Abstract
Pregnancy offers a window of opportunity to program the future health of both mothers and offspring. During gestation, women experience a series of physical and metabolic modifications and adaptations, which aim to protect the fetus development and are closely related to both pre-gestational nutritional status and gestational weight gain. Moreover, pre-gestational obesity represents a challenge of treatment, and nowadays there are new evidence as regard its management, especially the adequate weight gain. Recent evidence has highlighted the determinant role of nutritional status and maternal diet on both pregnancy outcomes and long-term risk of chronic diseases, through a transgenerational flow, conceptualized by the Development Origin of Health and Diseases (Dohad) theory. In this review we will analyse the physiological and endocrine adaptation in pregnancy, and the metabolic complications, thus the focal points for nutritional and therapeutic strategies that we must early implement, virtually before conception, to safeguard the health of both mother and progeny. We will summarize the current nutritional recommendations and the use of nutraceuticals in pregnancy, with a focus on the management of pregnancy complicated by obesity and hyperglycemia, assessing the most recent evidence about the effects of ante-natal nutrition on the long-term, on either maternal health or metabolic risk of the offspring.
Highlights
Pregnancy is a period of physical, hormonal and humoral changes, aimed to ensure the development and the necessary supply of nutrients to the fetus, and to prepare the maternal organism to delivery and breastfeeding
A study comparing metabolic outcome in offspring 15 years after GDM pregnancies observed that daughters of mothers with GDM had higher waist circumference and insulin resistance compared to daughters of non-GDM mothers, but maternal body mass index (BMI) was the strongest predictor of child adiposity [167]
We should be aware that specific maternal conditions during the preand peri-conceptional period are associated with higher risk of maternal complications and LGA infants, with obesity and impaired glucose metabolism in children and, subsequently, with increased cardiometabolic risk in adults
Summary
Pregnancy is a period of physical, hormonal and humoral changes, aimed to ensure the development and the necessary supply of nutrients to the fetus, and to prepare the maternal organism to delivery and breastfeeding. Discussing within the context of diabetes in pregnancy, he introduced the concept of fuel-mediated teratogenesis, i.e. alterations during cell differentiation, and fetal organogenesis induced by excessive exposure to nutrients of the fetal-placental unit, which have immediate, but mostly long-term consequences on metabolic and anthropometric functions [7] In recent years, this topic extended to the theory of “developmental origins of health and disease” (DOHaD). The placental changes throughout pregnancy may reflect adaptive responses to protect the fetus from the adverse metabolic environment, such as fatty acids storage in lipid droplets by the syncytiotrophoblast; when more marked metabolic conditions are determined, such as grade III obesity or severe maternal hypetriglyceridemia, the placenta is no longer able to accumulate lipids, with a consequent spillover towards the fetus [42]. In pregnancies complicated by obesity or GDM, the expression levels of placental molecules are disrupted, and this lack of balance may be associated with other metabolic complications [44]
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