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Maternal Nutrition in Pregnancy
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Maternal Nutrition in Pregnancy

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition in Women".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 64242

Special Issue Editors

Dr. ANNUNZIATA LAPOLLA

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
Interests: diabetes; obesity; gestational diabetes; diabetes in pregnancy; obesity in pregnancy
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Ewa Wender-Ozegowska

E-Mail Website
Guest Editor
Head of the Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
Interests: hyperglycemia, obesity and hypertension in pregnancy; rheumatologic disorders and pregnancy; reccurent pregnancy loss; ultrasound in pregnancy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pregnancy is a particular time of a women's life when nutritional status influences her health and pregnancy outcomes and the health of her fetus-neonate.

Physicians and other healthcare providers need to be aware of nutritional needs during pregnancy, as they differ significantly from non-pregnant populations.

We are organizing a Special Issue (SI) on the new insights into the role of maternal nutrition in pregnancy. We invite manuscripts (original research or review articles) about the influence of maternal weight on pregnancy outcome, the role of nutrition during pregnancy in different groups of patients ( malnourished, obese), as well as in various pathological situations (like diabetes, hypertension).

We are going to discuss current recommendations concerning nutrition during pregnancy. We want to cover pharmacological and non-pharmacological therapeutic options, evidence-based treatment algorithms, and novel experimental therapies. We encourage the authors to focus on prevention and reducing complications strategies. In the field of environmental research, we seek papers about social, economic, and cultural changes in public health and their influence on nutrition during pregnancy, especially in the rapidly growing group of obese women. 

We are also planning to invite authors that would present the latest achievements in molecular biologies, such as assessing gut microbiome in pregnancy. Papers combining a high academic standard with a practical focus are especially welcome.

Prof. Dr. Annunziata Lapolla
Prof. Dr. Ewa Wender-Ozegowska
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • pathophysiology of pregnancy
  • nutrition and its role in pregnancy
  • epidemiology of nutritional problems
  • obesity
  • education
  • complications
  • lifestyle

Published Papers (20 papers)

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8 pages, 273 KiB  
Communication
Pregnancy after Bariatric Surgery: Nutrition Recommendations and Glucose Homeostasis: A Point of View on Unresolved Questions
by Silvia Burlina, Maria Grazia Dalfrà and Annunziata Lapolla
Nutrients 2023, 15(5), 1244; https://doi.org/10.3390/nu15051244 - 01 Mar 2023
Cited by 4 | Viewed by 2493
Abstract
Obesity is increasing in all age groups and, consequently, its incidence has also risen in women of childbearing age. In Europe, the prevalence of maternal obesity varies from 7 to 25%. Maternal obesity is associated with short- and long-term adverse outcomes for both [...] Read more.
Obesity is increasing in all age groups and, consequently, its incidence has also risen in women of childbearing age. In Europe, the prevalence of maternal obesity varies from 7 to 25%. Maternal obesity is associated with short- and long-term adverse outcomes for both mother and child, and it is necessary to reduce weight before gestation to improve maternal and fetal outcomes. Bariatric surgery is an important treatment option for people with severe obesity. The number of surgeries performed is increasing worldwide, even in women of reproductive age, because improving fertility is a motivating factor. Nutritional intake after bariatric surgery is dependent on type of surgery, presence of symptoms, such as pain and nausea, and complications. There is also a risk of malnutrition after bariatric surgery. In particular, during pregnancy following bariatric surgery, there is a risk of protein and calorie malnutrition and micronutrient deficiencies due to increased maternal and fetal demand and possibly due to reduction of food intake (nausea, vomiting). As such, it is necessary to monitor and manage nutrition in pregnancy following bariatric surgery with a multidisciplinary team to avoid any deficiencies in each trimester and to ensure the well-being of the mother and fetus. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
14 pages, 1262 KiB  
Article
Effects of Nutritional and Social Factors on Favorable Fetal Growth Conditions Using Structural Equation Modeling
by Gugulethu Moyo, Zachary Stickley, Todd Little, John Dawson, Shera Thomas-Jackson, Jennifer Ngounda, Marizeth Jordaan, Liska Robb, Corinna Walsh and Wilna Oldewage-Theron
Nutrients 2022, 14(21), 4642; https://doi.org/10.3390/nu14214642 - 03 Nov 2022
Cited by 2 | Viewed by 1877
Abstract
Poor birth outcomes such as low birth weight, low birth length and short gestational age, are public health concern issues in South Africa (SA). This study utilized structural equation modeling (SEM) to explore how nutritional and social factors contribute to favorable fetal growth [...] Read more.
Poor birth outcomes such as low birth weight, low birth length and short gestational age, are public health concern issues in South Africa (SA). This study utilized structural equation modeling (SEM) to explore how nutritional and social factors contribute to favorable fetal growth conditions (FFGC) in pregnant women living with and without human immunodeficiency virus (HIV), in the Free State Province of SA. Sociodemographic characteristics, stress, health and nutrition-related information, and birth outcomes data were collected and analyzed from a subsample of 305 women enrolled in a cohort study from 2018–2020. Descriptive statistics were analyzed in R version 4.1.2 and SEM was conducted in Lavaan version 0.6–5. Higher gestational body mass index (GBMI) and income levels were associated with higher FFGC (p < 0.05). Household incomes were positively associated with dietary micronutrient quality (p = 0.002), GBMI (p = 0.012) and food security (p = 0.001). Low incomes (p = 0.004) and food insecurity (p < 0.001) were associated with higher stress, while social support was positively associated with food security status (p = 0.008). These findings highlight the complex interconnections between the social and nutritional factors that are associated with fetal growth conditions. Multisectoral community-based programs may be a useful strategy to address these challenges. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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20 pages, 1541 KiB  
Article
Quality Appraisal of Nutritional Guidelines to Prevent, Diagnose, and Treat Malnutrition in All Its Forms during Pregnancy
by Cinthya Muñoz-Manrique, Mónica Ancira-Moreno, Soraya Burrola-Méndez, Isabel Omaña-Guzmán, Elizabeth Hoyos-Loya, Sonia Hernández-Cordero, Alejandra Trejo-Domínguez, Mónica Mazariegos, Natalia Smith, Scarlett Alonso-Carmona, Jennifer Mier-Cabrera, Loredana Tavano-Colaizzi, Belén Sánchez-Múzquiz, Fermín Avendaño-Álvarez, Karla Muciño-Sandoval, Nadia C. Rodríguez-Moguel, Magali Padilla-Camacho, Salvador Espino-y-Sosa, Lizeth Ibarra-González and Cristina Medina-Avilés
Nutrients 2022, 14(21), 4579; https://doi.org/10.3390/nu14214579 - 01 Nov 2022
Cited by 3 | Viewed by 2782
Abstract
This work aimed to identify clinical practice guidelines (CPGs) that include recommendations for the prevention, diagnosis, and treatment of women’s malnutrition during pregnancy and to evaluate the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. [...] Read more.
This work aimed to identify clinical practice guidelines (CPGs) that include recommendations for the prevention, diagnosis, and treatment of women’s malnutrition during pregnancy and to evaluate the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. We conducted a literature review using PubMed and different websites from January 2009 to February 2021. The quality of the CPGs was independently assessed by reviewers using the AGREE II instrument, which defines guidelines scoring >70% in the overall assessment as “high quality”. The analysis included 43 guidelines. Among the main findings, we identified that only half of the CPGs (51.1%) obtained a final “high quality” evaluation. AGREE II results varied widely across domains and categories. The two domains that obtained the highest scores were scope and purpose with 88.3% (range 39 to 100%) and clarity of presentation with 87.2% (range 25 to 100%). Among the “high quality” CPGs, the best scores were achieved by the three guidelines published by the National Institute of Health and Care Excellence (NICE) and the World Health Organization (WHO). Due to the importance of maternal nutrition in pregnancy, it is essential to join forces to improve the quality of the guidelines, especially in CPGs that do not meet the reference standards for quality. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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12 pages, 284 KiB  
Article
High Prevalence of Anemia and Poor Compliance with Preventive Strategies among Pregnant Women in Mwanza City, Northwest Tanzania: A Hospital-Based Cross-Sectional Study
by Eveline T. Konje, Bernadin Vicent Ngaila, Albert Kihunrwa, Stella Mugassa, Namanya Basinda and Deborah Dewey
Nutrients 2022, 14(18), 3850; https://doi.org/10.3390/nu14183850 - 17 Sep 2022
Cited by 2 | Viewed by 2435
Abstract
Anemia in pregnancy is prevalent in Tanzania despite the implementation of existing prevention strategies. This study aims to determine the level of compliance with anemia preventive strategies among pregnant women and the factors associated with poor compliance. A cross sectional study was conducted [...] Read more.
Anemia in pregnancy is prevalent in Tanzania despite the implementation of existing prevention strategies. This study aims to determine the level of compliance with anemia preventive strategies among pregnant women and the factors associated with poor compliance. A cross sectional study was conducted among 768 pregnant women who attended the Bugando Medical Center, Sekou-Toure Regional Hospital, Nyamagana District Hospital, and Buzuruga Health Center in Mwanza, Northwest Tanzania. The prevalence of anemia at term was 68.8% (95% CI, 65.5–72.0%). The average hemoglobin level at term was 10.0 g/dL (95% CI, 9.8–10.1). Only 10.9% of pregnant women complied fully with anemia-preventive strategies. A decrease in mean hemoglobin level was observed across levels of compliance, with women who were non-compliant displaying a significantly lower mean hemoglobin level (8.3 g/dL) compared to women who were fully compliant (11.0 g/dL). Poor compliance was associated with no formal or primary education and initiating antenatal care in the 2nd or 3rd trimester. Anemia in pregnancy was commonly associated with lack of compliance with preventive strategies among participants. There is a need for community-based health education on the importance of complying with anemia-preventive strategies in order to reduce the burden during pregnancy and the consequences of anemia to the unborn baby. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
15 pages, 741 KiB  
Article
Short-Chain Fatty Acid Reference Ranges in Pregnant Women from a Mediterranean Region of Northern Spain: ECLIPSES Study
by Carla Martín-Grau, Andrés Díaz-López, Estefania Aparicio and Victoria Arija
Nutrients 2022, 14(18), 3798; https://doi.org/10.3390/nu14183798 - 15 Sep 2022
Cited by 2 | Viewed by 1810
Abstract
Maternal short-chain fatty acids (SCFAs) play a critical role in fetal development and metabolic programming. However, an important gap in the analysis of such relationships is the lack of reference values in pregnant women. Therefore, we establish serum SCFA percentile reference ranges both [...] Read more.
Maternal short-chain fatty acids (SCFAs) play a critical role in fetal development and metabolic programming. However, an important gap in the analysis of such relationships is the lack of reference values in pregnant women. Therefore, we establish serum SCFA percentile reference ranges both early and later in pregnancy in a population from a Mediterranean region of Northern Spain. A population-based follow-up study involving 455 healthy pregnant women (mean age 30.6 ± 5.0 years) from the ECLIPSES study is conducted. Sociodemographic, obstetric, anthropometric, lifestyle, dietary variables and blood samples were collected in the first and third trimesters. Serum SCFA concentrations were measured by LC-MS/MS. The 2.5/97.5 percentiles of the reference interval for serum acetic, propionic, isobutyric, and butyric acids were 16.4/103.8 µmol/L, 2.1/5.8 µmol/L, 0.16/1.01 µmol/L and 0.32/1.67 µmol/L in the first trimester of pregnancy, respectively. In the third trimester, butyrate levels increased with most of the maternal factors and categories studied, while acetic acid and isobutyric acid decreased only in some maternal categories. Propionic acid was not affected by maternal factors. Reference ranges did not vary with maternal age, body weight, social class or diet, but decreased with smoking, high physical activity, low BMI and primiparity. This study establishes for the first-time SCFAs reference ranges in serum for women in our region in both early and late pregnancy. This information can be useful to monitor pregnancy follow-up and detect risk values. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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11 pages, 821 KiB  
Article
Effect of Maternal Glucose and Triglyceride Levels during Early Pregnancy on Pregnancy Outcomes: A Retrospective Cohort Study
by Dandan Wu, Jianlin Zhang, Yimeng Xiong, Hui Wang, Danyang Lu, Mengxi Guo, Jian Zhang, Lei Chen, Jianxia Fan, Hefeng Huang and Xianhua Lin
Nutrients 2022, 14(16), 3295; https://doi.org/10.3390/nu14163295 - 11 Aug 2022
Cited by 4 | Viewed by 2275
Abstract
Maternal dysglycemia and lipid metabolic dysfunction have been recognized as risk factors for pregnancy complications and adverse perinatal outcome jointly and separately, but current diagnostic window-period which is at the end of the second trimester might be late to avoid chronic adverse impacts [...] Read more.
Maternal dysglycemia and lipid metabolic dysfunction have been recognized as risk factors for pregnancy complications and adverse perinatal outcome jointly and separately, but current diagnostic window-period which is at the end of the second trimester might be late to avoid chronic adverse impacts on both mother and fetus. A retrospective cohort study involving 48,973 women with fasting blood glucose (FPG) below diagnostic thresholds and lipid screening in early pregnancy was performed. Data of pregnancy outcomes including gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy (HDP), and neonatal outcomes were obtained for multivariable logistic analysis. As a result, higher FPG (≥75th, 4.68 mM) significantly increased risks of GDM (Adjusted odds ratio (AOR), 2.81; 95% CI, 2.60 to 3.05) and HDP (1.98; 1.81 to 2.16), and slightly increased risks of large for gestational age (LGA), macrosomia births and neonatal intensive care unit (NICU) compared to women with low FPG (≤25th, 4.21 mM). High maternal triglyceride (mTG) level had higher risks of GDM and HDP in all maternal FPG strata. Further analysis showed that women of top quartile of glucose combined with upper 10 percentile triglyceride have higher risks for GDM (AOR, 5.97; 95% CI, 5.26 to 6.78; risk difference 30.8, 95% CI 29.2 to 32.3) and HDP (AOR, 2.56; 95% CI, 2.20 to 2.99, risk difference 11.3, 95% CI 9.9 to 12.7) when compared to those in women of the bottom strata after adjustment. Therefore, both the early-pregnancy FPG and mTG levels should be screened among overall population including the low-risk population to reduce the incidence of pregnancy complications. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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12 pages, 642 KiB  
Article
Vitamin D Status and Gestational Diabetes in Russian Pregnant Women in the Period between 2012 and 2021: A Nested Case–Control Study
by Aleksandra S. Tkachuk, Elena A. Vasukova, Anna D. Anopova, Tatiana L. Karonova, Evgenii A. Pustozerov, Yana A. Teplova, Angelina I. Eriskovskaya, Artem O. Isakov, Elena Y. Vasilieva, Maria A. Kokina, Irina Y. Zazerskaya, Tatiana M. Pervunina, Elena N. Grineva and Polina V. Popova
Nutrients 2022, 14(10), 2157; https://doi.org/10.3390/nu14102157 - 22 May 2022
Cited by 2 | Viewed by 2235
Abstract
Several meta-analyses found an association between low maternal serum 25-hydroxyvitamin D (25(OH)D) level and gestational diabetes mellitus (GDM). However, some of them reported significant heterogeneity. We examined the association of serum 25(OH)D concentration measured in the first and in the second halves of [...] Read more.
Several meta-analyses found an association between low maternal serum 25-hydroxyvitamin D (25(OH)D) level and gestational diabetes mellitus (GDM). However, some of them reported significant heterogeneity. We examined the association of serum 25(OH)D concentration measured in the first and in the second halves of pregnancy with the development of GDM in Russian women surveyed in the periods of 2012–2014 and 2018–2021. We conducted a case–control study (including 318 pregnant women) nested on two previous studies. In 2012–2014, a total of 214 women (83 GDM and 131 controls) were enrolled before 15 weeks of gestation and maternal serum 25(OH)D concentrations were measured twice: at 8th–14th week of gestation and simultaneously with two-hour 75 g oral glucose tolerance test (OGTT) at 24th–32nd week of gestation. In the period of 2018–2021, 104 women (56 GDM and 48 controls) were included after OGTT and 25(OH)D concentrations were measured at 24th–32nd week of gestation. Median 25(OH)D levels were 20.0 [15.1–25.7] vs. 20.5 [14.5–27.5] ng/mL (p = 0.565) in GDM and control group in the first half of pregnancy and 25.3 [19.8–33.0] vs. 26.7 [20.8–36.8] ng/mL (p = 0.471) in the second half of pregnancy, respectively. The prevalence rates for vitamin D deficiency (25(OH)D levels < 20 ng/mL) were 49.4% and 45.8% (p = 0.608) in the first half of pregnancy and 26.2% vs. 22.1% (p = 0.516) in the second half of pregnancy in women who developed GDM and in women without GDM, respectively. The frequency of vitamin D supplements intake during pregnancy increased in 2018–2021 compared to 2012–2014 (p = 0.001). However, the third trimester 25(OH)D levels and prevalence of vitamin D deficiency (25.5 vs. 23.1, p = 0.744) did not differ in women examined in the periods of 2012–2014 and 2018–2021. To conclude, there was no association between gestational diabetes risk and maternal 25(OH)D measured both in the first and in the second halves of pregnancy. The increased prevalence of vitamin D supplements intake during pregnancy by 2018–2021 did not lead to higher levels of 25(OH)D. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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17 pages, 301 KiB  
Article
Testing the Impact of Familiarity with Health Benefits Information on Dietary Supplement Choice in Pregnancy: An Online Choice Experiment
by Lenka Malek, Wendy J. Umberger, Shao-Jia Zhou, Elisabeth Huynh and Maria Makrides
Nutrients 2022, 14(9), 1707; https://doi.org/10.3390/nu14091707 - 20 Apr 2022
Viewed by 1855
Abstract
To help meet the increased requirements for critical nutrients during and around pregnancy, supplementation with essential nutrients is recommended. This study aims to determine how the previous awareness of nutrient health benefits and/or the provision of this information influences the importance placed on [...] Read more.
To help meet the increased requirements for critical nutrients during and around pregnancy, supplementation with essential nutrients is recommended. This study aims to determine how the previous awareness of nutrient health benefits and/or the provision of this information influences the importance placed on nutrients (folate, iodine, omega-3 fatty acids, and vitamin D) when choosing between dietary supplement products for pregnancy. Discrete choice experiment data were collected as part of a cross-sectional online survey administered to 857 pregnant women living in Australia. Four segments of women were identified that differ in their preference criteria when choosing among dietary supplement products for pregnancy. When choosing between products, the reinforcement of perceived health benefits (i.e., showing information on health benefits to those already aware of the benefits) was most effective at increasing the importance of folate (in all segments) and iodine (in two segments, 63% of the sample). Neither prior awareness of health benefits alone nor information provided at the point-of-purchase without prior awareness were enough to increase the importance of folate. Our findings suggest a need for simultaneous strategies that (1) provide information on health benefits before purchase and (2) ensure that information on health benefits is available at the point-of-purchase. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
13 pages, 888 KiB  
Article
Calcium, Magnesium, and Zinc Supplementation during Pregnancy: The Additive Value of Micronutrients on Maternal Immune Response after SARS-CoV-2 Infection
by Ioana Mihaela Citu, Cosmin Citu, Madalin-Marius Margan, Marius Craina, Radu Neamtu, Oana Maria Gorun, Bogdan Burlea, Felix Bratosin, Ovidiu Rosca, Mirela Loredana Grigoras, Andrei Motoc, Daniel Malita, Octavian Neagoe and Florin Gorun
Nutrients 2022, 14(7), 1445; https://doi.org/10.3390/nu14071445 - 30 Mar 2022
Cited by 14 | Viewed by 4176
Abstract
Magnesium may contribute to the immune response during and after SARS-CoV-2 infection by acting as a cofactor for immunoglobulin production and other processes required for T and B cell activity. Considering magnesium as a recommended dietary supplement during pregnancy and the possible role [...] Read more.
Magnesium may contribute to the immune response during and after SARS-CoV-2 infection by acting as a cofactor for immunoglobulin production and other processes required for T and B cell activity. Considering magnesium as a recommended dietary supplement during pregnancy and the possible role of magnesium deficiency in COVID-19 and its complications, the current study sought to determine the effect of magnesium and magnesium-containing nutritional supplements on the immune response following SARS-CoV-2 infection in pregnant women, as well as to observe differences in pregnancy outcomes based on the supplements taken during pregnancy. The study followed a cross-sectional design, where patients with a history of SARS-CoV-2 infection during their pregnancy were surveyed for their preferences in nutritional supplementation and their profile compared with existing records from the institutional database. A cohort of 448 pregnant women with COVID-19 during 22 months of the pandemic was assembled, out of which 13.6% took a magnesium-only supplement, and 16.5% supplemented their diet with a combination of calcium, magnesium, and zinc. Around 60% of patients in the no-supplementation group had the SARS-CoV-2 anti-RBD lower than 500 U/mL, compared with 50% in those who took magnesium-based supplements. A quantity of magnesium >450 mg in the taken supplements determined higher levels of antibody titers after COVID-19. Low magnesium dosage (<450 mg) was an independent risk factor for a weak immune response (OR-1.25, p-value = 0.003). The observed findings suggest supplementing the nutritional intake of pregnant women with magnesium-based supplements to determine higher levels of SARS-CoV-2 anti-RBD antibodies, although causality remains unclear. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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11 pages, 533 KiB  
Article
Associations between Sociodemographic Factors, Lifestyle Behaviors, Pregnancy-Related Determinants, and Mediterranean Diet Adherence among Pregnant Women: The GESTAFIT Project
by Marta Flor-Alemany, Teresa Nestares, Nuria Marín Jiménez, Laura Baena-García and Virginia A. Aparicio
Nutrients 2022, 14(7), 1348; https://doi.org/10.3390/nu14071348 - 24 Mar 2022
Cited by 2 | Viewed by 2150
Abstract
We examined sociodemographic factors, lifestyle behaviors, and pregnancy-related determinants associated with adherence to the Mediterranean diet (MD) during pregnancy. A total of 152 Caucasian pregnant women were included in this cross-sectional study. Dietary habits and MD adherence were assessed with a food frequency [...] Read more.
We examined sociodemographic factors, lifestyle behaviors, and pregnancy-related determinants associated with adherence to the Mediterranean diet (MD) during pregnancy. A total of 152 Caucasian pregnant women were included in this cross-sectional study. Dietary habits and MD adherence were assessed with a food frequency questionnaire. Physical activity (PA) levels and physical fitness (PF) components (cardiorespiratory fitness, relative muscle strength, and flexibility) were objectively measured. A clustered overall PF index was calculated. Participants with a high MD adherence were older, had a lower body mass index (BMI), spent more time in moderate–vigorous PA, had a greater overall PF, cardiorespiratory fitness, and relative muscle strength compared to participants with low MD adherence (all, p < 0.05). When we explored factors associated with improved MD adherence with logistic regression analysis, we found that the following factors: lower pre-pregnancy BMI (OR = 2.337; p = 0.026), meeting PA recommendations (OR = 2.377; p = 0.045), higher relative muscle strength (OR = 2.265; p = 0.016), and higher overall PF (OR = 5.202; p = 0.004) increased the chances to adhere to the MD. Older age, lower BMI, greater PF, and meeting PA recommendations were associated with higher MD adherence. These factors should be considered for a better design of educational programs and guidelines focused on improving materno–fetal health status during pregnancy. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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11 pages, 3396 KiB  
Article
The Influence of Nutritional Supplementation for Iron Deficiency Anemia on Pregnancies Associated with SARS-CoV-2 Infection
by Mihaela Uta, Radu Neamtu, Elena Bernad, Adelina Geanina Mocanu, Adrian Gluhovschi, Alin Popescu, George Dahma, Catalin Dumitru, Lavinia Stelea, Cosmin Citu, Felix Bratosin and Marius Craina
Nutrients 2022, 14(4), 836; https://doi.org/10.3390/nu14040836 - 16 Feb 2022
Cited by 16 | Viewed by 4562
Abstract
Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and negative outcomes in patients with SARS-CoV-2 infection. As the COVID-19 pandemic poses a significant threat for pregnant women [...] Read more.
Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and negative outcomes in patients with SARS-CoV-2 infection. As the COVID-19 pandemic poses a significant threat for pregnant women in terms of infection risk and access to care, we developed a study to determine the impact of nutritional supplementation for iron deficiency anemia in correlation with the status of SARS-CoV-2 infection. In a case-control design, we identified 446 pregnancies that matched our inclusion criteria from the hospital database. The cases and controls were stratified by SARS-CoV-2 infection history to observe the association between exposure and outcomes in both the mother and the newborn. A total of 95 pregnant women were diagnosed with COVID-19, having a significantly higher proportion of iron deficiency anemia. Low birth weight, prematurity, and lower APGAR scores were statistically more often occurring in the COVID-19 group. Birth weight showed a wide variation by nutritional supplementation during pregnancy. A daily combination of iron and folate was the optimal choice to normalize the weight at birth. The complete blood count and laboratory studies for iron deficiency showed significantly decreased levels in association with SARS-CoV-2 exposure. Puerperal infection, emergency c-section, and small for gestational age were strongly associated with anemia in patients with COVID-19. It is imperative to screen for iron and folate deficiency in pregnancies at risk for complications, and it is recommended to supplement the nutritional intake of these two to promote the normal development and growth of the newborn and avoid multiple complications during pregnancy in the COVID-19 pandemic setting. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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11 pages, 577 KiB  
Article
Diet and Maternal Obesity Are Associated with Increased Oxidative Stress in Newborns: A Cross-Sectional Study
by Arturo Lopez-Yañez Blanco, Keyla M Díaz-López, Jenny Vilchis-Gil, Hector Diaz-Garcia, Jacqueline Gomez-Lopez, Patricia Medina-Bravo, Javier T Granados-Riveron, Juan M Gallardo, Miguel Klünder-Klünder and Rocío Sánchez-Urbina
Nutrients 2022, 14(4), 746; https://doi.org/10.3390/nu14040746 - 10 Feb 2022
Cited by 12 | Viewed by 3175
Abstract
Overweight and obesity have become a world-health public problem, mainly for developing countries. Both health conditions have a higher prevalence among women of childbearing age. Physiopathology, overweight and obesity are characterized by a chronic oxidative stress status, which has deleterious effects on mothers [...] Read more.
Overweight and obesity have become a world-health public problem, mainly for developing countries. Both health conditions have a higher prevalence among women of childbearing age. Physiopathology, overweight and obesity are characterized by a chronic oxidative stress status, which has deleterious effects on mothers and children. Hence, we determine whether the qualities of diet during pregnancy and maternal pregestational body mass index (BMI) are associated with increased oxidative stress markers in mothers and newborns. Two hundred forty-two (242) mother-newborn pairs were classified according to their pregestational BMI. Information on food intake was collected using a food frequency questionnaire in the third trimester of pregnancy. Levels of Malondialdehyde (MDA) and Nitric Oxide (NO) were measured in plasma from mothers at the end of the third trimester of pregnancy and from cord blood at birth. MDA and NO levels in mother–newborn pairs with maternal pregestational overweight or obesity were higher than in mother–newborn pairs with pregestational normal weight. For women (and newborns) who had a higher intake of fruit and vegetables, the levels of NO and MDA were lower. Lastly, women with pregestational obesity had lower fruit and vegetable intake during pregnancy and higher levels of oxidative stress and in their newborns. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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15 pages, 452 KiB  
Article
Relationship between Eating Habits, Physical Activity and Tobacco and Alcohol Use in Pregnant Women: Sociodemographic Inequalities
by Isabel Corrales-Gutierrez, Francisca Baena-Antequera, Diego Gomez-Baya, Fatima Leon-Larios and Ramon Mendoza
Nutrients 2022, 14(3), 557; https://doi.org/10.3390/nu14030557 - 27 Jan 2022
Cited by 6 | Viewed by 3560
Abstract
Pregnant women must maintain or acquire healthy habits during pregnancy to protect both their own health and their child’s. Such habits include an adequate eating pattern along with good adherence to the intake of certain supplements, practice of moderate physical activity and avoiding [...] Read more.
Pregnant women must maintain or acquire healthy habits during pregnancy to protect both their own health and their child’s. Such habits include an adequate eating pattern along with good adherence to the intake of certain supplements, practice of moderate physical activity and avoiding the consumption of toxic products such as tobacco and alcohol. The objective of this study is to assess the interrelation between such habits and their association with sociodemographic variables. To such end, a cross-sectional study was conducted with a representative sample of pregnant women who attended the scheduled morphology echography consultation at the 20th gestational week in their reference public hospital in the city of Seville (Spain). Results: Younger pregnant women and with lower educational levels are the ones that present the worst eating habits and the highest smoking rate. Pregnant women with lower educational levels are the least active. Non-smoking pregnant women present better eating habits than those who smoke. Pregnant women with lower educational levels are those who accumulate more unhealthy habits during pregnancy. This should be taken into account when planning the health care provided to pregnant women and in public health intersectoral policies. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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12 pages, 272 KiB  
Article
Modeling the Predictive Value of Evidence-Based Referral Criteria to Support Healthy Gestational Weight Gain among an Australian Pregnancy Cohort
by Shanna Fealy, Jenna Hollis, Julia Martin, Lucy Leigh, Christopher Oldmeadow, Clare E. Collins, Roger Smith, Shelley Wilkinson and Alexis Hure
Nutrients 2022, 14(2), 381; https://doi.org/10.3390/nu14020381 - 17 Jan 2022
Cited by 2 | Viewed by 2098
Abstract
Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight [...] Read more.
Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)’s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks’ gestation using the minimum weight change parameter of +/−2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61–0.83) and specificity (0.72, 95% CI 0.61–0.83), resulting in 55% (n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
11 pages, 433 KiB  
Article
Higher-Dose DHA Supplementation Modulates Immune Responses in Pregnancy and Is Associated with Decreased Preterm Birth
by Christina J. Valentine, Aiman Q. Khan, Alexandra R. Brown, Scott A. Sands, Emily A. Defranco, Byron J. Gajewski, Susan E. Carlson, Kristina M. Reber and Lynette K. Rogers
Nutrients 2021, 13(12), 4248; https://doi.org/10.3390/nu13124248 - 26 Nov 2021
Cited by 7 | Viewed by 3829
Abstract
Pregnancy and parturition involve extensive changes in the maternal immune system. In our randomized, multi-site, double-blind superiority trial using a Bayesian adaptive design, we demonstrated that 1000 mg/day of docosahexaenoic acid (DHA) was superior to 200 mg/day in preventing both early preterm birth [...] Read more.
Pregnancy and parturition involve extensive changes in the maternal immune system. In our randomized, multi-site, double-blind superiority trial using a Bayesian adaptive design, we demonstrated that 1000 mg/day of docosahexaenoic acid (DHA) was superior to 200 mg/day in preventing both early preterm birth (less than 34 weeks’ gestation) and preterm birth (less than 37 weeks’ gestation). The goal of this secondary study is to compare the effects of 1000 mg/day versus 200 mg/day on maternal inflammation, a possible mechanism by which DHA may prevent preterm birth. Maternal blood samples were collected at enrollment (12–20 weeks’ gestation) and at delivery. Red blood cell DHA levels were measured by gas chromatography, and plasma concentrations of sRAGE, IL-6, IL-1β, TNFα, and INFγ were measured by ELISA. Data were analyzed for associations with the DHA dose, gestational age at birth, and preterm birth (<37 weeks). Higher baseline and lower delivery levels of maternal sRAGE were associated with a greater probability of longer gestation and delivery at term gestation. Higher-dose DHA supplementation increased the probability of a smaller decrease in delivery sRAGE levels. Higher IL-6 concentrations at delivery were associated with the probability of delivering after 37 weeks, and higher-dose DHA supplementation increased the probability of greater increases in IL-6 concentrations between enrollment and delivery. These data provide a proposed mechanistic explanation of how a higher dose of DHA during pregnancy provides immunomodulatory regulation in the initiation of parturition by influencing sRAGE and IL-6 levels, which may explain its ability to reduce the risk of preterm birth. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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17 pages, 1283 KiB  
Article
Pregnancy Is Enough to Provoke Deleterious Effects in Descendants of Fructose-Fed Mothers and Their Fetuses
by Elena Fauste, María I. Panadero, Cristina Donis, Paola Otero and Carlos Bocos
Nutrients 2021, 13(10), 3667; https://doi.org/10.3390/nu13103667 - 19 Oct 2021
Cited by 2 | Viewed by 3305
Abstract
The role of fructose in the global obesity and metabolic syndrome epidemic is widely recognized. However, its consumption is allowed during pregnancy. We have previously demonstrated that maternal fructose intake in rats induces detrimental effects in fetuses. However, these effects only appeared in [...] Read more.
The role of fructose in the global obesity and metabolic syndrome epidemic is widely recognized. However, its consumption is allowed during pregnancy. We have previously demonstrated that maternal fructose intake in rats induces detrimental effects in fetuses. However, these effects only appeared in adult descendants after a re-exposure to fructose. Pregnancy is a physiological state that leads to profound changes in metabolism and hormone response. Therefore, we wanted to establish if pregnancy in the progeny of fructose-fed mothers was also able to provoke an unhealthy situation. Pregnant rats from fructose-fed mothers (10% w/v) subjected (FF) or not (FC) to a fructose supplementation were studied and compared to pregnant control rats (CC). An OGTT was performed on the 20th day of gestation, and they were sacrificed on the 21st day. Plasma and tissues from mothers and fetuses were analyzed. Although FF mothers showed higher AUC insulin values after OGTT in comparison to FC and CC rats, ISI was lower and leptinemia was higher in FC and FF rats than in the CC group. Accordingly, lipid accretion was observed both in liver and placenta in the FC and FF groups. Interestingly, fetuses from FC and FF mothers also showed the same profile observed in their mothers on lipid accumulation, leptinemia, and ISI. Moreover, hepatic lipid peroxidation was even more augmented in fetuses from FC dams than those of FF mothers. Maternal fructose intake produces in female progeny changes that alter their own pregnancy, leading to deleterious effects in their fetuses. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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14 pages, 1302 KiB  
Article
Associations of Food and Nutrient Intake with Serum Hepcidin and the Risk of Gestational Iron-Deficiency Anemia among Pregnant Women: A Population-Based Study
by Noor Rohmah Mayasari, Chyi-Huey Bai, Tzu-Yu Hu, Jane C.-J. Chao, Yi Chun Chen, Ya Li Huang, Fan-Fen Wang, Alexey A. Tinkov, Anatoly V. Skalny and Jung-Su Chang
Nutrients 2021, 13(10), 3501; https://doi.org/10.3390/nu13103501 - 03 Oct 2021
Cited by 12 | Viewed by 3908
Abstract
Hepcidin is a regulator of iron metabolism. Diet affects the body’s iron status, but how it influences hepcidin concentrations and the risk of gestational iron-deficiency anemia (IDA) remains unclear. We investigated relationships of food and nutrient intake with serum hepcidin levels in relation [...] Read more.
Hepcidin is a regulator of iron metabolism. Diet affects the body’s iron status, but how it influences hepcidin concentrations and the risk of gestational iron-deficiency anemia (IDA) remains unclear. We investigated relationships of food and nutrient intake with serum hepcidin levels in relation to the iron status at a population scale. A retrospective cross-sectional study was conducted based on data obtained from the Nationwide Nutrition and Health Survey in pregnant women, Taiwan (2017~2020). In total, 1430 pregnant women aged 20~45 years with a singleton pregnancy were included. Data from blood biochemistry, 24-h dietary recall, and a food frequency questionnaire were collected during a prenatal checkup. Adjusted multivariate linear and logistic regression analyses were employed to measure the beta coefficient (ß) and 95% confidence interval (CI) of serum hepcidin and the odds ratio (OR) of IDA. In IDA women, serum hepcidin levels were positively correlated with the intake frequency of Chinese dim sum and related foods (β = 0.037 (95% CI = 0.015~0.058), p = 0.001) and dark leafy vegetables (β = 0.013 (0.001~0.025), p = 0.040), but they were negatively correlated with noodles and related products (β = −0.022 (−0.043~−0.001), p = 0.038). An adjusted multivariate logistic regression analysis showed that dietary protein [OR: 0.990 (0.981~1.000), p = 0.041], total fiber [OR: 0.975 (0.953~0.998), p = 0.031], and rice/rice porridge [OR: 1.007 (1.00~1.014), p = 0.041] predicted gestational IDA. Total carbohydrates [OR: 1.003 (1.000~1.006), p = 0.036], proteins [OR: 0.992 (0.985~0.999), p = 0.028], gourds/shoots/root vegetables [OR: 1.007 (0.092~1.010), p = 0.005], and to a lesser extent, savory and sweet glutinous rice products [OR: 0.069 (0.937~1.002), p = 0.067] and dark leafy vegetables [OR: 1.005 (0.999~1.011), p = 0.088] predicted IDA. The risk of IDA due to vegetable consumption decreased with an increasing vitamin C intake (p for trend = 0.024). Carbohydrates and vegetables may affect the gestational iron status through influencing hepcidin levels. Vitamin C may lower the risk of gestational IDA due to high vegetable consumption. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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Review

Jump to: Research

24 pages, 1485 KiB  
Review
High Folate, Perturbed One-Carbon Metabolism and Gestational Diabetes Mellitus
by Jessica M. Williamson, Anya L. Arthurs, Melanie D. Smith, Claire T. Roberts and Tanja Jankovic-Karasoulos
Nutrients 2022, 14(19), 3930; https://doi.org/10.3390/nu14193930 - 22 Sep 2022
Cited by 6 | Viewed by 3971
Abstract
Folate is a dietary micronutrient essential to one-carbon metabolism. The World Health Organisation recommends folic acid (FA) supplementation pre-conception and in early pregnancy to reduce the risk of fetal neural tube defects (NTDs). Subsequently, many countries (~92) have mandatory FA fortification policies, as [...] Read more.
Folate is a dietary micronutrient essential to one-carbon metabolism. The World Health Organisation recommends folic acid (FA) supplementation pre-conception and in early pregnancy to reduce the risk of fetal neural tube defects (NTDs). Subsequently, many countries (~92) have mandatory FA fortification policies, as well as recommendations for periconceptional FA supplementation. Mandatory fortification initiatives have been largely successful in reducing the incidence of NTDs. However, humans have limited capacity to incorporate FA into the one-carbon metabolic pathway, resulting in the increasingly ubiquitous presence of circulating unmetabolised folic acid (uFA). Excess FA intake has emerged as a risk factor in gestational diabetes mellitus (GDM). Several other one-carbon metabolism components (vitamin B12, homocysteine and choline-derived betaine) are also closely entwined with GDM risk, suggesting a role for one-carbon metabolism in GDM pathogenesis. There is growing evidence from in vitro and animal studies suggesting a role for excess FA in dysregulation of one-carbon metabolism. Specifically, high levels of FA reduce methylenetetrahydrofolate reductase (MTHFR) activity, dysregulate the balance of thymidylate synthase (TS) and methionine synthase (MTR) activity, and elevate homocysteine. High homocysteine is associated with increased oxidative stress and trophoblast apoptosis and reduced human chorionic gonadotrophin (hCG) secretion and pancreatic β-cell function. While the relationship between high FA, perturbed one-carbon metabolism and GDM pathogenesis is not yet fully understood, here we summarise the current state of knowledge. Given rising rates of GDM, now estimated to be 14% globally, and widespread FA food fortification, further research is urgently needed to elucidate the mechanisms which underpin GDM pathogenesis. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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21 pages, 1263 KiB  
Review
Fetomaternal Expression of Glucose Transporters (GLUTs)—Biochemical, Cellular and Clinical Aspects
by Rafal Sibiak, Katarzyna Ozegowska, Ewa Wender-Ozegowska, Pawel Gutaj, Paul Mozdziak and Bartosz Kempisty
Nutrients 2022, 14(10), 2025; https://doi.org/10.3390/nu14102025 - 12 May 2022
Cited by 8 | Viewed by 4022
Abstract
Several types of specialized glucose transporters (GLUTs) provide constant glucose transport from the maternal circulation to the developing fetus through the placental barrier from the early stages of pregnancy. GLUT1 is a prominent protein isoform that regulates placental glucose transfer via glucose-facilitated diffusion. [...] Read more.
Several types of specialized glucose transporters (GLUTs) provide constant glucose transport from the maternal circulation to the developing fetus through the placental barrier from the early stages of pregnancy. GLUT1 is a prominent protein isoform that regulates placental glucose transfer via glucose-facilitated diffusion. The GLUT1 membrane protein density and permeability of the syncytial basal membrane (BM) are the main factors limiting the rate of glucose diffusion in the fetomaternal compartment in physiological conditions. Besides GLUT1, the GLUT3 and GLUT4 isoforms are widely expressed across the human placenta. Numerous medical conditions and molecules, such as hormones, adipokines, and xenobiotics, alter the GLUT’s mRNA and protein expression. Diabetes upregulates the BM GLUT’s density and promotes fetomaternal glucose transport, leading to excessive fetal growth. However, most studies have found no between-group differences in GLUTs’ placental expression in macrosomic and normal control pregnancies. The fetomaternal GLUTs expression may also be influenced by several other conditions, such as chronic hypoxia, preeclampsia, and intrahepatic cholestasis of pregnancy. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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14 pages, 539 KiB  
Review
Inositols, Probiotics, and Gestational Diabetes: Clinical and Epigenetic Aspects
by Ester Vitacolonna, Maria Masulli, Luisa Palmisano, Liborio Stuppia and Marica Franzago
Nutrients 2022, 14(8), 1543; https://doi.org/10.3390/nu14081543 - 08 Apr 2022
Cited by 7 | Viewed by 3102
Abstract
There is growing interest in the potential role of different stereoisomers of inositol or their combination as well as probiotics supplementation in healthy glucose metabolism during pregnancy and in promoting offspring health. The aim of this review is to clarify the effects of [...] Read more.
There is growing interest in the potential role of different stereoisomers of inositol or their combination as well as probiotics supplementation in healthy glucose metabolism during pregnancy and in promoting offspring health. The aim of this review is to clarify the effects of several inositol and probiotics-based supplements in the prevention and treatment of gestational diabetes (GDM). Moreover, we will discuss the epigenetic aspects and their short- and long-term effects in response to probiotic intervention as well as the possible implications of these findings in guiding appropriate supplementation regimens in pregnancy. Full article
(This article belongs to the Special Issue Maternal Nutrition in Pregnancy)
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