Maternal fruit and vegetable or vitamin C consumption during pregnancy is associated with fetal growth and infant growth up to 6 months: results from the Korean Mothers and Children's Environmental Health (MOCEH) cohort study

The association between maternal fruit consumption before and during pregnancy and fetal growth: The Lanzhou birth cohort study

Background

The association between maternal fruit consumption and fetal growth remains inconsistent. The current study aimed to determine whether maternal fruit consumption was associated with low birth weight (LBW) or small for gestational age (SGA) babies.

Methods

A large birth cohort study was conducted in Lanzhou, China, from 2010 to 2012 and included 10,076 pregnant women at the 1st, 2nd, and 3rd trimester of pregnancy for analysis. Fruit consumption in the 1st, 2nd, and 3rd trimester of pregnancy was measured by a self-designed food frequency questionnaire (FFQ) and divided into three groups: 1) inadequate fruit consumption: <200 g/d for the1st, 2nd, and 3rd trimester; 2) adequate fruit consumption: 200-350 g/d for the 1st trimester or 200-400 g/d for the 2nd and 3rd trimester; 3) excessive fruit consumption: >350 g/d for the 1st trimester or > 400 g/d for the 2nd and 3rd trimester. A case-control study was used to analyze the association between fruit intake during pregnancy and low birth weight infants.

Results

Compared to adequate fruit consumption, excessive fruit consumption throughout each trimester of pregnancy was associated with a lower risk of LBW, with an odds ratio (OR) ranging from 0.70 to 0.79 (95 % confidence interval, CI: 0.57-0.98); while inadequate fruit consumption was associated with a higher risk of infant LBW, with an OR ranging from 1.26 to 1.36 (95%CI: 1.04-1.66). After stratifying by mother's pre-pregnancy body mass index (BMI), the results were similar among women with underweight BMI. No significance was found between fruit consumption and SGA in the general population. Still, stratified analyses showed that inadequate fruit consumption was associated with an increased risk of SGA in underweight mothers, with an OR ranging from 1.66 to 1.79 (95%CI: 1.13-2.64).

Conclusions

Fruit consumption during pregnancy reduces the risk of LBW in Chinese women, especially in women with low pre-pregnancy BMI.

Dietary Patterns of Pregnant Women and Their Association with Diet Quality Measures: A Comparative Analysis

Healthy dietary patterns during pregnancy are crucial for ensuring maternal and foetal health outcomes. Numerous methodologies exist for assessing the diet of pregnant women, including dietary patterns and various appraisal tools of diet quality. This study aimed to assess the dietary patterns and diet quality of pregnant women and to investigate the relationship between dietary patterns, diet quality estimators, and the adequacy of nutrient intake. EPIC FFQ was applied to a sample of 251 pregnant women, and questionnaires were interpreted with the FETA program. Dietary patterns were then determined by means of principal component analysis. Our results showed a substantial association between dietary patterns and total diet quality, as measured by the Diet Quality Index for Pregnancy (DQI-Pc), PURE Healthy Diet Score, and FIGO Diet Quality Score. We also found correlations between certain dietary patterns and particular nutrient intakes recommended by the European Food Safety Authority during pregnancy. The most deficient intake was registered for iron (86.1%), zinc (87.3%) and magnesium (79.3%), posing a threat to normal bone development, anaemia prophylaxis, and immune status. These results highlight the importance of assessing and understanding eating habits during pregnancy in order to achieve optimal outcomes for both the mother and the foetus.

Maternal Vitamin C Intake during Pregnancy Influences Long-Term Offspring Growth with Timing- and Sex-Specific Effects in Guinea Pigs

Our previous work in guinea pigs revealed that low vitamin C intake during preconception and pregnancy adversely affects fertility, pregnancy outcomes, and foetal and neonatal growth in a sex-dependent manner. To investigate the long-term impact on offspring, we monitored their growth from birth to adolescence (four months), recorded organ weights at childhood equivalence (28 days) and adolescence, and assessed physiological parameters like oral glucose tolerance and basal cortisol concentrations. We also investigated the effects of the timing of maternal vitamin C restriction (early vs. late gestation) on pregnancy outcomes and the health consequences for offspring. Dunkin Hartley guinea pigs were fed an optimal (900 mg/kg feed) or low (100 mg/kg feed) vitamin C diet ad libitum during preconception. Pregnant dams were then randomised into four feeding regimens: consistently optimal, consistently low, low during early pregnancy, or low during late pregnancy. We found that low maternal vitamin C intake during early pregnancy accelerated foetal and neonatal growth in female offspring and altered glucose homeostasis in the offspring of both sexes at an age equivalent to early childhood. Conversely, low maternal vitamin C intake during late pregnancy resulted in foetal growth restriction and reduced weight gain in male offspring throughout their lifespan. We conclude that altered vitamin C during development has long-lasting, sex-specific consequences for offspring and that the timing of vitamin C depletion is also critical, with low levels during early development being associated with the development of a metabolic syndrome-related phenotype, while later deprivation appears to be linked to a growth-faltering phenotype.

Fruits and vegetables intake improves birth outcomes of women with gestational diabetes mellitus and hypertensive disorders of pregnancy

BACKGROUND

Disorders of pregnancy such as hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) have been associated with adverse birth outcomes. However, the ameliorating role of maternal nutrition in the relationship between disorders of pregnancy and adverse birth outcomes has received very little attention. We investigated the relationship between HDP and GDM, and adverse birth outcomes in a Ghanaian population and evaluated the effect modifying role of fruits and vegetables consumption in the relationship.

METHODS

We conducted a cross-sectional study among 799 mothers who had recently delivered singletons in the Cape Coast Metropolis, Ghana. Information on HDP, GDM and birth outcomes were retrieved from the maternal health book of the mothers. A food frequency questionnaire was used to assess fruits and vegetables intake during pregnancy. Modified Poisson regression was used to investigate the association between pregnancy disorders, and preterm birth (PTB) and low birth weight (LBW). Stratified analysis was used to assess the effect modifying role of fruits and vegetables consumption in the relationship.

RESULTS

The proportion of mothers with HDP and GDM was 11.3% and 7.5%, respectively. The proportion of the mothers with both conditions was 0.9%. The prevalence of PTB and LBW in the population was 27.9 and 7.3%, respectively. These disorders of pregnancy were associated with increased risk of PTB (Adjusted Prevalence Ration [APR] = 3.02; 95% CI: 2.42, 3.77) and LBW (APR = 5.32; 95% CI: 3.19, 8.88). In the stratified analysis, risk of PTB was higher among mothers classified in tertile I compared to mothers classified in tertiles II and III. For LBW, the risk increased with increasing fruits and vegetables consumption. The interaction p values were 0.0043 and 0.1604 for PTB and LBW, respectively.

CONCLUSIONS

We found mothers who were diagnosed with GDM and HDP to have increased risk of delivering a PTB and LBW baby. We also found fruits and vegetables consumption to modify the observed relationship. Mothers diagnosed with GDM and HDP should be advised during antenatal care visits to increase intake of fruits and vegetable consumption to help safeguard their health and that of the developing foetus.

Does a Ketogenic Diet Have a Place Within Diabetes Clinical Practice? Review of Current Evidence and Controversies

Carbohydrate restriction has gained increasing popularity as an adjunctive nutritional therapy for diabetes management. However, controversy remains regarding the long-term suitability, safety, efficacy and potential superiority of a very low carbohydrate, ketogenic diet compared to current recommended nutritional approaches for diabetes management. Recommendations with respect to a ketogenic diet in clinical practice are often hindered by the lack of established definition, which prevents its capacity to be most appropriately prescribed as a therapeutic option for diabetes. Furthermore, with conflicted evidence, this has led to uncertainty amongst clinicians on how best to support and advise their patients. This review will explore whether a ketogenic diet has a place within clinical practice by reviewing current evidence and controversies.

Exposure to ultra-processed foods during pregnancy and ultrasound fetal growth parameters

Periconceptional maternal ultra-processed food (UPF) consumption impairs embryonic growth. Impacts of exposure to UPF on distinct components of fetal growth in late pregnancy are unknown. We investigated the influence of frequency of UPF consumption during pregnancy on fetal head circumference (HC), abdominal circumference (AC) and femur length (FL). This study included 417 live-born singleton pregnancies prospectively followed-up since the antenatal period in the MINA-Brazil Study, with an available ultrasound scan at >24 gestational weeks. Frequency of food groups consumption in the previous month was categorised as no/monthly, weekly or daily. Ultrasound scans were conducted at 27·8 (sd: 1·7) gestational weeks. HC, AC and FL z-scores were calculated for gestational age using the INTERGROWTH-21st Project standards. Simultaneous-quantile regression models were fitted at the 10th, 50th and 90th percentiles of the distribution of each ultrasound parameter according to UPF consumption, with adjustment for potential confounders. Participants were aged on average 24·7 (sd: 6·5) years, 44·8 % were primiparous, and 26·9 % and 24·9 %, respectively, had weekly and daily UPF consumption. Compared with no/monthly intake, daily UPF consumption impaired HC across its distribution, with significant effect sizes varying from -0·24 to -0·40 z-score. Weekly UPF consumption decreased HC at the 90th percentile by -0·39 z-score (95 % CI: -0·78, -0·01) and FL at the 50th percentile by -0·32 z-score (95 % CI: -0·60, -0·04). No association was noted with AC. Frequency of UPF consumption was negatively associated with skeletal components of fetal growth in late pregnancy. Infant body composition may benefit from healthy food practices since pregnancy.

Relationships of pregnancy and postpartum diet quality with offspring birth weight and weight status through 12 months

OBJECTIVE

This study examined relationships of maternal pregnancy and postpartum diet quality with infant birth size and weight status indicators through 12 months and tested whether breastfeeding duration modifies these associations.

METHODS

In the Pregnancy Eating Attributes Study (PEAS), dietary intake was assessed six times in 458 mothers who were followed from early pregnancy through 12 months postpartum (2014-2018). Logistic and linear mixed models estimated relationships of pregnancy and postpartum diet quality (Healthy Eating Index [HEI]) with offspring who were large-for-gestational-age (LGA) at birth, as well as BMI z score (BMIz) and weight-for-length z score (WFLz) at birth, 6 weeks, 6 months, and 12 months.

RESULTS

Pregnancy HEI was inversely related to LGA (odds ratio [OR] = 0.95, 95% CI: 0.92 to 0.98); HEI was also inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.002) and BMIz (β = -0.009, 95% CI: -0.02 to -0.0009) from birth through 12 months. Postpartum HEI was inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.0009) and BMIz (β = -0.008, 95% CI: -0.02 to 0.0007) in infants who were breastfed for at least 6 months, but not in those who were breastfed for a shorter duration.

CONCLUSIONS

Maternal diet quality during pregnancy (and during postpartum in mothers who breastfed for a longer duration) was inversely related to LGA and weight status indicators from birth through 12 months. Increasing maternal diet quality may have use for promoting healthy infant weight development.

Effects of Low Vitamin C Intake on Fertility Parameters and Pregnancy Outcomes in Guinea Pigs

Identifying how specific nutrients can impact fertility, pregnancy, and neonatal outcomes will yield important insights into the biological mechanisms linking diet and reproductive health. Our study investigates how dietary vitamin C intake affects various fertility parameters and pregnancy and neonatal outcomes in the guinea pig, a natural model of vitamin C dependency. Dunkin Hartley guinea pigs were fed an optimal (900 mg/kg feed) or low (100 mg/kg feed) vitamin C diet ad libitum for at least three weeks prior to mating and throughout pregnancy. We found that animals receiving the low vitamin C diet had an increased number of unsuccessful matings, a higher incidence of foetal reabsorption, and, among pregnancies resulting in delivery at term, produced fewer offspring. Neonates from mothers on the low vitamin C diet had significantly decreased plasma vitamin C concentrations at birth and exhibited mild growth impairments in a sex-dependent manner. We conclude that a diet low of vitamin C induces a state of subfertility, reduces overall fecundity, and adversely impacts both pregnancy outcomes and growth in the offspring. Our study provides an essential foundation for future investigations to determine whether these findings translate to humans. If so, they could have important clinical implications for assisted reproductive technologies and nutritional recommendations for couples trying to conceive, pregnant women, and breastfeeding mothers.

Ascorbic acid intake during pregnancy

The continuing global increase in allergic conditions and diseases in children is now a serious public health and scientific issue. Amongst other concerns is the maternal antenatal diet as intake of essential nutrients. Even small deficits in essential vitamin C can permanently impair the developing brain for example. In this article, we first review ascorbic acid deficiency in different organs of both mother and foetus. However, major emphasis is on the importance of vitamin C in foetal immunity with studies showing an inverse relationship between maternal intake of fresh fruit and vegetables and allergic conditions in childhood, inter alia. Other review results are included.

Association between maternal plasma total antioxidant capacity and dietary antioxidants intake with birth size outcomes

BACKGROUND

Maternal antioxidants intake and plasma total antioxidant capacity (TAC) concentration during pregnancy might influence on birth outcomes. This study was conducted to determine the association between dietary antioxidants intake and plasma TAC during pregnancy with birth outcomes.

METHODS

Overall, 220 mother-infant pairs were recruited in the first trimester of pregnancy. Maternal whole blood was collected and TAC was determined by the ELISA kit. Food frequency questionnaire was used to collect information regarding usual dietary intake. Birth size measurements including birth weight, length and head circumference were measured according to standardized protocols.

RESULTS

Energy-adjusted intake of beta-carotene in the first trimester of gestation [beta (SE) = 0.0002 (0.00008); p = 0.016] and energy-adjusted intake of vitamin E in third trimester of pregnancy [beta (SE) = -0.31 (0.15); p = 0.046] had significantly positive and negative associations with birth length, respectively. The maternal plasma TAC was positively correlated with birth weight in both unadjusted and adjusted models [beta (SE) = 2.75 (1.35); p = 0.043 and beta (SE) = 3.43 (1.50); p = 0.023, respectively]. In addition, the adjusted model showed a significant positive relationship between the maternal plasma TAC and birth length [beta (SE) = 0.023 (0.009); p = 0.01].

CONCLUSION

This study showed the positive association of maternal plasma TAC with birth weight and length. Moreover, maternal dietary intake of beta-carotene in the first trimester and vitamin E in the third trimester of pregnancy had significant positive and negative correlations with birth length, respectively.

Effects of Nutritional and Social Factors on Favorable Fetal Growth Conditions Using Structural Equation Modeling

Poor birth outcomes such as low birth weight, low birth length and short gestational age, are public health concern issues in South Africa (SA). This study utilized structural equation modeling (SEM) to explore how nutritional and social factors contribute to favorable fetal growth conditions (FFGC) in pregnant women living with and without human immunodeficiency virus (HIV), in the Free State Province of SA. Sociodemographic characteristics, stress, health and nutrition-related information, and birth outcomes data were collected and analyzed from a subsample of 305 women enrolled in a cohort study from 2018−2020. Descriptive statistics were analyzed in R version 4.1.2 and SEM was conducted in Lavaan version 0.6−5. Higher gestational body mass index (GBMI) and income levels were associated with higher FFGC (p < 0.05). Household incomes were positively associated with dietary micronutrient quality (p = 0.002), GBMI (p = 0.012) and food security (p = 0.001). Low incomes (p = 0.004) and food insecurity (p < 0.001) were associated with higher stress, while social support was positively associated with food security status (p = 0.008). These findings highlight the complex interconnections between the social and nutritional factors that are associated with fetal growth conditions. Multisectoral community-based programs may be a useful strategy to address these challenges.

Effects of ambient air pollution, fresh fruit and vegetable intakes as well as maternal psychosocial stress on the outcome of newborn otoacoustic emission hearing screening

BACKGROUND

Newborn hearing screening results indicated that more than 40% of the detected infants had no recognized risk factors. To determine whether maternal exposure to ambient air pollutants and experience of stressful life event, as well as lack of fresh fruit and vegetable during pregnancy are associated with the abnormal hearing development among newborns.

METHODS

A total of 1193 newborns and their mothers were recruited in this study. Personal information and covariates were collected by face to face interview. Medical examination results of newborns and their mothers were extracted from medical record. We estimated personal air pollutant exposure level through inverse distance weighted method based on data from air quality monitoring stations and assessed the auditory development of newborns via distortion product otoacoustic emission (DPOAE). Unconditional logistic regression model was used to estimate the relationship between DPOAE screening result and the potential influential factors as well as the combined effect.

RESULTS

The results indicated that PM₁₀ exposure during the second trimester and stressful life event during the third trimester could increase the risk of not passing DPOAE test among newborns. However, frequent intakes of fruit and vegetable significantly reduced the risk. There was a synergetic interaction between PM₁₀ exposure and stressful life event on neonatal hearing development.

CONCLUSIONS

To alleviate abnormal auditory development among fetus, pregnant woman should decrease the exposures to ambient air pollutant and negative life event and at the same time, intake sufficient fresh fruit and vegetable.

Maternal diet quality during pregnancy and its influence on low birth weight and small for gestational age: a birth cohort in Beijing, China

This study aimed to describe diet quality of pregnant women and explore the association between maternal diet and the prevalence of low birth weight (LBW) and small for gestational age (SGA). A total of 3856 participants from a birth cohort in Beijing, China, were recruited between June 2018 and February 2019. Maternal diet in the first and second trimesters was assessed by the Chinese diet balance index for pregnancy (DBI-P), using data collected by the inconsecutive 2-d 24-h dietary recalls. Logistic regressions were performed to explore the independent effects of DBI-P components on LBW and SGA. The prevalence of LBW and SGA was 3·8% and 6·0%, respectively. Dietary intakes of the participants were imbalanced. The proportions of participants having insufficient intake of vegetables (87·3% and 86·6%), dairy product (95·9% and 96·7%) and aquatic foods (80·5% and 85·3%) were high in both trimesters. The insufficiency of fruit intake was more severe in the second (85·2%) than that in the first trimester (22·5%) (P < 0·05). After adjusting for potential confounders, the intake of fruits and dairy in the second trimester was negatively associated with the risk of LBW (OR = 0·850, 95% CI: 0·723, 0·999) and SGA (OR = 0·885, 95% CI: 0·787, 0.996), respectively. Sufficient consumption of fruits and dairy products in pregnancy may be suggested in order to prevent LBW and SGA.

Household food security during the COVID-19 pandemic in urban and semi-urban areas in Indonesia

BACKGROUND

One of the impacts of the COVID-19 pandemic was the weakening of the community's economic condition. The weak economy of the community will have an impact on household food security. This study aims to determine food security in the COVID-19 pandemic situation and the impact of the pandemic on food security in urban and semi-urban areas.

METHODS

A cross-sectional study with a total sample of 517 people who live in urban (Jakarta) and semi-urban (Depok) areas. The research data was collected online and purposively through Posyandu cadres who have access to family/community. Food security was measured using HFIAS (Household Food Insecurity Access Scale) method, while impact of COVID-19 pandemic was categorized into two categories: impacted (reduced income and laid off) and less impacted (not reduced income and laid off). Data analysis used the Chi-square test and multiple logistic regression.

RESULTS

There were 65.0% of households with various level of food insecurity during the COVID-19 pandemic. The results of the multivariate analysis showed that family income during the COVID-19 pandemic (AOR = 4.2; CI = 2.7-6.7), the type of impact of the COVID-19 pandemic, i.e., reduced income and stopped working (AOR = 2.6; CI = 1.6-4.1), and the age of the respondent (AOR = 1.7; CI = 1.1-2.5) were significantly related to household food security during the pandemic after being controlled by husband's work status. Households with lower income had 4 times higher risk to experience food insecurity compared to those with higher income. Heavily impacted households (through reduced income and stopped working) had 3 times higher risk to experience food insecurity compared to those who did not. Additionally, we found that households with younger respondent (< 31 years old) had 2 times higher risk to experience food insecurity compared to those older counterparts.

CONCLUSIONS

The COVID-19 pandemic impacted household food security in both urban and semi-urban areas through worsening employment status and income condition.

Maternal Long-Term Intake of Inulin Improves Fetal Development through Gut Microbiota and Related Metabolites in a Rat Model

Adequate dietary fiber intake during gestation is critical for maternal-fetal health. This experiment aims to uncover the impacts of maternal long-term intake of inulin on fetal development and its underlying mechanism. Eighty female Sprague-Dawley rats were randomly assigned to two groups receiving either a fiber-free diet or an inulin diet (inulin) for three parities. On the 19^th day of pregnancy in the third parity, blood, intestinal, placental, and colonic digesta samples were collected. Results showed that maternal intake of inulin significantly decreased the within-litter birth weight variation in parities 2 and 3. Inulin intake modified the gut microbiome profiles and elevated the colonic contents of short chain fatty acids (propionate and butyrate). Inulin decreased the serotonin (5-HT) concentration in the colon, whereas it increased the 5-HT concentrations in serum and placenta and the number of 5-HT⁺ enterochromaffin cells in the colon. The protein expression of melatonin-synthesizing enzyme (arylalkylamine N-acetyltransferase) and the melatonin concentration in the placenta were also increased by inulin. Inulin improved the placental redox status and nutrient transport. These findings indicated that maternal long-term intake of inulin improves fetal development by altering the intestinal microbiota and related metabolites in rats.

The Effect of Mobile Radiation on the Oxidative Stress Biomarkers in Pregnant Mice

Objective: Due to the growing use of communication instruments such as cell phones and wireless devices, there is growing public concern about possible harmful effects, especially in sensitive groups such as pregnant women. This study aimed to investigate the oxidative stress induced by exposure to 900 MHz mobile phone radiation and the effect of vitamin C intake on reducing possible changes in pregnant mice. Materials and methods: Twenty-one pregnant mice were divided into three groups (control, mobile radiation-exposed, and mobile radiation plus with vitamin C intake co-exposed (200 mg /kg)). The mice in exposure groups were exposed to 900 MHz, 2 watts, and a power density of 0.045 μw /cm2 mobile radiation for eight hours/day for ten consecutive days. After five days of rest, MDA (Malondialdehyde), 8-OHdG (8-hydroxy-2' -deoxyguanosine), and TAC (Total Antioxidant Capacity) levels were measured in the blood of animals. The results were analyzed by SPSS.22.0 software. Results: The results showed that exposure to mobile radiation increased MDA (P=0.002), and 8-OHdG (P=0.001) significantly and decreased Total Antioxidant Capacity in the exposed groups (P=0.001). Taking vitamin C inhibited the significant increase in MDA and 8-OHdG levels in exposed groups. Conclusion: Although exposure to mobile radiation can cause oxidative stress in the blood of pregnant mice, vitamin C as an antioxidant can prevent it.

Fruit and vegetable consumption before and during pregnancy and developmental delays in offspring aged 2 years in Japan

The association between fruit and vegetable consumption before and during pregnancy and offspring’s physical growth has been well reported, but no study has focused on offspring’s neurological development. We aimed to explore the association between maternal fruit and vegetable consumption before and during pregnancy and developmental delays in their offspring aged 2 years. Between July 2013 and March 2017, 23 406 women were recruited for the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Fruit and vegetable consumption was calculated using FFQ, and offspring’s developmental delays were evaluated by the Ages & Stages Questionnaires, Third Edition (ASQ-3) for infants aged 2 years. Finally, 10 420 women and 10 543 infants were included in the analysis. Totally, 14·9 % of children had developmental delay when screened using the ASQ-3. Women in the highest quartile of vegetable consumption from pre-pregnancy to early pregnancy and from early to mid-pregnancy had lower odds of offspring’s developmental delays (OR 0·74; 95 % CI 0·63, 0·89 and OR 0·70; 95 % CI 0·59, 0·84, respectively) than women in the lowest quartile. Women in the highest quartile of fruit consumption from early to mid-pregnancy had lower odds of offspring’s developmental delays (OR 0·78; 95 % CI 0·66, 0·92) than women in the lowest quartile. In conclusion, high fruit and vegetable consumption before and during pregnancy was associated with a lower risk of developmental delays in offspring aged 2 years.

The Influence of Nutrients Intake during Pregnancy on Baby's Birth Weight: A Systematic Review

BACKGROUND AND OBJECTIVE

Maternal food intake during pregnancy can substantially interfere in the baby's anthropometric measurements at birth. Our objective was to perform a systematic review that investigate the influence of nutrient intake via food during pregnancy on the baby's anthropometric measurements at birth.

METHODS

A search was performed without time limits on CINAHL, Embase, PubMed, Scopus and Web of Science databases and manual on studies references. All nutrients and baby's anthropometric measurements at birth were included as descriptors.

RESULTS

Thirty articles were included, the majority of prospective cohort studies, with 15.39 (2.36) quality points (maximum value: 22). Thirty-six results of associations were found, of which 17 studies had direct associations between nutrient intake and birth outcomes. Inverse associations were identified in 8 studies and 11 articles showed no significant associations in all analyses. Maternal food intake of vitamin C, calcium and magnesium during pregnancy seems to have a positive influence on the baby's birth weight, while carbohydrates intake have an inverse association with the same outcome.

CONCLUSION

It is suggested that vitamin C, calcium, magnesium and carbohydrates influence on baby's birth weight. So, these specific nutrients need more attention to the consumption, in addition to carried out new studies, with robust methodologies for measuring maternal food consumption and considering the several factors that can interfere in this assessment.

REGISTRATION

This review has been registered to the PROSPERO (International prospective register of systematic reviews) (ID: CRD42020167889).

Vitamin C Deficiency in the Young Brain-Findings from Experimental Animal Models

Severe and long-term vitamin C deficiency can lead to fatal scurvy, which is fortunately considered rare today. However, a moderate state of vitamin C (vitC) deficiency (hypovitaminosis C)-defined as a plasma concentration below 23 μM-is estimated to affect up to 10% of the population in the Western world, albeit clinical hallmarks in addition to scurvy have not been linked to vitC deficiency. The brain maintains a high vitC content and uniquely high levels during deficiency, supporting vitC's importance in the brain. Actions include both antioxidant and co-factor functions, rendering vitamin C deficiency likely to affect several targets in the brain, and it could be particularly significant during development where a high cellular metabolism and an immature antioxidant system might increase sensitivity. However, investigations of a non-scorbutic state of vitC deficiency and effects on the developing young brain are scarce. This narrative review provides a comprehensive overview of the complex mechanisms that regulate vitC homeostasis in vivo and in the brain in particular. Functions of vitC in the brain and the potential consequences of deficiency during brain development are highlighted, based primarily on findings from experimental animal models. Perspectives for future investigations of vitC are outlined.

Relationship between the quality of the pregnant woman's diet and birth weight: a prospective cohort study

BACKGROUND

Birth weight is a relevant predictor of childhood health outcomes. Studies investigating the association between modifiable risk factors, as the maternal diet quality, and birth weight are needed. We aimed to investigate the association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) score and birth weight.

METHODS

This is a prospective cohort that includes 547 Brazilian mother-child pairs. Dietary recalls and a food frequency questionnaire were obtained during pregnancy. Information on birth weight, sex, and gestation duration were obtained from the Live Birth Information System (SINASC).

RESULTS

On total, 3.8% of the newborns were classified as low birth weight (LBW), 6.0% with macrosomia, 10.2% small for gestational age (SGA), and 11.2% large for gestational age (LGA). The mean (SD) IQDAG score was 70.1 (11.8). Adjusted logistic regression models showed that women in the third tertile of the IQDAG score presented a lower risk of having LGA babies [OR 0.44 (95% CI 0.22, 0.90), p-trend = 0.02] compared to the first tertile. Women in the third tertile of omega-3 intake presented a lower risk of giving birth to LGA infants [OR 0.33 (95% CI 0.15, 0.69), p-trend = 0.00] and LBW infants [OR 0.18 (95% CI 0.04, 0.83), p-trend = 0.02] when compared to the first tertile. There was also a lower SGA trend among the children of women in the third tertile of omega-3 intake [OR 0.43 (95% CI 0.17, 1.07), p-trend = 0.03] compared to the first tertile.

CONCLUSION

A better diet quality and higher omega-3 intake are protective factors for LGA babies, and increased maternal omega-3 intake reduce the risk of LBW and LGA, and may be a protective factor against the birth of SGA infants.

Validation and reproducibility of a FFQ focused on pregnant women living in Northeastern Brazil

OBJECTIVE

The aim of the current study is to assess the validity and reproducibility of a FFQ focused on pregnant women living in Northeastern Brazil.

DESIGN

Three 24-hour-dietary recalls (24 hR) and two FFQ were applied at 15-d intervals between research stages in order to confirm the validity and reproducibility of the FFQ. Validity assessment was based on Pearson's correlation coefficient (PCC) or Spearman's correlation coefficient (SCC) between FFQ and the mean of three 24 hR (the 24 hR was used as reference standard), whereas reproducibility assessment was based on the intraclass correlation coefficient (ICC) among FFQ, and P < 0·05 was set as significance level.

SETTING

Public health network of a capital city in Northeastern Brazil.

PARTICIPANTS

Overall, 100 pregnant women were included in the study.

RESULTS

The PCC or SCC adopted in the validity analysis recorded the recommended values (from 0·4 and 0·7) for energy (0·44; P < 0·001), carbohydrate (0·40; P < 0·001), vitamins B2 (0·40; P < 0·001), B5 (0·40; P < 0·001), E (0·47; P < 0·001), B12 (0·48; P < 0·001), phosphorus (0·92; P < 0·001), Mg (0·81; P < 0·001), Se (0·70; P < 0·001), cholesterol (0·64; P < 0·001), saturated (0·76; P < 0·001), polyunsaturated (0·73; P < 0·001) and monounsaturated fats (0·87; P < 0·001) and fibres (0·77; P < 0·001). Mg (0·72; P < 0·001), Fe (0·65; P < 0·001), lipid (0·56; P < 0·001) and energy (0·55; P < 0·001) presented ICC within the recommended reproducibility values.

CONCLUSIONS

The FFQ developed in the current study is a useful tool to assess the usual food intake of pregnant women.

Adaptations of the human placenta to hypoxia: opportunities for interventions in fetal growth restriction

BACKGROUND

The placenta is the functional interface between the mother and the fetus during pregnancy, and a critical determinant of fetal growth and life-long health. In the first trimester, it develops under a low-oxygen environment, which is essential for the conceptus who has little defense against reactive oxygen species produced during oxidative metabolism. However, failure of invasive trophoblasts to sufficiently remodel uterine arteries toward dilated vessels by the end of the first trimester can lead to reduced/intermittent blood flow, persistent hypoxia and oxidative stress in the placenta with consequences for fetal growth. Fetal growth restriction (FGR) is observed in ∼10% of pregnancies and is frequently seen in association with other pregnancy complications, such as preeclampsia (PE). FGR is one of the main challenges for obstetricians and pediatricians, as smaller fetuses have greater perinatal risks of morbidity and mortality and postnatal risks of neurodevelopmental and cardio-metabolic disorders.

OBJECTIVE AND RATIONALE

The aim of this review was to examine the importance of placental responses to changing oxygen environments during abnormal pregnancy in terms of cellular, molecular and functional changes in order to highlight new therapeutic pathways, and to pinpoint approaches aimed at enhancing oxygen supply and/or mitigating oxidative stress in the placenta as a mean of optimizing fetal growth.

SEARCH METHODS

An extensive online search of peer-reviewed articles using PubMed was performed with combinations of search terms including pregnancy, placenta, trophoblast, oxygen, hypoxia, high altitude, FGR and PE (last updated in May 2020).

OUTCOMES

Trophoblast differentiation and placental establishment are governed by oxygen availability/hypoxia in early pregnancy. The placental response to late gestational hypoxia includes changes in syncytialization, mitochondrial functions, endoplasmic reticulum stress, hormone production, nutrient handling and angiogenic factor secretion. The nature of these changes depends on the extent of hypoxia, with some responses appearing adaptive and others appearing detrimental to the placental support of fetal growth. Emerging approaches that aim to increase placental oxygen supply and/or reduce the impacts of excessive oxidative stress are promising for their potential to prevent/treat FGR.

WIDER IMPLICATIONS

There are many risks and challenges of intervening during pregnancy that must be considered. The establishment of human trophoblast stem cell lines and organoids will allow further mechanistic studies of the effects of hypoxia and may lead to advanced screening of drugs for use in pregnancies complicated by placental insufficiency/hypoxia. Since no treatments are currently available, a better understanding of placental adaptations to hypoxia would help to develop therapies or repurpose drugs to optimize placental function and fetal growth, with life-long benefits to human health.

High-Fiber Diet during Pregnancy Characterized by More Fruit and Vegetable Consumption

Higher dietary fiber intakes during pregnancy may have the potential health benefits of increasing gut microbiome diversity, lowering the risk of glucose intolerance and pre-eclampsia, achieving appropriate gestational weight gain, and preventing constipation. In this observational cohort study, we have assessed the dietary fiber intakes of 804 women in late pregnancy, using a semi-quantitative food frequency questionnaire (SQ-FFQ). Overall, the median (interquartile range) dietary fiber intake was 24.1 (19.0–29.7) grams per day (g/day). Only 237/804 (29.5%) women met the recommended Adequate Intake (AI) of dietary fiber during pregnancy of 28 g/day. Women consuming the highest quartile of fiber intakes (34.8 (IQR 32.1–39.5) g/day) consumed more fruit, especially apples and bananas, than women consuming the lowest quartile of fiber intakes (15.9 (IQR 14.4–17.5) g/day). These women in the highest fiber-intake quartile were older (p < 0.01), more had completed further education after secondary school (p = 0.04), and they also consumed more vegetables (67 g/day) compared to the women in the lowest fiber consumption quartile (17 g vegetables/day). Bread intakes of 39–42 g/day were consistent in quantities consumed across all four fiber-intake quartiles. Our findings suggest that antenatal education advice targeting increased fruit and vegetable consumption before and during pregnancy may be a simple strategy to achieve increased total dietary fiber intakes to reach recommended quantities.

Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews

BACKGROUND

Stillbirth is generally defined as a death prior to birth at or after 22 weeks' gestation. It remains a major public health concern globally. Antenatal interventions may reduce stillbirths and improve maternal and neonatal outcomes in settings with high rates of stillbirth. There are several key antenatal strategies that aim to prevent stillbirth including nutrition, and prevention and management of infections.

OBJECTIVES

To summarise the evidence from Cochrane systematic reviews on the effects of antenatal interventions for preventing stillbirth for low risk or unselected populations of women.

METHODS

We collaborated with Cochrane Pregnancy and Childbirth's Information Specialist to identify all their published reviews that specified or reported stillbirth; and we searched the Cochrane Database of Systematic Reviews (search date: 29 Feburary 2020) to identify reviews published within other Cochrane groups. The primary outcome measure was stillbirth but in the absence of stillbirth data, we used perinatal mortality (both stillbirth and death in the first week of life), fetal loss or fetal death as outcomes. Two review authors independently evaluated reviews for inclusion, extracted data and assessed quality of evidence using AMSTAR (A Measurement Tool to Assess Reviews) and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm; clear evidence of no effect or equivalence; possible benefit or harm; or unknown benefit or harm or no effect or equivalence.

MAIN RESULTS

We identified 43 Cochrane Reviews that included interventions in pregnant women with the potential for preventing stillbirth; all of the included reviews reported our primary outcome 'stillbirth' or in the absence of stillbirth, 'perinatal death' or 'fetal loss/fetal death'. AMSTAR quality was high in 40 reviews with scores ranging from 8 to 11 and moderate in three reviews with a score of 7. Nutrition interventions Clear evidence of benefit: balanced energy/protein supplementation versus no supplementation suggests a probable reduction in stillbirth (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.94, 5 randomised controlled trials (RCTs), 3408 women; moderate-certainty evidence). Clear evidence of no effect or equivalence for stillbirth or perinatal death: vitamin A alone versus placebo or no treatment; and multiple micronutrients with iron and folic acid versus iron with or without folic acid. Unknown benefit or harm or no effect or equivalence: for all other nutrition interventions examined the effects were uncertain. Prevention and management of infections Possible benefit for fetal loss or death: insecticide-treated anti-malarial nets versus no nets (RR 0.67, 95% CI 0.47 to 0.97, 4 RCTs; low-certainty). Unknown evidence of no effect or equivalence: drugs for preventing malaria (stillbirth RR 1.02, 95% CI 0.76 to 1.36, 5 RCTs, 7130 women, moderate certainty in women of all parity; perinatal death RR 1.24, 95% CI 0.94 to 1.63, 4 RCTs, 5216 women, moderate-certainty in women of all parity). Prevention, detection and management of other morbidities Clear evidence of benefit: the following interventions suggest a reduction: midwife-led models of care in settings where the midwife is the primary healthcare provider particularly for low-risk pregnant women (overall fetal loss/neonatal death reduction RR 0.84, 95% CI 0.71 to 0.99, 13 RCTs, 17,561 women; high-certainty), training versus not training traditional birth attendants in rural populations of low- and middle-income countries (stillbirth reduction odds ratio (OR) 0.69, 95% CI 0.57 to 0.83, 1 RCT, 18,699 women, moderate-certainty; perinatal death reduction OR 0.70, 95% CI 0.59 to 0.83, 1 RCT, 18,699 women, moderate-certainty). Clear evidence of harm: a reduced number of antenatal care visits probably results in an increase in perinatal death (RR 1.14 95% CI 1.00 to 1.31, 5 RCTs, 56,431 women; moderate-certainty evidence). Clear evidence of no effect or equivalence: there was evidence of no effect in the risk of stillbirth/fetal loss or perinatal death for the following interventions and comparisons: psychosocial interventions; and providing case notes to women. Possible benefit: community-based intervention packages (including community support groups/women's groups, community mobilisation and home visitation, or training traditional birth attendants who made home visits) may result in a reduction of stillbirth (RR 0.81, 95% CI 0.73 to 0.91, 15 RCTs, 201,181 women; low-certainty) and perinatal death (RR 0.78, 95% CI 0.70 to 0.86, 17 RCTs, 282,327 women; low-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. Screening and management of fetal growth and well-being Clear evidence of benefit: computerised antenatal cardiotocography for assessing infant's well-being in utero compared with traditional antenatal cardiotocography (perinatal mortality reduction RR 0.20, 95% CI 0.04 to 0.88, 2 RCTs, 469 women; moderate-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined.

AUTHORS' CONCLUSIONS

While most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death, several interventions suggested a clear benefit, such as balanced energy/protein supplements, midwife-led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide-treated anti-malarial nets and community-based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful. However, there was variation in the effectiveness of interventions across different settings, indicating the need to carefully understand the context in which these interventions were tested. Further high-quality RCTs are needed to evaluate the effects of antenatal preventive interventions and which approaches are most effective to reduce the risk of stillbirth. Stillbirth (or fetal death), perinatal and neonatal death need to be reported separately in future RCTs of antenatal interventions to allow assessment of different interventions on these rare but important outcomes and they need to clearly define the target populations of women where the intervention is most likely to be of benefit. As the high burden of stillbirths occurs in low- and middle-income countries, further high-quality trials need to be conducted in these settings as a priority.

Fruit and vegetable consumption before and during pregnancy and birth weight of new-borns in Japan: the Tohoku medical megabank project birth and three-generation cohort study

BACKGROUND

Associations of fruit and vegetable consumption before and during pregnancy with birth weight of new-borns and the risk of low birth weight (LBW) remain unclear.

METHODS

Between July 2013 and March 2017, we recruited 23,406 pregnant women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study). Fruit and vegetable consumption before and during pregnancy was calculated using food frequency questionnaires. Information regarding birth weight was obtained from medical records, and LBW was defined as < 2500 g. We used a multivariable linear regression model and a multivariate logistic regression model to assess associations between fruit and vegetable consumption and birth weight/risk of LBW.

RESULTS

In total, 17,610 women were included in the analysis. Mean birth weight was 3061.8 ± 354.1 g, and 5.4% of the new-borns had LBW. Compared to women in the lowest quartile of fruit consumption between pre- and early pregnancy, women in the highest quartile had heavier new-borns (β = 49.4; 95% CI: 34.1-64.7) and lower risk of LBW (OR: 0.79; 95% CI: 0.65-0.95). Women in the highest quartile of fruit consumption from early to mid-pregnancy also had heavier new-borns (β = 32.3; 95% CI: 17.1-47.6), and they tended to have lower risk of LBW (OR: 0.83; 95% CI: 0.69-1.01). Results of analysing the association between changes in fruit consumption from pre- to mid-pregnancy and birth outcomes revealed that women with continuous high fruit consumption from pre- to mid-pregnancy had heavier new-borns (β = 37.6; 95% CI: 25.0-50.3), but they did not have lower risk of LBW (OR: 0.90; 95% CI: 0.77-1.06). Associations involving vegetable consumption and birth weight/risk of LBW were not observed.

CONCLUSIONS

Fruit consumption before and during pregnancy was positively associated with birth weight of new-borns and negatively associated with risk of LBW.

Access to Information Technologies and Consumption of Fruits and Vegetables in South Africa: Evidence from Nationally Representative Data

Extensive evidence indicates that fruit and vegetable (F+V) consumption leads to reduced chances of diet related non-communicable diseases (NCDs). However, the F+V consumption levels remain low. This paper investigates the extent to which access to information technologies improves F+V consumption in South Africa. A nationally representative sample of 20,908 households was analysed using the Poisson and logit regression models. The study results indicated that most households do not consume sufficient F+V per day. Only 26% of the household heads consumed F+V at least five times a day. Access to mobile phones, radio, television, and internet was associated with increasing frequency of F+V consumption, and higher chances that a household would consume the minimum recommended levels. The association between the communication technologies and F+V consumption varied. Television access had the highest association with both foods, while internet was only significantly associated with vegetable consumption. Several demographic and socio-economic factors played a key role in shaping F+V consumption patterns. The results show that there is scope to disseminate nutrition awareness and education programs, through mobile phones, internet, radio and television in South Africa. The interventions to promote F+V consumption should be tailored according to the different socio-economic profiles of the population.

Dietary total antioxidant capacity during pregnancy and birth outcomes

PURPOSE

To investigate the effect of maternal dietary total antioxidant capacity (DTAC) and main food sources on the risk of preterm birth (PB) and offspring birth size.

METHODS

Cohort study that included 733 Brazilian mother-child pairs. Two 24 h dietary recalls were obtained during pregnancy and the usual intake was estimated through the Multiple Source Method. Data of the offspring were extracted from the national live births information system. Adjusted multivariable logistic regression models were used to investigate the relationship that energy-adjusted DTAC and food sources have with the outcomes.

RESULTS

In total, 9.7% of the children were PBs, 6.0% were born with low birth weight (LBW), 6.7% with macrosomia, 9.3% were small for gestational age (SGA) and 16.4% large for gestational age (LGA). The mean energy-adjusted DTAC ± SD was 4.7 ± 2.1 mmol. The adjusted OR (95%CI) of PB for each increasing tertile of maternal DTAC were 0.71 (0.41, 1.30) and 0.54 (0.29, 0.98), when compared with the lowest intake. For LBW, these were 0.25 (0.09, 0.65) and 0.63 (0.28, 1.41). A likelihood of lower odds for PB was found for a higher intake of fruits [0.66 (0.39, 1.09)]. Women with a higher consumption of milk were less likely to have a child with LBW [0.48 (0.23, 1.01)], and children whose mothers reported a higher intake of beans had lower odds of being born LGA [0.61 (0.39, 0.93)].

CONCLUSION

The data suggest that a higher intake of foods with antioxidant activity during pregnancy might reduce the chance of adverse birth outcomes.

Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort

Background

A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines.

Objective

This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG).

Design

We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy.

Results

Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level.

Discussion

Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes.

Conclusions

This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.

Comparison of Dietary Micronutrient Intakes by Body Weight Status among Mexican-American and Non-Hispanic Black Women Aged 19-39 Years: An Analysis of NHANES 2003-2014

The objective of the current study was to examine micronutrient intake from foods in women of childbearing age and to better understand potential nutritional problems varied by body weight status in minority women. A sample of women aged 19-39 years from the National Health and Nutrition Examination Surveys (NHANES) 2003-2014 was analyzed. Dietary intakes of 13 micronutrients were estimated using the National Cancer Institute method. Mexican-American and non-Hispanic Black women were categorized into normal/under-weight, overweight, or obese groups according to their body mass index (BMI). Mexican-American and non-Hispanic Black women had lower dietary intakes for vitamins A, B2, B6, B12, and D, folate, calcium, and magnesium than non-Hispanic Whites. Among Mexican-Americans, obese women had the lowest dietary intake of vitamins A, B2, C and D. Obese non-Hispanic Black women had significantly lower dietary intakes of iron and zinc than their normal/under-weight counterparts. Comparable percentages (>30%) of Mexican-American and non-Hispanic Black women had dietary intake less than the Estimated Average Requirements (EARs) for several key nutrients including vitamin A, C and D, folate, calcium and magnesium, and the percentages varied by body weight status. These results indicate micronutrient inadequacies persist among and within racial/ethnic and body weight groups.