Role of nutrition in the risk of preeclampsia

Targeting oxidative stress in preeclampsia

Preeclampsia is a complex condition characterized by elevated blood pressure and organ damage involving kidneys or liver, resulting in significant morbidity and mortality for both the mother and the fetus. Increasing evidence suggests that oxidative stress, often caused by mitochondrial dysfunction within fetal trophoblast cells may play a major role in the development and progression of preeclampsia. Oxidative stress occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the capacity of antioxidant defenses, which can lead to placental cellular damage and endothelial cell dysfunction. Targeting oxidative stress appears to be a promising therapeutic approach that has the potential to improve both short- and long-term maternal and fetal outcomes, thus reducing the global burden of preeclampsia. The purpose of this review is to provide a comprehensive account of the mechanisms of oxidative stress in preeclampsia. Furthermore, it also examines potential interventions for reducing oxidative stress in preeclampsia, including natural antioxidant supplements, lifestyle modifications, mitochondrial targeting antioxidants, and pharmacological agents.A better understanding of the mechanism of action of proposed therapeutic strategies targeting oxidative stress is essential for the identification of companion biomarkers and personalized medicine approaches for the development of effective treatments of preeclampsia.

Adherence to different forms of plant-based diets and pregnancy outcomes in the Danish National Birth Cohort: A prospective observational study

INTRODUCTION

The number of people adhering to plant-based diets has been increasing dramatically in recent years, fueled by both environmental and animal welfare concerns. Beneficial or possible adverse consequences of such diets, particularly the most restrictive forms during pregnancy, have been minimally explored. The aim of this prospective observational study was to examine associations between different forms of plant-based diets during pregnancy with birth outcomes and pregnancy complications.

MATERIAL AND METHODS

The Danish National Birth Cohort included 100 413 pregnancies to 91 381 women in 1996-2002. The population consisted of 66 738 pregnancies, about which sufficient dietary data were available and included in the study. Dietary and supplemental intake was assessed by Food Frequency Questionnaire in gestational week 25 and women were characterized as fish/poultry-vegetarians, lacto/ovo-vegetarians, vegans or omnivorous, based on their self-report in gestational week 30. Main outcome measures were pregnancy and birth complications, birthweight and small for gestational age.

RESULTS

A total of 98.7% (n = 65 872) of participants were defined as omnivorous, whereas 1.0% (n = 666), 0.3% (n = 183) and 0.03% (n = 18) identified themselves as fish/poultry vegetarians, lacto/ovo-vegetarians or vegans, respectively. Protein intake was lower among lacto/ovo-vegetarians (13.3%) and vegans (10.4%) than among omnivorous participants (15.4%). Intake of micronutrients was also considerably lower among vegans, but when dietary supplements were taken into consideration, no major differences were observed. Compared with omnivorous mothers, vegans had a higher prevalence of preeclampsia and their offspring had on average -240 g (95% confidence interval -450 to -30) lower birthweight.

CONCLUSIONS

The women reporting that they adhered to vegan diets during pregnancy had offspring with lower mean birthweight and higher risk of preeclampsia compared with omnivorous mothers. Low protein intake might be one plausible explanation for the observed association with birthweight.

Associations of dietary patterns and pre-eclampsia: a matched case-control study

Little is known about the effects of dietary patterns on prevalent pre-eclampsia in Chinese population. This study aimed to investigate the associations between dietary patterns and the odds of pre-eclampsia among Chinese pregnant women. A 1:1 age- and gestational week-matched case-control study was conducted between March 2016 and February 2019. A total of 440 pairs of pre-eclampsia cases and healthy controls were included. Dietary intakes were assessed by a seventy-nine-item FFQ and subsequently grouped into twenty-eight distinct groups. Factor analysis using the principal component method was adopted to derive the dietary patterns. Conditional logistic regression was used to analyse the associations of dietary patterns with prevalent pre-eclampsia. We identified four distinct dietary patterns: high fruit-vegetable, high protein, high fat-grain and high salt-sugar. We found that high fruit-vegetable dietary pattern (quartile (Q)4 v. Q1, OR 0·71, 95 % CI 0·55, 0·92, Ptrend = 0·013) and high protein dietary pattern (Q4 v. Q1, OR 0·72, 95 % CI 0·54, 0·95, Ptrend = 0·011) were associated with a decreased odds of pre-eclampsia in Chinese pregnant women. Whereas high fat-grain dietary pattern showed a U-shaped association with pre-eclampsia, the lowest OR was observed in the third quartile (Q3 v. Q1, OR 0·75, 95 % CI 0·57, 0·98, Ptrend = 0·111). No significant association was observed for high salt-sugar dietary pattern. In conclusion, pregnancy dietary pattern characterised by high fruit-vegetable or high protein was found to be associated with a reduced odds of pre-eclampsia in Chinese pregnant women.

Potential mechanisms and modulators of food intake during pregnancy

Dietary choice during pregnancy is crucial not only for fetal development, but also for long-term health outcomes of both mother and child. During pregnancy, dramatic changes in endocrine, cognitive, and reward systems have been shown to take place. Interestingly, in different contexts, many of these mechanisms play a key role in guiding food intake. Here, we review how food intake may be impacted as a function of pregnancy-induced changes across species. We first summarize changes in endocrine and metabolic signaling in the course of pregnancy. Then, we show how these may be related to cognitive function and reward processing in humans. Finally, we link these to potential drivers of change in eating behavior throughout the course of pregnancy.

Low Prognostic Nutritional Index Contributes to High Adverse Events in Preeclampsia

Background

Preeclampsia (PE) is a common obstetric complication that has caused significant harm to pregnant mothers. The clinical significance of poor nutritional status in PE patients is unclear. The aim of our study was to evaluate the nutritional status as measured by the prognostic nutritional index (PNI) score at admission, and its ability to predict in-hospitalization adverse events in patients with PE.

Methods

We enrolled patients diagnosed with PE in the Third Affiliated Hospital of Guangzhou Medical University from January 2019 to December 2021. Patients were divided into low and high nutritional status group according to the cut-off value of PNI score at admission using the receiver operating characteristic (ROC) curve. PNI score were used to explore the relationship between PNI score and in-hospitalization adverse events presented with hazard ratio (HR) and 95% confidence intervals (CI).

Results

A total of 733 patients were included in the study. The proportion of adverse events and admission to intensive care unit (ICU) was higher in the low nutritional status group than in the high nutritional status group (P < 0.05). ROC curve analysis revealed an area under curve (AUC) of 0.628 for PNI score and the cut-off value of PNI was 37. The free-event rates determined by KM analysis were significantly lower in the low nutritional status compared to the high nutritional status (P < 0.05). Adjusted multivariate analysis showed that PNI score was independently associated with favorable outcomes (HR: 2.66; 95% CI: 1.724-4.050, P < 0.001).

Conclusion

High PNI score at admission was associated with reduced in-hospitalization risk of adverse events in patients with PE. Additional enhancing nutritional status during hospitalization may help to prevent unfavorable prognosis in clinical practices.

Maternal nutritional risk factors for pre-eclampsia incidence: findings from a narrative scoping review

BACKGROUND

Pre-eclampsia is a leading cause of maternal mortality and morbidity that involves pregnancy-related stressors on the maternal cardiovascular and metabolic systems. As nutrition is important to support optimal development of the placenta and for the developing fetus, maternal diets may play a role in preventing pre-eclampsia. The purpose of this scoping review is to map the maternal nutritional deficiencies and imbalances associated with pre-eclampsia incidence and discuss evidence consistency and linkages with current understandings of the etiology of pre-eclampsia.

METHODS

A narrative scoping review was conducted to provide a descriptive account of available research, summarize research findings and identify gaps in the evidence base. Relevant observational studies and reviews of observational studies were identified in an iterative two-stage process first involving electronic database searches then more sensitive searches as familiarity with the literature increased. Results were considered in terms of their consistency of evidence, effect sizes and biological plausibility.

RESULTS

The review found evidence for associations between nutritional inadequacies and a greater risk of pre-eclampsia. These associations were most likely mediated through oxidative stress, inflammation, maternal endothelial dysfunction and blood pressure in the pathophysiology of pre-eclampsia. Maternal nutritional risk factors for pre-eclampsia incidence with the strongest consistency, effect and biological plausibility include vitamin C and its potential relationship with iron status, vitamin D (both on its own and combined with calcium and magnesium), and healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood and monounsaturated vegetable oils. Foods high in added sugar, such as sugary drinks, were associated with increased risk of pre-eclampsia incidence.

CONCLUSION

A growing body of literature highlights the involvement of maternal dietary factors in the development of pre-eclampsia. Our review findings support the need for further investigation into potential interactions between dietary factors and consideration of nutritional homeostasis and healthy dietary patterns. Further research is recommended to explore gestational age, potential non-linear relationships, dietary diversity and social, cultural contexts of food and meals.

Macro- and Micronutrient of Junk Food and Preeclampsia on Pregnant Women

BACKGROUND: Preeclampsia (PE) is still a global public health issue in developed and developing countries. It is a major contributor to maternal and fetal morbidity and mortality. The pathophysiology of preeclampsia during pregnancy is unclear, but the WHO reported that PE is higher in developing countries than developed ones due to lifestyle and nutritional status. AIM: This study aimed to describe the influence of macro- and micronutrients of junk food on PE. METHODS: This case–control study was carried out on 148 samples, including pregnant women with preeclampsia (n = 74) and normal pregnant women (n = 74) with gestational age > 20 weeks. Data on junk food intake were collected using the SQ-FFQ form and then estimated using the Nutri Survey. Data were analyzed in SPSS version 17 using descriptive statistics. Pearson correlation coefficient was used to observe the correlation between variables with p < 0.05 and 95% confidence interval. RESULTS: Binary logistic regression revealed that the intake of fat (p = 0.005), vitamin C (p = 0.002), and sodium (p = 0.036) contained in the junk food were significantly associated with PE. The frequency of consumption of junk food also had a significant effect on the incidence of preeclampsia (p = 0.013). CONCLUSION: Intake of fat, vitamin C, and sodium were associated with PE, and they were risk factors of PE. The frequency of consuming junk food gave more risk to have PE.

Maternal Amino Acid Status in Severe Preeclampsia: A Cross-Sectional Study

Introduction: Preeclampsia has been one of the leading causes of maternal death in Indonesia. It is postulated that its relationship with oxidative stress may be the underlying pathology of the disease. Nutrients and amino acids have been suggested as a scavenger for oxygen-free radicals. No previous study regarding the amino acid status in preeclampsia has been conducted in women in Indonesia. Methods: This was a cross-sectional study of a total of 64 pregnant women, 30 with normal pregnancy and 34 with severe preeclampsia. Data were obtained in Cipto Mangunkusumo National Referral Hospital in Jakarta from July to December 2020. Maternal blood samples were taken during or soon after delivery. Amino acid levels were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bivariate analysis was then performed. Results: We identified 19 different levels of amino acids in this study. Four amino acids that were elevated in the preeclampsia group were phenylalanine, serine, glycine, and glutamate. Serine (331.55 vs. 287.43; p = 0.03), glycine (183.3 vs. 234.35, p = 0.03), and glutamate levels (102.23 vs. 160.70, p = 0.000) were higher in preeclamptic patients. While in the essential amino acids group, phenylalanine levels (71.5 vs. 85.5, p = 0.023) were higher, and methionine levels (16.3 vs. 12.9, p = 0.022) were lower in preeclamptic patients. Conclusions: These findings suggest that severe preeclampsia had differences in concentration of some amino acids compared to normal pregnancy. Glutamate and methionine were associated with preeclampsia. Furthermore, a more detailed study regarding amino acids in the pathomechanism of preeclampsia is suggested.

The association between food groups and preeclampsia: a case-control study

PURPOSE

The aim of current study was to investigate the correlation between preeclampsia and food groups among pregnant women.

METHODS

This case-control study was done on pregnant women with a diagnosis of preeclampsia in Sabzevar. The control group was included non-infected postpartum women.

RESULTS

Intake of vegetables (OR = 0.952, CI: 0.724-0.985, p < 0.001), fruits (OR = 0.901, CI: 0.852-0.990, p = 0.012), nuts and legumes (OR = 0.712, CI: 0.531-0.848, p = 0.009), and sugars and sweets (OR = 1.254, CI: 1.112-1.497, p < 0.001) were related to the odds of preeclampsia.

CONCLUSIONS

Women with preeclampsia had lower intake of vegetables, fruits, milk and products, and also fluids. Intake of sugars and sweets compared with the intake of vegetables, fruits, nuts, and legumes was associated with increasing odds of preeclampsia.

Eating habits and history of hyperemesis gravidarum as a risk factor of preeclampsia

OBJECTIVE

This study aimed to determine the relationship between eating habits and hyperemesis gravidarum with preeclampsia incidence.

METHOD

This study used a cross-sectional design. The total sample was 48 pregnant women with normal and preeclamptic pregnancies who had a gestational age above 20 weeks, collecting data using a questionnaire and data analysis using the chi-square test and odds ratio (OR).

RESULTS

The habit of eating irregular fruit during pregnancy was significantly associated with the incidence of preeclampsia, with an OR value of 8.57. Mothers who had hyperemesis gravidarum increased their risk 3.86 times for developing preeclampsia.

CONCLUSION

Eating habits and history of hyperemesis gravidarum is a risk factor of preeclampsia. Nutritional intervention is needed through nutrition education for pre-pregnant women so that their nutritional adequacy during pregnancy can be fulfilled, especially during the 1st trimester, namely the implantation phase and socialization of the community movement program for healthy living, especially the consumption of vegetables and fruits for women of childbearing age, women during pre-pregnancy, pregnant and breastfeeding.

Effect of low trans-fatty acid intakes on preeclampsia: A randomized controlled trial

Background:

Preeclampsia (PE) is a high blood pressure disorder accompanied by proteinuria during pregnancy. It remains unclear whether dietary trans-fatty acid (TFA) can influence PE risk. We examined the effect of low TFA dietary intakes during pregnancy on the risk of PE.

Materials and Methods:

We conducted a randomized open-label controlled trial on 800 pregnant women admitted to public health centers from May 2014 to August 2016. In the intervention group, participants received a diet with TFA <1% and those in the comparison group, participants had dietary intakes with no change on TFA content. Dietary intakes were assessed by 24-h recalls at the first prenatal care visit (<8 weeks) and at gestational ages of 13, 25, and 35 weeks. The hazard ratio (95% confidence interval [CI]) for PE was calculated using the Cox proportional-hazards model.

Results:

There were statistically significant differences in intakes of daily TFAs between the groups (P < 0.05). The hazard ratio (95% CI) for the incidence of PE in the intervention group was 0.56 (0.33–0.93).

Conclusion:

Low TFA dietary intake during pregnancy reduced the risk of PE.

Prenatal vitamin D supplementation reduces blood pressure and improves placental angiogenesis in an animal model of preeclampsia

BACKGROUND

Preeclampsia (PE), a pregnancy complication, is characterized by abnormal placental angiogenesis. The current study examines the effect of vitamin D deficiency/supplementation on pregnancy outcome and placental angiogenesis using an animal model of PE.

METHODS

Pregnant Wistar rats were divided into four groups: Control; PE; Vitamin D deficient with PE (VDD-PE) and Vitamin D supplemented with PE (VDS-PE). PE was induced by administering l-nitroarginine methyl ester (l-NAME) at the dose of 50 mg per kg body weight per day from day 14 to day 19 gestation in all the 4 groups. During the pre-pregnancy and pregnancy period, the rats from the Control and PE groups were fed a control diet, the VDD-PE group received a vitamin D deficient diet and the VDS-PE group received a vitamin D supplemented diet. Dams were sacrificed at d20 of gestation.

RESULTS

l-NAME administration increased systolic as well as diastolic blood pressure in both PE and VDD-PE groups as compared to the control (p < 0.01). Vitamin D supplementation was beneficial in reducing the blood pressure. Vitamin D deficiency also lowered the placental protein levels of pro-angiogenic proteins VEGF and Flt-1 (p < 0.05 and p < 0.01, respectively), while the levels of these proteins in the VDS-PE group were similar to those in the control group. Vitamin D status did not influence the levels of PlGF and Hif1α.

CONCLUSION

A low dose vitamin D supplementation given from pre-pregnancy and throughout pregnancy was beneficial in reducing the blood pressure and normalizing the placental levels of VEGF and Flt-1. This has implications for reducing the severity of preeclampsia.

Oxidative stress and mitochondrial dysfunction in early-onset and late-onset preeclampsia

Preeclampsia is a pregnancy-specific syndrome with multisystem involvement which leads to foetal, neonatal, and maternal morbidity and mortality. This syndrome is characterized by the onset of clinical signs and symptoms and delivery before (early-onset preeclampsia, eoPE), or after (late-onset preeclampsia, loPE), the 34 weeks of gestation. Preeclampsia is a mitochondrial disorder where its differential involvement in eoPE and loPE is unclear. Mitochondria regulate cell metabolism and are a significant source of reactive oxygen species (ROS). The syncytiotrophoblast in eoPE and loPE show altered mitochondrial structure and function resulting in ROS overproduction, oxidative stress, and cell damage and death. Mitochondrial dysfunction in eoPE may result from altered expression of several molecules, including dynamin-related protein 1 and mitofusins, compared with loPE where these factors are either reduced or unaltered. Equally, mitochondrial fusion/fission dynamics seem differentially modulated in eoPE and loPE. It is unclear whether the electron transport chain and oxidative phosphorylation are differentially altered in these two subgroups of preeclampsia. However, the activity of complex IV (cytochrome c oxidase) and the expression of essential proteins involved in the electron transport chain are reduced, leading to lower oxidative phosphorylation and mitochondrial respiration in the preeclamptic placenta. Interventional studies in patients with preeclampsia using the coenzyme Q₁₀, a key molecule in the electron transport chain, suggest that agents that increase the antioxidative capacity of the placenta may be protective against preeclampsia development. In this review, the mitochondrial dysfunction in both eoPE and loPE is summarized. Therapeutic approaches are discussed in the context of contributing to the understanding of mitochondrial dysfunction in eoPE and loPE.

Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia

Preeclampsia is a major complication of pregnancy manifested as hypertension and often intrauterine growth restriction, but the underlying pathophysiological mechanisms are unclear. Predisposing genetic and environmental factors cause placental maladaptations leading to defective placentation, apoptosis of invasive cytotrophoblasts, inadequate expansive remodeling of the spiral arteries, reduced uteroplacental perfusion pressure, and placental ischemia. Placental ischemia promotes the release of bioactive factors into the maternal circulation, causing an imbalance between antiangiogenic soluble fms-like tyrosine kinase-1 and soluble endoglin and proangiogenic vascular endothelial growth factor, placental growth factor, and transforming growth factor-β. Placental ischemia also stimulates the release of proinflammatory cytokines, hypoxia-inducible factor, reactive oxygen species, and angiotensin type 1 receptor agonistic autoantibodies. These circulating factors target the vascular endothelium, causing generalized endotheliosis in systemic, renal, cerebral, and hepatic vessels, leading to decreases in endothelium-derived vasodilators such as nitric oxide, prostacyclin, and hyperpolarization factor and increases in vasoconstrictors such as endothelin-1 and thromboxane A₂. The bioactive factors also target vascular smooth muscle and enhance the mechanisms of vascular contraction, including cytosolic Ca²⁺, protein kinase C, and Rho-kinase. The bioactive factors could also target matrix metalloproteinases and the extracellular matrix, causing inadequate vascular remodeling, increased arterial stiffening, and further increases in vascular resistance and hypertension. As therapeutic options are limited, understanding the underlying vascular mechanisms and molecular targets should help design new tools for the detection and management of hypertension in pregnancy and preeclampsia.

The effect of dietary patterns on hypertensive disorders of pregnancy in North Shewa, Ethiopia: A propensity score matched case-control study

OBJECTIVE

This study aimed to assess the effect of dietary patterns during pregnancy on HDP. A propensity score matched case-control study was conducted with 340 pregnant women (71 cases and 269 controls) in North Shewa Zone, Ethiopia. Data were collected through an interviewer-administered questionnaire and maternal anthropometry measurements. After propensity score matching, a conditional logistic regression model was used to identify the independent predictors of HDP by adjusting for the confounders. A p-value of < 0.05 was taken as statistically significant.

RESULTS

A high dietary diversity score (Adjusted Odd Ratio (AOR) = 0.45; 95% CI: 0.21, 0.93) was associated with a lower odds of HDP. Being merchant (AOR = 3.71 (95% CI: 1.16, 11.89), having previous history of HDP (AOR = 27.58; 95% CI: 4.53, 168.06) and high hemoglobin level (AOR = 2.26; 95% CI: 1.66, 3.09) were associated with an increased odds of HDP. Diet is an amendable factor, and the promotion of diversified diet is an important approach for preventing the occurrence of HDP. Women should be counselled to diversify their dietary intake to include a high amount of vegetables, legumes, and fruit.

Association of vitamin D with fatty acids in pregnancy

Preeclampsia is a pregnancy complication, associated with an increased risk of maternal and neonatal morbidity and mortality. The etiology of preeclampsia is not yet fully understood, although the current literature indicates an up regulation of inflammatory mediators. Vitamin D is known to have anti-inflammatory properties and influence vascular function. Fatty acids are also known to regulate inflammation in pregnancy. This study was carried out to explore the association of maternal vitamin D and fatty acids in pregnancy. The present study includes 69 normotensive control (NC) and 50 women with preeclampsia (PE). Maternal and cord serum 25-hydroxyvitamin D [25(OH)D] levels were lower (p<0.01for both) in women with PE compared to NC women. Maternal plasma total polyunsaturated fatty acids (PUFA) levels were lower (p<0.05) while levels of total saturated fatty acids (SFA) and total monounsaturated fatty acids (MUFA) were higher (p<0.05 for both) in women with PE. Cord erythrocyte PUFA levels were higher (p<0.01) in PE women. Maternal 25(OH)D levels were negatively associated with maternal systolic and diastolic BP (p<0.01 for both). Maternal 25(OH)D levels were positively associated with maternal total PUFA (p<0.01) and negatively associated with maternal total SFA (p<0.05), total MUFA (p<0.01). This study for the first time demonstrates an association of maternal vitamin D with fatty acid levels in pregnancy. Our results suggest that vitamin D and fatty acids may work in concert to regulate fetal growth.

Influences of environmental factors during preeclampsia

Preeclampsia is a pregnancy-specific disorder that impacts 5-8% of pregnancies and has long-term cardiovascular and metabolic implications for both mother and fetus. The mechanisms are unclear; however, it is believed that preeclampsia is characterized by abnormal vascularization during placentation resulting in the manifestation of clinical signs such as hypertension, proteinuria, and endothelial dysfunction. Although there is no current cure to alleviate the clinical signs, an emerging area of interest in the field is the influence of environmental factors including diet on the risk of preeclampsia. Because preeclampsia has serious cardiovascular implications to both the mother and fetus and most antihypertensive medications are contraindicated in pregnancy, it is important to investigate other potential therapeutic options such as dietary manipulation. The emerging field of nutrigenomics links diet with the gene expression of known pathways such as oxidative stress and inflammation via microbiome-mediated metabolites and could serve as one potential avenue of therapeutic targets for preeclampsia. Although the exact role of nutrition in the pathogenesis of preeclampsia is unknown, this review will focus on known pathways involved in the development of preeclampsia and how dietary intake modulates the microbiome, oxidative stress, and inflammation with an emphasis on nutrigenomics as a potential avenue of further investigation to better understand this pathology.

Racial/Ethnic Differences in Diet Quality and Eating Habits Among WIC Pregnant Women: Implications for Policy and Practice

PURPOSE

One of the major federal food assistance programs, the Special Supplemental Program for Women, Infants, and Children (WIC), serves approximately 1.5 million low-income pregnant women per year; however, limited information is available on their dietary habits. This is critical because low-income women are at higher risk of gaining excess weight during pregnancy. Thus, the study objectives were to (1) determine the overall diet quality of WIC pregnant women and (2) examine diet quality and eating behaviors by race/ethnicity and other sociodemographics.

DESIGN

This was a cross-sectional study.

SETTING

One of the 3 WIC offices in a north-central county in North Carolina, USA.

SAMPLE

Pregnant women (n = 198) in the second trimester.

MEASURES

Interviews included sociodemographics, food security, diet, and eating behaviors. Diet quality was assessed by the Healthy Eating Index (HEI) 2010 scores.

ANALYSIS

Descriptives, bivariate analysis, and multivariate analysis.

RESULTS

Average participant age was 26 years, and the mean HEI-2010 score was 56 of maximum score of 100. Specifically, African American women consumed significantly lower servings of whole grains (β = -1.71; 95% CI: -3.10 to -0.32; P < .05) and dairy (β = -1.42; 95% CI: -2.51 to -0.33; P < .05) compared with non-Hispanic white women. Hispanic women scored higher in daily intake of fruits (β = 0.98; 95% CI: 0.17-1.79; P < .05) and for consuming empty calories in moderation (β = 1.57; 95% CI: 0.06-3.09; P < .05). Frequency of intake of fast foods/outside meals was higher among African American women (57%, P = .025).

CONCLUSION

Efforts are warranted to promote optimal nutrition among WIC pregnant women. Specifically, African American women are highly vulnerable to poor dietary habits during pregnancy. Further investigation of barriers/facilitators for healthy eating is necessary to address nutrition disparities among WIC pregnant women.

Decreasing the main maternal and fetal complications in women undergoing in vitro fertilization (IVF) trained by nutrition and healthy eating practices during pregnancy

PURPOSE

In vitro fertilization (IVF) can lead to undesirable consequences for pregnant women and their newborns. Reducing the adverse maternal (mainly, gestational diabetes mellitus (GDM) and preeclampsia (PE)), and fetal outcomes in IVF-pregnant women (IVF-PW) was aimed with the correct training of nutrition principles during pregnancy.

MATERIALS AND METHODS

A quasi-experimental clinical trial with 170 IVF-PW in intervention and control groups was conducted. The subjects before the dietary intervention completed questionnaires of nutritional and lifestyle and 24-h food recall. The intervention group was trained with the diet modification programs from early (12-16 weeks) to late (week 34) pregnancy in six weekly, 15-20-min sessions. The GDM diagnosis was based on 75-g OGTT and FBS tests, respectively, in 24-28 weeks' gestation. Other adverse maternal (e.g. PE, cesarean delivery, and preterm delivery (<37 weeks)), and fetal (e.g. intrauterine growth retardation (IUGR), birth weight, and fetal viability) outcomes were also monitored. The dataset was assessed using both inferential and descriptive statistics.

RESULTS

A diet modification program with an increased intake of lactose, fiber, and some minerals (e.g. magnesium and zinc) and vitamins (e.g. B3 and B5) in conjunction with a lower intake rate of glucose and lipid could control the prevalence of adverse maternal and neonatal outcomes in IVF-PW. Although the GDM reduction in the two intervention (8.2%) and control (20.0%) groups was statistically insignificant, there was a significant difference in PE prevalence at a lower rate (39.0%) in the intervention group than the control. No significant difference in cesarean delivery (94.1-95.2%), and preterm delivery (45.9%) between the two groups was found. The IUGR (24.7-25.9%), birth weight (2.791-2.820 kg), and fetal viability (95.3-97.6%) also did not change significantly after the healthy eating practices during pregnancy.

CONCLUSIONS

Diet-based interventions in IVF-PW during pregnancy were efficient in improving the outcomes for both mother and baby.

Geophagia, nutrition and health of women with pregnancy-induced hypertension

BACKGROUND

Calcium is a major nutrient implicated in pregnancy-induced hypertension (PIH). Aside dietary sources, geophagia has been reported to provide calcium needed to prevent PIH. These soils are shown to contain significant amount of heavy metals which have been associated with hypertension.

OBJECTIVE

The aim of this study was to determine the relationship between geophagia and PIH, assess the dietary intakes and health of participants.

METHODS

This study was a case-control involving 30 women with PIH and 70 normotensive pregnant women.

RESULTS

Geophagia was not significantly associated with PIH. Women with PIH practicing geophagia recorded significantly low levels of haemoglobin, calcium and ferritin. Hypertensives recorded impaired fasting blood glucose (5.77±1.71mmol/L, p=0.051), higher levels of urea (3.60±1.29 mmol/L, p=0.000) and creatinine (382.67±11.66 µmol/L, p=0.000). Percentage intakes of macronutrients for normotensives were within the Adequate Macronutrient Distribution Range and PIH group recorded higher intakes of carbohydrate (72.75±16.16 %), lower protein (9.77±5.61 %) and fat (17.15±11.99%). Dietary calcium intakes in both groups were lower than recommended (< 1,000 mg/day).

CONCLUSION

In this study, geophagia during pregnancy is not directly associated with PIH but is detrimental to maternal health. The pregnant women in this study had considerably low intakes of energy and nutrients. There is a need for measures to ensure adequate maternal nutrition for a positive health and pregnancy outcomes.

Risk Factors for Preeclampsia in a High-Risk Cohort of Women Served by a Nursing-based Home Visiting Program

This descriptive study aimed to identify the impact of psychosocial risk factors on pregnancy outcomes for high risk women in an urban setting. Women in this category tend to experience adverse pregnancy outcomes, like preeclampsia, at greater rates than low or medium risk women. A retrospective paper chart review of East Harlem women served by LSA Family Health Service (LSA) Maternal Outreach Program (MOP) was conducted. All women who enrolled in the MOP with a singleton pregnancy from January 2015 to December 2017, were eligible for inclusion in our analyses. Data were analyzed using SPSS (version 23). Of 379 total participants, 68.6% (n=203) were Hispanic/Latina women, 44.8% (n=163) were English only speakers, 67.4% (n=226) were identified as overweight/obese, 90.6% (n=328) were mothers over the age of 20 among those for whom data were available. Sixty-two percent (n=235) initiated prenatal care in their first trimester, and 71.5% (n=271) were referred to the MOP by a hospital or other healthcare provider. The percentage of preeclampsia among mothers was 26.9% (n=102). After adjustment for type of LSA services received, and race/ethnicity, there were no associations between psychosocial risk factors and preeclampsia diagnosis in this population. Further research is needed on the relationship between psychosocial risk factors and preeclampsia to identify potential areas of intervention and reduce the burden of disease.

Fat intake during pregnancy and risk of preeclampsia: a prospective cohort study in Denmark

BACKGROUND

Previous studies suggest that eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA), may decrease the risk of preeclampsia, but many suffer from important methodological limitations.

METHODS

We prospectively examined the association between fat intake during pregnancy and preeclampsia and among 65,220 singleton pregnancies in the Danish National Birth Cohort (1996-2002). Women were asked to report their diet around gestation week 20 with a food frequency questionnaire. Preeclampsia diagnosis was obtained via linkage with the Danish National Patient Registry. We estimated relative risks (RR) and 95% confidence intervals (95% CI) of preeclampsia and severe preeclampsia according to fat intake using logistic regression models with generalized estimating equations to account for repeated pregnancies per woman while adjusting for potential confounders.

RESULTS

We documented 1302 cases of preeclampsia, including 301 cases of severe preeclampsia. Intake of long-chain omega-3 fatty acids was associated to preeclampsia. Women in the top quintile of DHA intake had a lower risk of preeclampsia (RR 0.67 (0.51-0.89)) and severe preeclampsia (RR 0.46 (0.25-0.83)) than women in the bottom quintile. Women who met daily recommended intake of EPA+DHA according to the Dietary Guidelines for Americans (≥250 mg/day), had a lower risk of severe preeclampsia (RR 0.77 (0.60-0.99)), but not of preeclampsia (RR 0.93 (0.82-1.05)). Conversely, ALA intake was associated with higher risk of severe preeclampsia (RR 1.71 (1.07-2.75)).

CONCLUSIONS

Higher intake of DHA is inversely related to preeclampsia and severe preeclampsia, whereas ALA increases the risk of severe preeclampsia among Danish women.

Prenatal Lipid-Based Nutrient Supplements Do Not Affect Pregnancy or Childbirth Complications or Cesarean Delivery in Bangladesh: A Cluster-Randomized Controlled Effectiveness Trial

Background: Pregnancy and childbirth complications and cesarean delivery are common in Bangladesh.Objective: We evaluated the effect of lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) on pregnancy and childbirth complications and cesarean delivery.Methods: We conducted the Rang-Din Nutrition Study, a cluster-randomized controlled effectiveness trial within a community health program in rural Bangladesh. We enrolled 4011 pregnant women in early pregnancy. Women in 48 clusters received iron and folic acid (IFA; 60 mg Fe + 400 μg folic acid/d) and women in 16 clusters received LNS-PL (20 g/d, 118 kcal) containing essential fatty acids and 22 vitamins and minerals. Pregnancy and childbirth complications and the cesarean delivery rate were secondary outcomes of the study.Results: Women in the LNS-PL group did not differ significantly from the IFA group with respect to mean systolic blood pressure at 36 wk gestation (113 and 112 mm Hg; P = 0.17), diastolic blood pressure at 36 wk gestation (68.9 and 68.7 mmHg; P = 0.88), or mean total number of pregnancy and childbirth complications (0.32 and 0.31; P = 0.86). They also did not differ significantly with respect to the prevalence of high blood pressure at 36 wk (1.74% and 2.03%; P = 0.62), antepartum hemorrhage (0.83% and 1.39%; P = 0.21), prolonged labor (8.34% and 8.79%; P = 0.68), early rupture of membranes (9.30% and 8.45%; P = 0.43), convulsions (1.57% and 1.08%; P = 0.24), high blood pressure in labor (1.54% and 1.19%; P = 0.46), obstructed labor (2.83% and 2.91%; P = 0.90), any complications during pregnancy or childbirth (35.9% and 37.1%; P = 0.64), episiotomy (6.31% and 6.44%; P = 0.90), or cesarean delivery (15.6% and 14.2%; P = 0.48).Conclusion: Compared with IFA, antenatal LNS-PL did not increase or decrease pregnancy and childbirth complications or cesarean delivery among women in rural Bangladesh. This trial was registered at clinicaltrials.gov as NCT01715038.

Maternal Choline Supplementation Alters Fetal Growth Patterns in a Mouse Model of Placental Insufficiency

Impairments in placental development can adversely affect pregnancy outcomes. The bioactive nutrient choline may mitigate some of these impairments, as suggested by data in humans, animals, and human trophoblasts. Herein, we investigated the effects of maternal choline supplementation (MCS) on parameters of fetal growth in a Dlx3+/− (distal-less homeobox 3) mouse model of placental insufficiency. Dlx3+/− female mice were assigned to 1X (control), 2X, or 4X choline intake levels during gestation. Dams were sacrificed at embryonic days E10.5, 12.5, 15.5, and 18.5. At E10.5, placental weight, embryo weight, and placental efficiency were higher in 4X versus 1X choline. Higher concentrations of hepatic and placental betaine were detected in 4X versus 1X choline, and placental betaine was positively associated with embryo weight. Placental mRNA expression of Igf1 was downregulated by 4X (versus 1X) choline at E10.5. No differences in fetal growth parameters were detected at E12.5 and 15.5, whereas a small but significant reduction in fetal weight was detected at E18.5 in 4X versus 1X choline. MCS improved fetal growth during early pregnancy in the Dlx3+/− mice with the compensatory downregulation of Igf1 to slow growth as gestation progressed. Placental betaine may be responsible for the growth-promoting effects of choline.

Analyses of Nutrients and Body Mass Index as Risk Factor for Preeclampsia

Background

Little is known about the pathogenesis of preeclampsia. Many factors are identified as risk factors for preeclampsia including nutrients and obesity. The aim of this study was to assess whether nutrients and body mass index (BMI) are risk factors for preeclampsia.

Methods

This was a case-control study at the Department of Obstetric and Gynecology in Dr. M. Djamil Hospital, Padang, Indonesia. A total of 140 patients were enrolled in this study with 70 cases and 70 controls. All subjects completed an interview for their nutritional status and prepregnancy BMI after delivery. The nutritional status was assessed by Food Frequency Questionnaire and then analyzed by Nutrisurvey Program. The independent samples t test was used for nutritional status, and Chi-square test was used for BMI. For nutrients, logistic regression procedures were employed to calculate potential risk factors associated with preeclampsia.

Results

Prevalence of abnormal BMI was more common in the preeclampsia group compared with those without preeclampsia 19 (27.1%) versus 12 (17.1%) but not found as a significant risk factor in this study (p = 0.222). Deficiency of vitamin E (OR 1.76, 95% CI 10.2 ± 30.5), zinc (OR 99.4, 95% CI 1.37 ± 7219), fat (OR 59.1, 95% CI 3.14 ± 500), calcium (OR 109, 95% CI 0.29 ± 40,041), vitamin C (OR 19.5, 95% CI 2.52 ± 151) were associated with increased risk of preeclampsia. Excess of carbohydrate was associated with increased risk of preeclampsia (OR 52.9, 95% CI 0.801 ± 3495).

Conclusions

Deficiency of vitamin E, zinc, fat, calcium, and vitamin C, and excess of calories and carbohydrate were associated with increased risk of preeclampsia.

Availability of two self-administered diet history questionnaires for pregnant Japanese women: A validation study using 24-hour urinary markers

BACKGROUND

Accurate and easy dietary assessment methods that can be used during pregnancy are required in both epidemiological studies and clinical settings. To verify the utility of dietary assessment questionnaires in pregnancy, we examined the validity and reliability of a self-administered diet history questionnaire (DHQ) and a brief-type self-administered diet history questionnaire (BDHQ) to measure energy, protein, sodium, and potassium intake among pregnant Japanese women.

METHODS

The research was conducted at a university hospital in Tokyo, Japan, between 2010 and 2011. The urinary urea nitrogen, sodium, and potassium levels were used as reference values in the validation study. For the reliability assessment, participants completed the questionnaires twice within a 4-week interval.

RESULTS

For the DHQ (n = 115), the correlation coefficients between survey-assessed energy-adjusted intake and urinary protein, sodium, and potassium levels were 0.359, 0.341, and 0.368, respectively; for the BDHQ (n = 112), corresponding values were 0.302, 0.314, and 0.401, respectively. The DHQ-measured unadjusted protein and potassium intake levels were significantly correlated with the corresponding urinary levels (r_s = 0.307 and r_s = 0.342, respectively). The intra-class correlation coefficients for energy, protein, sodium, and potassium between the time 1 and time 2 DHQ (n = 58) and between the time 1 and time 2 BDHQ (n = 54) ranged from 0.505 to 0.796.

CONCLUSIONS

Both the DHQ and the BDHQ were valid and reliable questionnaires for assessing the energy-adjusted intake of protein, sodium, and potassium during pregnancy. In addition, given the observed validity of unadjusted protein and potassium intake measures, the DHQ can be a useful tool to estimate energy intake of pregnant Japanese women.

Intake of antioxidant nutrients and coefficients of variation in pregnant women with preeclampsia

INTRODUCTION AND OBJECTIVE

Oxidative stress appears to play a critical role in the pathogenesis of preeclampsia. Evidence suggests that adequate intake of antioxidants can modulate this condition. The objective of this study was to assess the intake of antioxidant nutrients and coefficients of variation in pregnant women with preeclampsia.

METHODS

In a cross-sectional study in the public health network of the city of Maceió, Brazil, a dietary survey was performed consisting of 24-hour food recalls, with subsequent adjustment of nutrients using the estimated average requirement as the cutoff point, and a questionnaire on frequency of consumption of antioxidants.

RESULTS

We studied 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP) with mean ages of 25.8±6.7 years and 24.1±6.2 years (p=0.519), respectively. A low mean intake of antioxidants (vitamin A, selenium, zinc and copper) was observed in both PWP and PWoP, although intakes of vitamin A (p=0.045) and selenium (p=0.008) were higher in PWoP. In addition, we observed high coefficients of variation in nutrient intakes in both groups, which were higher for vitamin C (p<0.001), vitamin A (p=0.006) and copper (p=0.005) in PWP.

CONCLUSIONS

Consumption of antioxidant nutrients by pregnant women with preeclampsia is inadequate, with considerable daily variations in intake, which points to a need for nutrition education strategies aimed at improving intakes, because diet is without doubt a key factor in the modulation of oxidative stress caused by preeclampsia.

Reduced Maternal Erythrocyte Long Chain Polyunsaturated Fatty Acids Exist in Early Pregnancy in Preeclampsia

The present prospective study examines proportions of maternal erythrocyte fatty acids across gestation and their association with cord erythrocyte fatty acids in normotensive control (NC) and preeclamptic pregnancies. We hypothesize that maternal fatty acid status in early pregnancy influences fetal fatty acid stores in preeclampsia. 137 NC women and 58 women with preeclampsia were included in this study. Maternal blood was collected at 3 time points during pregnancy (16-20th weeks, 26-30th weeks and at delivery). Cord blood was collected at delivery. Fatty acids were analyzed using gas chromatography. The proportions of maternal erythrocyte α-linolenic acid, docosahexaenoic acid, nervonic acid, and monounsaturated fatty acids (MUFA) (p < 0.05 for all) were lower while total n-6 fatty acids were higher (p < 0.05) at 16-20th weeks of gestation in preeclampsia as compared with NC. Cord 18:3n-3, 22:6n-3, 24:1n-9, MUFA, and total n-3 fatty acids (p < 0.05 for all) were also lower in preeclampsia as compared with NC. A positive association was observed between maternal erythrocyte 22:6n-3 and 24:1n-9 at 16-20th weeks with the same fatty acids in cord erythrocytes (p < 0.05 for both) in preeclampsia. Our study for the first time indicates alteration in maternal erythrocyte fatty acids at 16th weeks of gestation which is further reflected in cord erythrocytes at delivery in preeclampsia.

Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women's Health

BACKGROUND

Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk.

OBJECTIVE

We investigated associations between prepregnancy dietary patterns and risk of HDPs.

DESIGN

We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors.

RESULTS

During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar; Mediterranean-style; fruit and low-fat dairy; and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58; 95% CI, 0.42, 0.81).

CONCLUSIONS

In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs.

Adequately diversified dietary intake and iron and folic acid supplementation during pregnancy is associated with reduced occurrence of symptoms suggestive of pre-eclampsia or eclampsia in Indian women

Background/Objective

Pre-eclampsia or Eclampsia (PE or E) accounts for 25% of cases of maternal mortality worldwide. There is some evidence of a link to dietary factors, but few studies have explored this association in developing countries, where the majority of the burden falls. We examined the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E in Indian women.

Methods

Cross-sectional data from India’s third National Family Health Survey (NFHS-3, 2005-06) was used for this study. Self-reported symptoms suggestive of PE or E during pregnancy were obtained from 39,657 women aged 15-49 years who had had a live birth in the five years preceding the survey. Multivariable logistic regression analysis was used to estimate the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E after adjusting for maternal, health and lifestyle factors, and socio-demographic characteristics of the mother.

Results

In their most recent pregnancy, 1.2% (n=456) of the study sample experienced symptoms suggestive of PE or E. Mothers who consumed an adequately diversified diet were 34% less likely (OR: 0.66; 95% CI: 0.51-0.87) to report PE or E symptoms than mothers with inadequately diversified dietary intake. The likelihood of reporting PE or E symptoms was also 36% lower (OR: 0.64; 95% CI: 0.47-0.88) among those mothers who consumed iron and folic acid supplementation for at least 90 days during their last pregnancy. As a sensitivity analysis, we stratified our models sequentially by education, wealth, antenatal care visits, birth interval, and parity. Our results remained largely unchanged: both adequately diversified dietary intake and iron and folic acid supplementation during pregnancy were associated with a reduced occurrence of PE or E symptoms.

Conclusion

Having a adequately diversified dietary intake and iron and folic acid supplementation in pregnancy was associated with a reduced occurrence of symptoms suggestive of PE or E in Indian women.

The association between dietary factors and gestational hypertension and pre-eclampsia: a systematic review and meta-analysis of observational studies

BACKGROUND

Dietary factors have been suggested to play a role in the prevention of hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia, but inconsistent findings have been reported. A systematic review and meta-analyses were performed to synthesize evidence from observational studies of reproductive-aged women on the association between dietary factors and HDP.

METHODS

MEDLINE and EMBASE were searched to identify studies published until the end of May 2014. Studies were included if they were observational studies of reproductive-age women and reported results on dietary factors (energy, nutrients, foods or overall dietary patterns, alone or in combination with dietary supplements) and gestational hypertension and/or pre-eclampsia. Studies were excluded if they reported on supplements not in combination with dietary intake, or examined a biomarker of dietary intake. Random effects meta-analyses were performed on calculated weighted mean differences (WMD) of dietary intake between cases and non-cases, and effect estimates were pooled.

RESULTS

In total, 23 cohort and 15 case-control studies were identified for systematic review, of which 16 could be included in the meta-analyses. Based on meta-analyses of cohort studies, unadjusted energy intake was higher for pre-eclampsia cases (WMD 46 kcal/day, 95% confidence interval (CI) -13.80 to 106.23; I 2 = 23.9%, P = 0.26), although this was not statistically significant. Unadjusted intakes of magnesium (WMD 8 mg/day, 95% CI -13.99 to -1.38; I 2 = 0.0%, P = 0.41) and calcium (WMD 44 mg/day, 95% CI -84.31 to -3.62, I 2 = 51.1%, P = 0.03) were lower for the HDP cases, compared with pregnant women without HDP. Higher calcium intake consistently showed lower odds for HDP after adjustment for confounding factors (OR = 0.76, 95% CI 0.57 to 1.01, I 2 = 0.0%, P = 0.79). A few studies examining foods and dietary patterns suggested a beneficial effect of a diet rich in fruit and vegetables on pre-eclampsia, although not all the results were statistically significant.

CONCLUSIONS

Based on a limited number of studies, higher total energy and lower magnesium and calcium intake measured during pregnancy were identified as related to HDP. Further prospective studies are required to provide an evidence base for development of preventive health strategies, particularly focusing on dietary factors during pre-pregnancy and early pregnancy.

Reduced risk of pre-eclampsia with organic vegetable consumption: results from the prospective Norwegian Mother and Child Cohort Study

OBJECTIVE

Little is known about the potential health effects of eating organic food either in the general population or during pregnancy. The aim of this study was to examine associations between organic food consumption during pregnancy and the risk of pre-eclampsia among nulliparous Norwegian women.

DESIGN

Prospective cohort study.

SETTING

Norway, years 2002-2008.

PARTICIPANTS

28 192 pregnant women (nulliparous, answered food frequency questionnaire and general health questionnaire in mid-pregnancy and no missing information on height, body weight or gestational weight gain).

MAIN OUTCOME MEASURE

Relative risk was estimated as ORs by performing binary logistic regression with pre-eclampsia as the outcome and organic food consumption as the exposure.

RESULTS

The prevalence of pre-eclampsia in the study sample was 5.3% (n=1491). Women who reported to have eaten organic vegetables 'often' or 'mostly' (n=2493, 8.8%) had lower risk of pre-eclampsia than those who reported 'never/rarely' or 'sometimes' (crude OR=0.76, 95% CI 0.61 to 0.96; adjusted OR=0.79, 95% CI 0.62 to 0.99). The lower risk associated with high organic vegetable consumption was evident also when adjusting for overall dietary quality, assessed as scores on a healthy food pattern derived by principal component analysis. No associations with pre-eclampsia were found for high intake of organic fruit, cereals, eggs or milk, or a combined index reflecting organic consumption.

CONCLUSIONS

These results show that choosing organically grown vegetables during pregnancy was associated with reduced risk of pre-eclampsia. Possible explanations for an association between pre-eclampsia and use of organic vegetables could be that organic vegetables may change the exposure to pesticides, secondary plant metabolites and/or influence the composition of the gut microbiota.

Associations of adherence to the New Nordic Diet with risk of preeclampsia and preterm delivery in the Norwegian Mother and Child Cohort Study (MoBa)

Preeclampsia and preterm delivery are serious complications of pregnancy and leading causes of perinatal mortality and morbidity worldwide. Dietary factors might be associated with these adverse outcomes. We investigated whether adherence to the New Nordic Diet (NND) was associated with preeclampsia and preterm delivery risks in the Norwegian Mother and Child Cohort Study (MoBa). Participants were recruited from all over Norway during the period 1999-2008. A previously constructed diet score assessing meal frequency, and the consumption of Nordic fruits, root vegetables, cabbages, potatoes, oatmeal porridge, whole grains, wild fish, game, berries, milk and water, was used to assess NND adherence. Associations between NND adherence and the outcomes were estimated in adjusted multivariate logistic regression models. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated. A total of 72,072 women was included in the study. High versus low NND adherence was associated with lower risk of total preeclampsia (OR 0.86; 95 % CI 0.78-0.95) and early preeclampsia (OR 0.71; 95 % CI 0.52-0.96). High compared with low NND adherence was associated with a lower risk of spontaneous preterm delivery among nulliparous women (OR 0.77; 95 % CI 0.66-0.89), whereas multiparous women with high NND adherence had a marginally significant higher risk of preterm delivery (OR 1.24; 95 % CI 1.00-1.53). High NND adherence was associated with a lower relative risk of preeclampsia and of spontaneous preterm delivery among nulliparous women; however, among multiparous women there was a higher relative risk of preterm delivery.

Intrauterine nutrition: long-term consequences for vascular health

There is a growing body of evidence that improper intrauterine nutrition may negatively influence vascular health in later life. Maternal malnutrition may result in intrauterine growth retardation and, in turn, metabolic disorders such as insulin resistance, diabetes, hypertension, and dyslipidemia, and also enhanced risk of atherosclerosis and cardiovascular death in the offspring. Energy and/or protein restriction is the most critical determinant for fetal programming. However, it has also been proposed that intrauterine n-3 fatty acid deficiency may be linked to later higher blood pressure levels and reduced insulin sensitivity. Moreover, it has been shown that inadequate supply of micronutrients such as folate, vitamin B12, vitamin A, iron, magnesium, zinc, and calcium may contribute to impaired vascular health in the progeny. In addition, hypertensive disorders of pregnancy that are linked to impaired placental blood flow and suboptimal fetal nutrition may also contribute to intrauterine growth retardation and aggravated cardiovascular risk in the offspring. On the other hand, maternal overnutrition, which often contributes to obesity and/or diabetes, may result in macrosomia and enhanced cardiometabolic risk in the offspring. Progeny of obese and/or diabetic mothers are relatively more prone to develop obesity, insulin resistance, diabetes, and hypertension. It was demonstrated that they may have permanently enhanced appetites. Their atheromatous lesions are usually more pronounced. It seems that, particularly, a maternal high-fat/junk food diet may be detrimental for vascular health in the offspring. Fetal exposure to excessive levels of saturated fatty and/or n-6 fatty acids, sucrose, fructose and salt, as well as a maternal high glycemic index diet, may also contribute to later enhanced cardiometabolic risk.

First trimester multivitamin/mineral use is associated with reduced risk of pre-eclampsia among overweight and obese women

The use of pregnancy-specific multivitamin supplements is widely recommended to support maternal homeostasis during pregnancy. Our objective was to investigate whether multivitamin use during pregnancy is associated with a reduced risk of pre-eclampsia. The effect of multivitamin use on incidence of pre-eclampsia in lean and overweight/obese women was analysed using data collected between 2006 and 2011 as part of the Environments for Healthy Living Project, Griffith University, Australia. A total of 2261 pregnancies were included in the analysis with pre-eclampsia reported in 1.95% of subjects. Body mass index (BMI) ≥ 25 was associated with a 1.97-fold [95% confidence interval (CI): 0.93, 4.16] increase in pre-eclampsia risk. First trimester multivitamin use was reported by 31.8% of women and after adjustment, was associated with a 67% reduction in pre-eclampsia risk (95%CI: 0.14, 0.75). Stratification by BMI demonstrated a 55% reduction in pre-eclampsia risk (95%CI: 0.30, 0.86) in overweight (BMI: 25-29.9) and 62% risk reduction (95%CI: 0.16, 0.92) in obese (BMI: ≥30) cohorts that supplemented with multivitamins in the first trimester of pregnancy. This finding may be particular to the Australian population and reflect inherent nutritional deficits. First trimester folate supplementation was found to reduce pre-eclampsia incidence [adjusted odds ratios (AOR) 0.42 95%CI: 0.13, 0.98] and demonstrated significance upon stratification by overweight status for women with BMI >25 (AOR 0.55 95%CI: 0.31, 0.96). These results support the hypothesis that multivitamin supplementation may be beneficial in reducing the incidence of pre-eclampsia during pregnancy and be of particular importance for those with a BMI ≥25.

Frequency of consumption of specific food items and symptoms of preeclampsia and eclampsia in Indian women

BACKGROUND

Preeclampsia/eclampsia is responsible for upwards of 20% of maternal morbidity and mortality in developing countries.

OBJECTIVE

We examined the relationship between frequency of food intake and symptoms of preeclampsia eclampsia and eclampsia among Indian women aged 15-49 (n = 39,657) for the most recent live birth in the 5 years preceding the National Family Health Survey-3 (2005-2006). Multiple logistic regression analysis was used to estimate the association between frequency of intake of specific food items, and self-reported symptoms of preeclampsia eclampsia and eclampsia, adjusting for maternal age, and other potential socio-demographic confounders.

RESULTS

Daily consumption of milk or curd (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81-0.96), green leafy vegetables, chicken/meat and weekly pulses/beans consumption are associated with substantially lower risk of preeclampsia eclampsia. Eclampsia risk is higher among those who consumed fruits (ORs ranges from 1.18 to 1.44) and chicken/meat occasionally (OR: 1.28; 95% CI: 1.11-1.48), and lower among those consuming vegetables daily.

CONCLUSION

Frequency of consumption of specific food items is associated with occurrence of preeclampsia eclampsia and eclampsia symptoms in Indian women.

Randomized, placebo-controlled, calcium supplementation trial in pregnant Gambian women accustomed to a low calcium intake: effects on maternal blood pressure and infant growth

BACKGROUND

Dietary calcium intake in rural Gambian women is very low (∼350 mg/d) compared with international recommendations. Studies have suggested that calcium supplementation of women receiving low-calcium diets significantly reduces risk of pregnancy hypertension.

OBJECTIVE

We tested the effects on blood pressure (BP) of calcium carbonate supplementation (1500 mg Ca/d) in pregnant, rural Gambian women.

DESIGN

The study was a randomized, double-blind, parallel, placebo-controlled supplementation trial from 20 wk of gestation (P20) until delivery (calcium: n = 330; placebo; n = 332). BP and anthropometric measures were taken at P20 and then 4 weekly until 36 wk of gestation (P36), and infant anthropometric measures were taken at 2, 13, and 52 wk postdelivery.

RESULTS

A total of 525 (calcium: n = 260; placebo: n = 265) women had BP measured at P36 and subsequently delivered a healthy term singleton infant. Mean compliance was 97%, and urinary calcium measures confirmed the group allocation. At P20, the mean (±SD) systolic blood pressure (SBP) was 101.2 ± 9.0 and 102.1 ± 9.3 mm Hg, and diastolic blood pressure (DBP) was 54.5 ± 7.3 and 55.8 ± 7.8 mm Hg, in the calcium and placebo groups, respectively. The intention-to-treat analysis that was adjusted for confounders showed no significant effect of calcium supplementation on the change between P20 and P36 (calcium compared with placebo; mean ± SEM) in SBP (-0.64 ± 0.65%; P = 0.3) or DBP (-0.22 ± 1.15%; P = 0.8). There was no significant effect of supplementation on BP, pregnancy weight gain, weight postpartum, or infant weight, length, and other measures of growth. However, the comparability of the original randomly assigned groups may have been compromised by the exclusion of 20.7% of women from the final analysis.

CONCLUSIONS

Calcium supplementation did not affect BP in pregnancy. This result may have been because the Gambian women were adapted to a low dietary calcium intake, and/or obesity, high gestational weight gain, high underlying BP, tobacco use, alcohol consumption, and sedentary lifestyles were rare. This trial was registered at the International Standard Randomized Controlled Trial Register (www.controlled-trials.com/mrct/) as ISRCTN96502494.

First trimester dietary intake, biochemical measures, and subsequent gestational hypertension among nulliparous women

INTRODUCTION

The purpose of this study was to evaluate the relationships between first-trimester dietary factors and biochemical measures and subsequent risk of gestational hypertension.

METHODS

This pilot study used a prospective design utilizing a convenience sample of nulliparous women enrolled at their first prenatal visit. A total of 57 women completed the study. Participants were divided into 2 groups for data analysis: normotensive pregnancy and gestational hypertension.

RESULTS

Nearly one-quarter of study participants (22.8%) developed gestational hypertension, of whom 84.6% had significant proteinuria meeting the criteria for preeclampsia. There were no significant differences in micronutrient or macronutrient dietary intakes between groups. Serum iron and zinc levels were lower for the gestational hypertension group compared with the normotensive pregnancy group (P ≤ .01). Low serum zinc levels were related to a risk of developing gestational hypertension (adjusted odds ratio, 0.930; 95% confidence interval, 0.872-0.992).

DISCUSSION

Ensuring adequate intake of zinc and monitoring serum zinc levels in nulliparous pregnant women may help to prevent or contribute to early detection of gestational hypertension.

Pregnancy Weight Gain Limitation by a Supervised Nutritional Program Influences Placental NF-κB/IKK Complex Expression and Oxidative Stress

OBJECTIVE

Nuclear factor kappa B (NF-κB) pathway and oxidative stress participate in endothelial dysfunction, which is one of the causes of pre-eclampsia. Among the human antioxidant mechanisms, there are the enzymes catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD). Our aim was to measure NF-κB, its inhibitor (IKK) and oxidative stress in placenta and umbilical cord of pregnant women submitted to a supervised nutritional program.

METHODS

TWO GROUPS WERE CONFORMED: A) 14 pregnant women with individualized nutritional counseling, and B) 12 pregnant women without nutritional guidance. NF-κB and IKK were assessed by real time PCR (RT-PCR). Enzymatic activity of CAT, GPx, lipoperoxidation (LPO) and SOD were also evaluated.

RESULTS

Pregnant women that followed a supervised nutritional program had lower levels of systolic (p=0.03) and diastolic pressure (p=0.043) although they were heavier than the control group (p=0.048). Among all the women, the Spearman correlation was positive between weight gain and placental NF-κB expression (1, p≤0.01). In the placenta, women with nutritional advice had lower enzymatic activity of GPx (p≤0.038) and showed a tendency of IKK to be higher than in women without a nutritional supervised program.

CONCLUSION

A supervised nutritional program in pregnancy offers a proven option to control weight gain, hypertension, NF-κB/IKK complex expression and oxidative stress reactions in the placenta.

Serum Cholesterol and Ceruloplasmin Levels in Second Trimester can Predict Development of Pre-eclampsia

Background:

Pre-eclampsia is one of the leading causes of high rates of maternal and perinatal mortality and morbidity. Pathophysiology of pre-eclampsia is still obscure. Currently, there are no screening tests for pre-eclampsia that are reliable, valid, and economical. Parameters of oxidative stress could be early markers of endothelial dysfunction that predates clinical pre-eclampsia.

Aim:

This study was to study ceruloplasmin in nulliparous women as marker of oxidative stress and lipid profile to evaluate their value in prediction of pre-eclampsia.

Materials and Methods:

Prospective observational study. 306 nulliparous women had their serum lipid profile and ceruloplasmin levels measured at 14-16 weeks period of gestation as sample 1 and at 18-20 weeks as sample 2. All cases were followed up till the end of pregnancy for development of pre-eclampsia.

Results:

There was no statistically significant difference between the normals and pre-eclampsia cases at 14-16 week for all the oxidative stress parameters (P > 0.05), but at 18-20 week, there was statistically significant difference between the normals and pre-eclampsia cases in cholesterol and ceruloplasmin parameters (P < 0.05).

Conclusion:

Cholesterol and ceruloplasmin levels in second trimester (18-20 weeks) can predict the development of pre-eclampsia.

Serum levels of zinc, calcium, and iron are associated with the risk of preeclampsia in pregnant women

Evidence indicates that various elements, including antioxidant minerals, might play an important role in preeclampsia (PE). This study was carried out to investigate the relationship between serum mineral levelsof zinc, calcium, iron, and selenium and the risk of preeclampsia in Korean women. Twenty-nine normal controls and 30 women with preeclampsia were recruited for the study. Preeclampsia was defined as having high blood pressure (≥ 140/90 mm Hg after 20 weeks gestation) and proteinuria (≥300 mg/24 hours). Serum mineral content was determined by instrumental neutron activation analysis. Serum zinc (P < .0001) and calcium (P = .0188) levels were lower in women with preeclampsia than those of normal women, while serum iron was significantly higher in women with preeclampsia (P = .0045). The odds ratio for preeclampsia was lower in women with higher serum zinc levels than those with lower levels after adjustment for age, height, and weight before delivery (P < .0001). The adjusted odds ratio for preeclampsia also decreased across tertiles of serum calcium concentration (P = .0452). However, there was an increased adjusted odds ratio for preeclampsia across tertiles of serum iron level (P = .0104). These results suggest that levels of serum minerals such as zinc, calcium, and iron may be associated with the risk of preeclampsia in Korean pregnant women.

Dimethyl acetals, an indirect marker of the endogenous antioxidant plasmalogen level, are reduced in blood lipids of Sudanese pre-eclamptic subjects whose background diet is high in carbohydrate

In Sudanese women with (n = 60) and without (n = 65) pre-eclampsia, circulating lipids, plasma and red cell saturated and monounsaturated fatty (MUFA) acids and dimethyl acetals (DMAs) were investigated. DMAs are an indirect marker of levels of plasmalogens, endogenous antioxidants, which play a critical role in oxidative protection, and cholesterol homeostasis. The pre-eclamptics had higher C18:1n-9 (p < 0.001) and ΣMUFA (p < 0.01) in plasma free fatty acids, C16:1n-7, C18:1n-9, ΣMUFA; 16:0/16:1n-7 (p < 0.01) in erythrocyte choline phosphoglycerides (ePC) and 16:1n-7, 18:1n-7 and 16:0/16:1n-7 (p < 0.01) in erythrocyte ethanolamine phosphoglycerides (ePE). In contrast, the DMAs 18:0, 18:1 and ΣDMAs in ePE, and 16:0, 18:0 and ΣDMAs in ePC were reduced (p < 0.001) in the pre-eclamptic women. This study of pregnant women with high carbohydrate and low fat background diet suggests pre-eclampsia is associated with oxidative stress and enhanced activity of the microsomal enzyme stearyl-CoA desaturase (delta 9 desaturase), as assessed by palmitic/palmitoleic (C16:0/C16:n-1) and stearic/oleic (C18/C18:1n-9) ratios.

Association between oxidized LDL and folate during pregnancy

High levels of oxidized low-density lipoprotein (ox-LDL) during pregnancy are a risk factor for preeclampsia. Ox-LDL levels might be affected by folate and total homocysteine (tHcy) levels because of their effects on oxygen free radicals. The relationships between ox-LDL and folate and tHcy during pregnancy, however, remain unclear. The present study investigated whether serum folate levels and plasma tHcy levels were associated with plasma ox-LDL levels in pregnant women. A sample of 137 healthy subjects with singleton pregnancies (age 30.3 ± 4.5 years) was recruited from a prenatal clinic in metropolitan Tokyo between June and October 2008. Their levels of plasma ox-LDL, plasma tHcy, and serum folate were measured, and lifestyle variables were obtained using a questionnaire. Dietary intake was assessed by means of a validated self-administered diet history questionnaire. A negative correlation between plasma ox-LDL levels and serum folate levels was found (r(s) = -.218, p =.011). However, there was no association between plasma ox-LDL levels and plasma tHcy levels (r(s) = .055, p = .525). The mean of the logarithmic ox-LDL levels was significantly lower among the participants taking folic acid-containing supplements regularly than among those who were not, after adjusting for confounding factors (p = .024). Serum folate levels and folic acid supplementation might be associated with plasma ox-LDL levels, independent of tHcy levels. The association observed between ox-LDL and folate can be used as evidence for dietary instruction by prenatal care providers.

Serum level and antioxidant activity of ceruloplasmin in preeclampsia

The antioxidants activities are decreased in the serum of women with preeclampsia. This study was aimed to determine the serum level and antioxidant activity of ceruloplasmin in preeclamptic women with gestational age over than 28 weeks. In a cross-sectional and descriptive-analytic study performed on 60 patients with preeclampsia (30 with mild and 30 with severe preeclampsia) and 30 women with normal pregnancy (control) in Tabriz al-Zahra Hospital, serum level and antioxidant activity of ceruloplasmin was evaluated. The mean gestational age was 32.94+/-2.79 week in mild preeclampsia group, 32.17+/-3.00 week in severe preeclampsia group and 32.46+/-4.04 week in control group (p = 0.821). The mean serum level of ceruloplasmin was 0.62+/-0.16 g L-1 in mild preeclampsia group, 0.61+/-0.23 g L-1 in severe preeclampsia group and 0.47+/-0.16 g L-1 in control group. The serum ceruloplasmin in control group was significantly lower (p = 0.006). The mean antioxidant activity of ceruloplasmin was 562.54+/-139.79 in mild preeclampsia group, 556.21+/-190.94 in severe preeclampsia group and 427.62+/-162.14 in control group. The antioxidant activity was measured as production of mg dL-1 of a colored product. The antioxidant activity of ceruloplasmin in control group patients was significantly lower (p = 0.002). Significant linear positive correlation was found between serum level of ceruloplasmin and antioxidant activity of ceruloplasmin (p<0.001 and r = 0.910). Serum level of ceruloplasmin is significantly lower in normal pregnancy than mild and severe preeclampsia. Antioxidant activity of ceruloplasmin is significantly lower in normal pregnancy than mild and severe preeclampsia.

Placental oxidative stress, selenium and preeclampsia

There is considerable evidence that placental oxidative stress plays a significant role in the etiology of preeclampsia. Prophylactic use of exogenous anti-oxidants such as vitamins E and C have proven to be ineffective and potentially dangerous. The current study addresses the role of endogenous anti-oxidant systems in preeclampsia. In particular, data on the selenodependent enzymes glutathione peroxidase and thioredoxin reductase will be presented and the role of selenium in preeclampsia will be considered. The aim of these studies was to determine the levels of endogenous antioxidants, selenium, and biological oxidation in normal and preeclamptic placental tissues. Furthermore, animal studies were conducted to assess the impact of selenium depletion on anti-oxidant expression and activity, oxidative stress and symptoms of preeclampsia. Selenium depletion generated placental oxidative stress and produced a preeclamptic like syndrome in pregnant rats suggesting a link between placental oxidative stress, endogenous antioxidant disequilibria and the pathogenesis of preeclampsia that may be linked to insufficient dietary selenium. The selenium of status of preeclamptic mothers was also considered and lower levels of selenium were observed when compared to normal controls. Selenium supplementation improves endogenous anti-oxidant expression in trophoblast cells and might provide an effective method of protecting the placenta from oxidative stress during preeclampsia. Clinical studies are now underway to investigate the benefits of low dose selenium supplementation on the development and progression of preeclampsia.

Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension?

PURPOSE

Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine whether regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH).

METHODS

Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks' gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n = 58), GH (n = 158), and normotensive pregnancies (n = 2351). Chocolate consumption (servings/week) during the first and third trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of less than 1 serving/week comprised the referent group. Adjusted odds ratios (aORs) were estimated by the use of logistic regression.

RESULTS

Chocolate intake was more frequent among normotensive (80.7%) than preeclamptic (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (first trimester: aOR, 0.55; 95% confidence interval [95% CI], 0.32-0.95; third trimester: aOR, 0.56; 95% CI, 0.32-0.97). Only first trimester intake was associated with reduced odds of GH (aOR,0.65; 95% CI, 0.45-0.87).

CONCLUSIONS

These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia.