birth weight, adjusted for maternal age and parity, decreased by 97 g (95% confidence interval (CI): 39, 156) for men and 70 g (95% CI: 11, 129) for women from 1925 to 1934; growth at school-age was significantly reduced for participants growing during the Depression. As adults, women prenatally exposed to the Depression had higher body mass index (Δ0.6 kg/m², 95% CI: 0.2, 1.1), higher fasting blood glucose levels (Δ0.16 mmol/L, 95% CI: 0.07, 0.23) and greater odds of being obese 1.43 (95% CI: 1.01, 2.02) compared to unexposed counterparts. Non-significant associations were observed in men.

Conclusion

Reduction in birth weight due to rapid shifts in the economic environment appears to have a modest but significant association with later obesity for women while male offspring appear to be less affected by these conditions.

An audit of seafood consumption awareness during pregnancy and its association with maternal and fetal outcomes in a Turkish population

This study was conducted to audit maternal seafood intake awareness during pregnancy and to determine whether there is an association between fish consumption and various pregnancy outcomes. In total, 553 low-risk and healthy pregnant women were given a questionnaire concerning fish consumption. Pregnant women who developed gestational diabetes mellitus, pre-term labour-birth, macrosomia, low birth weight and small for gestational age were analysed. Fatty fish consumers tended to have higher birth weight infants than lean fish consumers. Low fish consumption was significantly correlated with low birth weight and small for gestational age (SGA) infants. The more fatty fish that the low fish consumers consumed, the more likely they were to have SGA infants. Fish consumption did not have an impact on the development of gestational diabetes mellitus, macrosomia or pre-term labour-birth. Low fish consumption during pregnancy may be associated with the development of low birth weight and SGA infants in a Turkish population.

Vitamin D may be a link to black-white disparities in adverse birth outcomes

In the United States, significant, intractable disparities exist in rates of major pregnancy outcomes between non-Hispanic black and non-Hispanic white women. A previously unexplored candidate influence on the black-white disparity in adverse birth outcomes is maternal vitamin D status. This review summarizes the evidence relating maternal vitamin D to preeclampsia, spontaneous preterm birth, gestational diabetes, and fetal growth restriction, and addresses gaps in our understanding of the contribution of vitamin D to the intractable black-white disparity in these conditions. The literature reviewed highlights strong biologic plausibility of role for vitamin D in the pathophysiology of these poor pregnancy outcomes. Data also suggest that maternal vitamin D deficiency may increase the risk of preeclampsia and fetal growth restriction. Less research has been done in support of relations with spontaneous preterm birth and gestational diabetes, and fetal and infant survival have rarely been studied. Few trials of vitamin D supplementation have been conducted in pregnant women with adequate power to test effects on birth outcomes. Importantly, black pregnant women have rarely been studied in vitamin D-birth outcomes research. Although vitamin D is a promising candidate influence on black-white disparities in preeclampsia, spontaneous preterm birth, fetal growth restriction, and gestational diabetes, these associations require further study in large samples of black US women. Because vitamin D deficiency is widespread and black-white disparities in pregnancy outcomes and infant survival have been resistant to previous interventions, research to test vitamin D as a causal factor is of major public health significance.

TARGET AUDIENCE

Obstetricians & Gynecologist, Family Physicians.

LEARNING OBJECTIVES

After completion of this educational activity, the reader will be able to appreciate risk factors for inadequate vitamin D status. Understand the basic aspects of vitamin D metabolism. Become aware of recent literature linking inadequate vitamin D status and adverse pregnancy outcomes such as preeclampsia and preterm birth.

Evidence-based kernels: fundamental units of behavioral influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior.

Persistent, bioaccumulative and toxic substances in fish: human health considerations

Fish are important dietary items that provide essential nutrients. Fish however, bioaccumulate monomethyl mercury (MMHg) and organo-halogenated pollutants (OHP) that are persistent bioaccumulative and toxic substances (PBTS). Unlike man-made OHP, MMHg is mainly of natural origin but background concentrations of aquatic systems are determined by the environmental Hg-methylating potential. Industrial activities can modulate environmental discharges and fish bioaccumulation of PBTS. Fish and seafood consumption are associated with human body load of PBTS, but farming practices that utilize fishmeal increase the terrestrial food chain resulting in farm-animal accumulation of PBTS. These substances are neurotoxic and endocrine active that can impact humans and wild life, but chemical characteristics of MMHg and OHP modulate interactions with animal tissues. MMHg is protein reactive with a faster metabolism (months) than OHP that are stored and slowly (years) metabolized in fat tissues. Except for brain-Hg, neither Hg nor OHP in tissues are markers of toxic effects; however, deficits in neurobehavioral test-scores of children have been shown in some fish-eating populations. These deficits are transient and within normal range, and are not prodromes of neurological diseases. Although population studies show that consumption of fish at current levels of contamination do not explain neurological disorders, endocrine activity remains controversial. Understanding risk of hazard caused by fish-PBTS consumption requires a wide range of expertise. We discuss chemical, toxic, metabolic, and ecological characteristics associated with PBTS in fish. There are proven health outcome derived from fish consumption, while risk of exposure to avoidable PBTS is a chance that can be minimized by societal actions.

Maternal vitamin D deficiency increases the risk of preeclampsia

CONTEXT

Vitamin D has direct influence on molecular pathways proposed to be important in the pathogenesis of preeclampsia, yet the vitamin D-preeclampsia relation has not been studied.

OBJECTIVES

We aimed to assess the effect of maternal 25-hydroxyvitamin D [25(OH)D] concentration on the risk of preeclampsia and to assess the vitamin D status of newborns of preeclamptic mothers.

DESIGN AND SETTING

We conducted a nested case-control study of pregnant women followed from less than 16 wk gestation to delivery (1997-2001) at prenatal clinics and private practices.

PATIENTS

Patients included nulliparous pregnant women with singleton pregnancies who developed preeclampsia (n = 55) or did not develop preeclampsia (n = 219). Women's banked sera were newly measured for 25(OH)D.

MAIN OUTCOME MEASURE

The main outcome measure was preeclampsia (new-onset gestational hypertension and proteinuria for the first time after 20 wk gestation). Our hypotheses were formulated before data collection.

RESULTS

Adjusted serum 25(OH)D concentrations in early pregnancy were lower in women who subsequently developed preeclampsia compared with controls [geometric mean, 45.4 nmol/liter, and 95% confidence interval (CI), 38.6-53.4 nmol/liter, vs. 53.1 and 47.1-59.9 nmol/liter; P < 0.01]. There was a monotonic dose-response relation between serum 25(OH)D concentrations at less than 22 wk and risk of preeclampsia. After confounder adjustment, a 50-nmol/liter decline in 25(OH)D concentration doubled the risk of preeclampsia (adjusted odds ratio, 2.4; 95% CI, 1.1-5.4). Newborns of preeclamptic mothers were twice as likely as control newborns to have 25(OH)D less than 37.5 nmol/liter (adjusted odds ratio, 2.2; 95% CI, 1.2-4.1).

CONCLUSIONS

Maternal vitamin D deficiency may be an independent risk factor for preeclampsia. Vitamin D supplementation in early pregnancy should be explored for preventing preeclampsia and promoting neonatal well-being.

Combined effects of maternal smoking status and dietary intake related to weight gain and birth size parameters

OBJECTIVE

To investigate the interaction of smoking status and dietary intake during pregnancy and its relationship to maternal weight gain and birth size parameters.

DESIGN

An observational prospective study.

SETTING

Free-living conditions.

POPULATION

Four hundred and eight healthy pregnant Icelandic women.

METHODS

Maternal smoking status, lifestyle factors and dietary habits were evaluated with questionnaires. Intake of foods and supplements was also estimated with a semiquantitative food frequency questionnaire for the previous 3 months. All questionnaires were filled out between 11 and 15 weeks and between 34 and 37 weeks of gestation. Smoking status in relation to optimal and/or excessive weight gain during pregnancy was represented with logistic regression controlling for potential confounding factors.

MAIN OUTCOME MEASURES

Maternal weight gain, smoking status, dietary intake and birthweight.

RESULTS

Women who smoked throughout pregnancy were unlikely to gain optimal weight or more (OR 0.51, 95% CI 0.27-0.97), whereas smoking cessation in connection with pregnancy ('former smokers') doubled the risk of excessive weight gain (OR 2.03, 95% CI 1.24-3.35). The latter association was no longer significant after adjustment for dietary factors and other confounding factors. Former smokers ate the least amount of fruit and vegetables (fruit: 129 versus 180 and 144 g/day (median), P= 0.038; vegetables: 53 versus 76 and 72 g/day, P= 0.026 for former smokers, nonsmokers and smokers, respectively). Birthweight was lowest among infants born to smokers, but birthweight was similar for former smokers and nonsmokers (3583 +/- 491 g versus 3791 +/- 461 g and 3826 +/- 466 g, respectively; P= 0.003).

CONCLUSIONS

Smoking cessation in early pregnancy or pre-pregnancy is not associated with low birthweight. It is, however, associated with excessive maternal weight gain and a low fruit and vegetable intake.

Polyunsaturated Fatty Acids in the Diet and Breast Milk of Lactating Icelandic Women with Traditional Fish and Cod Liver Oil Consumption

BACKGROUND/AIMS

The proportion of polyunsaturated fatty acids (PUFA) in the diet and breast milk of lactating women with traditional fish and cod liver oil consumption was investigated under free-living conditions.

METHODS

Dietary intake of 77 lactating women was investigated by 24-hour recalls and breast milk samples were taken at the same occasions. Maternal intake data was calculated and fatty acid pattern from breast milk samples analyzed with gas chromatography.

RESULTS

Women using cod liver oil (n = 18) had a significantly higher total PUFA intake (14 +/- 10 vs. 9 +/- 7 g/day; 5.0 +/- 3.4 vs. 3.9 +/- 3.0 Energy%; p < 0.05) than women who did not use it (n = 59). In particular, mothers consuming cod liver oil had higher breast milk proportion of docosahexaenoic acid (DHA, 0.54 vs. 0.30%, p < 0.05). They also had higher breast milk proportions of eicosapentaenoic acid (EPA; 0.16 vs.0.07%; p < 0.05) and docosapentaenoic acid (DPA; 0.22 vs. 0.17%; p < 0.05).

CONCLUSION

The proportion of PUFA in the diet is significantly higher among women consuming cod liver oil. Its use also gives higher proportion of EPA,DPA and DHA in breast milk without decreasing other important fatty acids. As this may have an impact on the health and development of breast-fed infants in later life, regular maternal cod liver oil intake could be relevant for the infant as well as for the nutritional adequacy of the maternal diet.

Maternal diet in early and late pregnancy in relation to weight gain

OBJECTIVE

To identify dietary factors related to the risk of gaining weight outside recommendations for pregnancy weight gain and birth outcome.

DESIGN

An observational study with free-living conditions.

SUBJECTS

Four hundred and ninety five healthy pregnant Icelandic women.

METHODS

The dietary intake of the women was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out at between 11 and 15 weeks and between 34 and 37 weeks gestation. Comparison of birth outcome between the three weight gain groups was made with ANOVA and Bonferroni post hoc tests. Dietary factors related to at least optimal and excessive weight gain during pregnancy were represented with logistic regression controlling for potential confounding.

RESULTS

Of the women, 26% gained suboptimal and 34% excessive weight during pregnancy. Women in late pregnancy with at least optimal, compared with women with suboptimal, weight gain were eating more (OR = 3.32, confidence interval (CI)=1.81-6.09, P < 0.001) and drinking more milk (OR = 3.10, CI = 1.57-6.13, P = 0.001). The same dietary factors were related to excessive, compared with optimal, weight gain. Furthermore, eating more sweets early in pregnancy increased the risk of gaining excessive weight (OR=2.52, CI=1.10-5.77, P=0.029). Women with a body mass index of 25.0-29.9 kg/m(2) before pregnancy were most likely to gain excessive weight (OR = 7.37, CI 4.13-13.14, P < 0.001). Women gaining suboptimal weight gave birth to lighter children (P < 0.001) and had shorter gestation (P = 0.008) than women gaining optimal or excessive weight.

CONCLUSION

Women who are overweight before pregnancy should get special attention regarding lifestyle modifications affecting consequent weight gain during pregnancy. They are most likely to gain excessive weight and therefore most likely to suffer pregnancy and delivery complications and struggle with increasing overweight and obesity after giving birth.

Relationship between high consumption of marine fatty acids in early pregnancy and hypertensive disorders in pregnancy

OBJECTIVE

To investigate whether there is a relationship between maternal intake of cod-liver oil in early and late pregnancy and hypertensive disorders in pregnancy.

DESIGN

An observational prospective study.

SETTING

Free-living conditions in a community with traditional fish and cod-liver oil consumption.

POPULATION

Four hundred and eighty-eight low-risk pregnant Icelandic women.

METHODS

Maternal use of cod-liver oil, foods and other supplements was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out twice, between 11 and 15 weeks of gestation and between 34 and 37 weeks of gestation. Supplements related to hypertensive disorders in pregnancy, i.e. gestational hypertension and pre-eclampsia, were presented, with logistic regression controlling for potential confounding.

MAIN OUTCOME MEASURES

Gestational hypertension, pre-eclampsia, cod-liver oil and multivitamins.

RESULTS

The odds ratio for developing hypertensive disorders in pregnancy for women consuming liquid cod-liver oil was 4.7 (95% CI 1.8-12.6, P= 0.002), after adjusting for confounding factors. By dividing the amount of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) into centiles, the odds ratio for hypertensive disorders across groups for n-3 LCPUFA suggested a u-shaped curve (P = 0.008). Similar results were found for gestational hypertension alone. Further, the use of multivitamin supplements without vitamins A and D in late pregnancy doubled the odds of hypertensive disorders (OR 2.4, 95% CI 1.0-5.4, P= 0.044).

CONCLUSIONS

Consumption of high doses of n-3 LCPUFA in early pregnancy, or other nutrients found in liquid cod-liver oil, may increase the risk of developing hypertensive disorders in pregnancy.