Gestational Intake Affects Neonatal Outcomes Including Adiposity

Moms! Its your Gestational Intake using which your Fetus Survives & Develops

Supplements are a Regular Routine in Every Woman’s Life

Children are replicas of their moms and dads mostly with some of them not bearing any attributes of their parents which is rare. Personality and characteristic trait are genetically transferred which makes us gloat with glory when the child behaves like his/her parent. Reproduction is an indispensable part of every person’s life that adds meaning to our existence and helps in taking our family’s virtues and ideologies to future generations as well. But sadly, most women in reproductive age worldwide suffer from obesity/overweight and so younger adults, adolescents and kids. Such high prevalence of obesity during early years has been attributed to several risk factors that affect early during pregnancy in the form of higher maternal pre-pregnancy body mass index (BMI) and excessive gestational weight gain. These risk factors are modifiable ones but when left untreated they do have a serious effect on the infant size at birth and obesity risk later during life. We also have numerous studies showing that maternal obesity/overweight during pregnancy pose as significant risk factors for higher birth weight and neonatal adiposity and also for childhood obesity later.
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The pregnant mother is the sole means through which the developing fetus acquires all nutrients needed for normal growth and development but maternal pre-pregnancy status and environment also play an equally critical role as pre-pregnancy obesity has the ability to result in foetal macrosomia (where the birthweight ≥4 kg). Once pregnant, the in-utero environment has an upper hand on foetal development including cognitive, organ development and deposition of fat. The environment in which the fetus develops determines the foetus’s genetic transcription affecting it differently depending on the stage of pregnancy. Its isn’t uncommon for the pregnant woman to develop gestational diabetes during any time of pregnancy and the mother’s carbs intake and increase in insulin insensitivity results in higher levels of maternal blood glucose which can be transferred to the fetus besides the foetus’s own insulin production that increases foetal growth and adiposity. Hence, maintenance of maternal insulin levels is absolutely necessary to avoid any deviation in foetal glucose levels. When such is the effect of maternal nutrient intake it is also equally difficult to impose restrictions and help the woman lose weight before pregnancy as most of the pregnancies go unplanned. But once pregnant it is indeed possible to regulate dietary intake levels of the mother-to-be as maternal dietary energy and protein intake affect neonatal anthropometry making food consumption an integral part of the pregnancy process. Gynaecologists prescribe supplements even before the woman becomes pregnant (such as folates) and these continue until delivery of the child. Though maternal micro- and macronutrient intake affects neonatal body composition we don’t have much data available in this field of science as there are quite a lot other factors including physical activity, socioeconomic status, stress, smoking and drug intake that affect foetal growth and development. The study elaborated below uses cohort from the ROLO (Randomised Control trial of Low Glycemic index diet versus no dietary intervention to prevent recurrence of foetal macrosomia) to study the effect of maternal body composition, demographic characteristics, macronutrient intake and lifestyle changes on neonatal weight and adiposity.

Cohort from ROLO Study
The present study used 542 mother and infant pairs from the ROLO study in which the mothers had given birth to infants with macrosomia previously and hence, were put on a low-glucose diet to decrease the recurrence of macrosomia. Results of the ROLO study showed that the intervention group experienced significant reduction in glycaemic index and load and also had lower gestational weight gain and glucose intolerance but birthweight or risk of macrosomia was not significantly reduced.

All the 542 mothers underwent well-being tests, maternal weight, height, BMI and upper-arm circumference were measured during the first antenatal consultation with maternal weight measurements and gestational weight calculations performed during every subsequent consultation. Once the mothers gave birth, neonatal weight, height, mid-upper arm, abdominal, hip and thigh circumference, biceps, triceps, subscapular and thigh skinfold measurements were taken. This resulted in only 266 neonates having complete data of all the measurements taken. The pregnant woman’s macronutrient intake, glycemic intake and glycemic load was measured using a 3-day food diary given during each trimester of pregnancy. Cluster analysis of the food intake resulted in two main clusters of healthy and unhealthy individuals with regard to diet. While the unhealthy cluster ate more of refined foods, white bread, confectionary, chips, processed meats and high-energy beverages the healthy cluster chose to eat more of fruits, vegetables, cereals, fruit juice, low-fat milk and white meat. Dietary intake was analysed using a self-administered 170 item SLAN (Survey of Lifestyle, Attitudes and Nutrition in Ireland) food frequency questionnaire (FFQ) that was given during the initial stages of pregnancy and returned by 28 weeks of gestation. The data in the FFQ was in turn used to create a Dietary Approaches to Stop Hypertension (DASH) index with a score of 0 indicating total non-concordance and 11 indicating total concordance. A glucose challenge test (GCT) was done at 28 weeks of gestation.

Result
Maternal characteristics did not change between the control and intervention group except for gestational weight gain, glucose intolerance and maternal well-being score. There was no difference in neonatal weight, length or anthropometric measurements between the intervention and control group except in the case of thigh circumference measurement and in the case of neonatal waist: length ratio that was lower in the intervention group. The control group experienced more gestational weight gain than the intervention group. It was also seen that birthweight was associated with gestational weight gain, birth length was negatively associated with maternal smoking, neonatal abdominal circumference was positively linked with maternal saturated fatty acid (SFA) intake which showed a negative trend as the association switched over to polyunsaturated fatty acids (PUFA) intake in trimester 3. Neonatal thigh circumference was negatively associated with frequency of strenuous physical activity, neonatal chest circumference was positively associated with maternal weight and negatively associated with frequency of strenuous physical activity. Neonatal subscapular skinfold thickness was negatively associated with PUFA intake in third trimester, neonatal waist circumference: length ratio was negatively associated with maternal age and positively associated with maternal smoking and maternal mid-upper arm circumference (MUAC) in early pregnancy.

The study clearly shows that maternal diet and lifestyle factors were positively associated with the neonate’s body composition. It also shows the significant changes associated with the intake of different foods thereby proving that neonatal central adiposity was positively associated with maternal dietary saturated fat and negatively associated with low GI intervention groups.

Healthy Start Study
An observational, pre-birth cohort study was done on 1,410 pregnant women aged 16 years and above prior to 24 weeks of gestation after implementing various exclusion criteria. These moms participated in two research visits during pregnancy-the first visit occurred between 8 and 24 weeks of gestation and the second visit occurred between 24 and 32 weeks of gestation while a third visit happened at the hospital after delivery. The newborn baby’s weight, length, head circumference and skin-fold thickness were measured within 72 hours after delivery and the neonatal body composition, fat mass (FM) and fat-free mass (FFM) were calculate from total mass and volume. Maternal pre-pregnancy BMI was calculated using weight measurements and the woman was categorized accordingly and her physical activity levels were measured using a Pregnancy Physical Activity Questionnaire. The diet consumption of the pregnant woman was assessed several times during the study and its quality was assessed using the Healthy Eating Index-2010 that consisted of twelve components giving a maximum score of 100. The study showed a HEI-2010 score between 18 and 89 with a mean of 54.2. Women with a score ≤ 57 were likelier to be obese and have reported of smoking during pregnancy. Lower diet quality was related to younger maternal age, shorter length of gestation and higher energy expenditure. Also, those neonates born to women with this score also had significantly lower birth weight and fat-free mass (FFM) but there was no difference in birth head circumference or birth length between the two groups.

Results showed that energy intake as fat and saturated fat was significantly higher in the group with an HEI total score ≤57 but at the same time empty calories were also significantly lower which is a surprising one! Also neonates born to these women had .58% higher fat mass (FM) compared to neonates born to women with a score ≥57. But women with a score ≤57 had no significantly different FFM proving that an increased %FM linked to lower maternal diet quality shows an increase in neonatal FM rather than a decrease in FFM. This large pre-birth cohort showed that lower diet quality had a greater impact on neonatal adiposity, neonates of women with lower diet quality had 24.9 g more fat mass comparatively. Hence, poor maternal diet quality has the ability to increase neonatal adiposity regardless of maternal BMI.

Another study on Middle-Eastern women showed that women having a pregestational BMI were at a 2.5 times higher risk of giving birth to low birth weight infants and having a smaller birth height compared to women with a normal BMI while obese women were at a 7.44 times higher risk of giving birth to macrosomic infants compared to women with a normal BMI.
 
References
Maternal Low Glycemic Index Diet, Fat Intake and Postprandial Glucose Influences Neonatal Adiposity-Secondary Analysis from the ROLO Study: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-78

Maternal Diet Quality in Pregnancy & Neonatal Adiposity: The Healthy Start Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356926/

Impact of Maternal Body Mass Index & Gestational Weight Gain on Neonatal Outcomes among Healthy Middle-Eastern Females: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181255

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