The relationship between gestational weight gain and body composition of the fetus

Introdução: O aumento da adiposidade no ambiente intrauterino e alterações na composição corporal neonatal podem estar relacionados com obesidade e doenças crônicas no futuro. O ganho de peso gestacional (GPG) está associado à obesidade infantil, porém, estudos que avaliaram a relação entre o GPG materno e a composição corporal do concepto revelaram resultados inconsistentes, especialmente no que se refere à adiposidade fetal. Objetivo: Avaliar a relação entre o GPG materno e a adiposidade do feto e composição corporal neonatal. Métodos: Estudo epidemiológico prospectivo do tipo coorte, realizado em Araraquara e região, envolvendo gestantes atendidas em 34 Unidades de Saúde do SUS e na Maternidade Municipal \"Gota de Leite\". As gestantes foram acompanhadas em três períodos gestacionais (&le;19, 20-29 e 30-39 semanas), durante o parto, e posteriormente até 72 horas após o parto. Foram avaliadas 1005 gestantes no 1º período gestacional, 1002 pares de gestantes e fetos no 2º período, 991 pares de gestantes e fetos no 3º período e 412 pares de mães e respectivos neonatos. A taxa de ganho de peso (TGP) foi calculada a partir da diferença entre o peso aferido no período gestacional específico menos o peso avaliado no período gestacional anterior, dividido pelo número de semanas correspondente a esse intervalo. O GPG total foi obtido pela diferença entre o peso aferido na data do parto e o peso pré-gestacional e classificado em insuficiente, adequado e excessivo, de acordo com a última diretriz do Institute of Medicine (IOM). A adiposidade fetal e a composição corporal do neonato foram avaliadas, respectivamente, por ultrassonografia e pletismografia por deslocamento de ar. Modelos de regressão linear múltipla foram construídos de acordo com um conjunto de ajustes mínimos suficientes sugeridos por gráficos acíclicos direcionados, considerando os seguintes fatores de confusão: idade, cor da pele/etnia, escolaridade, renda per capita, tabagismo, ingestão de alcool, paridade, diabetes mellitus, hipertensão arterial, altura, IMC pré-gestacional, sexo, idade gestacional ao nascer, horas de vida do neonato. O nível de significância em todos os testes foi &alpha; = 5%. Resultados: Durante o 2º período gestacional, verificou-se que para cada 0,1 kg/semana da TGP, houve um aumento de 0,222 mm (p=0,012), 0,462 cm2 (p <0,001), e 0,310 cm2 (p <0,001) no tecido adiposo subcutâneo do abdômen, coxa e braço do feto, respectivamente. Também houve associação entre a TGP materna no 3º período gestacional e deposição de gordura subcutânea no braço (&beta;=0,484 cm2; p=0,001) e na coxa (&beta;=0,480 cm2; p=0,049) do feto. Quanto à composição corporal neonatal, observou-se que para cada 1 kg do GPG total houve aumento de 0,004 Kg (p=0,002) na massa gorda, 0,084% (p=0,025) no percentual de massa gorda e 0,009 Kg (p <0,001) na massa livre de gordura do neonato. Crianças de mulheres com GPG total insuficiente apresentaram massa livre de gordura 0,104 kg (p=0,009) menor que os neonatos de mães com GPG total adequado. Conclusão: De acordo com nosso conhecimento, este é o primeiro estudo na literatura internacional que investigou a associação entre ganho de peso materno e adiposidade fetal e composição corporal neonatal. Os resultados mostram um impacto diferente da TGP materno sobre o acúmulo de gordura fetal, de acordo com o período gestacional investigado. Também houve associação positiva entre GPG total e massa gorda, percentual de massa gorda e massa livre de gordura do neonato. Mães com GPG total insuficiente tiveram neonatos com menor massa livre de gordura.Introduction: The increase in adiposity in the intrauterine environment and changes in neonatal body composition may be related to obesity and chronic diseases in the future. Gestational weight gain (GWG) is associated with childhood obesity, however, studies that evaluated the relationship between the maternal GWG and the body composition of the fetus revealed inconsistent results, especially with regard to fetal adiposity. Objective: To evaluate the relationship between maternal GWG and adiposity of the fetus and body composition of the newborn. Methods: This is an epidemiological prospective cohort study, carried out in Araraquara and region, involving pregnant women attended at 34 Health Units from the Brazilian National Health Service - SUS and at the Municipal Maternity \"Gota de Leite\". The pregnant women were followed up in the respective gestational periods: &le; 19, 20-29 and 30-39 weeks, during delivery, and later up to 72 hours after delivery. One thousand and five (1005) pregnant women were evaluated in the 1st period of pregnancy, 1002 pairs of pregnant women and fetuses in the 2nd period, 991 pairs of pregnant women and fetuses in the 3rd period, and 412 pairs of mothers and newborns. The rate of weight gain (RWG) was calculated based on the difference between the weight measured in the gestational period minus the weight assessed in the previous gestational period, divided by the number of weeks corresponding to that interval. GWG was obtained by the difference between the weight measured at the date of delivery and the pre-gestational weight, and classified as insufficient, adequate, and excessive, according to the last guidelines of the Institute of Medicine (IOM). The fetal adiposity and body composition of the newborn were evaluated, respectively, by ultrasound and plethysmography by air displacement. Multiple linear regression models were constructed considering a set of sufficient minimum adjustments suggested by directed acyclic graphs, considering the following confounders: age, skin color/ethnicity, schooling, per capita income, smoking, alcohol intake, parity, diabetes mellitus, arterial hypertension, height, pre-gestational BMI, sex, gestational age at birth, hours of life of the newborn. The level of significance in all tests was &alpha; = 5%. Results: During the 2nd gestational period, it was found that for each 0.1 kg/week of RWG, there was an increase of 0.222 mm (p = 0.012), 0.462 cm2 (p<0.001), and 0.310 cm2 (p<0.001) in subcutaneous adipose tissue in the abdomen, thight and arm of the fetus, respectively. There was also an association between the RWG in the 3rd gestational period and deposition of subcutaneous fat in the arm (&beta;=0.484 cm2; p=0.001) and thigh (&beta;=0.480 cm2; p=0.049) of the fetus. Concerning the newborn\'s body composition, it was observed that for each 1 kg of total GWG there was an increase of 0.004 Kg (p=0.002) in the fat mass, 0,084% (p=0.025) in the percentage of fat mass, and 0.009 Kg (p<0.001) in the fat-free mass of the newborn. Considering the guidelines of the IOM, neonates of mothers who had an insufficient total GWG had a fat-free mass of 0.104 kg (p=0.009) less than those born to women with adequate total GWG. Conclusion: As far as we know, this is the first study in the international literature that investigated the association between maternal weight gain in three different periods of gestation and fetal adiposity and newborn adiposity. The results show a different impact of the maternal RWG on the accumulation of fetal fat, according to the gestational period investigated. There was also a positive association between total GWG and mass fat, percentage of fat mass, and fat-free mass of the fetus, regardless of pre-gestational BMI. Women with insufficient total GWG had neonates with lower fat-free mass

Consumo alimentar de vitamina a por gestantes no Brasil: uma revisão sistemática

Objective: To conduct a systematic review of the Vitamin “A” food consumption by pregnant women in Brazil. Methods: The review consisted of a search for articles published in the period from 1999 to 2015 in SciELO, PubMed, and LILACS databases. At the end, eight articles were selected for this review. Results: The methods used for the analysis of the intake of vitamin “A” were: food frequency questionnaire (FFQ) – considering the diet or only vitamin “A” foods and the dietary recall (24hDR). Only two articles estimated the adequacy of the Vitamin “A” food consumption by the population assessed. Some methodological limitations were quite frequent, emphasizing the lack and/or limitation of information on the sample representativeness, loss of studies, accuracy of the methods applied and the control of confounding variables. Conclusion: It is observed that there are still few studies that critically assess the Vitamin “A” food consumption by pregnant women in Brazil, and that the identification and control of possible biases of the dietary surveys can improve the reliability of the information found.Objetivo: Realizar una revisión sistemática sobre el consumo alimentario de vitamina A en embarazadas de Brasil. Métodos: La revisión se dio por la búsqueda de artículos publicados en El periodo entre 1999 y 2015 en las bases de datos SciELO, PubMed y LILACS. Por fin fueron seleccionados ocho artículos para esta revisión. Resultados: Los métodos utilizados para el análisis Del consumo de la vitamina A fueron el cuestionario de la frecuencia alimentaria (QFA) – de la dieta o solamente de alimentos fuentes de vitamina A – y el recordatorio de 24h (R24h). Solamente dos artículos calcularon la adecuación para ingestión de vitamina A para la población evaluada. Algunas limitaciones metodológicas fueron muy frecuentes, destacándose la ausencia y/o limitación de informaciones sobre la representatividad de la muestra, las pérdidas del estudio, la eficacia de los métodos aplicados y El control de las variables de confusión. Conclusión: Todavía se observan pocos estudios que evalúan con criterios el consumo de la vitamina A en las embarazadas de Brasil y que la identificación y el control de los posibles sesgos de la averiguación dietética puede que mejore la fidedignidad de los datos encontrados.Objetivo: Realizar uma revisão sistemática sobre o consumo alimentar de vitamina A por gestantes no Brasil. Métodos: A revisão constituiu na busca de artigos publicados no período de 1999 a 2015 nas bases SciELO, PubMed e LILACS. Ao final, foram selecionados oito artigos para esta revisão. Resultados: Os métodos utilizados para análise do consumo de vitamina A foram o questionário de frequência alimentar (QFA) – da dieta ou apenas de alimentos fontes de vitamina A – e o recordatório alimentar (R24h). Apenas dois artigos calcularam a adequação da ingestão de vitamina A para a população avaliada. Algumas limitações metodológicas foram bastante frequentes, destacando-se a ausência e/ou limitação de informações sobre representatividade da amostra, perdas do estudo, acurácia dos métodos aplicados e controle das variáveis de confusão. Conclusão: Observa-se que ainda são escassos os estudos que avaliam de forma criteriosa o consumo de vitamina A por gestantes no Brasil, e que a identificação e controle dos possíveis vieses do inquérito dietético poderão melhorar a fidedignidade dos dados encontrados

Maternal plasma transforming growth factor-β1 (TGF-β1) and newborn size: the Araraquara Cohort Study

Objective: To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. Methods: This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the “Araraquara Cohort Study”. Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. Results: Maternal plasma TGF-β1 concentration was inversely associated with newborn weight (β = -43.0; p = 0.012), length (β = -0.16, p = 0.028), head circumference (β = -0.13, p = 0.004), ponderal index (β = -0.32, p = 0.011) and fat-free mass (β = -0.05, p = 0.005). However, the association persisted just for head circumference (β = -0.26; p = 0.030) and ponderal index (β = - 0.28; p = 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. Conclusions: Maternal plasma TGF-β1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-β1 in different trimesters of pregnancy and its effect during the early stages of fetal development

Data_Sheet_1_The relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression on offspring growth and body composition.PDF

Background and objectiveImprinted genes are important for the offspring development. To assess the relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression and offspring growth and body composition.MethodsThirty-nine overweight/obese and 25 normal weight pregnant women were selected from the “Araraquara Cohort Study” according to their pre-pregnancy BMI. Fetal growth and body composition and newborn growth were assessed, respectively, by ultrasound and anthropometry. The methylation of H19DMR in maternal blood, cord blood, maternal decidua and placental villi tissues was evaluated by methylation-sensitive restriction endonuclease qPCR, and H19 and IGF2 expression by relative real-time PCR quantification. Multiple linear regression models explored the associations of DNA methylation and gene expression with maternal, fetal, and newborn parameters.ResultsH19DMR was less methylated in maternal blood of the overweight/obese group. There were associations of H19DMR methylation in cord blood with centiles of fetal biparietal diameter (BPD) and abdominal subcutaneous fat thickness and newborn head circumference (HC); H19DMR methylation in maternal decidua with fetal occipitofrontal diameter (OFD), HC, and length; H19DMR methylation in placental villi with fetal OFD, HC and abdominal subcutaneous fat thickness and with newborn HC. H19 expression in maternal decidua was associated with fetal BPD and femur length centiles and in placental villi with fetal OFD and subcutaneous arm fat. IGF2 expression in maternal decidua was associated with fetal BPD and in placental villi with fetal OFD.ConclusionTo our knowledge, this is the first study to demonstrate associations of imprinted genes variations at the maternal-fetal interface of the placenta and in cord blood with fetal body composition, supporting the involvement of epigenetic mechanisms in offspring growth and body composition.</p

Table_2_The relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression on offspring growth and body composition.docx

Background and objectiveImprinted genes are important for the offspring development. To assess the relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression and offspring growth and body composition.MethodsThirty-nine overweight/obese and 25 normal weight pregnant women were selected from the “Araraquara Cohort Study” according to their pre-pregnancy BMI. Fetal growth and body composition and newborn growth were assessed, respectively, by ultrasound and anthropometry. The methylation of H19DMR in maternal blood, cord blood, maternal decidua and placental villi tissues was evaluated by methylation-sensitive restriction endonuclease qPCR, and H19 and IGF2 expression by relative real-time PCR quantification. Multiple linear regression models explored the associations of DNA methylation and gene expression with maternal, fetal, and newborn parameters.ResultsH19DMR was less methylated in maternal blood of the overweight/obese group. There were associations of H19DMR methylation in cord blood with centiles of fetal biparietal diameter (BPD) and abdominal subcutaneous fat thickness and newborn head circumference (HC); H19DMR methylation in maternal decidua with fetal occipitofrontal diameter (OFD), HC, and length; H19DMR methylation in placental villi with fetal OFD, HC and abdominal subcutaneous fat thickness and with newborn HC. H19 expression in maternal decidua was associated with fetal BPD and femur length centiles and in placental villi with fetal OFD and subcutaneous arm fat. IGF2 expression in maternal decidua was associated with fetal BPD and in placental villi with fetal OFD.ConclusionTo our knowledge, this is the first study to demonstrate associations of imprinted genes variations at the maternal-fetal interface of the placenta and in cord blood with fetal body composition, supporting the involvement of epigenetic mechanisms in offspring growth and body composition.</p

Table_1_The relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression on offspring growth and body composition.DOCX

Background and objectiveImprinted genes are important for the offspring development. To assess the relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression and offspring growth and body composition.MethodsThirty-nine overweight/obese and 25 normal weight pregnant women were selected from the “Araraquara Cohort Study” according to their pre-pregnancy BMI. Fetal growth and body composition and newborn growth were assessed, respectively, by ultrasound and anthropometry. The methylation of H19DMR in maternal blood, cord blood, maternal decidua and placental villi tissues was evaluated by methylation-sensitive restriction endonuclease qPCR, and H19 and IGF2 expression by relative real-time PCR quantification. Multiple linear regression models explored the associations of DNA methylation and gene expression with maternal, fetal, and newborn parameters.ResultsH19DMR was less methylated in maternal blood of the overweight/obese group. There were associations of H19DMR methylation in cord blood with centiles of fetal biparietal diameter (BPD) and abdominal subcutaneous fat thickness and newborn head circumference (HC); H19DMR methylation in maternal decidua with fetal occipitofrontal diameter (OFD), HC, and length; H19DMR methylation in placental villi with fetal OFD, HC and abdominal subcutaneous fat thickness and with newborn HC. H19 expression in maternal decidua was associated with fetal BPD and femur length centiles and in placental villi with fetal OFD and subcutaneous arm fat. IGF2 expression in maternal decidua was associated with fetal BPD and in placental villi with fetal OFD.ConclusionTo our knowledge, this is the first study to demonstrate associations of imprinted genes variations at the maternal-fetal interface of the placenta and in cord blood with fetal body composition, supporting the involvement of epigenetic mechanisms in offspring growth and body composition.</p