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1.
Maternal dyslipidemia and altered cholesterol metabolism in early pregnancy as a risk factor for small for gestational age neonates.
Kim, SY, Lee, SM, Kwon, GE, Kim, BJ, Koo, JN, Oh, IH, Kim, SM, Shin, S, Kim, W, Joo, SK, et al
Scientific reports. 2021;(1):21066
Abstract
We evaluated the relationship between maternal cholesterol levels and its biologically active precursors and metabolites in the first trimester and subsequent risk for small-for-gestational-age birthweight (SGA). This is a secondary analysis of a prospective cohort study which enrolled healthy singleton pregnancies (n = 1337). Maternal fasting blood was taken in the first trimester and followed up till delivery. The lipid parameters were compared between women who delivered SGA neonates (SGA-group, birthweight < 10th percentile, n = 107) and women who did not (non-SGA-group, n = 1230). In addition, metabolic signatures of cholesterol were evaluated in a subset consisting of propensity-score matched SGA (n = 56) and control group (n = 56). Among lipid parameters, maternal high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in SGA-group than in non-SGA-group (p = 0.022). The risk for SGA was negatively correlated with maternal serum HDL-C quartiles (p = 0.003), and this association remained significant after adjustment for confounding variables. In metabolic signatures of cholesterol, the cholesterol/lathosterol ratio in SGA-group was significantly higher than non-SGA-group [(2.7 (1.6-3.7) vs. 2.1 (1.5-2.9), respectively; p = 0.034)], suggesting increased endogenous cholesterol biosynthesis. We demonstrated that dyslipidemia and increased cholesterol biosynthesis led to delivery of SGA neonates even in early pregnancy.
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2.
Intensive Medical Nutrition Therapy Alone or with Added Metformin to Prevent Gestational Diabetes Mellitus among High-Risk Mexican Women: A Randomized Clinical Trial.
Perichart-Perera, O, Mier-Cabrera, J, Flores-Robles, CM, Martínez-Cruz, N, Arce-Sánchez, L, Alvarado-Maldonado, IN, Montoya-Estrada, A, Romo-Yañez, J, Rodríguez-Cano, AM, Estrada-Gutierrez, G, et al
Nutrients. 2021;(1)
Abstract
The aim of this study was to examine the efficacy of intensive medical nutrition therapy (MNT) plus metformin in preventing gestational diabetes mellitus (GDM) among high-risk Mexican women. An open-label randomized clinical trial was conducted. Inclusion criteria were pregnant women with three or more GDM risk factors: Latino ethnic group, maternal age >35 years, body mass index >25 kg/m2, insulin resistance, and a history of previous GDM, prediabetes, a macrosomic neonate, polycystic ovarian syndrome, or a first-degree relative with type 2 diabetes. Women before 15 weeks of gestation were assigned to group 1 (n = 45): intensive MNT-plus metformin (850 mg twice/day) or group 2 (n = 45): intensive MNT without metformin. Intensive MNT included individual dietary counseling, with ≤50% of total energy from high carbohydrates. The primary outcome was the GDM incidence according to the International Association of Diabetes Pregnancy Study Groups criteria. There were no significant differences in baseline characteristics and adverse perinatal outcomes between the groups. The GDM incidence was n = 11 (24.4%) in the MNT plus metformin group versus n = 7 (15.5%) in the MNT without metformin group: p = 0.42 (RR: 1.57 [95% CI: 0.67-3.68]). There is no benefit in adding metformin to intensive MNT to prevent GDM among high-risk Mexican women. Clinical trials registration: NCT01675310.
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Integrated metabolome analysis reveals novel connections between maternal fecal metabolome and the neonatal blood metabolome in women with gestational diabetes mellitus.
Zhao, C, Ge, J, Li, X, Jiao, R, Li, Y, Quan, H, Li, J, Guo, Q, Wang, W
Scientific reports. 2020;(1):3660
Abstract
Gestational Diabetes Mellitus (GDM), which is correlated with changes in the gut microbiota, is a risk factor for neonatal inborn errors of metabolism (IEMs). Maternal hyperglycemia exerts epigenetic effects on genes that encode IEM-associated enzymes, resulting in changes in the neonatal blood metabolome. However, the relationship between maternal gut microbiota and the neonatal blood metabolome remains poorly understood. This study aimed at understanding the connections between maternal gut microbiota and the neonatal blood metabolome in GDM. 1H-NMR-based untargeted metabolomics was performed on maternal fecal samples and targeted metabolomics on the matched neonatal dry blood spots from a cohort of 40 pregnant women, including 22 with GDM and 18 controls. Multi-omic association methods (including Co-Inertia Analysis and Procrustes Analysis) were applied to investigate the relationship between maternal fecal metabolome and the neonatal blood metabolome. Both maternal fecal metabolome and the matched neonatal blood metabolome could be separated along the vector of maternal hyperglycemia. A close relationship between the maternal and neonatal metabolomes was observed by multi-omic association approaches. Twelve out of thirty-two maternal fecal metabolites with altered abundances from 872 1H- NMR features (Bonferroni-adjusted P < 0.05) in women with GDM and the controls were identified, among which 8 metabolites contribute (P < 0.05 in a 999-step permutation test) to the close connection between maternal and the neonatal metabolomes in GDM. Four of these eight maternal fecal metabolites, including lysine, putrescine, guanidinoacetate, and hexadecanedioate, were negatively associated (Spearman rank correlation, coefficient value < -0.6, P < 0.05) with maternal hyperglycemia. Biotin metabolism was enriched (Bonferroni-adjusted P < 0.05 in the hypergeometric test) with the four-hyperglycemia associated fecal metabolites. The results of this study suggested that maternal fecal metabolites contribute to the connections between maternal fecal metabolome and the neonatal blood metabolome and may further affect the risk of IEMs.
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4.
Comparison of sun exposure versus vitamin D supplementation for pregnant women with vitamin D deficiency.
Hajhashemi, M, Khorsandi, A, Haghollahi, F
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2019;(8):1347-1352
Abstract
INTRODUCTION Maternal vitamin D deficiency is widespread health problem that is more important in pregnant women, which affects fetus growth and bone development. The aim of this study was to evaluate the effect of sun exposure versus vitamin D supplementation for pregnant women with vitamin D deficiency. MATERIALS AND METHODS This prospective clinical trial was performed on 87 pregnant women with vitamin D deficiency. Group A was treated with vitamin D 4000 IU per day for 10 weeks, while group B was recommended for sun exposure for 30 minutes daily (30% body surface area) for 10 weeks in summer and between 10 am-4 pm in direct sunlight. After the delivery, 25-hydroxyvitamin D3 levels were measured in the same previous center. Moreover, weight, height, and head circumference of fetus were measured at delivery in both groups and compared with each other. RESULTS After 10-week intervention, 25-hydroxyvitamin D3 levels was significantly higher in group treated with vitamin D as compared to sun expose group (31.27 versus 19.79 ng/ml). (p < .001). However, height (p = .118), weight (p = .245), and head circumference (p = .681) of infants in both groups did not show significant differences. CONCLUSIONS Vitamin D supplementation is more effective than sun exposure in increasing 25-hydroxyvitamin D3 in pregnant women with vitamin D deficiency.
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Effects of prophylactic iron supplementation on outcome of nonanemic pregnant women: A non-randomized clinical trial.
Asadi, N, Vafaei, H, Kasraeian, M, Yoosefi, S, Faraji, A, Abbasi, L
Journal of the Chinese Medical Association : JCMA. 2019;(11):840-844
Abstract
BACKGROUND The aim of the current study was to investigate the effects of prophylactic iron supplementation on the pregnancy outcome of nonanemic pregnant women in a sample of Iranian population. METHODS This non-randomized clinical trial was conducted during a 2-year period in obstetrics clinics of Shiraz, southern Iran. We included a sample of singleton pregnancies registered in our clinics. Those with comorbidities were excluded. Serum ferritin was measured at baseline and participants were classified accordingly: those with normal serum ferritin levels (≥30 µg/dL) who received standard prophylactic iron supplementation during the pregnancy (Group 1); those who had minor thalassemia and elevated serum ferritin levels (≥30 µg/dL) who did not receive prophylactic iron supplementation or those with normal ferritin levels (≥30 µg/dL) who refused to receive iron supplementation due to gastrointestinal upset (Group 2); and those with iron deficiency anemia with low serum ferritin levels (<30 µg/dL) who received standard iron supplementation during pregnancy (Group 3). All the participants were followed to the delivery and maternal and neonatal outcomes were recorded and compared between three study groups. RESULTS Overall we included 30 pregnant women in each group with mean age of the participants was 28.66 ± 6.02 years. There was no significant difference between three study groups regarding gestational age at delivery (p = 0.250), birthweight (p = 0.893), Apgar at 1 (p = 0.532) and 5 (p = 0.590) minutes, and route of delivery (p = 0.590). The overall rate of maternal complication of the pregnancy was comparable between the three study groups (p = 0.188). However, those in group 1, had significantly higher rate of gestational diabetes mellitus (GDM) when compared to other two groups (p = 0.038). CONCLUSION Prophylactic iron supplementation in pregnant women with normal ferritin levels is associated with increased risk of GDM. Other pregnancy and neonatal outcomes are not affected by the prophylactic iron supplementation.
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Food-basket intervention to reduce micronutrient deficiencies among Maasai-pregnant women in Tanzania: a quasi-experimental study.
Mshanga, N, Martin, H, Petrucka, P
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2019;(5):625-634
Abstract
BACKGROUND Micronutrients comprised of vitamin and mineral nutrients that are needed during pregnancy for foetal growth, development and maturation, as well as for reducing/preventing maternal complications. However, micronutrient-rich foods (vegetables and fruits) are lacking in the Ngorongoro Conservation Area as a result of restrictions on cultivation in conservation areas and the unavailability of vegetables and fruits in local markets. The present study introduced a food basket intervention and assessed the effectiveness of the food baskets with respect to addressing anaemia, vitamin A and iron deficiencies among pregnant Maasai women within the Ngorongoro Conservation Area. METHODS The quasi-experimental study included Misigiyo ward as a control group (provided education only) and Olbalbal ward as an intervention group (provided food baskets and education). The study assessed haemoglobin, serum ferritin and retinol at baseline and during follow-up. Haemoglobin, serum ferritin and retinol were quantitatively (duplicate) measured with HemoCue™ (HemoCue AB, Ängelholm, Sweden), Maglumi 800 (Snibe Diagnostic, Shenzhen, China) and vitamin A enzyme-linked immunosorbent assay, respectively. Dependent and independent t-tests were used to compare the micronutrient blood levels between and within the groups. RESULTS The present study found a statistically significant increase in serum retinol (P < 0.001) in the intervention group compared to the control group; moreover, baseline serum retinol was positively associated with the follow-up serum retinol, whereas baseline haemoglobin and serum ferritin were negatively associated. CONCLUSIONS The food basket intervention holds promise with repect to reducing micronutrient deficiency, especially in communities where micronutrient-rich foods are scarce.
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An alternative method for measuring oxidative stress in intrahepatic cholestasis of pregnancy: thiol/disulphide homeostasis.
Sanhal, CY, Daglar, K, Kara, O, Yılmaz, ZV, Turkmen, GG, Erel, O, Uygur, D, Yucel, A
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2018;(11):1477-1482
Abstract
PURPOSE The aim of our study was to evaluate the oxidative stress (OS) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) by evaluating thiol/disulphide homeostasis using an alternative technique. METHODS A total of 57 pregnant women with ICP were compared with 50 gestational age and body mass index matched controls. A recently defined method was used for the measurement of plasma native-total thiol and disulphide levels. The independent two-sample t test, Mann-Whitney-U test, Chi-square test, binary logistic regression with backward elimination and receiver operating characteristic (ROC) curve was performed for statistical analyses. RESULTS Pregnant women with ICP (n = 57) versus controls (n = 50) had significantly lower serum levels of native thiol (233.8 ± 47.4 μmol/L vs. 308.5 ± 51.7 μmol/L, p < .001), total thiol (258.4 ± 46.5 μmol/L vs. 328.0 ± 52.0 μmol/L, p < .001) and higher levels of disulphide (12.3 ± 3.6 μmol/L vs. 9.7 ± 3.4 μmol/L, p < .001). Binary logistic regression showed that the most important variables related to ICP were native thiol and total thiol. According to the ROC curve, the optimal cut-off level for native thiol was 280.0 μmol/L (sensitivity: 86%, specificity: 84.2%, area under the curve (AUC):0.896, 95% CI: 0.831-0.962, p < .001), and the optimal cut-off level for total thiol was 300.0 μmol/L (sensitivity: 86%, specificity: 80.7%, AUC: 0.883, 95% CI: 0.815-0.951, p < .001). CONCLUSIONS To our knowledge, this is the first study in the literature exploring thiol/disulphide balance in ICP. We found that thiol/disulphide balance indicate OS in pregnant woman with ICP.
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Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity.
Clifton, RG, Evans, M, Cahill, AG, Franks, PW, Gallagher, D, Phelan, S, Pomeroy, J, Redman, LM, Van Horn, L, ,
Obesity (Silver Spring, Md.). 2016;(2):305-13
Abstract
OBJECTIVE The Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium is designed to determine, in pregnant women with overweight or obesity, whether various behavioral and lifestyle interventions reduce excessive gestational weight gain (GWG) and subsequent adverse maternal and neonatal outcomes and obesity in offspring. The design and planning process of the LIFE-Moms Consortium is described. METHODS The LIFE-Moms Consortium is a collaboration among seven clinical centers, a Research Coordinating Unit, and the NIH designed to support each clinical center's conduct of a separate trial of a unique intervention. Specific common measures, procedures, and eligibility criteria are consistent across the seven trials allowing data to be combined in exploratory analyses and/or compared readily. RESULTS Numerous committees and working groups were created to define common measures and outcomes during pregnancy and through 1 year postpartum, develop Consortium policies, and oversee progress of the trials. The primary outcome for the Consortium is excessive GWG. Secondary outcomes include maternal, neonatal, and infant anthropometric measures, physical activity, sleep, and complications of pregnancy and delivery. CONCLUSIONS A multi-center consortium of independent, lifestyle interventions with common measures and outcomes may enhance the ability to identify promising interventions for improving outcomes in pregnant women and their offspring.
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Maternal obesity during pregnancy is negatively associated with maternal and neonatal iron status.
Jones, AD, Zhao, G, Jiang, YP, Zhou, M, Xu, G, Kaciroti, N, Zhang, Z, Lozoff, B
European journal of clinical nutrition. 2016;(8):918-24
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Abstract
BACKGROUND/OBJECTIVES Obesity among pregnant women may adversely affect both maternal iron status throughout pregnancy and placental transfer of iron. The objective of this study was to determine the association of maternal body mass index (BMI) with (1) maternal iron status and inflammation in mid and late pregnancy, (2) the change in maternal iron status throughout pregnancy and (3) neonatal iron status. SUBJECTS/METHODS We examined longitudinal data from 1613 participants in a pregnancy iron supplementation trial in rural China. Women with uncomplicated singleton pregnancies were enrolled in the early second trimester of pregnancy and followed through parturition. Maternal blood samples obtained at enrollment and in the third trimester and cord blood samples were analyzed for a range of hematological and iron biomarkers. RESULTS There was a negative association between maternal BMI and iron status at enrollment (transferrin receptor (sTfR): r=0.20, P<0.001; body iron (BI): r=-0.05; P=0.03). This association was markedly stronger among obese women. Maternal BMI was positively associated with maternal inflammation (C-reactive protein: r=0.33, P<0.001). In multiple linear regression models, maternal BMI was negatively associated with neonatal iron status (cord serum ferritin: -0.01, P=0.008; BI: -0.06, P=0.006) and associated with a lower decrease in iron status throughout pregnancy (sTfR: -4.6, P<0.001; BI: 1.1, P=0.004). CONCLUSIONS Maternal obesity during pregnancy may adversely affect both maternal and neonatal iron status, potentially through inflammatory pathways.
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Influence of medical nutrition therapy on borderline glucose intolerance in pregnant Taiwanese women.
Ho, TC, Yan, YH, Lu, MC, Yu, CW, Wang, P
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2016;(7):1181-6
Abstract
OBJECTIVE To investigate the influence of medical nutrition therapy (MNT) on borderline glucose intolerance (BGI) in pregnant Taiwanese women. METHODS A total of 5194 singleton pregnant women were enrolled in this prospective, non-randomized study. The participants were subjected to the 50 g 1-h glucose challenge test (GCT) and 100 g 3-h oral glucose tolerance test (OGTT) to screening gestational diabetes mellitus (GDM). BGI was defined as a positive GCT and normal OGTT results. GDM was defined as a positive GCT and abnormal OGTT results. The women were categorized into the following groups: (1) GCT-negative, n = 3881; (2) BGI with MNT, n = 273; (3) BGI without MNT, n = 712; and (4) GDM, n = 328. Multiple logistic analyses were used to estimate the risks of pregnancy outcomes. RESULTS The odds ratios (95% confidence interval) for total cesareans, third- or fourth-degree perineal lacerations, gestational hypertension or preeclampsia and macrosomia were 1.24 (1.04-1.49), 1.55 (1.06-1.28), 1.78 (1.21-2.61) and 2.50 (1.28-4.91) in the BGI without MNT group compared to the GCT-negative group. There was no difference between BGI with MNT and GCT-negative groups. CONCLUSIONS Women with BGI who did not receive MNT had increased risks of adverse pregnancy outcomes, whereas who received MNT had no different risk with GCT-negative women.