Maternal obesity during pregnancy leads to derangements in one-carbon metabolism and the gut microbiota: implications for fetal development and offspring wellbeing

A healthy diet prior to and during pregnancy is beneficial in acquiring essential B vitamins involved in one-carbon metabolism, and to maintain a healthy gut microbiota. Each play important roles in fetal development, immune-system remodeling and pregnancy-nutrient acquisition. Evidence shows that there is a reciprocal interaction between the one-carbon metabolism and the gut microbiota, as dietary intake of B vitamins has been shown to influence the composition of the gut microbiota, and certain gut bacteria also synthesize B vitamins. This reciprocal interaction contributes to the individual's overall availability of B vitamins and, therefore, should be maintained in a healthy state during pregnancy. There is an emerging consensus that obese pregnant women often have derangements in one-carbon metabolism and gut dysbiosis, due to a high intake of nutritiously poor foods and a chronic systemic inflammatory state. For example, low folate and vitamin B12 in obese women coincide with the decreased presence of B vitamin-producing bacteria and increased presence of inflammatory-associated bacteria from around mid-pregnancy. These alterations are risk factors for adverse pregnancy outcomes, impaired fetal development, and disruption of fetal growth and microbiota formation; which may lead to potential long-term offspring metabolic and neurological disorders. Therefore, preconceptional and pregnant obese women may benefit from dietary and lifestyle counselling to improve their dietary nutrient intake, and from monitoring their B vitamin levels and gut microbiome by blood tests and microbiota stool samples. Additionally, there is evidence that some probiotic bacteria have folate biosynthetic capacity and could be used to treat gut dysbiosis. So, their use as intervention strategy for obese women holds potential and should be further investigated. Currently, there are many knowledge gaps concerning the relationship between one-carbon metabolism and the gut microbiota, and future research should focus on intervention strategies to counteract B vitamin deficiencies and gut dysbiosis in obese pregnant women; commencing with the use of probiotic and prebiotic supplements

The intake of ultra-processed foods and homocysteine levels in women with(out) overweight and obesity:The Rotterdam Periconceptional Cohort

Purpose: Today’s diet consists of a substantial proportion of ultra-processed foods (UPF), especially in women with overweight and obesity in the reproductive period. High UPF intake results in an inadequate and unbalanced diet leading to derangements of several metabolic pathways detrimental to pregnancy and birth outcomes. Therefore, we aim to investigate whether UPF intake in the periconceptional period affects total homocysteine plasma levels (tHcy). Methods: 1532 participants were included from the prospective Rotterdam Periconceptional Cohort. UPF intake was calculated using Food Frequency Questionnaires including items classified as 4 in the Nova classification, and tHcy was measured by using liquid chromatography-tandem mass spectrometry system, with an interassay coefficient of variation of &lt; 5.5%. Multivariable linear regression modeling was used and adjusted for covariates and significant interaction terms. Results: Women with overweight or obesity showed significantly higher percentage of UPF intake (respectively, 50.3 and 51.3%) and higher tHcy (respectively, 6.6 and 6.3 µmol/L, Kruskal–Wallis test; respectively, p &lt; 0.001 and p = 0.04) compared to women with normal BMI (UPF intake: 46.8%, tHcy: 6.1 µmol/L). A 10% higher intake of UPF was associated with an increase in tHcy (adjusted: β = 1.31, 95% CI = 0.38–2.23). Analysis stratified for BMI classification showed comparable associations in normal weight participants (adjusted: β = 1.07, 95% CI = 0.06–2.07); however, no significant association in participants with overweight (adjusted: β = 0.06, 95% CI = − 0.95–1.07) and obesity (adjusted: β = 1.70, 95% CI = − 0.52–3.92) was shown. Conclusion: This study showed that a higher intake of UPF is associated with increased tHcy. Better knowledge and awareness of the nutritional quality of the diet in the periconceptional period may contribute to 1-CM and subsequently improve pregnancy course and outcome. Trial registration number and date: NTR4356, November 2010.</p

Ventricular tachycardia and pregnancy

The risk of developing new-onset arrhythmia or exacerbation of a pre-existing arrhythmia is increased during pregnancy because of profound physiological and hormonal changes. The incidence of arrhythmias in pregnancy is not well-reported and especially data on ventricular arrhythmia are scarce. Arrhythmia during pregnancy is associated with adverse maternal and fetal outcomes and the optimization of clinical management is hindered bya paucity of evidence, as guidelines are either based on studies in the general population or on case series in pregnancy. In any case, optimal care for these patients includes a multidisciplinary approach, integrating the different considerations in maternal cardiac, obstetric and fetal health. In this manuscript we present three cases of ventricular arrhythmia during pregnancy and describe our considerations in clinical decision-making with regard to diagnostic challenges and treatment choices

Preconceptional maternal weight loss and hypertensive disorders in pregnancy: a systematic review and meta-analysis

Background: Hypertensive disorders of pregnancy (HDP), including pregnancy-induced hypertension (PIH), Preeclampsia (PE), Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) and chronic hypertension, are leading causes of maternal and perinatal morbidity and mortality. Although the pathophysiology of HDP is complex, preconceptional weight reduction in obese women might reduce these complications. We conducted a systematic review and meta-analysis to investigate the effectiveness of preconceptional weight loss by lifestyle intervention or bariatric surgery in overweight and obese women and the reduction of the risk of HDP. Methods and results: Databases are searched until September 2019 resulting in 2547 articles: 110 full-text analysis and 29 detailed analysis. Reduced risks were shown for HDP in seven articles (n = 4381) of weight loss after lifestyle intervention or bariatric surgery (OR range 0.10–0.64), for PIH in four articles (n = 46,976) (OR range 0.14–0.79), and for PE in seven articles (n = 169,734) (OR range 0.14–0.84). The stratified analysis of weight loss after lifestyle intervention and bariatric surgery shows comparable results. The meta-analysis of 20 studies of the effectiveness of lifestyle intervention and bariatric surgery revealed reduced risks of HDP (OR 0.45 (95% CI 0.32–0.63)), PIH (OR 0.61 (95%CI 0.44–0.85)) and PE (OR 0.67 (95%CI 0.51–0.88)). Conclusions: Preconceptional weight loss after lifestyle intervention or bariatric surgery is effective in reducing risks of HDP, PIH and PE, and emphasizes the need to optimize weight in overweight and obese women with a child wish. More research is recommended to investigate short-term and long-term beneficial and harmful side-effects of these interventions on maternal and offspring health

Supraventricular arrhythmia in pregnancy

The physiological changes during pregnancy predispose a woman for the development of new-onset or recurrent arrhythmia. Supraventricular arrhythmia is the most common form of arrhythmia during pregnancy and, although often benign in nature, can be concerning. We describe three complex cases of supraventricular arrhythmia during pregnancy and review the currently available literature on the subject. In pregnancies complicated by arrhythmia, a plan for follow-up and both maternal and fetal monitoring during pregnancy, delivery and post partum should be made in a multidisciplinary team. Diagnostic modalities should be used as in non-pregnant women if there is an indication. All antiarrhythmic drugs cross the placenta, but when necessary, medical treatment should be used with consideration to the fetus and the mother's altered pharmacodynamics and kinetics. Electrical cardioversion is safe during pregnancy, and electrophysiological study and catheter ablation can be performed in selected patients, preferably with zero-fluoroscopy technique. Sometimes, delivering the fetus (if viable) is the best therapeutic option. In this review, we provide a framework for the workup and clinical management of supraventricular arrhythmias in pregnant women, including cardiac, obstetric and neonatal perspectives