Docosahexaenoic Acid Supplementation during Pregnancy: A Potential Tool to Prevent Membrane Rupture and Preterm Labor

Polyunsaturated fatty acids (PUFAs) are required to maintain the fluidity, permeability and integrity of cell membranes. Maternal dietary supplementation with ω-3 PUFAs during pregnancy has beneficial effects, including increased gestational length and reduced risk of pregnancy complications. Significant amounts of ω-3 docosahexaenoic acid (DHA) are transferred from maternal to fetal blood, hence ensuring high levels of DHA in the placenta and fetal bloodstream and tissues. Fetal DHA demand increases exponentially with gestational age, especially in the third trimester, due to fetal development. According to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), a daily intake of DHA is recommended during pregnancy. Omega-3 PUFAs are involved in several anti-inflammatory, pro-resolving and anti-oxidative pathways. Several placental disorders, such as intrauterine growth restriction, premature rupture of membranes (PROM) and preterm-PROM (pPROM), are associated with placental inflammation and oxidative stress. This pilot study reports on a preliminary evaluation of the significance of the daily DHA administration on PROM and pPROM events in healthy pregnant women. Further extensive clinical trials will be necessary to fully elucidate the correlation between DHA administration during pregnancy and PROM/pPROM occurrence, which is related in turn to gestational duration and overall fetal health.     

Dietary evaluation of pregnant adolescents during first, second and third trimester

In order to identify risk of inadequate intake of calories and nutrients during pregnancy, 75 pregnant adolescents (14 to 18 years old) apparently healthy, from low socioeconomic level, in their first prenatal control (12 weeks) were studied by two 24 hour recalls and a food frequency questionnaire at each trimester. Nutritional status was assessed by body mass index (pregestation weight/height) and classified according to American Medicine Institute reference. Paired t-test, frequency distribution and ANOVA were used for statistical analysis. Low weight was found in 34.6% of adolescent at the first visit and 5.3% were overweight. Even though, caloric intake was below recommendation, significant increases were observed between first and second trimester for energy, carbohydrates, niacin and zinc (p < 0.001) and for fat, proteins, riboflavin, thiamin, vitamin C, calcium and iron (p < 0.05). From second to third trimester, differences (p < 0.05) were significant only for vitamin A. Between first and third trimester, differences were significant (p < 0.05) for energy, proteins, carbohydrates, niacin, riboflavin, zinc and for thiamin, vitamin A and calcium (p < 0.05). A high proportion of pregnant adolescent did not reach recommendations for energy, folate, calcium and zinc. Food intake pattern did not change significantly among trimesters. Mean total weight gain was 9.2 kg and 0.412 +/- 0.4 g/week. Newborn's mean weight was 3.221 +/- 418 grams. It is concluded that adolescents are at high nutritional risk and deficiency of dietary intake should be followed. Attention should be addressed from the preconceptional period to postpartum in order to improve maternal and fetal conditions.     

High-DHA eggs: Feasibility as a means to enhance circulating DHA in mother and infant

Dietary DHA enhances infant attention and visual development. Because the DHA content of red blood cells and plasma lipids varies approximately threefold in pregnancy, maternal DHA status may influence subsequent infant function. It would be feasible to study the effects of higher maternal DHA intake on infant development if dietary intake of DHA could be increased by a reliable means. This study was designed to determine whether women provided with one dozen high-DHA hen eggs (135 mg DHA/egg) would consume the eggs and have higher blood DHA levels than women consuming ordinary eggs (18 mg DHA/egg). The study was a randomized, double-masked comparison of the effect of eggs with different concentrations of DHA on intake and blood lipid DHA content of women and their infants. A third nonrandomized group ate few eggs. In this study, DHA intake reported from eggs was eightfold higher in the high-DHA egg group compared to the ordinary egg group. Including all groups, DHA intake ranged from 0 to 284 mg/d. In this intake range, maternal blood lipid DHA content at enrollment best predicted DHA content at delivery, accounting for 36.5 and 51.7% of the variance in ordinary and high-DHA egg intake groups, respectively. The high-DHA vs. ordinary egg groups had similar maternal and cord blood lipid DHA, but there was a positive relationship between maternal plasma phospholipid DHA and daily DHA intake from eggs controlled for study duration (r=0.278, P=0.048). DHA intake and birth weight were also correlated (r=0.299, P=0.041). High-DHA eggs were well accepted and increased DHA intake. Other benefits of DHA intake during pregnancy were also suggested.     

Association between prematurity and maternal anemia in Venezuelan pregnant women during third trimester at labor

To determine the association and its magnitude between prematurity and anemia in women in their third trimester of pregnancy and at labor. An incident case-control study was conducted using 2 controls per case. Data was obtained in a tertiary hospital in Valencia, Venezuela. A total of 543 women who delivered between May and December 1996 entered into the study. Women having a preterm delivery, less than 37 weeks of gestation at delivery, were defined as cases (n = 181). Anemia was defined according to WHO as Hb less than 11 g/dL. Logistic regression was used to analyze the data and likelihood ratio test was done for model comparison. Maternal anemia was found to be significantly associated with prematurity (Odds Ratio: 1.70; 95% CI = 1.18 to 2.57 P = .001), after adjusting for Placental Abruption, PROM, Previous Premature Labor, Prenatal Care Visits, and Uterine Bleeding during more than one trimester. Maternal anemia at the end of the third trimester of pregnancy, at labor, was associated with an increased risk of prematurity.     

Maternal Low-Grade Chronic Inflammation and Intrauterine Programming of Health and Disease

Overweight and obesity during pregnancy have been associated with increased birth weight, childhood obesity, and noncommunicable diseases in the offspring, leading to a vicious transgenerational perpetuating of metabolic derangements. Key components in intrauterine developmental programming still remain to be identified. Obesity involves chronic low-grade systemic inflammation that, in addition to physiological adaptations to pregnancy, may potentially expand to the placental interface and lead to intrauterine derangements with a threshold effect. Animal models, where maternal inflammation is mimicked by single injections with lipopolysaccharide (LPS) resembling the obesity-induced immune profile, showed increased adiposity and impaired metabolic homeostasis in the offspring, similar to the phenotype observed after exposure to maternal obesity. Cytokine levels might be specifically important for the metabolic imprinting, as cytokines are transferable from maternal to fetal circulation and have the capability to modulate placental nutrient transfer. Maternal inflammation may induce metabolic reprogramming at several levels, starting from the periconceptional period with effects on the oocyte going through early stages of embryonic and placental development. Given the potential to reduce inflammation through inexpensive, widely available therapies, examinations of the impact of chronic inflammation on reproductive and pregnancy outcomes, as well as preventive interventions, are now needed.     

Serum levels and urinary excretion of magnesium in pregnancy. Effect of milk intake

Magnesium levels in serum, as well as 24-hr urine and 2-hr post-fasting urine levels, were studied in 107 pregnant women, who were later separated into two groups. One group was advised to follow their usual intake, and the other, to supplement the diet with 750 cc of milk. The control group (30 healthy non-pregnant women) underwent the same protocol. Magnesium intake in pregnant women was much lower than that recommended for gestation. In both groups of pregnant women, serum magnesium levels were lower than those of the controls, in the second and third trimester of pregnancy. Urinary magnesium in 24-hr urine was higher in each trimester of pregnancy than the controls. Hypomagnesemia and hypermagnesuria not influenced by milk intake was observed.     

Liver Fatty Acid Binding Protein Gene-Ablation Exacerbates Weight Gain in High-Fat Fed Female Mice

Loss of liver fatty acid binding protein (L‐FABP) decreases long chain fatty acid uptake and oxidation in primary hepatocytes and in vivo. On this basis, L‐FABP gene ablation would potentiate high‐fat diet‐induced weight gain and weight gain/energy intake. While this was indeed the case when L‐FABP null (?/?) mice on the C57BL/6NCr background were pair‐fed a high‐fat diet, whether this would also be observed under high‐fat diet fed ad libitum was not known. Therefore, this possibility was examined in female L‐FABP (?/?) mice on the same background. L‐FABP (?/?) mice consumed equal amounts of defined high‐fat or isocaloric control diets fed ad libitum. However, on the ad libitum‐fed high‐fat diet the L‐FABP (?/?) mice exhibited: (1) decreased hepatic long chain fatty acid (LCFA) β‐oxidation as indicated by lower serum β‐hydroxybutyrate level; (2) decreased hepatic protein levels of key enzymes mitochondrial (rate limiting carnitine palmitoyl acyltransferase A1, CPT1A; HMG‐CoA synthase) and peroxisomal (acyl CoA oxidase 1, ACOX1) LCFA β‐oxidation; (3) increased fat tissue mass (FTM) and FTM/energy intake to the greatest extent; and (4) exacerbated body weight gain, weight gain/energy intake, liver weight, and liver weight/body weight to the greatest extent. Taken together, these findings showed that L‐FABP gene‐ablation exacerbated diet‐induced weight gain and fat tissue mass gain in mice fed high‐fat diet ad libitum—consistent with the known biochemistry and cell biology of L‐FABP.     

Study of the Ghrelin/LEAP-2 Ratio in Humans and Rats during Different Phases of Pregnancy

The Liver-Expressed Antimicrobial Peptide 2 (LEAP-2) has emerged as an endogenous GHS-R antagonist and blunts the orexigenic action of ghrelin. This study aimed to determine the Ghrelin/LEAP-2 ratio in humans and rats during pregnancy. In humans, we conducted a nested case-control study within an observational prospective cohort. Healthy and mild preeclamptic pregnant women were studied at each trimester of gestation and three months postpartum. In addition, a group of non-pregnant women was studied into the follicular and luteal phases of the menstrual cycle. Furthermore, Ghrelin/LEAP-2 ratio was investigated in non-pregnant rats and at different periods of rat pregnancy. Human and rat serum ghrelin and LEAP-2 levels were determined using the commercially available ELISA kits. The Ghrelin/LEAP-2 ratio peak around the second trimester of gestation in healthy pregnant women (p < 0.05). Additionally, there were no statistically significant differences in Ghrelin/LEAP-2 ratio between healthy and preeclamptic pregnant women at each trimester of gestation (p > 0.05). The Ghrelin/LEAP-2 ratio in pregnant rat reached the peak around mid-gestation with a similar pattern to the human pregnancy. LEAP-2 was visualized by immunohistochemistry in human term placenta and rat placentas on days 12, 16 and 21 of pregnancy. In conclusion, this study provides the first evidence of a Ghrelin/LEAP-2 ratio peak around the half-way point of pregnancy onwards during human and rat pregnancy, and it might be associated with increased rates of weight gain during pregnancy. Thus, this study suggests that LEAP-2 and Ghrelin/LEAP-2 ratio might play an important role in maternal physiology adaptation of weight gain during pregnancy.     

Urban-rural differences in food intake of poor families in Guatemala]

The present paper deals with the urban-rural differences in food consumption patterns and nutrient intake of poor families in Guatemala, based on consumption data collected in 1987 using the 24-hour dietary recall method. The main results show mean intake energy and protein levels below the mean recommended allowances in both groups of families included in the study. Higher levels of protein and calorie intakes, however, are also reported for families in the urban areas. In spite of the fact that caloric and protein intake levels are lower in the urban sector, the food consumption pattern is more diversified and of better quality than the habitual diet of the rural families. This explains why a higher average level of calcium and vitamin A (retinol equivalents) is observed, in comparison with the rural families.     

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

Background

Based on data obtained from pregnant women who participated in the Mothers and Children’s Environmental Health (MOCEH) study in South Korea, we aimed to determine whether maternal intake of fruits and vegetables or vitamin C is associated with fetal and infant growth.

Methods

A total of 1138 Korean pregnant women at 12–28 weeks gestation with their infants were recruited as study participants for the MOCEH. Intake of fruits and vegetables or vitamin C during pregnancy was assessed by a 1-day 24-h recall method. Fetal biometry was determined by ultrasonography at late pregnancy. Infant weight and length were measured at birth and 6 months.

Results

A multiple regression analysis after adjusting for covariates showed that maternal intake of fruits and vegetables was positively associated with the biparietal diameter of the fetus and infant’s weight from birth to 6 months. Also, maternal vitamin C intake was positively associated with the abdominal circumference of the fetus and infant birth length. In addition, there was a significant inverse relationship between consumption of fruits and vegetables (below the median compared to above the median of ≥519 g/d) and the risk of low growth (<25th percentile) of biparietal diameter (odds ratio (OR): 2.220; 95% confidence interval (CI): 1.153–4.274) and birth weight (OR: 1.434; 95% CI: 1.001–2.056). A significant inverse relationship also existed between vitamin C consumption (below vs above the estimated average requirement (EAR) of ≥85 mg/d) and the risk of low growth (<25th percentile) of birth weight (OR: 1.470; 95% CI: 1.011–2.139), weight from birth to 6 months (OR: 1.520; 95% CI: 1.066–2.165), and length at birth (OR: 1.579; 95% CI: 1.104–2.258).

Conclusions

An increased intake of fruits and vegetables or vitamin C at mid-pregnancy is associated with increased fetal growth and infant growth up to 6 months of age.

     

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 μg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group.     

Dietary fat and body weight control

The global obesity epidemic has heightened the debate about dietary factors contributing to weight gain. Media stories have promulgated the notion that obesity has increased despite reductions in dietary fat intake. Some have even speculated that lower dietary fat levels may be driving the rapid rise in weight gain within the population. A close examination of the science reveals a different picture and supports the hypothesis that dietary fat, within the context of the total dietary composition consumed by many populations, promotes obesity. Hence, dietary fat control is still an important strategy as part of an overall approach to body weight management in our modern environment. Dietary fat increases the energy density of foods. Abundant evidence from preclinical and clinical studies indicates that fat promotes excess energy intake and positive energy balance. Dietary fat does not promote its own oxidation in the body and is stored efficiently, promoting a positive fat balance. Thus, both the behavioral and metabolic responses to dietary fat increase the probability of positive energy balance and body fat gain. Restoring fat balance when consuming diets rich in fat requires increasing the size of the body fat mass, increasing physical activity, or reducing dietary fat intake. Numerous epidemiologic, preclinical, and controlled clinical studies have shown that body fat is positively associated with dietary fat intake and that dietary fat manipulation leads to appropriate changes in body fat mass. Finally, data from the National Weight Control Registry, a database of >3000 individuals who have successfully maintained a substantial weight loss, indicate that moderating dietary fat intake is a key strategy for long-term management of body weight.     

Food habits and the apparent nature and extent of dietary nutritional deficiencies in the Peruvian Andes

Food patterns, and energy and nutrient intake of a sample of rural and urban families in the Peruvian Andes are analyzed and compared with requirements and recommended figures of nutrient allowances. It is concluded that, with the exception of vitamin A, there is very little nutrient deficiency where calorie requirements are met. About half the population in the region suffers from some degree of calorie deficiency in the sense that the total quantity of food available to the family is insufficient to satisfy energy needs of all family members. The incidence of calorie deficiency is about equally distributed between rural and urban areas and there is strong evidence that calorie intake is positively correlated with the proportion of home-produced to total (home-produced and purchased) food.     

Elevated IL-6 and IL-22 in Early Pregnancy Are Associated with Worse Disease Course in Women with Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD), including Ulcerative Colitis (UC) and Crohn’s disease (CD), are inflammatory conditions of the intestinal tract that affect women in their reproductive years. Pregnancy affects Th1- and Th2-cytokines, but how these changes occur during pregnancy in IBD is unclear. We performed a longitudinal profiling of serum cytokines in a cohort of 11 healthy pregnant women and 76 pregnant women with IBD from the first trimester of pregnancy to the first 12 months post-partum. Participants were monitored for biochemical disease activity (C-reactive protein [CRP] and fecal calprotectin [FCP]) and clinical activities. Maternal cytokines were measured using ELISA. We identified changes in Th1 and Th17 cytokines throughout pregnancy in healthy pregnant women. During pregnancy, maternal serum cytokine expressions were influenced by IBD, disease activity, and medications. Active UC was associated with an elevation in IL-21, whereas active CD was associated with elevated IFN-γ, IL-6, and IL-21. Interestingly, T1 serum cytokine levels of IL-22 (>0.624 pg/mL) and IL-6 (>0.648 pg/mL) were associated with worse IBD disease activity throughout pregnancy in women with UC and CD, respectively. This shows serum cytokines in pregnancy differ by IBD, disease activity, and medications. We show for the first time that T1 IL-22 and IL-6 correlate with IBD disease course throughout pregnancy.     

Maternal Methyl Donors Supplementation during Lactation Prevents the Hyperhomocysteinemia Induced by a High-Fat-Sucrose Intake by Dams

Maternal perinatal nutrition may program offspring metabolic features. Epigenetic regulation is one of the candidate mechanisms that may be affected by maternal dietary methyl donors intake as potential controllers of plasma homocysteine levels. Thirty-two Wistar pregnant rats were randomly assigned into four dietary groups during lactation: control, control supplemented with methyl donors, high-fat-sucrose and high-fat-sucrose supplemented with methyl donors. Physiological outcomes in the offspring were measured, including hepatic mRNA expression and global DNA methylation after weaning. The newborns whose mothers were fed the obesogenic diet were heavier longer and with a higher adiposity and intrahepatic fat content. Interestingly, increased levels of plasma homocysteine induced by the maternal high-fat-sucrose dietary intake were prevented in both sexes by maternal methyl donors supplementation. Total hepatic DNA methylation decreased in females due to maternal methyl donors administration, while Dnmt3a hepatic mRNA levels decreased accompanying the high-fat-sucrose consumption. Furthermore, a negative association between Dnmt3a liver mRNA levels and plasma homocysteine concentrations was found. Maternal high-fat-sucrose diet during lactation could program offspring obesity features, while methyl donors supplementation prevented the onset of high hyperhomocysteinemia. Maternal dietary intake also affected hepatic DNA methylation metabolism, which could be linked with the regulation of the methionine-homocysteine cycle.     

Relationship between maternal anthropometry and weight gain with birth weight, and risks of low birth weight, small for gestational age and prematurity at an urban population of Buenos Aires, Argentina

To asses the relationship between body mass index and net weight gain during pregnancy with birth weight and the risks of low birth weight, small for date and prematurity 9613 records from Sardá's Perinatal Database between 1994-1995 were reviewed. Exclusion criteria were fetal death, twin pregnancy, congenital malformations, lack of prenatal visits and lack of preconceptional weight and height. 9.6% of mothers and 15% of adolescents presented with low preconceptional BMI (median: 24.8 +/- 4.3 kg/m2); in contrast, 28% were overweight and obese. Net weight gain (median 9.25 +/- 4.9 kg) accounted for 16% of previous weight and was higher with lower BMI (p = 0.001). Birth weight (median 3375 +/- 467 g) decreased with lower BMI (p = 0.001) and the risks of low birth weight (p < 0.05), small for date (p < 0.05), and prematurity (p = 0.05) was independently associated with BMI, and increased (p < 0.001) when lower the net weight gain was. The best predictors for low birth weight, small for date and prematurity risks were low preconceptional weight (40-51 kg) (adjusted OR 1.72; [95%CI 1.48-1.95], 2.12 [1.82-2.41] and 1.46 [1.12-1.79] respectively). Net weight gain and several predictive variables did not explain more than 10.8% of the variability of birth weight. Preconceptional weight should have important implications for the design of future nutritional strategies at a poblational level, especially for adolescents.