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The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 74732

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Special Issue Editor

Dr. Megan E. Jensen

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Guest Editor

Asthma Breathing Program, Hunter Medical Research Institute, School of Medicine & Public Health, College of Health Medicine & Wellbeing, University of Newcastle, Newcastle, NSW 2308, Australia
Interests: nutrition; asthma; pediatrics; vitamin D; dietitian; clinical trials; obesity; body composition; pregnancy; breastfeeding; respiratory
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Special Issue Information

Dear Colleagues,

Pregnancy is a critical time in determining maternal health and future offspring health. Diet and lifestyle practices in the preconception and gestational period play an important role in optimising the health of both mother and child and in determining the risk of certain morbidities during pregnancy, including diabetes and hypertension, as well as their management. This Special Issue will collate the most recent research on the guidelines for dietary intake (including individual nutrients, dietary patterns, diet quality and food restrictions/avoidance) and lifestyle recommendations (including sleep, physical activity and environmental exposures) during pregnancy and the role they play in determining maternal and fetal health outcomes during pregnancy. Original research, systematic reviews and meta-analyses are preferred; however, narrative reviews are also welcome. Manuscripts that investigate nutrition/lifestyle factors as exposures during pregnancy and their impact on health during pregnancy are preferred; however, articles which examine the guidelines for, and/or the role of, diet and healthy lifestyles in the preconception period will also be considered, where the outcome is measured during pregnancy. Articles which examine maternal/offspring outcomes in the neonatal period may also be considered where the diet/lifestyle exposure was measured during gestation.

Dr. Megan E. Jensen
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Diet
Nutrients
Energy intake
Gestational weight gain
Physical activity
Sleep
Environmental exposures
Maternal health
Pregnancy
Nutrition policy

Published Papers (13 papers)

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Research

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9 pages, 3055 KiB

Open AccessArticle

Maternal Dietary Carbohydrate Intake and Newborn Aortic Wall Thickness

by Kirsty M. Mckenzie, Reeja Nasir, Yang Kong, Hasthi U. Dissanayake, Rowena McMullan, Adrienne Gordon, Alice Meroni, Melinda Phang and Michael R. Skilton

Nutrients 2021, 13(4), 1382; https://doi.org/10.3390/nu13041382 - 20 Apr 2021

Cited by 1 | Viewed by 2613

Abstract

Evidence from animal models indicates that maternal diet during pregnancy affects offspring cardiometabolic health. Improving carbohydrate quality during high-risk pregnancies reduces aortic intima-medial thickness; a marker for early atherosclerosis; in the infant offspring. We sought to determine whether maternal carbohydrate quantity and quality are associated with newborn aortic intima-medial thickness in healthy pregnancies. Maternal diet throughout pregnancy was evaluated in 139 mother–child dyads using a validated food frequency questionnaire. Carbohydrate intake was expressed as quantity (% total energy), quality (fibre, glycaemic index), and glycaemic burden (glycaemic load). Aortic intima-medial thickness was measured by high-frequency ultrasound of the neonatal abdominal aorta. Neither quantity nor quality of maternal carbohydrate intake during pregnancy was associated with meaningful differences in offspring maximum aortic intima-medial thickness with the exception of fibre intake in women with overweight or obesity which was inversely associated (−8 μm [95% CI −14, −1] per g fibre, p = 0.04). In healthy pregnancy, the quantity and quality of maternal carbohydrate intake is likely not a meaningful modifiable lifestyle factor for influencing offspring vascular health. The effect of carbohydrate quality may only be evident in high-risk pregnancies, consistent with previous findings. These findings may be confirmed in prospective dietary trials in pregnancy. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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10 pages, 1909 KiB

Open AccessArticle

The Impact of Sample Type on Vitamin D Quantification and Clinical Classification during Pregnancy

by Soriah M. Harvey, Vanessa E. Murphy, Peter G. Gibson, Michael Clarke and Megan E. Jensen

Nutrients 2020, 12(12), 3872; https://doi.org/10.3390/nu12123872 - 18 Dec 2020

Cited by 5 | Viewed by 2220

Abstract

Measurement of vitamin D status has significant use in clinical and research settings, including during pregnancy. We aimed to assess the agreement of total 25-hydroxyvitamin D (25(OH)D) concentration, and its three analytes (25-hydroxyvitamin D₃ (25(OH)D₃), 25-hydroxyvitamin D₂ (25(OH)D₂) and Epi-25-hydroxyvitamin D₃ (Epi-25(OH)D₃)), in plasma and serum samples collected during pregnancy, and to examine the proportion of women who change vitamin D status category based on sample type. Matching samples were collected from n = 114 non-fasting women between 12–25 weeks gestation in a clinical trial in Newcastle, Australia. Samples were analysed by liquid chromatography-tandem mass-spectrometry (LC-MS/MS) to quantify total 25(OH)D and its analytes and examined using Bland-Altman plots, Pearson correlation (r), intraclass correlation coefficient and Cohen’s Kappa test. Serum total 25(OH)D ranged from 33.8–169.8 nmol/L and plasma ranged from 28.6–211.2 nmol/L. There was a significant difference for total 25(OH)D based on sample type (measurement bias 7.63 nmol/L for serum vs plasma (95% Confidence Interval (CI) 5.36, 9.90, p ≤ 0.001). The mean difference between serum and plasma concentrations was statistically significant for 25(OH)D₃ (7.38 nmol/L; 95% CI 5.28, 9.48, p ≤ 0.001) and Epi-25(OH)D₃ (0.39 nmol/L; 95% CI 0.14, 0.64, p = 0.014). Of 114 participants, 28% were classified as vitamin D deficient (<50 nmol/L) or insufficient (<75 nmol/L) based on plasma sample and 36% based on serum sample. Nineteen (16.7%) participants changed vitamin D status category based on sample type. 25-hydroxyvitamin D quantification using LC-MS/MS methodology differed significantly between serum and plasma, yielding a higher value in plasma; this influenced vitamin D status based on accepted cut-points, which may have implications in clinical and research settings. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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21 pages, 447 KiB

Open AccessArticle

Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study

by Zoe Szewczyk, Natasha Weaver, Megan Rollo, Simon Deeming, Elizabeth Holliday, Penny Reeves and Clare Collins

Nutrients 2020, 12(11), 3532; https://doi.org/10.3390/nu12113532 - 17 Nov 2020

Cited by 1 | Viewed by 2845

Abstract

The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women’s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m² (range: 14.7 kg/m²–64 kg/m²). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0–39.9 kg/m²) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or “midwifery-in-the-home-visits”. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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12 pages, 475 KiB

Open AccessArticle

Serum 25 Hydroxyvitamin D Levels During Pregnancy in Women with Asthma: Associations with Maternal Characteristics and Adverse Maternal and Neonatal Outcomes

by Megan E. Jensen, Carlos A. Camargo, Jr., Soriah M. Harvey, Peter G. Gibson and Vanessa E. Murphy

Nutrients 2020, 12(10), 2978; https://doi.org/10.3390/nu12102978 - 29 Sep 2020

Cited by 3 | Viewed by 2328

Abstract

Low 25-hydroxyvitamin D (25(OH)D) levels are common in pregnancy and associated with adverse maternal/neonatal outcomes. In pregnant women with asthma, this study examined the association of lifestyle- and asthma-related factors on 25(OH)D levels and maternal/neonatal outcomes by vitamin D status. Serum 25(OH)D was measured at 16 and 35 weeks gestation in women with asthma (n = 103). Body mass index (BMI), gestational weight gain (GWG), smoking status, inhaled corticosteroid (ICS) use, asthma control, airway inflammation, and exacerbations, and maternal/neonatal outcomes were collected. Baseline and change (Δ) in 25(OH)D were modelled separately using backward stepwise regression, adjusted for season and ethnicity. Maternal/neonatal outcomes were compared between low (25(OH)D < 75 nmol/L at both time points) and high (≥75 nmol/L at one or both time points) vitamin D status. Fifty-six percent of women had low vitamin D status. Obesity was significantly associated with lower baseline 25(OH)D (Adj-R² = 0.126, p = 0.008); ICS and airway inflammation were not. Excess GWG and season of baseline sample collection were significantly associated with Δ25(OH)D (Adj-R² = 0.405, p < 0.0001); asthma-related variables were excluded (p > 0.2). Preeclampsia was more common in the low (8.6%) vs. high (0%) vitamin D group (p < 0.05). Obesity and excess GWG may be associated with gestational 25(OH)D levels, highlighting the importance of antenatal weight management. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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16 pages, 1166 KiB

Open AccessArticle

Fatty Acid Reference Intervals in Red Blood Cells among Pregnant Women in Norway–Cross Sectional Data from the ‘Little in Norway’ Cohort

by Pedro Araujo, Marian Kjellevold, Ive Nerhus, Lisbeth Dahl, Inger Aakre, Vibeke Moe, Lars Smith and Maria Wik Markhus

Nutrients 2020, 12(10), 2950; https://doi.org/10.3390/nu12102950 - 25 Sep 2020

Cited by 11 | Viewed by 3995

Abstract

There is a growing interest in determining fatty acid reference intervals from pregnancy cohort, especially considering the lack of reference values for pregnant women in the literature and the generalized misconception of equating reference intervals for nonpregnant women as equivalent to pregnant women. Seafood and supplements are important dietary sources for the omega-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA), such as eicosapentaenoic acid (EPA, 20:5ω-3), docosapentaenoic acid (DPA, 22:55ω-3), and docosahexaenoic acid (DHA, 22:6ω-3). Sufficient intake of EPA and DHA is vital during pregnancy for the development of the fetus, as well as for maintaining adequate levels for the mother. This study describes the fatty acid status and suggests reference values and cut-offs for fatty acids in red blood cells (RBC) from pregnant women (n = 247). An electronic food frequency questionnaire (e-FFQ) mapped the dietary habits of the participants, and gas chromatography was used to determine the fatty acid levels in RBC. The association between e-FFQ variables and fatty acid concentrations was established using a principal component analysis (PCA). Twenty-nine-point-one percent (29.1%) of the participants reported eating seafood as dinner according to the Norwegian recommendations, and they added in their diet as well a high percentage (76.9%) intake of ω-3 supplements. The concentration levels of fatty acids in RBC were in agreement with those reported in similar populations from different countries. The reference interval 2.5/97.5 percentiles for EPA, DPA, DHA were 0.23/2.12, 0.56/2.80, 3.76/10.12 in relative concentration units (%), and 5.99/51.25, 11.08/61.97, 64.25/218.08 in absolute concentration units (µg/g), respectively. The number of participants and their selection from all over Norway vouch for the representativeness of the study and the validity of the proposed reference values, and therefore, the study may be a useful tool when studying associations between fatty acid status and health outcome in future studies. To the best of our knowledge, this is the first PCA study reporting a direct association between ω-3 LCPUFA and intake of seafood and ω-3 supplements in a pregnancy cohort. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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19 pages, 1532 KiB

Open AccessArticle

Omega-6:Omega-3 Fatty Acid Ratio and Total Fat Content of the Maternal Diet Alter Offspring Growth and Fat Deposition in the Rat

by Sally A. V. Draycott, Matthew J. Elmes, Beverly S. Muhlhausler and Simon Langley-Evans

Nutrients 2020, 12(9), 2505; https://doi.org/10.3390/nu12092505 - 19 Aug 2020

Cited by 10 | Viewed by 3135

Abstract

Omega-3 long-chain polyunsaturated fatty acids (LCPUFA) have been shown to inhibit lipogenesis and adipogenesis in adult rats. Their possible early life effects on offspring fat deposition, however, remain to be established. To investigate this, female Wistar rats (n = 6–9 per group) were fed either a 9:1 ratio of linoleic acid (LA) to alpha-linolenic acid (ALA) or a lower 1:1.5 ratio during pregnancy and lactation. Each ratio was fed at two total fat levels (18% vs. 36% fat w/w) and offspring were weaned onto standard laboratory chow. Offspring exposed to a 36% fat diet, irrespective of maternal dietary LA:ALA ratio, were lighter (male, 27 g lighter; female 19 g lighter; p < 0.0001) than those exposed to an 18% fat diet between 3 and 8 weeks of age. Offspring exposed to a low LA (18% fat) diet had higher proportions of circulating omega-3 LCPUFA and increased gonadal fat mass at 4 weeks of age (p < 0.05). Reduced Srebf1 mRNA expression of hepatic (p < 0.01), gonadal fat (p < 0.05) and retroperitoneal fat (p < 0.05) tissue was observed at 4 weeks of age in male and female offspring exposed to a 36% fat diet, and hepatic Srebf1 mRNA was also reduced in male offspring at 8 weeks of age (p < 0.05). Thus, while offspring fat deposition appeared to be sensitive to both maternal dietary LA:ALA ratio and total fat content, offspring growth and lipogenic capacity of tissues appeared to be more sensitive to maternal dietary fat content. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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14 pages, 299 KiB

Open AccessArticle

Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations?

by Kaylee Slater, Megan E. Rollo, Zoe Szewczyk, Lee Ashton, Tracy Schumacher and Clare Collins

Nutrients 2020, 12(8), 2438; https://doi.org/10.3390/nu12082438 - 13 Aug 2020

Cited by 21 | Viewed by 6276

Abstract

The maternal diet influences the long-term health status of both mother and offspring. The current study aimed to compare dietary intakes of pregnant women compared to food and nutrient recommendations in the Australian Guide to Healthy Eating (AGHE) and Nutrient Reference Values (NRVs). Usual dietary intake was assessed in a sample of women in their 3rd trimester of pregnancy attending antenatal outpatient clinics at John Hunter Hospital, Newcastle, New South Wales (NSW). Dietary intake was measured using the Australian Eating Survey, a validated, semi-quantitative 120-item food frequency questionnaire. Daily food group servings and nutrient intakes were compared to AGHE and NRV targets. Of 534 women participating, none met the AGHE recommendations for all food groups. Highest adherence was for fruit serves (38%), and lowest for breads and cereals (0.6%). Only four women met the pregnancy NRVs for folate, iron, calcium, zinc and fibre from food alone. Current dietary intakes of Australian women during pregnancy do not align with national nutrition guidelines. This highlights the importance of routine vitamin and mineral supplementation during pregnancy, as intakes from diet alone may commonly be inadequate. Future revisions of dietary guidelines and pregnancy nutrition recommendations should consider current dietary patterns. Pregnant women currently need more support to optimise food and nutrient intakes. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

16 pages, 1294 KiB

Open AccessArticle

Multiple Micronutrients and Docosahexaenoic Acid Supplementation during Pregnancy: A Randomized Controlled Study

by Maddalena Massari, Chiara Novielli, Chiara Mandò, Stefania Di Francesco, Matteo Della Porta, Roberta Cazzola, Mauro Panteghini, Valeria Savasi, Silvia Maggini, Ella Schaefer and Irene Cetin

Nutrients 2020, 12(8), 2432; https://doi.org/10.3390/nu12082432 - 13 Aug 2020

Cited by 23 | Viewed by 7319

Abstract

Maternal dietary intake during pregnancy needs to meet increased nutritional demands to maintain metabolism and to support fetal development. Docosahexaenoic acid (DHA) is essential for fetal neuro-/visual development and in immunomodulation, accumulating rapidly within the developing brain and central nervous system. Levels available to the fetus are governed by the maternal diet. In this multicenter, parallel, randomized controlled trial, we evaluated once-daily supplementation with multiple micronutrients and DHA (i.e., multiple micronutrient supplementation, MMS) on maternal biomarkers and infant anthropometric parameters during the second and third trimesters of pregnancy compared with no supplementation. Primary efficacy endpoint: change in maternal red blood cell (RBC) DHA (wt% total fatty acids) during the study. Secondary variables: other biomarkers of fatty acid and oxidative status, vitamin D, and infant anthropometric parameters at delivery. Supplementation significantly increased RBC DHA levels, the omega-3 index, and vitamin D levels. Subscapular skinfold thickness was significantly greater with MMS in infants. Safety outcomes were comparable between groups. This first randomized controlled trial of supplementation with multiple micronutrients and DHA in pregnant women indicated that MMS significantly improved maternal DHA and vitamin D status in an industrialized setting—an important finding considering the essential roles of DHA and vitamin D. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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Review

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16 pages, 1449 KiB

Open AccessReview

Epidemiology and (Patho)Physiology of Folic Acid Supplement Use in Obese Women before and during Pregnancy

by Melissa van der Windt, Sam Schoenmakers, Bas van Rijn, Sander Galjaard, Régine Steegers-Theunissen and Lenie van Rossem

Nutrients 2021, 13(2), 331; https://doi.org/10.3390/nu13020331 - 23 Jan 2021

Cited by 23 | Viewed by 7962

Abstract

Preconception folic acid supplement use is a well-known method of primary prevention of neural tube defects (NTDs). Obese women are at a higher risk for having a child with a NTD. As different international recommendations on folic acid supplement use for obese women before and during pregnancy exist, this narrative review provides an overview of epidemiology of folate deficiency in obese (pre)pregnant women, elaborates on potential mechanisms underlying folate deficiency, and discusses considerations for the usage of higher doses of folic acid supplements. Women with obesity more often suffer from an absolute folate deficiency, as they are less compliant to periconceptional folic acid supplement use recommendations. In addition, their dietary folate intake is limited due to an unbalanced diet (relative malnutrition). The association of obesity and NTDs also seems to be independent of folate intake, with studies suggesting an increased need of folate (relative deficiency) due to derangements involved in other pathways. The relative folate deficiency, as a result of an increased metabolic need for folate in obese women, can be due to: (1) low-grade chronic inflammation (2) insulin resistance, (3) inositol, and (4) dysbiotic gut microbiome, which plays a role in folate production and uptake. In all these pathways, the folate-dependent one-carbon metabolism is involved. In conclusion, scientific evidence of the involvement of several folate-related pathways implies to increase the recommended folic acid supplementation in obese women. However, the physiological uptake of synthetic folic acid is limited and side-effects of unmetabolized folic acid in mothers and offspring, in particular variations in epigenetic (re)programming with long-term health effects, cannot be excluded. Therefore, we emphasize on the urgent need for further research and preconception personalized counseling on folate status, lifestyle, and medical conditions. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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19 pages, 1433 KiB

Open AccessReview

Maternal Arsenic Exposure and Gestational Diabetes: A Systematic Review and Meta-Analysis

by Noemi Salmeri, Roberta Villanacci, Jessica Ottolina, Ludovica Bartiromo, Paolo Cavoretto, Carolina Dolci, Rosalba Lembo, Matteo Schimberni, Luca Valsecchi, Paola Viganò and Massimo Candiani

Nutrients 2020, 12(10), 3094; https://doi.org/10.3390/nu12103094 - 11 Oct 2020

Cited by 29 | Viewed by 3228

Abstract

Gestational diabetes mellitus (GDM) is a metabolic complication associated with adverse outcomes for mother and fetus. Arsenic (As) exposure has been suggested as a possible risk factor for its development. The aim of this meta-analysis was to provide a comprehensive overview of published evidence on the association between As and GDM. The systematic search from PubMed, MEDLINE, and Scopus was limited to full-length manuscripts published in peer-reviewed journals up to April 2020, identifying fifty articles. Ten studies met the inclusion criteria, nine for quantitative synthesis with a total of n = 1984 GDM cases. The overall pooled risk was 1.56 (95% Confidence Interval - CI = 1.23, 1.99) with moderate heterogeneity (χ² = 21.95; I²% = 64). Several differences among the included studies that may account for heterogeneity were investigated. Stratification for exposure indicator confirmed a positive association for studies assessing urine As. A slightly higher risk was detected pooling studies based in Asia rather than in North America. Stratification for GDM diagnostic criteria showed higher risks when diagnosis was made according to the Canadian Diabetes Association (CDA-SOGC) or World Health Organization (WHO) criteria, whereas a lower risk was observed when adopting the American Diabetes Association (ADA) criteria. These results provide additional evidence for a possible association between As exposure and GDM, although the data need to be interpreted with caution due to heterogeneity. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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23 pages, 663 KiB

Open AccessReview

Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus

by Louise Rasmussen, Charlotte Wolff Poulsen, Ulla Kampmann, Stine Bech Smedegaard, Per Glud Ovesen and Jens Fuglsang

Nutrients 2020, 12(10), 3050; https://doi.org/10.3390/nu12103050 - 6 Oct 2020

Cited by 91 | Viewed by 25080

Abstract

Gestational diabetes mellitus (GDM) among pregnant women increases the risk of both short-term and long-term complications, such as birth complications, babies large for gestational age (LGA), and type 2 diabetes in both mother and offspring. Lifestyle changes are essential in the management of GDM. In this review, we seek to provide an overview of the lifestyle changes which can be recommended in the management of GDM. The diet recommended for women with GDM should contain sufficient macronutrients and micronutrients to support the growth of the foetus and, at the same time, limit postprandial glucose excursions and encourage appropriate maternal gestational weight gain. Blood glucose excursions and hyperglycaemic episodes depend on carbohydrate-intake. Therefore, nutritional counselling should focus on the type, amount, and distribution of carbohydrates in the diet. Further, physical activity has beneficial effects on glucose and insulin levels and it can contribute to a better glycaemic control. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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19 pages, 1383 KiB

Open AccessReview

The Impact of Maternal Body Composition and Dietary Fat Consumption upon Placental Lipid Processing and Offspring Metabolic Health

by Zachary J. W. Easton and Timothy R. H. Regnault

Nutrients 2020, 12(10), 3031; https://doi.org/10.3390/nu12103031 - 3 Oct 2020

Cited by 11 | Viewed by 3392

Abstract

The proportion of women of reproductive age who are overweight or obese is increasing globally. Gestational obesity is strongly associated in both human studies and animal models with early-onset development of adult-associated metabolic diseases including metabolic syndrome in the exposed offspring. However, animal model studies have suggested that gestational diet in obese pregnancies is an independent but underappreciated mediator of offspring risk for later life metabolic disease, and human diet consumption data have highlighted that many women do not follow nutritional guidelines prior to and during pregnancy. Thus, this review will highlight how maternal diet independent from maternal body composition impacts the risk for later-life metabolic disease in obesity-exposed offspring. A poor maternal diet, in combination with the obese metabolic state, are understood to facilitate pathological in utero programming, specifically through changes in lipid handling processes in the villous trophoblast layer of the placenta that promote an environment associated with the development of metabolic disease in the offspring. This review will additionally highlight how maternal obesity modulates villous trophoblast lipid processing functions including fatty acid transport, esterification and beta-oxidation. Further, this review will discuss how altering maternal gestational diet may ameliorate these functional changes in lipid metabolic processes in the obese placenta. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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Other

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8 pages, 836 KiB

Open AccessBrief Report

Fetal Head Growth during Early to Mid-Gestation Associated with Weight Gain in Mothers with Hyperemesis Gravidarum: A Retrospective Cohort Study

by Mitsue Muraoka, Koichiro Takagi, Mariko Ueno, Yoshihiro Morita and Hiroaki Nagano

Nutrients 2020, 12(6), 1664; https://doi.org/10.3390/nu12061664 - 3 Jun 2020

Cited by 3 | Viewed by 3034

Abstract

The epigenetic impact of malnutrition in mothers with hyperemesis gravidarum (HG) on their offspring has not been fully elucidated. Recently, several reports have demonstrated that children born to mothers with HG were small for gestational age and had low birth weight, reduced insulin sensitivity, and neurodevelopmental delays during childhood. Therefore, we examined the relationship between fetal growth and changes in the maternal body weight in HG cases. A total of 34 patients with HG were hospitalized and delivered at term between 2009 and 2012. The records of 69 cases of pregnant women without a history of HG were extracted after matching their maternal age, parity, pregestational body mass index (BMI), gestational age, and fetal sex ratio with those of the HG group for comparison. The maternal weight gain at term was less in the HG than in the control group. There was no statistical difference in birth weight, placental weight, and ultrasonic fetometric parameters expressed in standard deviation (SD) scores, including biparietal diameter, abdominal circumference, and femur length, between the HG and the control group. Whereas fetal head growth in the HG group was positively associated with maternal weight gain at 20 weeks of gestation only, this association was not observed in the control group. We herein demonstrate that maternal weight gain from the nadir is associated with fetal head growth at mid-gestation. Thus, maternal undernutrition in the first trimester of pregnancy could affect fetal brain growth and development, leading to an increased risk of neurodevelopmental delays in later life. Full article

(This article belongs to the Special Issue The Guidelines for Balanced Diet and Healthy Lifestyles during Pregnancy: The Management of Health and Morbidity in Pregnancy)

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