Associations between First Trimester Maternal Nutritional Score, Early Markers of Placental Function, and Pregnancy Outcome.

Francesca Parisi,Irene Cetin,Valeria M Savasi,Luca Mandia,Ilenia Di Bartolo

doi:10.3390/nu12061799

Francesca Parisi, Irene Cetin + Show 3 more

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https://doi.org/10.3390/nu12061799

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Abstract

This study investigated the associations between maternal adherence to a healthy diet, first trimester placental markers, and pregnancy outcome. Singleton spontaneous pregnancies were enrolled at 11+0–13+6 gestational weeks in a prospective cohort study. A nutritional score (0–10) measuring the adherence to a healthy diet was calculated. A transabdominal ultrasound scan for placental marker assessment was performed (uterine artery (UtA) doppler, placental volume). Biochemical placental markers were recorded (Pregnancy Associated Plasma Protein A (PAPP-A), free β- Human Chorionic Gonadotropin (HCG)). Birth outcomes were obtained from medical records. Associations between the maternal nutritional score, first trimester placental markers, and pregnancy outcome were investigated by using multi-adjusted general linear models. In total, 112 pregnancies were enrolled with a median nutritional score of 7 (range 3–10). Median gestational age at birth was 277 days (range 203–296). The nutritional score was positively associated with PAPP-A concentrations, whereas a negative association was detected with the UtA mean pulsatility index and placental volume. A positive association was detected between nutritional score and gestational age at birth. This study demonstrates that a first trimester nutritional score as a measure of adherence to a healthy diet is significantly associated with early biochemical and ultrasound markers of placental development, with further association with gestational age at birth.

Highlights

In the age of the obesity pandemic, an evolutionary revolution is underway in reproductive medicine: Maternal nutrition in pregnancy, as the main determinant of fetal nutrition, may lead to permanent modifications in fetal growth trajectories, gene expression, and metabolic pathways, which eventually will turn into a modified disease risk profile in postnatal life [1,2]
This study demonstrates that a first trimester nutritional score measuring the adherence to a healthy diet and lifestyle in pregnancy is significantly associated with early biochemical and ultrasound markers of placental development independently of pregestational BMI
Higher first trimester maternal nutritional scores were associated with increased plasma protein-A (PAPP-A) concentrations, lower

Summary

Introduction

In the age of the obesity pandemic, an evolutionary revolution is underway in reproductive medicine: Maternal nutrition in pregnancy, as the main determinant of fetal nutrition, may lead to permanent modifications in fetal growth trajectories, gene expression, and metabolic pathways, which eventually will turn into a modified disease risk profile in postnatal life [1,2]. Nutrients 2020, 12, 1799 antioxidants, one-carbon biomarkers, vitamin D) are important regulators of endothelial function, angiogenesis, and placental metabolic functions, explaining the association between micronutrient deficiencies in the periconceptional period, placental oxidative stress, and subsequent pregnancy complications, including preterm delivery and hypertensive disorders [4,5]. As single food items and micronutrients, without considering the composite biological interactions between nutrients, have shown inconclusive associations with complex health outcomes, recent research took into consideration maternal dietary patterns as potential predictors of adverse pregnancy and health outcomes [6]. Low adherence to the Mediterranean diet has been associated with several adverse outcomes, both in pregnancy (e.g., birth defects, gestational diabetes mellitus, hypertensive disorders) and childhood (e.g., atopy, cardiovascular risk profile, body composition) [7,8,9]

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