Maternal Dietary Habits Research Articles

OC06.07: Changes in fetal ductus arteriosus dynamics following restriction of polyphenol-rich foods in late pregnancy

Since we have previously demonstrated that maternal ingestion of polyphenol-rich foods (herbal teas, dark chocolate, grape and orange juices, berries, and others) may cause fetal ductal constriction by inhibition of prostaglandin synthesis, we tested the hypothesis that ductus arteriosus dynamics improves in third trimester fetuses whose mothers are submitted to a flavonoid-poor diet for a period superior to two weeks. 46 fetuses above 28 weeks of gestation were submitted to two Doppler echocardiographic studies with an interval of at least two weeks. Ductal velocities (DV) (systolic and diastolic), ductal pulsatility index (PI) and right to left ventricular dimensions ratio (RV/LV) were assessed. In the first evaluation, the examiners were blinded to maternal dietary habits. After the echocardiographic study, a detailed food frequency questionnaire based on validated instruments was applied and a diet based on flavonoid-poor foods (less than 30 mg/100g of food) was recommended. T test for independent samples was used, with a critical p < 0.05. Mean gestational age was 33 ± 3 weeks (28–38 weeks). Mean daily maternal estimated flavonoid intake was 1277 mg. After dietary orientation, mean daily flavonoid consumption decreased to 126 mg (p = 0.0001). Comparing the two echocardiographic studies, significant decreases in DV and RV/LV ratio and increase in ductal PI were observed [systolic velocity = 1.2 ± 0,4m/s (0.7–1.7) to 0, 9 ± 0.3m/s (0.6–1.3) (p = 0.018); diastolic velocity = 0.21 ± 0.09m/s (0.15–0.38) to 0.18 ± 0.06m/s (0.11–0,25) (p = 0.016); RV/LV = 1.3 ± 0.2 (0.9–1.5) to 1.1 ± 0.2 (0.8–1.4) (p = 0.004); ductal PI = 2.2 ± 0.3 (1.6–2.7) to 2.4 ± 0.4 (1.9–2.9) (p = 0.04)]. A flavonoid-rich diet during third trimester may interfere with fetal ductal flow dynamics, this effect being reversed by decreasing maternal intake of these foods.

The complex relationship between folate/homocysteine metabolism and risk of Down syndrome

Folates are essential nutrients that are required for one-carbon biosynthetic and epigenetic processes. A deficiency in cellular folates results in aberrant DNA methylation, point mutations, chromosome breakage, defective chromosome recombination and aneuploidy. In 1999 it was first reported that impairments in folate/homocysteine metabolism, due to genetic polymorphisms of metabolic enzymes, could increase the risk for having an infant with Down syndrome (DS). That paper stimulated considerable investigation into the possible role of folate/homocysteine metabolism in the risk of having a DS child and several studies have been performed so far in different countries to better address this issue. However, despite 10 years of active research, the question is still unsolved. Overall, both in vitro and in vivo studies indicate that an impaired folate/homocysteine metabolism can result in chromosome 21 nondisjunction; however, the birth of a DS child seems to be the result of the interplay of several factors of genetic, epigenetic, environmental, and stochastic origin, making it difficult to discriminate the single contribution of each of them. My opinion is that it is now time for the design of a collaborative study large enough to have the power to separate trisomy 21 into all its component parts and to test for the contribution of folate/homocysteine gene polymorphisms to each of them. This study should be paralleled by in vitro and in vivo studies aimed at clarifying the contribution, if any, of folate/homocysteine metabolism to the methylation pattern of regions involved in recombination and segregation of chromosome 21. Further studies are also required to address the possible contribution of both the paternal diet and the maternal grandmother dietary habits to chromosome 21 nondisjunction events.

Exposure to persistent organic pollutants in utero and related maternal characteristics on birth outcomes: A multivariate data analysis approach

Persistent organic pollutants (POPs) have the capacity to pass through the placental barrier and into the fetal blood stream, and pose health risks to fetuses and neonates who are believed to be more vulnerable to the effects of environmental pollutants. In this study, the prevalence of POPs, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs) and polybrominated biphenyl ethers (PBDEs), were determined in 41 cord blood samples collected during the year 2006 in Singapore. The effects of these xenobiotics and the maternal characteristics on fetal growth and development were explored using multivariate data analysis (MVA) techniques, including partial least-squares regression (PLSR) and discriminant analysis (PLS–DA). POPs were found in all cord blood samples, corroborating the transplacental transfer (TPT) of these xenobiotics. Chlordanes and PCBs were observed to have adverse effects on fetal growth (i.e. birth weight, length, head circumference) and health (as indicated by Apgar scores), indicating the chemical exposure in utero could also be deemed as an influential factor on fetal growth, even at the normal doses in general population. Maternal height, weight, ethnicity, dietary habits and lifestyle were also the determinants for the neonatal variables. Exposure to POPs may alter maternal hormone levels, which could regulate the offspring sex. Trans-chlordane, p,p′-DDE, p,p′-DDT and PCB 138 and 158 were speculated as testosterone triggers which lead to more baby boys, while the effects of β-HCH and PCB 180 were opposite.

Cover Picture – Mol. Nutr. Food Res. 4/2008

AbstractRegular issues provide a wide range of research and review articles covering all aspects of Molecular Nutrition &amp; Food Research.Selected topics of issue 4 are: Phenolics from purple grape and apple and their prevention of early atherosclerosis .Proliferation inhibition of human bladder cancer cells by the grape and wine constituent piceatannol Anticancer actions of natural and synthetic vitamin E Maternal dietary habits and mycotoxins occurrence in human mature milk

Maternal dietary habits and mycotoxin occurrence in human mature milk

During 2006, 82 samples of human mature milk were collected at Italian hospitals and checked for aflatoxin M1 (AFM1) and ochratoxin A (OTA) by immunoaffinity column extraction and HPLC. AFM1 was detected in four (5%) of milk samples (ranging from < 7 ng/L to 140 ng/L; mean level: 55.35 ng/L); OTA was detected in 61 (74%) of milk samples (ranging from < 5 ng/L to 405 ng/L; mean level: 30.43 ng/L. OTA levels were significantly higher (p less, not double equals 0.05) in milk of habitual consumers of bread, bakery products and cured pork meat. No other statistically significant differences were observed although habitual consumers of pasta (p = 0.059), cookies (p = 0.061) and juices (p = 0.063) had mean contamination values of OTA higher than the moderate consumer. The very few AFB1 positive samples did not allow statistical comparisons. The present study confirms that the occurrence of OTA in human milk is related to maternal dietary habits. The findings support the possibility of dietary recommendations to woman, during pregnancy and lactation, aimed to tentatively reduce the OTA contamination of human milk.

Body mass index, alcohol, tobacco and symptomatic gallstone disease: a Swedish twin study

Both genetic and environmental factors are involved in the pathogenesis of gallstone disease (GD). We aimed to examine the association between symptomatic GD and overweight (body mass index, BMI, 25-30 kg m(-2)), obesity (BMI > 30 kg m(-2)), alcohol, smoking and smoke-free tobacco by analysing a large twin population. The Swedish Twin Registry (STR) was linked to the Swedish Hospital Discharge and Causes of Death Registries for GD and GD-surgery related diagnoses. Weight, height, use of alcohol, smoking and smoke-free tobacco were provided by STR and analysed for possible associations by conditional logistic regression. Overweight and obesity were associated with a significantly higher risk for symptomatic GD in the whole study population (OR 1.86 and OR 3.38; CI: 1.52-2.28 and 2.28-5.02 respectively). High alcohol consumption was associated with a lower risk for GD in the whole population (OR 0.62; CI: 0.51-0.74) with no difference between discordant monozygotic and dizygotic twins (OR 1.08 and OR 0.96; CI: 0.82-1.42 and 0.79-1.16). Smoking or smoke-free tobacco was not correlated with GD. Consistent with epidemiological studies, we found positive associations between BMI and the development of symptomatic GD. High alcohol consumption was associated with a decreased risk against GD. Tobacco use has no impact on GD.

OC98: Is maternal intake of green tea and other polyphenol‐rich beverages associated with ductal constriction in human fetuses?

This study provides clinical evidence pointing toward corroboration of the hypothesis that maternal consumption of widely used polyphenol-rich substances, such as herbal teas and grape juice, during pregnancy could be associated with fetal ductal constriction (DC), as a result of prostaglandin inhibition-mediated anti-inflammatory effects of the catechin components of these beverages. All third-trimester fetuses with ductal constriction from November 2005 to March 2007 were included in this report. Maternal dietary habits as well as usage of any medicines were thoroughly investigated. Fifty-four third-trimester fetuses with DC with a mean gestational age of 33 ± 3 weeks (range, 28–40 weeks) were reviewed. In 41 fetuses (76%), there was evidence of maternal ingestion of polyphenol-rich beverages (MIPRB) at least three times a week. None of these fetuses had been exposed to non-steroidal anti-inflammatory drugs during pregnancy. A control echocardiogram was obtained 1–3 weeks after discontinuation of these substances in 30 fetuses. Twenty-nine (96%) showed important improvement or complete recovery of the signs of DC. A decrease in mean ductal peak systolic velocity (1.71 ± 0.29 m/s to 1.37 ± 0.34 m/s, P = 0.0001) and mean peak diastolic velocity (0.36 ± 0.07 m/s to 0.24 ± 0.05 m/s, P = 0.0001), with an increase in mean ductal pulsatility index (1.70 ± 0.41 to 2.19 ± 0.43, P = 0.001) were observed. Maternal ingestion of substances containing polyphenols is very common in fetuses with DC and discontinuing these beverages results in improvement in the vast majority of cases.

Relationship of nutrient intakes and bone mineral density of elderly women in Daegu, Korea

The purpose of this study was to examine the relationship between nutrient intake and bone mineral density (BMD) of elderly women in Daegu, Korea. In this study, the bone mineral densities of 101 elderly women in Daegu were measured, and their nutrient intake, dietary habits, and maternal factors were determined through a survey. The subjects were divided into the normal group, the osteopenia group, and osteoporosis group to find out if there is a correlation between bone mineral density and maternal factors, dietary habits, and nutrient intake through their T-scores, analyzed according to the standards of WHO. Classification by T-scores of the participants were the normal group 25.7%, the osteopenia group 39.6%, the osteoporosis group 34.7%. Menopause age of the osteoporosis group was lower, postmenopausal period was longer, and last delivery age was significantly higher than the normal group (p<0.05). Osteoporosis group had a lower percentage of 'everyday' fruit and vegetable intakes and higher percentage of 'never' dairy intake than of the normal group. Vitamin A, vitamin B1, and vitamin B2 intakes of participants in the osteoporosis group were lower than those in the normal group (p<0.05). In conclusion, nutritional education is necessary to encourage high intake of milk and vegetables and fruits along with calcium, vitamin A, B1, and B1 intakes and low intake of sodium for the prevention of elderly women's osteoporosis.

Cadmium quantification in Brazilian mothers colostrum: a regional study

OBJECTIVES: to estimate the amount of cadmium in human colostrum of mothers from Taubaté. METHODS: it was a cross-sectional study with mothers who delivered in University Hospital of Taubaté, in year 2003. The colostrum was collected in special tubes, one day after the delivery and frozen at -200 C. The independent variables were maternal age, birthweight, gestational age, parity, dietary habits, smoking report and maternal occupation. Cadmium was quantified by atomic absorption spectrometry. It was used Mann-Whitney non-parametric approach to compare mean values; Pearson correlation was also used to verify associations. The level of significance was alpha = 5%. RESULTS: the mean value of cadmium was 54.5 mg/L (sd=381.0 mg/L). Cadmium was detected in 18 out of 58 samples (31.0%). There was neither correlation nor differences between the cadmium values and the independent variables maternal age, birthweight, gestational age, parify and smoking report. CONCLUSIONS: these values are above those the amounts described in other papers and it is important to identify the possible sources of this heavy metal in maternal environment.

Mercury and lead during breast-feeding.

Hg and Pb are of public health concern due to their toxic effects on vulnerable fetuses, persistence in pregnant and breast-feeding mothers, and widespread occurrence in the environment. To diminish maternal and infant exposure to Hg and Pb, it is necessary to establish guidelines based on an understanding of the environmental occurrence of these metals and the manner in which they reach the developing human organism. In the present review, environmental exposure, acquisition and storage of these metals via maternal-infant interaction are systematically presented. Though Hg and Pb are dispersed throughout the environment, the risk of exposure to infants is primarily influenced by maternal dietary habits, metal speciation and interaction with nutritional status. Hg and Pb possess similar adverse effects on the central nervous system, but they have environmental and metabolic differences that modulate their toxicity and neurobehavioural outcome in infant exposure during fetal development. Hg is mainly found in protein matrices of animal flesh (especially fish and shellfish), whereas Pb is mainly found in osseous structures. The potential of maternal acquisition is higher and lasts longer for Pb than for Hg. Pb stored in bone has a longer half-life than monomethyl-mercury acquired from fish. Both metals appear in breast milk as a fraction of the levels found in maternal blood supplied to the fetus during gestation. Habitual diets consumed by lactating mothers pose no health hazard to breast-fed infants. Instead, cows' milk-based formulas pose a greater risk of infant exposure to neurotoxic substances.

Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation

To investigate the relation between maternal smoking habits, plasma lipids and milk fatty acid (FA) content and composition. Breastfeeding mothers who gave birth to healthy, full-term infants were recruited. Mothers were interviewed on smoking habits, being defined smokers (S) when usually smoking at least five cigarettes per day before pregnancy. Department of Pediatrics, San Paolo Hospital, Milan, Italy. In total, 92 mothers: 61 non-S (NS) and 31 S. Pooled hindmilk was collected at the first raise of milk (colostrum stage), 1, 3 and 6 months, and total lipid (TL) content and fatty acid (FA) composition were evaluated. Maternal dietary habits were assessed by a food-frequency questionnaire. Two subsamples (16 NS, 6 S) were investigated after delivery and at 3 months for serum lipids and FA status. At 6 months after delivery, the number of mothers still breastfeeding decreased to 30. Variables were compared using nonparametric tests. In smoking mothers serum levels of triglycerides, cholesterol and low-density lipoproteins were higher, while those of high-density lipoproteins were lower. TL content in breast milk was similar in the two groups just after delivery but higher in milk from NS at 1 month. TL content and FA absolute amounts of linoleic, arachidonic, alpha-linolenic and docosahexaenoic (DHA) acid in breast milk were lower in S vs NS 1 month after delivery. Also 3 months after delivery, the breast milk of smoking mothers contained less DHA than the breast milk of nonsmoking mothers. Maternal cigarette smoking in early pregnancy is associated with higher plasma lipid levels and lower milk TL and DHA content in the first months of lactation.

Fetal Alcohol Syndrome

1. Helen M. Thackray, MD* 2. Cynthia Tifft, MD, PhD† 1. 2. *Clinical Fellow, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD. 3. 4. †Chair, Department of Medical Genetics, Children’s National Medical Center, Washington, DC. Objectives After completing this article, readers should be able to: 1. Describe the signs of fetal alcohol syndrome in the context of in utero exposure to alcohol. 2. Describe the relationship of facial characteristics and neuorobehavioral findings in fetal alcohol syndrome with age. 3. Compare and contrast the neurobehavioral aspects of children who have fetal alcohol syndrome with children who have other diagnoses and similar intelligence quotients. 4. Delineate the causes of fetal alcohol syndrome. Alcohol is the most common human teratogen, but its significant physical and neurobehavioral effects are completely preventable. Fetal alcohol syndrome (FAS) was described initially in case reports by Lemoine in 1968 and Jones and Smith in 1973. It is a pattern of physical, behavioral, and cognitive abnormalities seen in individuals exposed to alcohol in utero. The association between these findings and maternal use of alcohol during pregnancy has been well documented, with studies in both animals and humans suggesting teratogenicity from as little as one binge drinking episode in early pregnancy. The diagnostic criteria are not a result of fetal physical dependence or addiction or the presence of alcohol in the neonate at delivery; rather, they are teratogenic effects caused by in utero exposure to alcohol in the mother’s blood. In 1996, following a congressional mandate that the Institute of Medicine and National Academy of Sciences study FAS and related birth defects, these institutions published a review of the current understanding of FAS and revised the diagnostic criteria. Despite increased awareness of this preventable birth defect, new cases continue to occur in significant numbers and are routinely under-recognized by medical personnel. It is imperative that maternal alcohol use and its sequelae be considered and addressed in daily pediatric practice. The purpose of this article is to review the diagnosis, epidemiology, management, prognosis, and prevention of FAS. FAS represents a …

Delayed evoked potentials in children exposed to methylmercury from seafood.

Methylmercury poisoning may cause constriction of visual fields and deafness, especially if exposure occurs prenatally. However, the risks associated with exposure from contaminated seafood is unclear. We examined 149 children attending first grade in a Madeiran fishing community. As maternal dietary habits were relatively unchanged, current maternal hair concentrations were used as indicator of the child's prenatal exposure to methylmercury (geometric average, 9.64 microg/g [48.2 nmol/g]). After adjustment for age and sex, the mean (+/-SD) latency of peak III of the brainstem auditory evoked potentials at 40 Hz was increased by 0.128+/-0.047 ms when maternal hair-mercury concentrations exceeded 10 microg/g (50 nmol/g) (p for association, 0.002), and the increase of the N145 pattern-reversal visual evoked potential latency at 15 minutes of arc was 3.16+/-1.57 ms (p for association, 0.002). No such relationships were seen with the child's own hair-mercury concentration, and other clinical examinations revealed no mercury-associated deficits. Neurophysiological evidence of adverse effects on brain function are relatively independent of confounders, and should be considered in the risk assessment of this seafood pollutant.

Does antenatal care influence postpartum health behaviour? Evidence from a community based cross-sectional study in rural Tamil Nadu, South India.

To study the association between attendance to antenatal care and postpartum health behaviour among women in rural Tamil Nadu, South India. Community based, cross-sectional questionnaire study of 30 randomly selected areas served by health subcentres. Rural parts of Salem District, Tamil Nadu, South India. 1321 women who were delivered in the six months before the questionnaire-based interview. Feeding of colostrum, time of initiation of breastfeeding and maternal dietary habits during the first month postpartum. The median number of antenatal visits was four (range 0-51; lower quartile 3, upper quartile 7)., The fifth month of pregnancy was the median time for the initiation of antenatal care. Pregnant women 1. who had a large number of antenatal care visits, 2. who initiated antenatal care in the first trimester or 3. who reported having received information about breastfeeding were more likely to feed colostrum (odds ratio 1.48; 95% CI 1.06 to 2.07), (odds ratio 1.40; 95% CI 1.06 to 1.85), (odds ratio 1.66; 95% CI 1.29 to 2.14, respectively). Only women who reported having received information about breastfeeding were more likely to initiate early breastfeeding (odds ratio 1.81; 95% CI 1.34 to 2.43). Use of antenatal care facilities was not associated with maternal postpartum dietary habits. A large number of women attended antenatal care in the study area, but antenatal care had a limited effect on postpartum health behaviour. As antenatal care is considered an essential part of primary health care and takes up considerable resources, we recommend further research to explain the gap between the intentions of antenatal care and the actual outcome of such care.

Dietary habits, prepregnancy weight, and weight gain during pregnancy. Risk of pre term rupture of amniotic sac membranes.

Premature rupture of amniotic sac membranes (PROM) is associated with perinatal morbidity and mortality. A matched case-control study was undertaken to determine whether dietary habits, prepregnancy weight, and weight gain during pregnancy were associated with increased risks for PROM. Three study groups were defined, consisting of women delivering pre term with PROM (PP), full term with PROM (FP), and pre term without PROM (PWP). Cases were singly matched by race, age, and parity with women having full term deliveries without PROM. Data were collected by face-to-face structured interviews with eligible subjects and by medical records abstraction. Conditional multiple logistic regression indicated that during pregnancy, PP cases were significantly more likely to have gained less than 21 pounds (9.5 kg) (OR = 2.7, CI = 1.14-6.36) and were only half as likely as controls to have improved their diet (OR = 0.43, CI = 0.18-0.99) while controlling for cigarette smoking, urinary tract infection, chorioamnionitis, chlamydia, and a history of previous PROM. FP cases were significantly less likely than controls to have gained 31-40 pounds (14-18 kg) while pregnant (OR = 0.56, CI = 0.33-0.94) and were significantly more likely than controls to have a somewhat inadequate pregnancy diet (OR = 2.05, CI = 1.11-3.77) while controlling for a history of previous PROM. PWP cases were significantly less likely to have gained 31-40 pounds (14-18 kg) (OR = 0.42, CI = 0.21-0.84) or greater than 40 pounds (18 kg) (OR = 0.37, CI = 0.17-0.80) while pregnant or to have had adequate dairy products intake (OR = 0.60, CI = 0.36-0.99) while controlling for cigarette usage. Maternal dietary habits, weight gain during pregnancy, and supplement intake are associated with the occurrence of both pre term and full term PROM and pre term delivery without PROM.

The Role of Lipids in Nutrition during the First Months of Life

The most important functional components of dietary lipids (triglycerides, cholesterol esters and phospholipids) are fundamental to normal growth and development of infants. Fatty acids are classified according to their chain length and their degree of saturation. Each class of fatty acid is involved in specific metabolic reactions: short-chain fatty acids act as local growth factors in the colon; medium- and saturated long-chain fatty acids are a good source of energy; polysaturated long-chain fatty acids are involved in metabolic regulation; and very long-chain fatty acids are important structural components of membranes. The development of the central nervous system depends on the amount and the quality of the lipid supply in the last months of prenatal and the first months of postnatal life. Placental cord blood during foetal life and breast milk provide fatty acids in the correct amounts and ratios. Fats in breast milk provide half the infant's calorific needs and maternal dietary habits can influence the lipid composition of milk. The preparation of blends of fats for formulas is under investigation in order to improve the lipid quality and to make formulas more similar to breast milk. A major goal of current research is to define the nutritional and metabolic relationships between fatty acid groups and between fats and the other dietary sources of calories in order to improve the composition of infant formulas, in particular for premature babies.