Morrison, Janna L.

Regnault, Timothy R.H.

English

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Western University Scholarship@Western Paediatrics Publications Paediatrics Department 6-1-2016 Nutrition in pregnancy: Optimising maternal diet and fetal adaptations to altered nutrient supply Janna L. Morrison University of South Australia Timothy R.H. Regnault Western University, tim.regnault@uwo.ca Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Morrison, Janna L. and Regnault, Timothy R.H., "Nutrition in pregnancy: Optimising maternal diet and fetal adaptations to altered nutrient supply" (2016). Paediatrics Publications. 2245. https://ir.lib.uwo.ca/paedpub/2245 nutrientsEditorialNutrition in Pregnancy: Optimising Maternal Dietand Fetal Adaptations to Altered Nutrient SupplyJanna L. Morrison 1,* and Timothy R. H. Regnault 21 Early Origins of Adult Health Research Group, Sansom Institute for Health Research,University of South Australia, Adelaide 5001, Australia2 The Susan Vitali-Lovell Laboratories for Studies in Fetal Programming of Human Health Risks,Department of Obstetrics and Gynaecology and Physiology and Pharmacology, Western University,London, ON N6A-5C1, Canada; tim.regnault@uwo.ca* Correspondence: janna.morrison@unisa.edu.au; Tel.: +618-8302-2166Received: 30 May 2016; Accepted: 30 May 2016; Published: 4 June 2016Keywords: maternal diet; fetal growth; postnatal health; adipose tissue; growth trajectory;macronutrients; micronutrient; fetal growth restriction; placentaMaternal nutrition during pregnancy, and how this impacts placental and fetal growth andmetabolism, is of considerable interest to women, their partners and their health care professionals.In developing countries, maternal undernutrition is a major factor contributing to adverse pregnancyoutcomes. Conversely, with the increased prevalence of high calorie diets and resulting overweightand obesity issues in developed countries, the impact of this overnutrition situation upon pregnancyoutcome is highlighted as a contributing factor for adverse metabolic outcomes in offspring later in life.Further, while low or excessive food intake per se is an important aspect of pregnancy development,the specific role that the placenta plays in nutrient metabolism and overall nutrient supply to thefetus in situations of undernutrion, overnutrition or poor diet composition is still poorly defined.Both epidemiology and animal studies now highlight that undernutrition, overnutrition, and dietcomposition negatively impact fetoplacental growth and metabolic patterns, having adverse later lifemetabolic effects for the offspring. This issue aims to highlight new research in a number of theseabovementioned areas across the early life course.A great deal of data now highlights the periconceptional period as a critical period upon whichinsults may generate later life physiological and metabolic changes in the resulting offspring. In thereview submitted by Padhee and colleagues [1], the procedures of ARTs are examined, specificallyin terms of how common procedures associated with the handling and preparation of gametes andembryos may impact later life metabolism, particularly impacting offspring cardiometabolic health.These later life defective metabolic effects are also understood to be established during pregnancy.In surveying preconceptional women, pregnant and lactating women and women of reproductive age,Cuervo et al. report that these groups are not appropriately consuming foods for their physiologicalstatus, based upon the Spanish dietary guidelines and highlight a real need for improved educationand community outreach programs to these groups of women to ensure adequate maternal and thusfetal nutrition [2].Poor maternal nutritional intake after the periconceptional period during pregnancy canalso negatively impact fetal genetic growth trajectory and can result in fetal growth restriction.Vonnahme et al. [3], describe the effects of maternal undernutrition on vascularity of nutrienttransferring tissue during different stages of pregnancy. In addition to maternal nutrient supply,the effectiveness of the placenta in transporting nutrients and oxygen to the fetus is important indetermining fetal growth. A range of adaptations to placental development occur when the fetus isgrowth restricted and these are described by Zhang et al. [4]. Regardless of the cause of low birthNutrients 2016, 8, 342; doi:10.3390/nu8060342 www.mdpi.com/journal/nutrientsNutrients 2016, 8, 342 2 of 5weight, Zheng et al. show a relationship between the placental microbiome and fetal growth [5].Zohdi et al. describe the effects of maternal protein restriction during pregnancy on fetal developmentthat increase the risk of cardiovascular disease later in life [6]. Davis et al. illustrate the importance ofthe adrenal gland in the fetal adaptation for placental insufficiency, highlighting the important role ofnorepinephrine in regulating fetal growth but not pancreatic mass in the growth restricted fetus [7].Wood-Bradley and team provide a review of the literature surrounding the potential mechanisms bywhich maternal nutrition (focusing on malnutrition due to protein restriction, micronutrient restrictionand excessive fat intake) influences offspring kidney development and thereby function in later life [8].In the same light, Blumfield et al. detail evidence that a maternal diet during pregnancy that is low inprotein is related to higher systolic blood pressure in childhood [9]. Furthermore, Colon-Ramos andcolleagues investigated the potential association between maternal dietary patterns during pregnancyand birth outcomes in a diverse population with a historically high burden of low birth weight andother adverse birth outcomes [10].Experiences in the perinatal period also play a key role in defining how offspring respond tostress(es) in postnatal life. To this point, Tsuduki and colleagues report upon the impact a high fat dietduring mouse lactation, where it appears to increase the susceptibility of later life obesity inducedthrough postnatal social stress [11]. This paper highlights the importance of understanding how anearly life environment predisposes offspring to potential detrimental responses to postnatal adversesituations. In a review by Dunlop et al., the impact of fetal growth restriction on postnatal metabolismin skeletal muscle, but also the effect of a “second hit”, such as a Western diet in postnatal life, ispresented [12].While meeting dietary guidelines is important, overall maternal health status also plays a pivotalrole in determining fetal nutrient supply. In situations of maternal disease, such as infection withhuman immunodeficiency virus (HIV), the ability of the mother to consume sufficient substrates tomaintain herself and meet fetal demands is often compromised. In situations of HIV, resting energyexpenditure is increased and the disease may limit dietary intake and reduce nutrient absorption,in addition to influencing the progression of HIV disease as reported by Ramlal and colleagues [13].Their study described typical diets of HIV-infected, pregnant Malawian women and highlighted thatpoor quality maternal diets should be enhanced to meet demands of this particular group of pregnantwomen, vulnerable to both HIV and malnutrition.While deficiencies in nutrition during pregnancy can result in adverse offspring outcomes, oncepregnant, maternal weight gain during and after pregnancy are critical issues for maternal and fetalhealth as well. In the pilot RCT report lead by Martin et al., a cohort of women were recruited withthe aim of reducing postpartum weight retention and improving breastfeeding outcomes [14]. Thefindings indicate that the approach reported is feasible and acceptable to pregnant women and thatthe methodology, including the collection of blood for biomarker assessment, could be adapted basedon qualitative feedback to a larger, adequately powered RCT. Assessing maternal body composition,as part of monitoring maternal well-being, prior to and during pregnancy is critical to estimatethe requirements for dietary energy during gestation and when investigating relationships betweenmaternal nutritional status and offspring development. Forsum and co-workers investigate thepossibility of estimating body density and the use of a two-component model (2CM) to calculate totalbody fat concluding it may present a new clinically appropriate methodology [15].Many nutritional studies in pregnancy have focussed on the impact of changes in total ormacronutrient intake. This current issue features several studies that expand our knowledge regardingnutrient uptake during pregnancy, but have focused on changes in micronutrients during pregnancy.Grieger and Clifton, provide updated evidence from epidemiological and RCTs on the impact ofdietary and supplemental intakes of omega-3 long-chain polyunsaturated fatty acids, zinc, folate,iron, calcium, and vitamin D, as well as dietary patterns, on infant birth weight [16]. Additionally, instudying maternal intakes of polyunsaturated fatty acids (PUFAs), Bascuñán et al. report a Chileanstudy that highlights the need for new strategies to improve n-3 PUFA intake throughout pregnancyNutrients 2016, 8, 342 3 of 5and breastfeeding periods and the need to develop dietary interventions to improve the quality ofconsumed foods with particular emphasis on n-3 PUFA for adequate fetal development [17]. Fishintake during pregnancy is recognized as an important source of PUFAs. Starling and co-workerspresent a systematic review of fish intake during pregnancy and fetal neurodevelopment [18]. Thereview covers approximately a 14 year period of publications between January 2000 and March2014 involving over 270 papers, of which only eight were selected for a qualitative comparison ofstudy findings.Deficiencies in a range of micronutrients in low vs middle income countries that may act throughepigenetic mechanisms to influence fetal development and risk of chronic disease in adult life areidentified by Darnton-Hill et al. [19]. They also discuss supplementation programs. One particularmicronutrient that is important for sulphonation of steroids and hormones is sulphate. Dawson et al.describe the requirements for sulphate during pregnancy, the consequences of reduced sulphonationcapacity and the use of animal models to adequately understand the role of sulphate in humanpregnancy [20]. Folic acid and Vitamin B12, are crucial factors for metabolic pathways, and havebeen extensively studied and demonstrated to play important roles in preventing the development ofneural tube defects (NTDs). Wang et al. present data that in a local Chinese population consumptionof non-staple foods such as milk, fresh fruits, and nuts were associated with decreasing NTDs riskin offspring [21]. Further independent roles for folate and Vitamin B12 deficiency amongst pregnantwomen are presented in this issue. The relationship between maternal Vitamin B12 neonatal HDL ispresented by Adaikalakotwewari et al. [22], and folate deficiency resulting in birth defects is highlightedby Li et al., who present a mouse model to provide evidence that folate deficiency can impair decidualangiogenesis [23].The importance of adequate Vitamin D in women of reproductive age and its role in fetaldevelopment is of great interest and importance. A review of calcitrol biosynthesis during pregnancy,particularly by the placenta is presented by Olmos-Ortiz et al. [24]. Additionally, Choi et al. describe thehigh prevalence of Vitamin D deficiency in Korean women during pregnancy [25], particularly in thewinter, while Yu et al. report the cord blood Vitamin D in babies born in Shanghai [26]. Finally regardingVitamin D, the impact of sun exposure and Vitamin D supplementation on achieving appropriateVitamin D status in women whom are breastfeeding is explored by Dawodu and colleagues [27].In this issue, several new studies highlighted the importance of diet intake and composition uponmaternal and fetal well-being parameters in human population and animal studies. Many of thesestudies show that deficiencies in consumption/delivery of components (e.g., protein, vitamins, PUFAs)of a diet can lead to adverse fetal/offspring development and detail how consumption of certain foodsmay have beneficial effects on fetal/offspring growth and development. We hope that the articlescontained within this issue, and the material they reference and describe, are of interest to women,their partners and their health care professionals in promoting continual and informed dialogue aboutnutrition in pregnancy.References1. Padhee, M.; Zhang, S.; Lie, S.; Wang, K.; Botting, K.; McMillen, I.; MacLaughlin, S.; Morrison, J. Thepericonceptional environment and cardiovascular disease: Does in vitro embryo culture and transferinfluence cardiovascular development and health? Nutrients 2015, 7, 1378–1425. [CrossRef] [PubMed]2. Cuervo, M.; Sayon-Orea, C.; Santiago, S.; Martínez, J. Dietary and health profiles of Spanish women inpreconception, pregnancy and lactation. Nutrients 2014, 6, 4434–4451. [CrossRef] [PubMed]3. Vonnahme, K.; Lemley, C.; Caton, J.; Meyer, A. Impacts of maternal nutrition on vascularity of nutrienttransferring tissues during gestation and lactation. Nutrients 2015, 7, 3497–3523. [CrossRef] [PubMed]4. Zhang, S.; Regnault, T.; Barker, P.; Botting, K.; McMillen, I.; McMillan, C.; Roberts, C.; Morrison, J. Placentaladaptations in growth restriction. Nutrients 2015, 7, 360–389. [CrossRef] [PubMed]5. Zheng, J.; Xiao, X.; Zhang, Q.; Mao, L.; Yu, M.; Xu, J. The placental microbiome varies in association with lowbirth weight in full-term neonates. Nutrients 2015, 7, 6924–6937. [CrossRef] [PubMed]Nutrients 2016, 8, 342 4 of 56. Zohdi, V.; Lim, K.; Pearson, J.; Black, M. Developmental programming of cardiovascular disease followingintrauterine growth restriction: Findings utilising a rat model of maternal protein restriction. Nutrients 2015,7, 119–152. [CrossRef] [PubMed]7. Davis, M.; Macko, A.; Steyn, L.; Anderson, M.; Limesand, S. Fetal adrenal demedullation lowers circulatingnorepinephrine and attenuates growth restriction but not reduction of endocrine cell mass in an ovine modelof intrauterine growth restriction. Nutrients 2015, 7, 500–516. [CrossRef] [PubMed]8. Wood-Bradley, R.; Barrand, S.; Giot, A.; Armitage, J. Understanding the role of maternal diet on kidneydevelopment; an opportunity to improve cardiovascular and renal health for future generations. Nutrients2015, 7, 1881–1905. [CrossRef] [PubMed]9. Blumfield, M.; Nowson, C.; Hure, A.; Smith, R.; Simpson, S.; Raubenheimer, D.; MacDonald-Wicks, L.;Collins, C. Lower protein-to-carbohydrate ratio in maternal diet is associated with higher childhood systolicblood pressure up to age four years. Nutrients 2015, 7, 3078–3093. [CrossRef] [PubMed]10. Colón-Ramos, U.; Racette, S.; Ganiban, J.; Nguyen, T.; Kocak, M.; Carroll, K.; Völgyi, E.; Tylavsky, F.Association between dietary patterns during pregnancy and birth size measures in a diverse population insouthern US. Nutrients 2015, 7, 1318–1332. [CrossRef] [PubMed]11. Tsuduki, T.; Yamamoto, K.; Shuang, E.; Hatakeyama, Y.; Sakamoto, Y. High dietary fat intake during lactationpromotes the development of social stress-induced obesity in the offspring of mice. Nutrients 2015, 7,5916–5932. [CrossRef] [PubMed]12. Dunlop, K.; Cedrone, M.; Staples, J.; Regnault, T. Altered fetal skeletal muscle nutrient metabolism followingan adverse in utero environment and the modulation of later life insulin sensitivity. Nutrients 2015, 7,1202–1216. [CrossRef] [PubMed]13. Ramlal, R.; Tembo, M.; King, C.; Ellington, S.; Soko, A.; Chigwenembe, M.; Chasela, C.; Jamieson, D.; vander Horst, C.; Bentley, M.; et al. Dietary patterns and maternal anthropometry in hiv-infected, pregnantMalawian women. Nutrients 2015, 7, 584–594. [CrossRef] [PubMed]14. Martin, J.; MacDonald-Wicks, L.; Hure, A.; Smith, R.; Collins, C. Reducing postpartum weight retention andimproving breastfeeding outcomes in overweight women: A pilot randomised controlled trial. Nutrients2015, 7, 1464–1479. [CrossRef] [PubMed]15. Forsum, E.; Henriksson, P.; Löf, M. The two-component model for calculating total body fat from bodydensity: An evaluation in healthy women before, during and after pregnancy. Nutrients 2014, 6, 5888–5899.[CrossRef] [PubMed]16. Grieger, J.; Clifton, V. A review of the impact of dietary intakes in human pregnancy on infant birthweight.Nutrients 2015, 7, 153–178. [CrossRef] [PubMed]17. Bascuñán, K.; Valenzuela, R.; Chamorro, R.; Valencia, A.; Barrera, C.; Puigrredon, C.; Sandoval, J.;Valenzuela, A. Polyunsaturated fatty acid composition of maternal diet and erythrocyte phospholipidstatus in Chilean pregnant women. Nutrients 2014, 6, 4918–4934. [CrossRef] [PubMed]18. Starling, P.; Charlton, K.; McMahon, A.; Lucas, C. Fish intake during pregnancy and foetalneurodevelopment—A systematic review of the evidence. Nutrients 2015, 7, 2001–2014. [CrossRef] [PubMed]19. Darnton-Hill, I.; Mkparu, U. Micronutrients in pregnancy in low- and middle-income countries. Nutrients2015, 7, 1744–1768. [CrossRef] [PubMed]20. Dawson, P.; Elliott, A.; Bowling, F. Sulphate in pregnancy. Nutrients 2015, 7, 1594–1606. [CrossRef] [PubMed]21. Wang, M.; Wang, Z.-P.; Gao, L.-J.; Yang, H.; Zhao, Z.-T. Maternal consumption of non-staple food in the firsttrimester and risk of neural tube defects in offspring. Nutrients 2015, 7, 3067–3077. [CrossRef] [PubMed]22. Adaikalakoteswari, A.; Vatish, M.; Lawson, A.; Wood, C.; Sivakumar, K.; McTernan, P.; Webster, C.;Anderson, N.; Yajnik, C.; Tripathi, G.; et al. Low maternal vitamin B12 status is associated with lowercord blood HDL cholesterol in white Caucasians living in the UK. Nutrients 2015, 7, 2401–2414. [CrossRef][PubMed]23. Li, Y.; Gao, R.; Liu, X.; Chen, X.; Liao, X.; Geng, Y.; Ding, Y.; Wang, Y.; He, J. Folate deficiency could restraindecidual angiogenesis in pregnant mice. Nutrients 2015, 7, 6425–6445. [CrossRef] [PubMed]24. Olmos-Ortiz, A.; Avila, E.; Durand-Carbajal, M.; Díaz, L. Regulation of calcitriol biosynthesis and activity:Focus on gestational vitamin D deficiency and adverse pregnancy outcomes. Nutrients 2015, 7, 443–480.[CrossRef] [PubMed]Nutrients 2016, 8, 342 5 of 525. Choi, R.; Kim, S.; Yoo, H.; Cho, Y.; Kim, S.; Chung, J.; Oh, S.-Y.; Lee, S.-Y. High prevalence of vitamin Ddeficiency in pregnant Korean women: The first trimester and the winter season as risk factors for vitamin Ddeficiency. Nutrients 2015, 7, 3427–3448. [CrossRef] [PubMed]26. Yu, X.; Wang, W.; Wei, Z.; Ouyang, F.; Huang, L.; Wang, X.; Zhao, Y.; Zhang, H.; Zhang, J. Vitamin D statusand related factors in newborns in Shanghai, China. Nutrients 2014, 6, 5600–5610. [CrossRef] [PubMed]27. Dawodu, A.; Davidson, B.; Woo, J.; Peng, Y.-M.; Ruiz-Palacios, G.; Guerrero, M.; Morrow, A. Sun exposureand vitamin D supplementation in relation to vitamin D status of breastfeeding mothers and infants in theglobal exploration of human milk study. Nutrients 2015, 7, 1081–1093. [CrossRef] [PubMed]© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open accessarticle distributed under the terms and conditions of the Creative Commons Attribution(CC-BY) license (http://creativecommons.org/licenses/by/4.0/).

Nutrition in pregnancy: Optimising maternal diet and fetal adaptations to altered nutrient supply

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Nutrition in pregnancy: Optimising maternal diet and fetal adaptations to altered nutrient supply

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