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Apostolopoulou A, Tranidou A, Chroni V, Tsakiridis I, Tsekitsidi E, Kalaitzopoulou I, Magriplis E, Bakaloudi D, Chrysoula L, Pazaras N, Dagklis T, Chourdakis M. Preconceptional micronutrient adequacy among women in Greece: a prospective epidemiological study. J Matern Fetal Neonatal Med 2024; 37:2343613. [PMID: 38637273 DOI: 10.1080/14767058.2024.2343613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The importance of micronutrient intake during the preconceptional and early pregnancy period for both maternal and fetal outcomes is well-known, however, relevant data are not available for Greek pregnant women. The aim of the present study is to delineate the nutritional status preceding conception among a representative cohort of Greek pregnant women. METHODS This was a prospective study of pregnant women from routine care, recruited at 11+0-13+6 gestational weeks, between December 2020 and October 2022, at the 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece. Eligible participants for the study included healthy pregnant women aged 20 years or older, possessing a proficient understanding of the Greek language, and not engaged in specific nutritional programs. A validated Food Frequency Questionnaire was applied to gather information regarding nutritional habits in the last 6 months prior to conception. The consumption of nutrients was compared to the reference intake levels suggested by the European Food Safety Authority. Further analyses between different participants' subgroups were performed. RESULTS Overall, 1100 pregnant women (mean age: 32.4 ± 4.9 years) were enrolled. Almost all examined micronutrients' intake was significantly different from dietary reference values. Furthermore, nutrient adequacy ratio was below 60% in 6 out of 22 micronutrients examined, and Mean Adequacy Ratio was 93%. However, Mean Adequacy Ratio is characterized by extreme variance between the examined values. Iodine, folic acid, potassium, and vitamin D intake levels were significantly lower than the recommended intake levels (p < .001 for all), while vitamin K and niacin (p < .001 for both) were consumed in great extent. Sodium median intake, without calculating extra salt addition also exceeded the reference value levels (p = .03). Notably, magnesium intake exceeded the upper safety limits in 12.4% of the sample. CONCLUSION Potential inadequacies in important micronutrients for uneventful pregnancy outcomes have been revealed.. Special attention is needed for magnesium to balance possible toxicity with evident benefits.
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Affiliation(s)
- Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antigoni Tranidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Violeta Chroni
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioustini Kalaitzopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Dimitra Bakaloudi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lydia Chrysoula
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Pazaras
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Weigel MM, Armijos RX. Obstetrical Complications in Venezuelan Refugee and Migrant Women: Analysis of Ecuadorian National Hospital Discharge Data, 2018-2021. J Immigr Minor Health 2024; 26:830-840. [PMID: 38700574 DOI: 10.1007/s10903-024-01600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 09/20/2024]
Abstract
An estimated 7.7 million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018-2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group.
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Affiliation(s)
- M Margaret Weigel
- Department of Environmental & Occupational Health, Innovation Center 130E, Indiana University School of Public Health, Bloomington, IN, USA.
- Global Environmental Health Research Laboratory, School of Public Health, Bloomington, IN, USA.
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, IN, USA.
- IU Center for Global Health Equity, Indianapolis, IN, USA.
| | - Rodrigo X Armijos
- Department of Environmental & Occupational Health, Innovation Center 130E, Indiana University School of Public Health, Bloomington, IN, USA
- Global Environmental Health Research Laboratory, School of Public Health, Bloomington, IN, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, IN, USA
- IU Center for Global Health Equity, Indianapolis, IN, USA
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Asimakopoulos G, Pergialiotis V, Antsaklis P, Theodora M, Loutradis D, Daskalakis G. Effect of dietary myo-inositol supplementation on the insulin resistance and the prevention of gestational diabetes mellitus: an open-label, randomized controlled trial. Arch Gynecol Obstet 2024; 310:1895-1903. [PMID: 39141124 DOI: 10.1007/s00404-024-07618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Myo-inositol (MI) is an insulin-sensitizing dietary supplement, enhancing the transfer of glucose into the cell. Gestational diabetes mellitus (GDM) is characterized by abnormal glucose tolerance, which is associated with elevated insulin resistance. The present study aimed to assess the effect of MI supplementation during pregnancy on the incidence of GDM. METHODS We performed a single-center, open-label, randomized controlled trial. A cohort of 200 pregnant women at 11-13+6 weeks of gestation were randomly assigned in two groups: MI group (n = 100) and control group (n = 100). The MI group received MI and folic acid (4000 mg MI and 400 mcg folic acid daily), while the control group received folic acid alone (400 mcg folic acid daily) until 26-28 weeks of gestation, when the 75 g Oral Glucose Tolerance Test (OGTT) was performed for the diagnosis of GDM. Clinical and metabolic outcomes were assessed. RESULTS The incidence of GDM was significantly higher in the MI group (14.9%) compared to the control group (28.5%) (P = 0.024). Women treated with MI had significantly lower OGTT glucose values, than those not treated with MI (P < 0.001). The insulin resistance as assessed by HOMA-IR was significantly lower in the MI group versus control (P = 0.045). Furthermore, MI group had significantly higher insulin sensitivity as measured by the Matsuda Index, compared to the control group (P = 0.037). CONCLUSION MI supplementation seems to be an effective option to improve the glycemic control of pregnant women and prevent the onset of GDM. TRIAL REGISTRATION ISRCTN registry: ISRCTN16142533. Registered 09 March 2017.
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Affiliation(s)
- George Asimakopoulos
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Antsaklis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mariana Theodora
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Daskalakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Gualtieri P, Frank G, Cianci R, Dominici F, Mappa I, Rizzo G, De Santis GL, Bigioni G, Di Renzo L. Fish Consumption and DHA Supplementation during Pregnancy: Study of Gestational and Neonatal Outcomes. Nutrients 2024; 16:3051. [PMID: 39339651 DOI: 10.3390/nu16183051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Several studies have explored the association between fish consumption during pregnancy and favorable neonatal outcomes, although some yield conflicting results. The American College of Obstetricians and Gynecologists recommends two to three servings of low-mercury fish per week for pregnant or breastfeeding women. However, fish can be a source of pollutants, like methylmercury, impacting neurological development. Conflicting studies on docosahexaenoic acid (DHA) supplementation exist in the literature, possibly due to varied supplement dosages. This survey, involving 501 women, investigated fish consumption and DHA supplement intake concerning gestational and neonatal outcomes. Notably, 92.1% of participants consumed fish weekly, with significant differences observed in gestational weight gain, birth weight, and length for those eating fish ≥3 times weekly compared to non-consumers. This study supports the recommendation for pregnant women to include fish in their diet while limiting exposure to environmental pollutants. Omega-3 fatty acid supplements are suggested to attain nutritional benefits without mercury risk.
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Affiliation(s)
- Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giulia Frank
- PhD School of Applied Medical-Surgical Sciences, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Francesca Dominici
- School of Specialization in Food Science, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Ilenia Mappa
- Department of Maternal Fetal Medicine, Ospedale Cristo Re, 00167 Rome, Italy
| | - Giuseppe Rizzo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy
| | - Gemma Lou De Santis
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giulia Bigioni
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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Karimi M, Mofidi Nejad M, Tabaeifard R, Omid N, Rezaei Z, Azadbakht L. The association between dietary habits and self-care behavior of pregnant women with pregnancy complications. Sci Rep 2024; 14:19681. [PMID: 39181929 PMCID: PMC11344835 DOI: 10.1038/s41598-024-70162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
Pregnancy as a sensitive period has a critical effect on the mother and infant's life. It is well understood that dietary habits and mother awareness can improve health status and prevent pregnancy complications such as gestational diabetes, pre-eclampsia, and nausea and vomiting. The current study was conducted to investigate the association between dietary habits and self-care behaviors with pregnancy complications. This cross-sectional study was conducted across 300 pregnant women in their third trimester referred to healthcare centers and Yas hospital in Tehran, Iran. Dietary habits and self-care behaviors were assessed by valid and reliable questionnaires. Dietary intake and physical activity were evaluated using valid and reliable Food Frequency Questionnaires and Pregnancy Physical Activity questionnaires, respectively. Women with self-care behaviors had a lower rate of pre-eclampsia (P = 0.9). Regarding food habits, pregnant women who ate their meals faster had a non-significantly higher rate of gestational diabetes and pre-eclampsia. Pregnant women who consumed red meat on a daily frequency had a significantly higher rate of nausea and vomiting (OR 1.85; 95% CI 1.05-3.28, P = 0.03). Also, there was a significant positive association between the mother's pre-pregnancy BMI and gestational diabetes and pre-eclampsia [(OR 2.03; 95% CI 1.03-3.98, P = 0.03) and (OR 4.23; 95% CI 1.12-16.0, P = 0.03) respectively]. There was no significant association between pregnant women's dietary habits and GDM and pre-eclampsia. However, pregnant women with pre-pregnancy overweight and obesity had increased odds of gestational diabetes and pre-eclampsia significantly.
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Affiliation(s)
- Mehdi Karimi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mofidi Nejad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Razieh Tabaeifard
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Noushin Omid
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Zahra Rezaei
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Wills AK, Hillesund ER, van Lippevelde W, Barker M, Vik FN, Øverby NC. Preconception diet in adolescence and its association with hypertensive disorders of pregnancy and preterm birth. Results from the HUNT study. Br J Nutr 2024; 132:91-98. [PMID: 38634260 PMCID: PMC7616499 DOI: 10.1017/s0007114524000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Our aim was to estimate associations of adolescent dietary patterns and meal habits with hypertensive disorders of pregnancy (HDP) and preterm birth. We used data from a prospective cohort study (Norwegian Young-HUNT1) where dietary information was collected during adolescence and pregnancy outcomes were obtained through record linkage to the Norwegian national birth registry. The outcomes were HDP, hypertension, pre-eclampsia/eclampsia, and preterm birth in the first pregnancy and in any pregnancy. Diet was self-reported from validated questionnaires, and exposures were dietary indexes (healthy; unhealthy; fruit and vegetable; fibre index) and meal habits. Recruitment took place in schools. Eligible participants were females aged 13-19 years at the time of dietary assessment with a subsequent singleton pregnancy (n 3622). Women who reported a higher fibre intake in adolescence had a lower risk of pre-eclampsia in the first pregnancy (Relative Risk: 0·84; 95 % CI 0·7, 1·0), although this was weaker in sensitivity analyses. Regular meal habits in mid-adolescence (aged 13-15 years), particularly breakfast and lunch, were weakly associated with a lower risk of hypertension in pregnancy. Our results are the first to indicate an association between aspects of diet and dietary behaviour in mid-adolescence and subsequent HDP. More evidence is needed from larger studies to replicate the results and from alternative study designs to disentangle causality.
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Affiliation(s)
- Andrew Keith Wills
- Centre for Lifecourse Nutrition, Department of Nutrition and Public Health, University of Agder, Postboks 422, 4604Kristiansand, Norway
| | - Elisabet Rudjord Hillesund
- Centre for Lifecourse Nutrition, Department of Nutrition and Public Health, University of Agder, Postboks 422, 4604Kristiansand, Norway
| | - Wendy van Lippevelde
- Unit Consumer Behaviour, Department of Marketing, Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, 9000Ghent, Belgium
| | - Mary Barker
- School of Health Sciences, Faculty of Environmental and Life Sciences and MRC Lifecourse Epidemiology Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Frøydis Nordgård Vik
- Centre for Lifecourse Nutrition, Department of Nutrition and Public Health, University of Agder, Postboks 422, 4604Kristiansand, Norway
| | - Nina Cecilie Øverby
- Centre for Lifecourse Nutrition, Department of Nutrition and Public Health, University of Agder, Postboks 422, 4604Kristiansand, Norway
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O'Nan SL, Huang R, Zhao P, Garr Barry V, Lawlor M, Carter EB, Kelly JC, Frolova AI, England SK, Raghuraman N. Dietary risk factors for hypertensive disorders of pregnancy. Pregnancy Hypertens 2024; 36:101120. [PMID: 38508015 DOI: 10.1016/j.preghy.2024.101120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To assess whether diet quality and specific dietary components are associated with hypertensive disorders of pregnancy (HDP). STUDY DESIGN Nested case control study in a prospectively collected cohort of 450 participants with singleton pregnancies who completed the National Institutes of Health Diet Health Questionnaire II (DHQ-II) in the third trimester or within 3 months of delivery. Patients with fetal anomalies, conception by in-vitro fertilization, and deliveries at outside hospitals were excluded from the original prospective cohort study. Cases were patients diagnosed with HDP and controls were patients without HDP. Cases and controls were matched by BMI class in a 1:2 ratio. Exposures of interest were HEI-2015 score components and other DHQ-II dietary components including minerals, caffeine, and water. These dietary components were compared between cohorts using univariate analyses. MAIN OUTCOME MEASURES HEI-2015 total scores representing diet quality, component scores, and objective background data between patients with HDP and patients without HDP. RESULTS 150 patients with HDP were matched to 300 controls without HDP. Baseline demographics were similar between groups, including BMI. Patients with HDP were less likely to have high quality diets (HEI ≥ 70) than controls (7.3 % v 15.7 %, P = 0.02). HDP were associated with significantly higher dairy, saturated fat, and sodium intake compared to controls. Other components were similar between groups. CONCLUSION Patients with HDP are more likely to have lower diet quality and higher consumption of sodium, dairy, and saturated fats. These results can be used to study antenatal diet modification in patients at high risk of HDP.
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Affiliation(s)
- Suzanne L O'Nan
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA.
| | - Ruizhi Huang
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Peinan Zhao
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Valene Garr Barry
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Megan Lawlor
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Ebony B Carter
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Jeannie C Kelly
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Antonina I Frolova
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Sarah K England
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
| | - Nandini Raghuraman
- Washington University School of Medicine in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Louis, MO, USA
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Ngene NC, Moodley J. Preventing maternal morbidity and mortality from preeclampsia and eclampsia particularly in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102473. [PMID: 38513504 DOI: 10.1016/j.bpobgyn.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024]
Abstract
Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE. The frequency of PE has increased over the last few decades due to population-wide increases in risk factors viz. obesity, diabetes, multifetal pregnancies and pregnancies at an advanced maternal age. Whilst multimodal tools with components comprising risk factors, biomarkers and sonography are used for predicting PE, aspirin is most effective in preventing early-onset PE. The incidence and clinical consequences of PE and eclampsia are influenced by socioeconomic and cultural factors, therefore management strategies should involve multi-sector partnerships to mitigate the adverse outcomes.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, Johannesburg, Gauteng, South Africa; Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, Faculty of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa.
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Schiavone MJ, Pérez MP, Aquieri A, Nosetto D, Pronotti MV, Mazzei M, Kudrle C, Avaca H. The Role of Obesity in the Development of Preeclampsia. Curr Hypertens Rep 2024; 26:247-258. [PMID: 38512586 DOI: 10.1007/s11906-024-01299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW This comprehensive review provides an in-depth exploration of the complex relationship between obesity and preeclampsia (PE) and emphasizes the clinical implications of this association. It highlights the crucial role of screening tools in assessing individual risk and determining the need for additional antenatal care among women with obesity. The review investigates various markers for identifying the risk of developing PE, while emphasizing the significance of interventions such as exercise, weight management, and a balanced diet in reducing the incidence of preeclampsia and improving outcomes for both mother and fetus. RECENT FINDINGS Actually, there is a global pandemic of obesity, particularly among women of childbearing age and pregnant women. PE, which is characterized by maternal hypertension, proteinuria, and complications, affects 2-4% of pregnancies worldwide, posing significant risks to maternal and perinatal health. Women with obesity face an elevated risk of developing PE due to the systemic inflammation resulting from excess adiposity, which can adversely affect placental development. Adipose tissue, rich in proinflammatory cytokines and complement proteins, contributes to the pathogenesis of PE by promoting the expression of antiangiogenic factors in the mother. This review emphasizes the need for appropriate screening, interventions, and a holistic approach to reduce the incidence of preeclampsia and enhance maternal-fetal well-being, thus providing valuable insights into the multifaceted association between obesity and PE.
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Affiliation(s)
- Miguel Javier Schiavone
- Department of Hypertension, Hospital Británico de Buenos Aires, Solís 2184 - C 1134 ADT - CABA, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Mariana Paula Pérez
- Department of Hypertension, Hospital de Agudos J. M. Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Analía Aquieri
- Department of Hypertension, Hospital de Clínicas José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniela Nosetto
- Department of Hypertension, Hospital Británico de Buenos Aires, Solís 2184 - C 1134 ADT - CABA, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Victoria Pronotti
- Department of Hypertension, Hospital Británico de Buenos Aires, Solís 2184 - C 1134 ADT - CABA, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Mazzei
- Department of Hypertension, Hospital Británico de Buenos Aires, Solís 2184 - C 1134 ADT - CABA, Ciudad Autónoma de Buenos Aires, Argentina
| | - Cyntia Kudrle
- Department of Hypertension, Hospital Británico de Buenos Aires, Solís 2184 - C 1134 ADT - CABA, Ciudad Autónoma de Buenos Aires, Argentina
| | - Horacio Avaca
- Department of Hypertension, Hospital Británico de Buenos Aires, Solís 2184 - C 1134 ADT - CABA, Ciudad Autónoma de Buenos Aires, Argentina
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10
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Talebi S, Mehrabani S, Ghoreishy SM, Wong A, Moghaddam A, Feyli PR, Amirian P, Zarpoosh M, Kermani MAH, Moradi S. The association between ultra-processed food and common pregnancy adverse outcomes: a dose-response systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:369. [PMID: 38750456 PMCID: PMC11097443 DOI: 10.1186/s12884-024-06489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the relationship between ultra-processed foods (UPFs) consumption and common adverse pregnancy outcomes including gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants. UPFs are described as formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers, and other cosmetic additives. Examples include savory snacks, reconstituted meat products, frozen meals that have already been made, and soft drinks. METHODS A comprehensive search was performed using the Scopus, PubMed, and Web of Science databases up to December 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using a random-effects model. RESULTS Our analysis (encompassing 54 studies with 552,686 individuals) revealed a significant association between UPFs intake and increased risks of GDM (RR = 1.19; 95% CI: 1.10, 1.27; I2 = 77.5%; p < 0.001; studies = 44; number of participants = 180,824), PE (RR = 1.28; 95% CI: 1.03, 1.59; I2 = 80.0%; p = 0.025; studies = 12; number of participants = 54,955), while no significant relationships were found for PTB, LBW and SGA infants. Importantly, a 100 g increment in UPFs intake was related to a 27% increase in GDM risk (RR = 1.27; 95% CI: 1.07, 1.51; I2 = 81.0%; p = 0.007; studies = 9; number of participants = 39,812). The non-linear dose-response analysis further indicated a positive, non-linear relationship between UPFs intake and GDM risk Pnonlinearity = 0.034, Pdose-response = 0.034), although no such relationship was observed for PE (Pnonlinearity = 0.696, Pdose-response = 0.812). CONCLUSION In summary, both prior to and during pregnancy, chronic and excessive intake of UPFs is associated with an increased risk of GDM and PE. However, further observational studies, particularly among diverse ethnic groups with precise UPFs consumption measurement tools, are imperative for a more comprehensive understanding.
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Affiliation(s)
- Sepide Talebi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Mehrabani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Student research committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Aliasghar Moghaddam
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
| | - Peyman Rahimi Feyli
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
| | - Parsa Amirian
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mahsa Zarpoosh
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mohammad Ali Hojjati Kermani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Moradi
- Department of Nutrition and Food Sciences, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran.
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11
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Ni X, Qiao T, Wang R, Wang F, Liang Y, Wei S. Assessing the reproducibility and validity of a food frequency questionnaire for pregnant women from the Chinese Miao ethnic group. Front Nutr 2024; 11:1322225. [PMID: 38774260 PMCID: PMC11106495 DOI: 10.3389/fnut.2024.1322225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
Background Currently, no food frequency questionnaire is available to be administered exclusively to ethnic minorities in China. This study aimed to evaluate the reproducibility and validity of a culturally tailored semi-quantitative food frequency questionnaire (FFQ) designed for pregnant women belonging to the Miao ethnic group in China. Methods A total of 74 questions in the FFQ were administered to collect dietary information from Miao women in China during their pregnancy. This study included 153 and 127 pregnant women, respectively, for testing the validity and reproducibility of the results. Baseline FFQ data (FFQ1) were collected initially, followed by the administration of a repeated FFQ 4-6 weeks later (FFQ2). Two 24-h recalls (24HR) were used as references to compare food groups and nutrient intake. Pearson/Spearman's coefficients were used to measure the validity and reproducibility of the FFQ. Quartile cross-classification, weighted kappa coefficients, and Bland-Altman plots were employed to assess the agreement. Results Most food groups and nutrient intake estimated by the FFQ were higher than those estimated by the 24HR. Food groups and nutrients' correlations for FFQ vs. 24HR after being energy-adjusted and de-attenuated, respectively, were 0.10 (vegetables) to 0.45 (grains/tubers) and 0.15 (iron) to 0.52 (riboflavin). Comparatively, correlation coefficients for FFQ1 vs. FFQ2 ranged from 0.41 (fruit) to 0.71 (vegetables) and from 0.45 (energy) to 0.64 (calcium). The percentage of pregnant women classified in the same or adjacent quartiles ranged from 64.08% (vegetables) to 95.29% (sour soup) and from 68.88% (vitamin E) to 78.81% (energy). Weighted kappa coefficients exceeded 0.2 for food groups and most nutrients, and Bland-Altman plots demonstrated acceptable agreement between the two tools. Conclusions This study provides novel information on the validation of FFQ. It demonstrates that the FFQ exhibits ideal reproducibility and acceptable validity in estimating and ranking the intake of food groups and most nutrients among pregnant women belonging to the Chinese Miao ethnic group.
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Affiliation(s)
- Xiaorong Ni
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Tian Qiao
- Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Rong Wang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Fang Wang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Yi Liang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
- Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shaofeng Wei
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, China
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12
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Deady C, McCarthy FP, Barron A, McCarthy CM, O’Keeffe GW, O’Mahony SM. An altered gut microbiome in pre-eclampsia: cause or consequence. Front Cell Infect Microbiol 2024; 14:1352267. [PMID: 38774629 PMCID: PMC11106424 DOI: 10.3389/fcimb.2024.1352267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Hypertensive disorders of pregnancy, including pre-eclampsia, are a leading cause of serious and debilitating complications that affect both the mother and the fetus. Despite the occurrence and the health implications of these disorders there is still relatively limited evidence on the molecular underpinnings of the pathophysiology. An area that has come to the fore with regard to its influence on health and disease is the microbiome. While there are several microbiome niches on and within the body, the distal end of the gut harbors the largest of these impacting on many different systems of the body including the central nervous system, the immune system, and the reproductive system. While the role of the microbiome in hypertensive disorders, including pre-eclampsia, has not been fully elucidated some studies have indicated that several of the symptoms of these disorders are linked to an altered gut microbiome. In this review, we examine both pre-eclampsia and microbiome literature to summarize the current knowledge on whether the microbiome drives the symptoms of pre-eclampsia or if the aberrant microbiome is a consequence of this condition. Despite the paucity of studies, obvious gut microbiome changes have been noted in women with pre-eclampsia and the individual symptoms associated with the condition. Yet further research is required to fully elucidate the role of the microbiome and the significance it plays in the development of the symptoms. Regardless of this, the literature highlights the potential for a microbiome targeted intervention such as dietary changes or prebiotic and probiotics to reduce the impact of some aspects of these disorders.
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Affiliation(s)
- Clara Deady
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- The Infant Research Centre, University College Cork, Cork, Ireland
| | - Aaron Barron
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Cathal M. McCarthy
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Gerard W. O’Keeffe
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Cork Neuroscience Centre, University College Cork, Cork, Ireland
| | - Siobhain M. O’Mahony
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
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13
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Hoteit M, Mahfouz R, Sacre Y, Obeid S, Abou Nasr M, El Hajj M, Hanna-Wakim L, Fakih C. Assessment of dietary-lifestyle patterns and adherence to the USDA recommendations in Lebanese pregnant women amid the economic crisis: Findings from a national representative cross-sectional study. PLoS One 2024; 19:e0301170. [PMID: 38603738 PMCID: PMC11008882 DOI: 10.1371/journal.pone.0301170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
As Lebanon's economic crisis become uncontrollable, Lebanese pregnant women face malnutrition, with many having to skip meals and switch to resort to cheap and unhealthy alternatives altogether. The objectives of the study were to assess the dietary and lifestyle patterns of Lebanese pregnant women and to evaluate their diets compliance with the United States Department of Agriculture (USDA) pregnancy recommendations, before and during the Lebanese escalating economic crisis. A cross-sectional study was conducted between April 2021 and January 2022. A validated self-administrated questionnaire was administered during the first, second and third trimesters of pregnancy among 363 women in all Lebanese governorates. Most of the pregnant women were free of diseases. While the majority did not smoke, 14.1% smoked hookah / shisha during pregnancy. The adherence to the USDA recommendations in our sample did not significantly vary prior to and throughout the socioeconomic crisis, and it was generally low. Only the mean consumption of vegetables increased during the socioeconomic crisis (p<0.05). Regarding physical activity, while the proportion of active women slightly decreased during the socioeconomic crisis, around 55% were still active. In conclusion, higher attention should be given to the dietary habits and health of this critical population, through effective interventions that increase awareness and achieve measurable improvements.
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Affiliation(s)
- Maha Hoteit
- Food Sciences Unit, National Council For Scientific Research (CNRS-L), Beirut, Lebanon
- PHENOL Research Group (Public Health Nutrition Program Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Rana Mahfouz
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Yonna Sacre
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sara Obeid
- PHENOL Research Group (Public Health Nutrition Program Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Mariane Abou Nasr
- PHENOL Research Group (Public Health Nutrition Program Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Mohamad El Hajj
- PHENOL Research Group (Public Health Nutrition Program Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Lara Hanna-Wakim
- Department of Agricultural and Food Engineering, School of Engineering, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadi Fakih
- Al Hadi Laboratory and Medical Center, Beirut, Lebanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lebanese University, Beirut, Lebanon
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14
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Tretter M. Mitigating Health-Related Uncertainties During Pregnancy: The Role of Smart Health Monitoring Technologies. J Med Internet Res 2024; 26:e48493. [PMID: 38526554 PMCID: PMC11002737 DOI: 10.2196/48493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Pregnancy is a time filled with uncertainties, which can be challenging and lead to fear or anxiety for expectant parents. Health monitoring technologies that allow monitoring of the vital signs of both the mother and fetus offer a way to address health-related uncertainties. But are smart health monitoring technologies (SHMTs) actually an effective means to reduce uncertainties during pregnancy, or do they have the opposite effect? Using conceptual reasoning and phenomenological approaches grounded in existing literature, this Viewpoint explores the effects of SHMTs on health-related uncertainties during pregnancy. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.Using conceptual reasoning and phenomenological approaches grounded in existing literature, the effects of SHMTs on health-related uncertainties during pregnancy are explored. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.
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Affiliation(s)
- Max Tretter
- Chair of Systematic Theology (Ethics), Seminar for Systematic Theology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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15
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Parker J, O’Brien CL, Yeoh C, Gersh FL, Brennecke S. Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies. J Clin Med 2024; 13:1774. [PMID: 38541997 PMCID: PMC10971491 DOI: 10.3390/jcm13061774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 05/04/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE.
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Affiliation(s)
- Jim Parker
- School of Medicine, University of Wollongong, Wollongong 2522, Australia
| | - Claire Louise O’Brien
- Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia;
| | - Christabelle Yeoh
- Next Practice Genbiome, 2/2 New McLean Street, Edgecliff 2027, Australia;
| | - Felice L. Gersh
- College of Medicine, University of Arizona, Tucson, AZ 85004, USA;
| | - Shaun Brennecke
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Melbourne 3052, Australia;
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne 3052, Australia
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16
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Valiati N, Puel EM, Stefani CM, Lataro RM. Does probiotic ingestion reduce the risk of preeclampsia? A systematic review. Appl Physiol Nutr Metab 2024; 49:135-147. [PMID: 37844331 DOI: 10.1139/apnm-2023-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
We aimed to systematically review the literature on the effects of probiotic consumption on the risk of preeclampsia (PE) development. Eight databases, clinical trial registries, and grey literature were searched until February 2022. Studies were included if they (1) were randomized clinical trials (RCTs), (2) included pregnant women aged ≥ 18 years old, (3) used probiotics products, and (4) were written in the Latin alphabet. A random-effects meta-analysis was performed using the risk ratio as the effect measure with 95% confidence intervals (CI) for PE. The search strategy identified 359 records, from which six RCTs were included. The six RCTs evaluated pregnant women with comorbidities and enrolled 593 women that received probiotics and 625 receiving placebo. None of the included RCTs analyzed healthy women. Probiotics increased by 12% the PE risk (RR 1.12, 95% CI, CI = 0.83-1.53, p = 0.46, χ2 = 3.31, df = 5 (p = 0.65), I2 = 0%). The certainty of the evidence, evaluated through the Grading of Recommendations Assessment, Development and Evaluation approach, was rated as very low. In conclusion, probiotics supplementation may slightly increase PE rates in pregnant women with comorbidities. The risk may be higher in obese women and for periods of ingestion longer than eight weeks. However, the evidence certainty is very low. PROSPERO registration No.CRD42021278611.
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Affiliation(s)
- Nayara Valiati
- Department of Physiological SciencesCenter of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Esthela M Puel
- Department of Physiological SciencesCenter of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Cristine M Stefani
- Department of DentistryFaculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Renata M Lataro
- Department of Physiological SciencesCenter of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Mitran AM, Gherasim A, Niță O, Mihalache L, Arhire LI, Cioancă O, Gafițanu D, Popa AD. Exploring Lifestyle and Dietary Patterns in Pregnancy and Their Impact on Health: A Comparative Analysis of Two Distinct Groups 10 Years Apart. Nutrients 2024; 16:377. [PMID: 38337662 PMCID: PMC10857126 DOI: 10.3390/nu16030377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The significance of dietary patterns during pregnancy is highlighted by accumulating evidence, emphasizing their pivotal role in promoting a healthy pregnancy for both the mother and the child. This study aimed to assess the current dietary patterns of pregnant women, compare the energy and nutrient intake of two distinct groups with a 10-year interval, and identify changes in dietary patterns. EPIC FFQ was applied, and its data were interpreted with the FETA program version 6 (CAMB/PQ/6/1205). By means of principal component analysis, three different food patterns were identified in each study group: vegetarian, balanced, and traditional (2013); and prudent, vegetarian, and modern (2023). Analyzing the relationship between food groups and gestational weight, we found that gestational weight gain in 2013 was positively correlated with eggs and egg dishes and milk and milk products, whereas in 2023, gestational weight gain was positively correlated with fats and oils, non-alcoholic beverages, and the modern pattern. Additionally, in 2023, pre-gestational BMI correlated positively with eggs and egg dishes. The balanced pattern emerged as a predictor for a lower likelihood of inadequate gestational weight gain in both groups. Furthermore, normal and overweight pregnant women showed a reduced likelihood of excessive gestational weight gain.
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Affiliation(s)
- Andreea-Maria Mitran
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Andreea Gherasim
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.N.); (L.M.); (L.I.A.)
| | - Otilia Niță
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.N.); (L.M.); (L.I.A.)
| | - Laura Mihalache
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.N.); (L.M.); (L.I.A.)
| | - Lidia Iuliana Arhire
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (O.N.); (L.M.); (L.I.A.)
| | - Oana Cioancă
- Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Dumitru Gafițanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Alina Delia Popa
- Department of Nursing, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
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Scott M, Qamar Z. Navigating Nutrition Inequities: BIPOC Maternal Health and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)'s Fruit and Vegetable Voucher. J Perinat Neonatal Nurs 2024; 38:18-24. [PMID: 38278640 DOI: 10.1097/jpn.0000000000000793] [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] [Indexed: 01/28/2024]
Abstract
INTRODUCTION The proposal to administer cuts for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could create deficiencies in nutrition for already food insecure, low-income Black, Indigenous, and Persons of Color (BIPOC) pregnant, postpartum women, and children. WIC is a US Department of Agriculturefunded nutritional program for women, infants, and children. The current proposal is to cut the funding by $800 million for the 2024 fiscal year, affecting 75% of its low-income recipients and predominantly BIPOC. METHODS Relevant websites and journal articles were analyzed to determine how the proposed cuts would create barriers within the social determinants of health that contribute to disparities in health outcomes of WIC recipients. RESULTS Many studies have demonstrated that nutrition in the first 1000 days is critical for the healthy development of newborns. Prior research suggests that maternal health outcomes for BIPOC populations are contingent upon the increased allocation of nutritional support programs such as WIC and SNAP (Supplemental Nutrition Assistance Program). Nutrients provided by the cash benefit voucher have been proven to contribute to participants' health outcomes, and allotment increases can benefit maternal and infant health outcomes. CONCLUSION AND FUTURE DIRECTIONS Neonatal nurses can help advocate for more robust policies that support the health of their patients. Future directions call for systematic changes in policies and legislation that directly affect maternal health outcomes, supportive breastfeeding policies, and applied research on solutions to improve maternal health outcomes of BIPOC populations in addition to increased awareness, education, and implementation of VeggieRx programs, investment in affordable, sustainable grassroots urban agriculture solutions.
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Affiliation(s)
- Monique Scott
- Public Health Department, San Francisco State University (SFSU), San Francisco, California; and Family, Interiors, Nutrition, and Apparel (FINA), San Francisco State University (SFSU), San Francisco, California
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19
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Olendzki BC, Hsiao BS, Weinstein K, Chen R, Frisard C, Madziar C, Picker M, Pauplis C, Maldonado-Contreras A, Peter I. Dietary Intake of Pregnant Women with and without Inflammatory Bowel Disease in the United States. Nutrients 2023; 15:nu15112464. [PMID: 37299427 DOI: 10.3390/nu15112464] [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: 05/02/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Pregnancy is a vulnerable time where the lives of mother and baby are affected by diet, especially high-risk pregnancies in women with inflammatory bowel disease (IBD). Limited research has examined diet during pregnancy with IBD. AIMS Describe and compare the diet quality of pregnant women with and without IBD, and examine associations between dietary intake and guidelines during pregnancy. METHODS Three 24 h recalls were utilized to assess the diets of pregnant women with IBD (n = 88) and without IBD (n = 82) during 27-29 weeks of gestation. A customized frequency questionnaire was also administered to measure pre- and probiotic foods. RESULTS Zinc intake (p = 0.02), animal protein (g) (p = 0.03), and ounce equivalents of whole grains (p = 0.03) were significantly higher in the healthy control (HC) group than the IBD group. Nutrients of concern with no significant differences between groups included iron (3% IBD and 2% HC met the goals), saturated fat (only 1% of both groups met the goals), choline (23% IBD and 21% HC met the goals), magnesium (38% IBD and 35% HC met the goals), calcium (48% IBD and 60% HC met the goals), and water intake (49% IBD and 48% HC met the goals). CONCLUSIONS Most pregnant women in this cohort fell short of the dietary nutrients recommended in pregnancy, especially concerning for women with IBD.
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Affiliation(s)
- Barbara C Olendzki
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Bi-Sek Hsiao
- Department of Nutrition, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Kaitlyn Weinstein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rosemary Chen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Camilla Madziar
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Mellissa Picker
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Connor Pauplis
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Ana Maldonado-Contreras
- Department of Microbiology and Physiology Systems, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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20
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Toghi CJ, Martins LZ, Pacheco LL, Caetano ESP, Mattos BR, Rizzi E, Dias-Junior CA. Pravastatin Prevents Increases in Activity of Metalloproteinase-2 and Oxidative Stress, and Enhances Endothelium-Derived Nitric Oxide-Dependent Vasodilation in Gestational Hypertension. Antioxidants (Basel) 2023; 12:antiox12040939. [PMID: 37107314 PMCID: PMC10135677 DOI: 10.3390/antiox12040939] [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: 03/15/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Pre-eclampsia (PE) is a hypertensive disorder of pregnancy and has been associated with placental growth restriction. The pre-eclamptic placenta releases free radicals to maternal circulation, thus increasing oxidative stress. An impaired redox state leads to reduction in circulating nitric oxide (NO) levels and activation of extracellular matrix metalloproteinases (MMPs). However, activation of MMPs induced by oxidative stress is still unclear in PE. Antioxidant effects have been demonstrated with the use of pravastatin. Therefore, we hypothesized that pravastatin protects against oxidative stress-induced activation of MMPs in a rat model of PE. The animals were divided into four groups: normotensive pregnant rats (Norm-Preg); pregnant rats treated with pravastatin (Norm-Preg + Prava); hypertensive pregnant rats (HTN-Preg); and hypertensive pregnant rats treated with pravastatin (HTN-Preg + Prava). The deoxycorticosterone acetate (DOCA) and sodium chloride (DOCA-salt) model was used to induce hypertension in pregnancy. Blood pressure, and fetal and placental parameters were recorded. The gelatinolytic activity of MMPs, NO metabolites and lipid peroxide levels were also determined. Endothelium function was also examined. Pravastatin attenuated maternal hypertension, prevented placental weight loss, increased NO metabolites, inhibited increases in lipid peroxide levels, and reduced the activity of MMP-2, and these effects were observed along with enhanced endothelium-derived NO-dependent vasodilation. The present results provide evidence that pravastatin protects against activation of MMP-2 induced by oxidative stress in pre-eclamptic rats. These findings may also involve improvement in endothelial function related to NO and antihypertensive effects of pravastatin, thus suggesting pravastatin as a therapeutic intervention for PE.
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Affiliation(s)
- Cristal Jesus Toghi
- Department of Biophysics and Pharmacology, Institute of Biosciences, Sao Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil
| | - Laisla Zanetoni Martins
- Department of Biophysics and Pharmacology, Institute of Biosciences, Sao Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil
| | - Leonardo Lopes Pacheco
- Department of Biophysics and Pharmacology, Institute of Biosciences, Sao Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil
| | - Edileia Souza Paula Caetano
- Department of Biophysics and Pharmacology, Institute of Biosciences, Sao Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil
| | - Bruna Rahal Mattos
- Unit of Biotechnology, University of Ribeirao Preto (UNAERP), Ribeirao Preto 14096-900, SP, Brazil
| | - Elen Rizzi
- Unit of Biotechnology, University of Ribeirao Preto (UNAERP), Ribeirao Preto 14096-900, SP, Brazil
| | - Carlos Alan Dias-Junior
- Department of Biophysics and Pharmacology, Institute of Biosciences, Sao Paulo State University (UNESP), Botucatu 18618-689, SP, Brazil
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21
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Body Composition and Nutritional Status of the Spanish National Breaking Team Aspiring to the Paris 2024 Olympic Games. Nutrients 2023; 15:nu15051218. [PMID: 36904217 PMCID: PMC10005051 DOI: 10.3390/nu15051218] [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: 02/06/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Breaking is a sports dance modality that will debut for the first time at the Paris 2024 Olympic Games. This dance form combines street dance steps with acrobatics and athletic elements. It complies with gender equality, maintains aesthetic appeal, and is practised indoors. The objective of this study is to assess the characteristics of body composition and nutritional status of the athletes that make up the Breaking national team. This national team was recruited, and they underwent an analysis of body composition using bioimpedance measurement and a nutritional interview status with the completion of a survey on the frequency of the consumption of sports supplements and ergogenic aids. In addition, they completed a consumption questionnaire for a series of food groups with specified protein, lipid, and carbohydrate content. After that, parameters were analyzed in relation to their nutritional status during a complete medical examination at the Endocrinology and Nutrition Service of the Sports Medicine Center of CSD. A descriptive analysis of the results obtained was carried out to find the mean values of the variables analyzed. The analytical parameters described an adequate nutritional status, except for the mean capillary determination of 25-OH-vitamin D3, which was 24.2 ng/dL (SD: 10.3). Bone mineral density values were higher than those of the general population. This is the first time that a study of these characteristics has been carried out on Breakers, so it is highly relevant to increase knowledge in this area in order to conduct nutritional interventions aimed at improving the sports performance of these athletes.
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Chang KJ, Seow KM, Chen KH. Preeclampsia: Recent Advances in Predicting, Preventing, and Managing the Maternal and Fetal Life-Threatening Condition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2994. [PMID: 36833689 PMCID: PMC9962022 DOI: 10.3390/ijerph20042994] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 06/12/2023]
Abstract
Preeclampsia accounts for one of the most common documented gestational complications, with a prevalence of approximately 2 to 15% of all pregnancies. Defined as gestational hypertension after 20 weeks of pregnancy and coexisting proteinuria or generalized edema, and certain forms of organ damage, it is life-threatening for both the mother and the fetus, in terms of increasing the rate of mortality and morbidity. Preeclamptic pregnancies are strongly associated with significantly higher medical costs. The maternal costs are related to the extra utility of the healthcare system, more resources used during hospitalization, and likely more surgical spending due to an elevated rate of cesarean deliveries. The infant costs also contribute to a large percentage of the expenses as the babies are prone to preterm deliveries and relevant or causative adverse events. Preeclampsia imposes a considerable financial burden on our societies. It is important for healthcare providers and policy-makers to recognize this phenomenon and allocate enough economic budgets and medical and social resources accordingly. The true cellular and molecular mechanisms underlying preeclampsia remain largely unexplained, which is assumed to be a two-stage process of impaired uteroplacental perfusion with or without prior defective trophoblast invasion (stage 1), followed by general endothelial dysfunction and vascular inflammation that lead to systemic organ damages (stage 2). Risk factors for preeclampsia including race, advanced maternal age, obesity, nulliparity, multi-fetal pregnancy, and co-existing medical disorders, can serve as warnings or markers that call for enhanced surveillance of maternal and fetal well-being. Doppler ultrasonography and biomarkers including the mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and serum pregnancy-associated plasma protein A (PAPP-A) can be used for the prediction of preeclampsia. For women perceived as high-risk individuals for developing preeclampsia, the administration of low-dose aspirin on a daily basis since early pregnancy has proven to be the most effective way to prevent preeclampsia. For preeclamptic females, relevant information, counseling, and suggestions should be provided to facilitate timely intervention or specialty referral. In pregnancies complicated with preeclampsia, closer monitoring and antepartum surveillance including the Doppler ultrasound blood flow study, biophysical profile, non-stress test, and oxytocin challenge test can be arranged. If the results are unfavorable, early intervention and aggressive therapy should be considered. Affected females should have access to higher levels of obstetric units and neonatal institutes. Before, during, and after delivery, monitoring and preparation should be intensified for affected gravidas to avoid serious complications of preeclampsia. In severe cases, delivery of the fetus and the placenta is the ultimate solution to treat preeclampsia. The current review is a summary of recent advances regarding the knowledge of preeclampsia. However, the detailed etiology, pathophysiology, and effect of preeclampsia seem complicated, and further research to address the primary etiology and pathophysiology underlying the clinical manifestations and outcomes is warranted.
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Affiliation(s)
- Kai-Jung Chang
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
- Department of Obstetrics and Gynecology, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan
- School of Medicine, Tzu-Chi University, Hualien 970, Taiwan
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23
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Mukherjee I, Singh S, Karmakar A, Kashyap N, Mridha AR, Sharma JB, Luthra K, Sharma RS, Biswas S, Dhar R, Karmakar S. New immune horizons in therapeutics and diagnostic approaches to Preeclampsia. Am J Reprod Immunol 2023; 89:e13670. [PMID: 36565013 DOI: 10.1111/aji.13670] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 11/02/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
Hypertensive disorders of pregnancy (HDP) are one of the commonest maladies, affecting 5%-10% of pregnancies worldwide. The American College of Obstetricians and Gynecologists (ACOG) identifies four categories of HDP, namely gestational hypertension (GH), Preeclampsia (PE), chronic hypertension (CH), and CH with superimposed PE. PE is a multisystem, heterogeneous disorder that encompasses 2%-8% of all pregnancy-related complications, contributing to about 9% to 26% of maternal deaths in low-income countries and 16% in high-income countries. These translate to 50 000 maternal deaths and over 500 000 fetal deaths worldwide, therefore demanding high priority in understanding clinical presentation, screening, diagnostic criteria, and effective management. PE is accompanied by uteroplacental insufficiency leading to vascular and metabolic changes, vasoconstriction, and end-organ ischemia. PE is diagnosed after 20 weeks of pregnancy in women who were previously normotensive or hypertensive. Besides shallow trophoblast invasion and inadequate remodeling of uterine arteries, dysregulation of the nonimmune system has been the focal point in PE. This results from aberrant immune system activation and imbalanced differentiation of T cells. Further, a failure of tolerance toward the semi-allogenic fetus results due to altered distribution of Tregs such as CD4+FoxP3+ or CD4+CD25+CD127(low) FoxP3+ cells, thereby creating a cytotoxic environment by suboptimal production of immunosuppressive cytokines like IL-10, IL-4, and IL-13. Also, intracellular production of complement protein C5a may result in decreased FoxP3+ regulatory T cells. With immune system dysfunction as a major driver in PE pathogenesis, it is logical that therapeutic targeting of components of the immune system with pharmacologic agents like anti-inflammatory and immune-modulating molecules are either being used or under clinical trial. Cholesterol synthesis inhibitors like Pravastatin may improve placental perfusion in PE, while Eculizumab (monoclonal antibody inhibiting C5) and small molecular inhibitor of C5a, Zilucoplan are under investigation. Monoclonal antibody against IL-17(Secukinumab) has been proposed to alter the Th imbalance in PE. Autologous Treg therapy and immune checkpoint inhibitors like anti-CTLA-4 are emerging as new candidates in immune horizons for PE management in the future.
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Affiliation(s)
- Indrani Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.,Amity Institute of Biotechnology (AIB), Amity University, Noida, India
| | - Sunil Singh
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Abhibrato Karmakar
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Kashyap
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Radhey Shyam Sharma
- Ex-Head and Scientist G, Indian Council of Medical Research, New Delhi, India
| | - Subhrajit Biswas
- Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University, Noida, India
| | - Ruby Dhar
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Subhradip Karmakar
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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24
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Esquivel MK. Nutritional Status and Nutrients Related to Pre-Eclampsia Risk. Am J Lifestyle Med 2023; 17:41-45. [PMID: 36636396 PMCID: PMC9830236 DOI: 10.1177/15598276221129841] [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] [Indexed: 01/16/2023] Open
Abstract
Elevated blood pressure during pregnancy, pre-eclampsia, is in part a result of inflammatory processes related to pregnancy. Reducing risk for pre-eclampsia is important to improve birth outcomes and reduce morbidity and mortality. Nutritional status and dietary intake of key foods and nutrients can aid in the reduction of pre-eclampsia risk. Excessive gestational weight gain is associated with pre-eclampsia risk, however, fluid retention, may be the driver of this relationship. While diets rich in fruits, vegetables, and dietary fiber can reduce pre-eclampsia risk and adherence to a western diet pattern can increase risk. Other nutrients, which may improve hypertension, such as sodium or salt, have little to no effect on pre-eclampsia risk. Key nutrients impacting pre-eclampsia risk are described in this article.
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Affiliation(s)
- Monica Kazlausky Esquivel
- Department of Human Nutrition, Food and Animal Sciences,
College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
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25
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Plant-Based Diets Improve Maternal-Fetal Outcomes in CKD Pregnancies. Nutrients 2022; 14:nu14194203. [PMID: 36235855 PMCID: PMC9573150 DOI: 10.3390/nu14194203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Reducing protein intake in patients with chronic kidney disease (CKD) limits glomerular stress induced by hyperfiltration and can prevent the progression of kidney disease; data in pregnancy are limited. The aim of this study is to analyze the results obtained in CKD patients who followed a plant-based moderately protein-restricted diet during pregnancy in comparison with a propensity-score-matched cohort of CKD pregnancies on unrestricted diets. A total of 52 CKD pregnancies followed up with a protein-restricted plant-based diet (Torino, Italy) were matched with a propensity score based on kidney function and proteinuria with CKD pregnancies with unrestricted protein intake (Cagliari Italy). Outcomes included preterm (<37 weeks) and very preterm (<34 weeks) delivery and giving birth to a small-for-gestational-age baby. The median age in our cohort was 34 years, 63.46% of women were primiparous, and the median body mass index (BMI) was 23.15 kg/m2 with 13.46% of obese subjects. No statistical differences were found between women on a plant-based diet and women who were not in terms of age, parity, BMI, obesity, CKD stage, timing of referral, or cause of CKD. No differences were found between the two groups regarding the week of delivery. However, the combined negative outcome (birth before 37 completed gestational weeks or birth-weight centile <10) occurred less frequently in women following the diet than in women in the control group (61.54% versus 80.77%; p = 0.03). The lower risk was confirmed in a multivariable analysis adjusted for renal function and proteinuria (OR: 0.260 [Q1:0.093-Q3:0.724]; p = 0.010), in which the increase in proteinuria from the first to the last check-up before delivery was lower in patients on plant-based diets (median from 0.80 to 1.87 g/24 h; p: ns) than in controls (0.63 to 2.39 g/24 h p <0.0001). Plant-based, moderately protein-restricted diets in pregnancy in patients with CKD are associated with a lower risk of preterm delivery and small-for-gestational-age babies; the effect may be mediated by better stabilization of proteinuria.
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