Abstract
Evidence that fetal nutrition influences adult health has heightened interest in nutritional interventions targeting pregnancy. However, as is true for other placental mammals, human females have evolved mechanisms that help buffer the fetus against short-term fluctuations in maternal diet and energy status. In this review, we first discuss the evolution of increasingly elaborate vertebrate strategies of buffering offspring from environmental fluctuations during development, including the important innovation of the eutherian placenta. We then present the Maternal Nutritional Buffering Model, which argues that, in contrast to many micronutrients that must be derived from dietary sources, the effects of short-term changes in maternal macronutrient intake during pregnancy, whether due to a deficit or supplementation, will be minimized by internal buffering mechanisms that work to ensure a stable supply of essential resources. In contrast to the minimal effects of brief macronutrient supplementation, there is growing evidence that sustained improvements in early life and adult pre-pregnancy nutrition could improve birth outcomes in offspring. Building on these and other observations, we propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself. Our model leads to the prediction that birth weight will be more strongly influenced by the mother’s chronic pre-pregnancy nutrition than by pregnancy diet, and highlights the need for policy solutions aimed at optimizing future, intergenerational health outcomes.Lay summary: We propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself.
Highlights
Work in the past three decades has highlighted the importance of prenatal nutrition as an influence on developmental and adult biology in offspring [1, 2]
Lay summary: We propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself
We argue that the effects of macronutrient supplementation during pregnancy on offspring size, a proxy of fetal nutrient availability, are dampened by homeostatic mechanisms that evolved to insulate the fetus against transient shifts in nutrient availability, including short-term nutrient deficiencies
Summary
Work in the past three decades has highlighted the importance of prenatal nutrition as an influence on developmental and adult biology in offspring [1, 2]. A predominant focus on retrospective studies, and on longitudinal cohort studies that collect observational data, means that few long-term studies have focused on developing maternal interventions to harness these periods of heightened developmental sensitivity to improve offspring health outcomes across the life course [9]. A study assessing the impacts of nutritional supplementation among 1296 pregnant women from rural villages in Burkina Faso found a modest, non-significant improvement in BW of 31 g among women in a mixed macroand micronutrient supplementation group relative to controls provided with multiple micronutrient supplements [16] These findings are consistent with the findings of a Cochrane Review evaluating the effects of this and 10 other balanced energy/protein supplementation trials in pregnancy among 5385 women that reported an average increase in offspring BW of only 41 g [17], or the equivalent of 1% of the average US BW of 3800 g.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
