Pre-pregnancy fat intake in relation to hypertensive disorders of pregnancy

Dietary fat intake with risk of gestational diabetes mellitus and preeclampsia: a systematic review and meta-analysis of prospective cohort studies

CONTEXT

Gestational diabetes mellitus (GDM) and preeclampsia (PE) are commonly observed medical complications in pregnancy. Dietary total fat and fatty acids associated with GDM and PE risk have been examined in several epidemiological studies. In some instances, systematic reviews and meta-analyses might provide more accurate dietary recommendations.

OBJECTIVES

This systematic review and dose-response meta-analysis was conducted to investigate the association between dietary total fat and fatty acids and the risk of GDM and PE.

DATA SOURCES

Research on dietary fat intake and the risk of GDM and PE was conducted through systematic searches of the PubMed, Scopus, and Web of Science databases for articles published up to August 19, 2023. An investigation of associations between dietary intake of total fat and fatty acids and the risk of GDM and PE was performed using prospective cohort study designs.

RESULTS

Twenty-one prospective cohort studies were considered eligible. Findings indicated that higher intakes of total fat (relative risk [RR], 1.08; 95% confidence interval [CI], 1.02-1.14), animal fat (RR, 1.56; 95%CI, 1.34-1.89), vegetable fat (RR, 1.23; 95%CI, 1.05-1.45), dietary cholesterol (RR, 1.48; 95%CI, 1.10-2.00), and omega-3 fatty acid (RR, 1.11; 95%CI, 1.02-1.20) are associated with a greater risk of GDM. However, no significant association was found between dietary total fat and fatty acids and the risk of PE. Dose-response meta-analyses suggested every 10% increment in total energy intake from total fat, 5% from animal fat, 5% from vegetable fat, and 100 mg from cholesterol was related to 15%, 12%, 7%, 14%, and 20% higher GDM risk, respectively.

CONCLUSIONS

Overall, total fat, animal fat, vegetable fat, dietary cholesterol, and omega-3 fatty acid consumption are associated with a small but statistically significant increase in GDM risk.

PROTOCOL REGISTRATION

PROSPERO (CRD42023466844).

Maternal fatty acid intake and human embryonic growth: the Rotterdam Periconception Cohort

The required intake of macronutrients by women during the periconceptional period for optimal fetal growth is the subject of ongoing investigation. Intake of polyunsaturated fatty acids (PUFA) is positively associated with fetal neural development, growth velocity and birth weight. However, limited evidence indicates that PUFAs play a role in embryogenesis. We aim to investigate the associations between maternal PUFA dietary intake and first trimester embryonic volume (EV) and head volume (HV). In a prospective cohort study (2013-2020), 464 pregnant women at < 8 weeks of gestation were included. Maternal dietary intake of PUFAs, including omega 3 (docosahexaenoic acid, DHA and eicosapentaeonic acid, EPA) and 6, was obtained from food frequency questionnaires, and first trimester three-dimensional ultrasound examinations were performed to measure EV and HV using Virtual Reality techniques. More than 70% of the population had omega 3 intakes below recommendations. A higher intake of PUFAs was associated with a smaller embryonic HV/EV ratio after adjusting for confounders (EPA p = 0.012, DHA p = 0.015, omega 3 and 6 p < 0.001), but no associations were found with EV or HV alone. Omega 3 from fish oil supplements alone was not associated with embryonic growth. Strong adherence to a PUFA-rich dietary pattern was associated with a smaller embryonic HV/EV ratio (DHA and EPA-rich diet p = 0.054, PUFA-rich diet p = 0.002). It is important to increase awareness of the high prevalence of omega 3-deficiency among pregnant women, and the opportunity for prevention by increasing PUFA intake, thereby reducing the risks of adverse pregnancy outcomes which originate during the periconceptional period.

Macronutrient and Micronutrient Intake Among US Women Aged 20 to 44 Years

Importance

Nutritional status before and during pregnancy is important for maternal health and fetal growth and development.

Objective

To describe secular trends in nutrient intake from foods, beverages, and supplements among pregnant and nonpregnant women of reproductive age in the US.

Design, Setting, and Participants

This was a secondary series of cross-sectional analyses of the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Pregnant (n = 1392) and nonpregnant (n = 9737) women aged 20 to 44 years who provided at least 1 reliable dietary recall were included for analysis. These analyses were performed between February 2022 and July 2024.

Main Outcomes and Measures

The primary outcomes included the mean usual intake of macronutrients and micronutrients, as well as the prevalence of inadequate intake of micronutrients.

Results

This representative sample included 1392 pregnant women (mean [SE] age, 28.5 [0.3] years) and 9737 nonpregnant women (mean [SE] age, 32.2 [0.1] years). Among pregnant women, a weighted mean (SE) of 27.0% (1.8%) of women were in their first trimester, and 33.8% (2.2%) were in their second trimester. Mean (SE) carbohydrate intake decreased between 1999-2000 and 2013-2018 among pregnant women (306.9 [7.6] to 274.9 [5.7] g/d; β = -2.1 [0.4]; P < .001) and between 1999-2000 and 2017-2018 among nonpregnant women (251.9 [4.9] to 216.9 [3.3] g/d; β = -1.9 [0.4]; P = .002). Between 1999-2000 and 2013-2018, the proportion of pregnant women who consumed below the Estimated Average Requirement of vitamin A increased by 10.9 percentage points (pp) (95% CI, 5.2-16.7 pp), and the proportion of pregnant women who consumed below the Estimated Average Requirement of vitamin C increased by 8.9 pp (95% CI, 3.9-14.0 pp). Similarly, the proportion of nonpregnant women with inadequate intake of vitamin A, vitamin C, and iron increased by 19.9 pp (95% CI, 12.3-27.5 pp), 11.1 pp (95% CI, 4.5-17.7 pp), and 4.9 pp (95% CI, 1.7-8.2 pp), respectively, between 1999-2000 and 2017-2018. The mean (SE) calcium intake increased from 1120.6 (41.4) to 1308.7 (49.0) mg/d for pregnant women (β = 11.7 [4.3]; P = .03) and from 849.5 (19.8) to 981.2 (27.9) mg/d for nonpregnant women (β = 6.7 [2.6]; P = .03; β2 = -1.3 [0.2]; P < .001). Among pregnant women, the prevalence of inadequate intake decreased by 16.1 pp (95% CI, 8.3-23.9 pp) for magnesium (P < .001) and 33.2 pp (95% CI, 24.0-42.4 pp) for vitamin K (P < .001); among nonpregnant women, the proportion with inadequate intake decreased by 16.1 pp (95% CI, 10.4-21.7 pp) for calcium (P < .001), 15.5 pp (95% CI, 7.3-23.6 pp) for magnesium (P < .001), and 33.3 pp (23.5-43.0 pp) for vitamin K (P < .001).

Conclusions and Relevance

This cross-sectional study of pregnant and nonpregnant women of reproductive age found that vitamin A, vitamin C, and iron intake decreased over the past 2 decades, which may have substantial maternal and fetal health implications. By identifying these nutrient gaps and trends in inadequate intake in this at-risk population, scientific, health care, and regulatory communities may be better poised to adopt recommendations to improve nutrient intake.

Therapeutic potential of Omega-3 polyunsaturated fatty acids on the immune function of patients with hypertensive disorder complicating pregnancy and preeclampsia

BACKGROUND

This paper aims to explore the mechanism of Omega-3 polyunsaturated fatty acids (PUFA) on the immune function of patients having pregnancy induced hypertension (PIH).

METHODS

Through a retrospective study, 168 patients with PIH syndrome who were cured at the First Affiliated Hospital of Hebei North University (January 2020 to December 2021) were randomly divided into the Omega-3 treated group and the control group, with 84 cases in each group. The control group received treatment with magnesium sulfate. The other group was treated with PUFAs based on the magnesium sulfate treatment. To evaluate the differences in diastolic pressure, systolic pressure and inflammatory factors between the Omega-3 treated group and control group, statistical analysis was conducted using SPSS 23.0 software. The measurement data were subject to t-test, and x 2 test was adopted for counting data.

RESULTS

The treatment efficiency of the Omega-3 treated group and the control group was 95.24% and 80.95%, respectively, with a significant difference (P<0.05). Before receiving treatment, there was no difference in diastolic and systolic pressure, various inflammatory factors and various immune functions between these two groups (P>0.05). The group treated with omega-3 had lower CD3+, CD4+ and the CD4+/CD8+ ratio than the control group (P<0,05). The Omega-3 treated group had significantly higher IL-4 and CD8+ than those in the control group (P<0.05).

CONCLUSION

Intravenous injection of Omega-3 can reduce blood pressure, improve immune function, and reduce inflammatory reactions in patients with gestational hypertension.

Preconception diet in adolescence and its association with hypertensive disorders of pregnancy and preterm birth. Results from the HUNT study

Our aim was to estimate associations of adolescent dietary patterns and meal habits with hypertensive disorders of pregnancy (HDP) and preterm birth. We used data from a prospective cohort study (Norwegian Young-HUNT1) where dietary information was collected during adolescence and pregnancy outcomes were obtained through record linkage to the Norwegian national birth registry. The outcomes were HDP, hypertension, pre-eclampsia/eclampsia, and preterm birth in the first pregnancy and in any pregnancy. Diet was self-reported from validated questionnaires, and exposures were dietary indexes (healthy; unhealthy; fruit and vegetable; fibre index) and meal habits. Recruitment took place in schools. Eligible participants were females aged 13-19 years at the time of dietary assessment with a subsequent singleton pregnancy (n 3622). Women who reported a higher fibre intake in adolescence had a lower risk of pre-eclampsia in the first pregnancy (Relative Risk: 0·84; 95 % CI 0·7, 1·0), although this was weaker in sensitivity analyses. Regular meal habits in mid-adolescence (aged 13-15 years), particularly breakfast and lunch, were weakly associated with a lower risk of hypertension in pregnancy. Our results are the first to indicate an association between aspects of diet and dietary behaviour in mid-adolescence and subsequent HDP. More evidence is needed from larger studies to replicate the results and from alternative study designs to disentangle causality.

Paradoxes: Cholesterol and Hypoxia in Preeclampsia

Preeclampsia, a hypertensive disease of pregnancy of unknown etiology, is intensely studied as a model of cardiovascular disease (CVD) not only due to multiple shared pathologic elements but also because changes that develop over decades in CVD appear and resolve within days in preeclampsia. Those affected by preeclampsia and their offspring experience increased lifetime risks of CVD. At the systemic level, preeclampsia is characterized by increased cellular, membrane, and blood levels of cholesterol; however, cholesterol-dependent signaling, such as canonical Wnt/βcatenin, Hedgehog, and endothelial nitric oxide synthase, is downregulated indicating a cholesterol deficit with the upregulation of cholesterol synthesis and efflux. Hypoxia-related signaling in preeclampsia also appears to be paradoxical with increased Hypoxia-Inducible Factors in the placenta but measurably increased oxygen in maternal blood in placental villous spaces. This review addresses the molecular mechanisms by which excessive systemic cholesterol and deficient cholesterol-dependent signaling may arise from the effects of dietary lipid variance and environmental membrane modifiers causing the cellular hypoxia that characterizes preeclampsia.

Bioactive metabolites of OMEGA-6 and OMEGA-3 fatty acids are associated with inflammatory cytokine concentrations in maternal and infant plasma at the time of delivery

BACKGROUND & AIMS

Inflammation is necessary for a healthy pregnancy. However, unregulated or excessive inflammation during pregnancy is associated with severe maternal and infant morbidities, such as pre-eclampsia, abnormal infant neurodevelopment, or preterm birth. Inflammation is regulated in part by the bioactive metabolites of omega-6 (n-6) and omega-3 (n-3) fatty acids (FAs). N-6 FAs have been shown to promote pro-inflammatory cytokine environments in adults, while n-3 FAs have been shown to contribute to the resolution of inflammation; however, how these metabolites affect maternal and infant inflammation is still uncertain. The objective of this study was to predict the influence of n-6 and n-3 FA metabolites on inflammatory biomarkers in maternal and umbilical cord plasma at the time of delivery.

METHODS

Inflammatory biomarkers (IL-1β, IL-2, IL-6, IL-8, IL-10, and TNFα) for maternal and umbilical cord plasma samples in 39 maternal-infant dyads were analyzed via multi-analyte bead array. Metabolites of n-6 FAs (arachidonic acid and linoleic acid) and n-3 FAs (eicosapentaenoic acid and docosahexaenoic acid) were assayed via liquid chromatography-mass spectrometry. Linear regression models assessed relationships between maternal and infant inflammatory markers and metabolite plasma concentrations.

RESULTS

Increased plasma concentrations of maternal n-6 metabolites were predictive of elevated pro-inflammatory cytokine concentrations in mothers; similarly, higher plasma concentrations of umbilical cord n-6 FA metabolites were predictive of elevated pro-inflammatory cytokine concentrations in infants. Higher plasma concentrations of maternal n-6 FA metabolites were also predictive of elevated pro-inflammatory cytokines in infants, suggesting that maternal n-6 FA status has an intergenerational impact on the inflammatory status of the infant. In contrast, maternal and cord plasma concentrations of n-3 FA metabolites had a mixed effect on inflammatory status in mothers and infants, which may be due to the inadequate maternal dietary intake of n-3 FAs in our study population.

CONCLUSIONS

Our results reveal that maternal FA status may have an intergenerational impact on the inflammatory status of the infant. Additional research is needed to identify how dietary interventions that modify maternal FA intake prior to or during pregnancy may impact maternal and infant inflammatory status and associated long-term health outcomes.