Maternal Growth Research Articles

Translation of nutrient recommendations into personalized optimal diets for Chinese urban lactating women by linear programming models

BackgroundLactating women need to consume a high-quality diet to replete nutrient stores depleted during pregnancy and to ensure sufficient nutrition for breastfeeding. However, several studies reported suboptimal dietary quality and nutrient intake of lactating mothers in China. The objectives of this study was to apply dietary modeling method to develop individualized optimal diets, which meet the nutrient requirements for lactating women in urban China.MethodsData were collected from a sample of 576 lactating women from 0 to 240 days postpartum during the Maternal Infant Nutrition Growth study conducted between 2011 and 2012 in three cities including Beijing, Guangzhou, and Suzhou. Dietary intake data were collected with an interviewer-administered 24-h survey. Linear programming was applied to develop dietary plans that meet recommendations for lactation women in the China Dietary Reference Intakes 2013 and the Chinese Dietary Guideline 2016, while with least deviation from the observed dietary intake.ResultsThrough dietary modeling, individual optimal diets were developed for 576 lactating women. The optimal diets met all the food and nutrient intake constraints set in the linear programming models. The large difference between observed and optimized diets suggests that the nutrient needs of lactating mothers in China may only be met after substantial dietary changes. In addition, the analysis showed that it was difficult to meet the recommended intake for six nutrients: vitamin A, vitamin B1, vitamin B6, calcium, selenium, and dietary fiber. Moreover, four clusters in the optimized diets were identified by K-means cluster analysis. The four clusters confirmed that the optimal diets developed by linear programming could characterize the variety in dietary habits by geographical regions and duration of lactation.ConclusionLinear programming could help translate nutrient recommendations into personal diet advices for a sample of urban lactating mothers from China. The study showed that dietary modeling is helpful to support healthy eating of lactation women by translating dietary guidelines into personalized meal plans.Trial registrationThe Maternal Infant Nutrition Growth study was registered in ClinicalTrials.gov with identifier NCT01971671. Registration date October 29, 2013.

The Use of Biochemical and Biophysical Markers in Early Screening for Preeclampsia in Mongolia.

Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality, particularly in developing countries. In Mongolia, preeclampsia and eclampsia have occurred among pregnancy complications at a rate of 25% in recent years. Recent studies in the literature have screened for preeclampsia by combining maternal factors with biomarkers. This study was conducted using prospective cohort research including 393 singleton pregnancies at 11–13+6 weeks. Maternal plasmas pregnancy-associated plasma protein-A (PAPP-A) and maternal serum placental growth factor (PlGF) were measured using Perkin Elmer time-resolved fluoroimmunoassay (DELFIA) kits, and the measurement of mean arterial pressure (MAP) was performed by automated devices and the uterine artery pulsatility index was measured by Doppler ultrasound. In the study population, there were 16.7% showing complicated preeclampsia. The receiver-operating characteristics (ROC) curve analysis showed a sensitivity of 71.21%, and a specificity of 75.54% when the mean arterial pressure cut-off was 89.5 mm; while a sensitivity of 33.36% and specificity of 77.68% were observed when the uterine artery mean pulsatility index (mPI) cut-off was 2.34; a sensitivity of 79.66% and specificity of 44.04% were observed when the PAPP-A cut-off was 529.1 mU/L; and a sensitivity of 74.58% and specificity of 46.6% were observed when the PlGF cut-off was 39.87 pg/mL. The detection rates following the combination of markers with the maternal history were as follows: 62.7% with mean arterial pressure, 69.5–82.9% with two markers 86.5% with three markers and 91.4% with four markers. In conclusion, the mean arterial pressure was highly sensitive and demonstrated its easy usage and cost-effectiveness as a predictive marker for the early screening of preeclampsia from other biomarkers.

Transgenerational effect of maternal growth environment on flowering date in rice (Oryza sativa L.)

Flowering date reflects the adjustment of a plant’s growth period to a given environment. This is true of rice, which is a major food source around the world. We tested whether rice plants can recognize and record natural variation in their growth environments and thus control flowering in their progeny. We grew seedlings of two japonica cultivars from the same seed stock at two locations, in cool and warm climates, in Japan until they produced seeds. We then tested their progeny at the same locations. The progeny of mother plants of both cultivars grown in a cool climate flowered significantly earlier (by 1 to 6 days) than the progeny of mother plants grown in a warm climate. This transgenerational effect was partially explained by water temperatures during the vegetative growth stage. This is the first study to show the effect of transgenerational effect of natural environments on flowering date in rice.

In Overweight or Obese Pregnant Women, Maternal Dietary Factors are not Associated with Fetal Growth and Adiposity

The aim of our study was to evaluate associations between maternal dietary factors and fetal growth and adiposity in overweight and obese women. Women randomised to the ‘Standard Care’ group of the LIMIT trial were included. Maternal dietary factors including Healthy Eating Index, total energy, fat, carbohydrates, protein, glycaemic load and index were measured using the Harvard semi-quantitative Food Frequency questionnaire at time of study entry, 28 and 36 weeks’ gestation. Fetal ultrasound measurements of biometry and adiposity were obtained at 28 and 36 weeks’ gestation. Linear regression models were used to associate between dietary factors and fetal growth and adiposity measurements. There were 721 women included in this exploratory analysis. A 10 unit increase in the log total energy was associated with a reduction in mid-thigh lean mass by 4.94 mm at 28 weeks (95% CI −9.57 mm, −0.32 mm; p = 0.036) and 7.02 mm at 36 weeks (95% CI −13.69 mm, −0.35 mm; p = 0.039). A 10 unit increase in Healthy Eating Index score was associated with a reduced mean subscapular skin fold measure at 28 weeks by 0.17 mm (95% CI −0.32 mm, −0.03 mm; p = 0.021). We did not identify consistent associations between maternal diet and measures of fetal growth and adiposity in overweight and obese women.

Maternal Obesity, Diabetes during Pregnancy, Gestational Weight Gain, Breastfeeding, and Child’s BMI Growth Trajectory from Ages 2 to 6 Years

Limited studies have evaluated the interplay among maternal obesity, maternal diabetes including preexisting type 1 (T1D), type 2 (T2D) or gestational diabetes mellitus (GDM), excessive gestational weight gain (EGWG), and breast feeding (BF) in association with childhood growth trajectory. Here we assessed their associations with child’s BMI trajectory from ages 2 to 6 years. Data included 71,892 singleton children born at 28-44 gestational weeks in 2007-2011 at Kaiser Permanente Southern California hospitals who had at least 5 BMI measurements between ages 2 to 6. First, BMI trajectory patterns for these children were identified using group-based trajectory modeling method. Second, the relationships between maternal exposures and growth trajectory groups were evaluated using multinomial logistic regression adjusting for maternal age at delivery, race/ethnicity, education, and child’s sex. Three distinct BMI trajectory groups were identified: group 1 (59% of the cohort) had stable low BMI over time, group 2 (35% of the cohort) had stable median BMI over time, and group 3 (6% of the cohort) had high and increasing BMI over time. Relative to group 1, the adjusted odds ratio (OR[95% CI]) of being in group 3 associated with maternal exposures were 8.0 [7.3-8.8] for pre-pregnancy obesity, 2.8 [2.6-3.1] for pre-pregnancy overweight, 2.1 [1.2-3.8] for T1D, 1.7 [1.5-2.0] for T2D, 1.2 [1.1-1.4] for GDM, 1.5 [1.4-1.6] for EGWG, and 1.3 [1.2-1.4] for BF<6 months after adjusting for each other. ORs of being in group 2 were much smaller and were insignificant for T1D and GDM. Further adjustment for birth weight and gestational age at delivery had a small effect on the OR estimates but did not change the conclusion. Thus, among the four exposures, high and increasing BMI trajectory in offspring from age 2 to 6 years was strongly associated with maternal obesity and overweight; modestly with maternal T1D, T2D, and EGWG; and slightly with BF<6 months and GDM. Disclosure X. Wang: None. M.P. Martinez: None. A. Xiang: None.

Porcine somatic cell nuclear transfer donor sources affect transplant success: A meta-analysis

Herd boars, male domestic pigs used for stud, are economically important, and somatic cell nuclear transfer (SCNT) is a promising technology to expand herd boar yields. However, live births are dictated by donor cell source, and fetal donors may offer more advantages than adult donors. A meta-analysis was conducted to better understand how donor sources affect SCNT outcomes. Of the 1,431 records viewed, 10 were selected for review. Blastocyst formation rates, successful pregnancies, and live births were assessed to measure efficacy. SCNT blastocyst formation differed between adult and fetal donors among the studies. SCNT pigs had more malformed fetuses as well, which negatively affected the post-birth mortality. Organs of porcine fetuses are limited by deficiencies of maternal nutrient and growth hormones, which compromise post-birth adaptations. SCNT pregnancy success is neither determined by donor source nor by live births. Live births are also tied to donor age. Embryos from fetal donors are more frequently healthy likely due to less differentiation and less reprogramming of reconstructed embryos. Adult donors in contrast have more cell differentiation and as such accumulate more mutations and damage. This may reduce reconstructed embryo viability. Finally, SCNT efficiency may be improved with more in vitro passages, but more work is required to validate this concept.

Partitioning components of maternal growth to determine efficiency of feed use in gestating sows.

The objective of this study was to evaluate the effect of parity and stage of gestation on predicted maternal weight gain and efficiency of feed use in gestating sows from a commercial sow farm. A total of 712 females (Camborough, PIC, Hendersonville, TN) were group-housed from days 5 to 112 of gestation and individually fed with electronic sow feeders (ESF). Feed intake and body weight (BW) were recorded daily throughout gestation via the ESF and a scale located in an alleyway just after sows exited the feeding station. Gilts (parity 1) and sows received 6,450 or 7,418 kcal ME, respectively, whereas 12 thin females received 9,675 kcal ME per day. Maternal weight gain, not including products of conceptus, and feed efficiency were predicted using a series of equations to model nutrient utilization in gestation. Data were divided into 3 parity groups: 1, 2, and 3+, and gestation was divided into 3 periods: days 5 to 39, 40 to 74, and 75 to 109. After dividing energy requirements into tissue pools for maintenance, growth (maternal protein and fat deposition), and products of conceptus, the greatest portion of the energy requirement was for maintenance and maternal growth. The predicted energy used for maternal protein and fat deposition decreased (P < 0.05) in each period of gestation, regardless of parity group. Parity 2 sows had the greatest (P < 0.05) energy use for maternal protein and fat deposition in all stages of gestation, whereas parity 1 sows had a negative energy balance during the final stage of gestation. Parity 1 sow BW increased (P < 0.05) in each period of gestation; however, parity 2 and 3+ sow BW remained static from days 75 to 109 of gestation. Parity 3+ sows had the greatest (P < 0.05) maternal BW throughout the course of gestation compared with other parity groups. Regardless of parity, maternal ADG decreased (P < 0.05) from days 40 to 74 before increasing (P < 0.05) during the final stage of gestation. Parity 1 sows had the greatest (P < 0.05) ADG in all gestation periods. Parity 1 sow G:F decreased (P < 0.05) in each sequential period of gestation. Parity 2 and 3+ sow G:F decreased (P < 0.05) from days 40 to 74 but improved (P < 0.05) during the final period of gestation. Parity 1 sow G:F was greater than parity 2 and 3+ sows in most gestation periods. Overall, this study and subsequent prediction models show how stage of gestation and parity affect the growth of different tissue pools, sow maternal BW, and feed usage throughout the course of gestation.

Recognizing complex trauma in child welfare‐affected mothers of colour

AbstractChild welfare‐affected mothers of colour live with the deleterious effects of complex trauma unrecognized by the child welfare system. Child welfare system instead focuses on mothers' more overt functional difficulties, facilitating a misalignment between mothers' felt needs and mandated services. Qualitative data from a mixed‐methods study were used to explore the phenomenon of complex trauma in 20 urban‐dwelling mothers using a combined interpretive phenomenological and directed content analysis. Mothers experienced chronic and compound exposure to traumatic events. Themes of interpersonal violations of trust and pervasive mistrust of others, revictimization, absence of appropriate mental health treatment, and maternal growth emerged. Implications for utilizing a trauma‐informed approach for policy and practice are discussed.

Neonatal autonomic function after pregnancy complications and early cardiovascular development

BackgroundHeart rate variability (HRV) has emerged as a predictor of later cardiac risk. This study tested whether pregnancy complications that may have long-term offspring cardiac sequelae are associated with differences in HRV at birth, and whether these HRV differences identify abnormal cardiovascular development in the postnatal period.MethodsNinety-eight sleeping neonates had 5-min electrocardiogram recordings at birth. Standard time and frequency domain parameters were calculated and related to cardiovascular measures at birth and 3 months of age.ResultsIncreasing prematurity, but not maternal hypertension or growth restriction, was associated with decreased HRV at birth, as demonstrated by a lower root mean square of the difference between adjacent NN intervals (rMSSD) and low (LF) and high-frequency power (HF), with decreasing gestational age (p < 0.001, p = 0.009 and p = 0.007, respectively). We also demonstrated a relative imbalance between sympathetic and parasympathetic tone, compared to the term infants. However, differences in autonomic function did not predict cardiovascular measures at either time point.ConclusionsAltered cardiac autonomic function at birth relates to prematurity rather than other pregnancy complications and does not predict cardiovascular developmental patterns during the first 3 months post birth. Long-term studies will be needed to understand the relevance to cardiovascular risk.

Abstract MP68: Association of Clinical and Subclinical Blood Pressure Elevation During Pregnancy With Maternal Health and Risk of Neonatal Low Birth Weight

Introduction: Gestational hypertension is a leading cause of maternal mortality and fetal growth restriction (FGR). However, elevated maternal blood pressure at which trimester contributes to FGR is unknown, and whether gestational prehypertension (a systolic blood pressure [SBP] of 120 - 139 mmHg or a diastolic blood pressure [DBP] of 80 - 89 mmHg) is related with FGR and maternal health is not fully studied. Methods: We analyzed the relation of elevated gestational blood pressure with risk of neonatal low-birth-weight (LBW, birth weight &lt; 2,500 g) and maternal health throughout pregnancy in 21,620 women from a birth cohort in Wuhan, China. Maternal health indicators, including SBP and DBP, were clinically measured during up to 22 antenatal visits. LBW were acquired from medical records. Linear mixed models were used to evaluate the relations of maternal SBP and DBP with LBW. Logistic regressions were used to assess the associations of SBP and DBP in late pregnancy (38.3 weeks) with LBW. Linear regressions were used to evaluate the association of prehypertension/hypertension with indicators of maternal health. Results: Gestational blood pressure increases throughout pregnancy, but a significant elevation of SBP and DBP between 15 and 25 gestational weeks were only observed for women who later delivered LBW newborns. High gestational SBP (≥ 140 mmHg) or DBP (≥ 90 mmHg) was associated with a 220% or 98% higher risk of LBW ( P &lt; 0.03). Notably, preclinical high SBP (120 - 139 mmHg) was also associated with a 40% higher risk of LBW ( P = 0.036). At late pregnancy, elevated gestational SBP and DBP were associated with elevated liver enzymes, blood urea nitrogen, creatinine, and uric acid levels, and decreased activated partial thromboplastin time and prothrombin time. Conclusions: A fast blood pressure elevation in the second trimester may relate with increased risk of LBW. Pregnancy prehypertension was associated with not only LBW risk, but also impaired maternal liver, kidney, and coagulation functions.

Maternal chitosan oligosaccharide supplementation during late gestation and lactation affects offspring growth

Chitosan oligosaccharide (COS), a natural compound derived from chitin, has growth promotion property. However, the nature of the relationship between maternal COS supplementation and offspring growth is not yet understood. Therefore, we intended to determine the effects of maternal COS supplementation in late gestation and lactation on the offspring growth performance. Twenty-four pregnant Yorkshire sows were distributed into two equal groups (n = 12) and fed either with a basal diet (control group) or a basal diet containing 100 mg/kg COS, from gestation day 85 until lactation day 21. Serum samples were collected from six sows of average body weight, from each group on farrowing day (lactation day 1) and lactation day 21, whereas colostrum and milk samples were respectively obtained on lactation days 1 and 21. We found that maternal COS supplementation significantly increased (p < .05) the average piglet weaning weight per litter. Supplementation of COS in the sow diet elevated (p < .05) the serum interleukin-10, immunoglobulin A (IgA) and IgM concentrations, as well as total antioxidant capacity. Moreover, higher (p < .05) colostrum IgM and milk lactose contents were simultaneously observed in COS-treated sows compared to the control sows. In summary, COS supplementation during late gestation and lactation can boost antioxidant capacity and humoural immunity of sows, and contributes to improving colostrum and milk quality, ultimately, enhancing the offspring growth performance.

A Novel Case of Biliary Atresia in a Premature Neonate With 1p36 Deletion Syndrome.

We describe the case of a premature male neonate diagnosed with biliary atresia who was found to have chromosome 1p36 deletion syndrome. Our patient was born prematurely, at a gestational age of 28 weeks. Pregnancy was complicated by advanced maternal age, gestational hypertension, and intrauterine growth restriction. Physical examination revealed several dysmorphic features, prompting a genetic evaluation, which revealed chromosome 1p36 deletion syndrome. At week 7 of life, he was found to have acholic stools. Direct bilirubin was found to be elevated despite discontinuation of total parenteral nutrition at 3 weeks of life, thus raising the suspicion for biliary atresia. Biliary atresia was confirmed by constellation of clinical, imaging and intraoperative findings. First reported in 1996, 1p36 deletion syndrome has been researched increasingly and several new phenotypic associations have been reported over the years. While attempts at linking specific phenotypic abnormalities with individual gene(s) deletion(s) are being made, deletion patterns that would affect specific organ system or function remain to be fully understood. Thus, clinicians currently rely on reports of previously identified abnormalities. To our knowledge, our patient is the first report of biliary atresia in a patient with chromosome 1p36 deletion syndrome. It is important to determine the etiology of the cholestasis, when present, while caring for premature neonates with 1p36 deletion syndrome. This is necessary to avoid assuming that the cholestasis is arising from total parenteral nutrition administration and not from other gastrointestinal anomalies including biliary atresia, which is a time-sensitive diagnosis.

Therapeutic Effect of Long-Term Epidural Block in Rats with Pregnancy Induced Hypertension

Background Pregnancy induced hypertension (PIH) causes a variety of systemic disorders that negatively affect the maternal placenta and fetal growth. Epidural sympathetic block elicits symptoms of decreased blood pressure. This study was designed to determine the therapeutic effect of long-term epidural block in rats with PIH. Methods Forty healthy pregnant Sprague Dawley rats were randomized into four groups with each group consisting of 10 rats. On gestation day (GD) 14, rats in control group underwent a sham procedure; rats in RUPP group were operated on to obtain reduced uterine perfusion pressure (RUPP); rats in RUPP plus normal saline (NS) group were also subjected to the RUPP procedure and underwent epidural block with 25 μl normal saline twice daily until delivery; rats in RUPP plus epidural block (EB) group were treated as those in RUPP plus NS group except that an epidural block with 25 μl of 0.125% bupivacaine was administered two times per day until delivery. On GD 20, blood pressure was measured in all groups before delivery, and blood samples were collected in order to quantify the serum concentrations of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase 1 (sFlt-1). Results The mean arterial pressure (MAP) of rats in RUPP group (147.6 ± 6.0 mmHg) was markedly increased when compared with control group (80.8 ± 4.6 mmHg) (p < 0.05). The MAP of rats in RUPP plus EB group (114.4 ± 7.2 mmHg) was clearly decreased in contrast with RUPP group but was still higher than in control group (p < 0.05). The variation of fetal weight in all groups followed a similar trend to that of MAP. However, there were no significant differences between control group and RUPP plus EB group with respect to placental weight (p = 0.186). Variation in MAP was positively correlated with the expression of sFlt-1 in each group but was negatively correlated with VEGF. Conclusion This study demonstrates that long-term epidural block decreases blood pressure in PIH rats and improves the serum concentrations of VEGF and sFlt-1. Taken together, long-term epidural block may have a potential role in PIH treatment.

Maternal growth restriction and stress exposure in rats differentially alters expression of components of the placental glucocorticoid barrier and nutrient transporters

The placenta plays a major role in the development of fetal growth restriction, which affects 10% of pregnancies and contributes to chronic adult disease risk. We have reported that female rats born small develop cardiometabolic dysfunction only during pregnancy. The physiological tests performed during pregnancy induced a maternal stress response as indicated by increased maternal corticosterone concentrations. This stress effected placental growth compared to females who were unhandled during pregnancy. Maternal stress and growth restriction independently program F2 offspring metabolic dysfunction. This study investigated the effects of maternal stress and growth restriction on placental and fetal metabolic parameters that may contribute to F2 offspring metabolic disease. Maternal growth restriction reduced F2 fetal weight whilst maternal stress reduced placental weight. Stressed mothers had reduced insulin and increased glucose concentrations, changes that were reflected in the fetus. Fetal β-cell number was reduced by maternal growth restriction, but was increased by stress exposure. Maternal growth restriction reduced placental Slc2a1, Igf2, Slc38a2 and Nr3c1 gene expression. Maternal stress decreased the expression of Slc2a1, Igf2, Slc38a2, Nr3c1, Slc2a3, Slc2a4, Nr3c2, Hsd11b2, Crhr1 and Ogt. Maternal birth weight effects on fetal weight were likely due to changes in placental nutrient transporter and Igf2 expression. On the contrary, maternal stress induced a systemic effect by altering maternal metabolic parameters, placental gene expression and fetal glucose and insulin concentrations. This study highlights the importance of informing pregnant women on effective ways to cope with stress during pregnancy to prevent adverse long-term disease outcomes in their children.

Effect of maternal vitamin D3 supplementation on maternal health, birth outcomes, and infant growth among HIV-infected Tanzanian pregnant women: study protocol for a randomized controlled trial

BackgroundVitamin D has significant immunomodulatory effects on both adaptive and innate immune responses. Observational studies indicate that adults infected with HIV with low vitamin D status may be at increased risk of mortality, pulmonary tuberculosis, and HIV disease progression. Growing observational evidence also suggests that low vitamin D status in pregnancy may increase the risk of adverse birth and infant health outcomes. As a result, antiretroviral therapy (ART) adjunct vitamin D3 supplementation may improve the health of HIV-infected pregnant women and their children.Methods/designThe Trial of Vitamins-5 (ToV5) is an individually randomized, double-blind, placebo-controlled trial of maternal vitamin D3 (cholecalciferol) supplementation conducted among 2300 HIV-infected pregnant women receiving triple-drug ART under Option B+ in Dar es Salaam, Tanzania. HIV-infected pregnant women of 12–27 weeks gestation are randomized to either: 1) 3000 IU vitamin D3 taken daily from randomization in pregnancy until trial discharge at 12 months postpartum; or 2) a matching placebo regimen. Maternal participants are followed-up at monthly clinic visits during pregnancy, at delivery, and then with their children at monthly postpartum clinic visits. The primary efficacy outcomes of the trial are: 1) maternal HIV disease progression or death; 2) risk of small-for-gestational age (SGA) births; and 3) risk of infant stunting at 1 year of age. The primary safety outcome of the trial is incident maternal hypercalcemia. Secondary outcomes include a range of clinical and biological maternal and child health outcomes.DiscussionThe ToV5 will provide causal evidence on the effect of vitamin D3 supplementation on HIV progression and death, SGA births, and infant stunting at 1 year of age. The results of the trial are likely generalizable to HIV-infected pregnant women and their children in similar resource-limited settings utilizing the Option B+ approach.Trial registrationClinicalTrials.gov identifier: NCT02305927. Registered on 29 October 2014.

Abstract P302: Nicotinamide Ameliorates IgA Nephropathy and Pregnancy Outcome in Pregnant Grouped-ddy Mice

Objective: IgA nephropathy (IgAN) affects women in childbearing ages. We have reported that nicotinamide (Nam) ameliorates a preeclampsia (PE)-like condition and pregnancy outcome in PE mouse models ( PNAS 2016, AJP 2017). Our preliminary data show that pregnant grouped ddY (gddY) mice, a model of IgAN, have PE-like phenotype and adverse pregnancy outcome. The aim of the present study is to clarify whether Nam ameliorates IgAN and pregnancy outcome in pregnant gddY mice. Design and Method: Pregnant gddY mice 9-11 weeks of age were divided into four groups (gddY, gddY+Nam, gddY+sFlt-1, and gddY+sFlt-1+Nam). PE-like phenotype was induced by administering sFlt-1 adenovirus (4x10 8 pfu) at 14.5 dpc. Nam 500 mg/kg/day was administered daily using gavage from 12.5 dpc. Age-matched pregnant slc:ddY mice were used as a control. Results: Compared with control ddY mice, gddY mice showed higher SBP and urinary albumin excretion (Fig. 1), and smaller litter size and fetal weights. Moreover, gddY+sFlt-1 mice showed severe endotheliosis and poor pregnancy outcome. Nam alleviated hypertension, albuminuria (Fig. 1), mesangial expansion and endotheliosis in gddY and gddY+sFlt-1 mice. In addition, Nam prolonged pregnancy period of gddy+sFlt-1 mice. Fetal weights from gddY+Nam mice, and gddY+sFlt-1+Nam mice were larger than those of gddY and gddY+sFlt-1 mice. Conclusions: Nam alleviated maternal hypertension, proteinuria and fetal growth restriction in pregnant gddY and gddY+sFlt-1 mice. Nam could help treat maternal IgAN with pregnancy and PE with IgAN.

The relationship between maternal body composition in early pregnancy and foetal mid-thigh soft-tissue thickness in the third trimester in a high-risk obstetric population

Maternal obesity is an emerging challenge in contemporary obstetrics. To date there has been no study analysing the relationship between specific maternal body composition measurements and foetal soft-tissue measurements. The aim of this study was to determine whether measurement of maternal body composition at booking predicts foetal soft-tissue trajectories in the third trimester. We analysed the relationship between foetal thigh in the third trimester and both maternal BMI and body composition using the Tanita digital scales in the first trimester. Foetal subcutaneous thigh tissue measurements were obtained at intervals of 28, 32 and 36 weeks of gestation. A total of 160 women were identified. There was a direct correlation between MTST at 36 weeks and BMI (p = .002). There was a positive correlation between MTST at 36 weeks and leg fat mass (p = .13) and leg fat free mass (p = .013). There was a positive correlation between arm fat free mass and MTST at 36 weeks. We showed there is an association between maternal fat distribution and foetal subcutaneous thigh tissue measurements. MTST may be more useful in determining if a child is at risk of macrosomia.Impact statementPrevious studies have suggested that maternal obesity programmes intrauterine foetal adiposity and growth. The aim of this study was to examine the relationship in a high-risk obstetric population between measurements of maternal body composition in early pregnancy and the assessment of foetal adiposity in the third trimester using serial ultrasound measurements of mid-thigh soft-tissue thickness. BMI is only a surrogate measurement of fat and does not measure fat distribution. Our study shows the distribution of both maternal fat and fat-free mass in early pregnancy may be positively associated with foetal soft-tissue measurements in the third trimester. Maternal arthropometric measurements other than BMI may help predict babies at risk of macrosomia and neonatal adiposity.

Gain-of-Function Mutants of the Cytokinin Receptors AHK2 and AHK3 Regulate Plant Organ Size, Flowering Time and Plant Longevity.

The phytohormone cytokinin is a regulator of numerous processes in plants. In Arabidopsis (Arabidopsis thaliana), the cytokinin signal is perceived by three membrane-located receptors named ARABIDOPSIS HISTIDINE KINASE2 (AHK2), AHK3, and AHK4/CRE1. How the signal is transmitted across the membrane is an entirely unknown process. The three receptors have been shown to operate mostly in a redundant fashion, and very few specific roles have been attributed to single receptors. Using a forward genetic approach, we isolated constitutively active gain-of-function variants of the AHK2 and AHK3 genes, named repressor of cytokinin deficiency2 (rock2) and rock3, respectively. It is hypothesized that the structural changes caused by these mutations in the sensory and adjacent transmembrane domains emulate the structural changes caused by cytokinin binding, resulting in domain motion propagating the signal across the membrane. Detailed analysis of lines carrying rock2 and rock3 alleles revealed how plants respond to locally enhanced cytokinin signaling. Early flowering time, a prolonged reproductive growth phase, and, thereby, increased seed yield suggest that cytokinin regulates various aspects of reproductive growth. In particular, it counteracts the global proliferative arrest, a correlative inhibition of maternal growth by seeds, an as yet unknown activity of the hormone.

Impact of donor and recipient adiposity on placental and fetal growth in adolescent sheep.

The influence of maternal obesity during oocyte development and its putative interaction with nutrient reserves at conception on pregnancy outcome were examined in an adolescent sheep model. Donor ewes were nutritionally managed to achieve contrasting adiposity (control (CD)/obese (ObD)) for 6 weeks prior to superovulation and inseminated by a non-obese sire. Morulae from 6 CD and 7 ObD were transferred in singleton into adolescent recipients of identical age but differing adiposity, classified as relatively fat or thin respectively. Thereafter, all were overnourished to promote rapid growth/adiposity (2 × 2 design, 13/14 pregnancies/group). A fifth recipient group of intermediate adiposity received embryos from another 5 CD, was offered a moderate intake to maintain adiposity throughout gestation and acted as controls for normal pregnancy outcome (optimally treated control (OTC), 19 pregnancies). Donor obesity did not influence ovulation, fertilisation or recovery rates or impact embryo morphology. Gestation length and colostrum yield were unaffected by donor or recipient adiposity and were reduced relative to OTC. Total fetal cotyledon and lamb birth weights were independent of initial donor adiposity but reduced in relatively thin vs relatively fat recipients and lower than those in the OTC group. In spite of high placental efficiency, the incidence of fetal growth restriction was greatest in the thin recipients. Thus, maternal adiposity at conception, but not pre-conception maternal obesity, modestly influences the feto-placental growth trajectory, whereas comparison with the OTC indicates that high gestational intakes to promote rapid maternal growth remain the dominant negative influence on pregnancy outcome in young adolescents. These findings inform dietary advice for pregnant adolescent girls.

A mixed methods study to assess the effectiveness of food-based interventions to prevent stunting among children under-five years in Districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol

BackgroundMaternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to prevent stunting in children under-five years.MethodsA mixed methods study design will be conducted to evaluate the effectiveness of food-based interventions to prevent stunting among children under-five years in districts Thatta and Sujawal, Sindh Province, Pakistan. The study will include cross sectional surveys, a community-based cluster randomized controlled trial and a process evaluation. The study participants will be pregnant women, lactating mothers and children under-five years. The cross-sectional surveys will be conducted with 7360 study participants at baseline and endline. For the randomized control trial, 5000 participants will be recruited and followed monthly for compliance of food-based supplements, dietary diversity, pregnancy outcomes, and maternal and child morbidity and mortality. Anthropometric measurements and hemoglobin levels will be measured at baseline, quarterly and at endline. The interventions will consist of locally produced lipid-based nutrient supplement (Wawamum) for children 6–23 months, micronutrient powders for children 24–59 months, and wheat soya blends for pregnant and lactating mothers. Government lady health workers will deliver interventions to participants. The effectiveness of the project will be measured in terms of the impact of the proposed interventions on stunting, nutritional status, micronutrient deficiencies, and other key indicators of the participants. The process evaluation will assess the acceptability, feasibility and potential barriers of project implementation through focus group discussions, key informant interviews and household surveys. Data analysis will be conducted using STATA version 12.DiscussionThere is considerable evidence on the effectiveness of food-based interventions in managing stunting in developing countries. However, these studies do not account for the local environmental factors and widespread nutrient deficiencies in Pakistan. These studies are often conducted in controlled environments, where the results cannot be generalized to programs operating under field conditions. The findings of this study will provide sufficient evidence to develop policies and programs aimed to prevent stunting in children 6–59 months and to improve maternal and child health and growth outcomes in poor resource settings.Trial registrationNCT02422953. Registered on April 15, 2015.