Supplementation of n-3 fatty acids during pregnancy and lactation reduces maternal plasma lipid levels and provides DHA to the infants.

OBJECTIVE: Docosahexaenoic acid (DHA, 22:6 n-3) is considered an essential fatty acid for the fetus and newborn infant, but the optimal level of supply is not known. We studied the effect of supplementing pregnant and lactating women with marine n-3 polyunsaturated fatty acids (PUFAs) as compared to n-6 PUFAs related to maternal and infant lipid levels. STUDY DESIGN: Five hundred and ninety pregnant women in weeks 17-19 of pregnancy were recruited. They were given either 10 mL cod liver oil (n-3 PUFAs) or corn oil (n-6 PUFAs) daily until three months after delivery, and 341 women took part in the study until giving birth. RESULTS: Maternal supplementation with cod liver oil increased the concentration of DHA in maternal as well as infant plasma and umbilical tissue phospholipids, as compared to corn oil. The maternal plasma triacylglycerol increase during pregnancy was less pronounced in women supplemented with cod liver oil as compared to corn oil. The concentration of high-density lipoprotein (HDL)-cholesterol was unchanged during pregnancy in the cod liver oil group, whereas it decreased in the corn oil group, promoting a greater increase in the ratio of total cholesterol/HDL-cholesterol in the corn oil group. CONCLUSION: Maternal supplementation with n-3 fatty acids during pregnancy and lactation provides more DHA to the infant and reduces maternal plasma lipid levels compared to supplementation with n-6 fatty acids.     

Fish consumption during pregnancy: an overview of the risks and benefits

Evidence supports the benefits of fish consumption during pregnancy, primarily because of the effects of n-3 polyunsaturated fatty acids on the neurodevelopment of the fetus. Many fish may also be potent sources of methylmercury and polychlorinated biphenol exposure, which have been shown to have severe negative impacts on both the mother and fetus. Therefore, all women of childbearing age should be informed of both the benefits and risks of fish consumption.     

Efficacy of n-3 fatty acids supplementation on the prevention of pregnancy induced-hypertension or preeclampsia: A systematic review and meta-analysis

The efficacy of n-3 fatty acids supplementation on the prevention of pregnancy-induced hypertension or preeclampsia remains unclear. The aim of study was to examine the effect of supplementation with EPA, and/or DHA, and/or ALA during pregnancy on the pregnancy-induced hypertension or preeclampsia. A systematic search was performed on Scopus, PubMed, Web of Science (WoS), Cochrane Library, and Google scholar, which covered the period between 1991 and 2018. The clinical trials with any control groups (i.e. placebo or other supplementation) were selected. The whole process of meta-analysis and data analysis was done using Comprehensive Meta-Analysis (Version 2.0, Biostat). The searched keywords were: “Fatty Acids, Omega-3”, “n-3 Polyunsaturated Fatty Acid” “Eicosapentaenoic Acid”, “Docosahexaenoic Acids”, “n-3 Polyunsaturated Fatty Acid”, “n-3 PUFAs”, “alpha-Linolenic Acid”, “fish oil”, “Nuts”, “nutrient”, or their synonyms “pregnancy induced hypertension” and preeclampsia. In addition, some key journals, according to Scopus report and the references of the original and review articles, were manually searched for possible related studies. The meta-analysis of the 14 comparisons demonstrated that n-3 fatty acids supplementation played a protective role against the risk of preeclampsia (RR, 0.82; 95% CI, 0.70–0.97; p = 0.024; I2 = 19.0%). The analysis of the 10 comparisons revealed that n-3 fatty acid supplements for pregnant women did not mitigate the risk of pregnancy-induced hypertension (RR, 0.98; 95% CI, 0.90–1.07; p = 0.652; I2 = 0%). The n-3 fatty acid supplements are an effective strategy to prevent the incidence of preeclampsia in women with low-risk pregnancies.     

Maternal mortality and severe maternal morbidity from acute fatty liver of pregnancy in the Netherlands

Objective

To assess maternal death and severe maternal morbidity from acute fatty liver of pregnancy (AFLP) in the Netherlands.

Study design

A retrospective study of all cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of severe maternal morbidity in the Netherlands between 2004 and 2006, in which all 98 maternity units in the Netherlands participated. Maternal mortality ratio (MMR) and incidence of severe maternal morbidity were the main outcome measures.

Results

The MMR from direct maternal mortality from AFLP was 0.13 per 100,000 live births (95% CI 0.05-0.29). The incidence of severe maternal morbidity from AFLP was 3.2 per 100,000 deliveries (95% CI 1.8-5.7).

Conclusions

AFLP is a rare condition which still causes severe maternal morbidity and in some cases mortality. Referral to a tertiary care hospital for treatment of this uncommon disease should be considered.     

Fetal and maternal plasma homocysteine levels during the second half of uncomplicated pregnancy

Objective: To measure fetal and maternal plasma homocysteine (Hcy) concentrations in uncomplicated pregnancies.

Methods: Paired maternal venous and fetal umbilical cord blood (n?=?81) samples were evaluated for plasma Hcy and vitamin B₁₂ levels, in addition to eight neonatal umbilical cord blood samples obtained immediately following delivery.

Results: Both fetal and maternal Hcy concentrations were positively correlated with advancing gestational age (ρ?=?0.44, p?<?0.0001; and ρ?=?0.27, p?<?0.05, respectively). Fetal plasma Hcy concentrations [2.2?µmol/l (IQR: 2.0–3.2)] were significantly lower than both neonatal umbilical vein [5.0?µmol/l (IQR: 4.4–6.5); p?<?0.001] and maternal plasma Hcy levels [4.4?μmo/l (IQR: 3.4–5.4); p?<?0.001]. In addition, Hcy values at term were higher in the umbilical vein compared with the umbilical artery [5.0?μmol/l (IQR: 3.4–5.4) versus 4.2?μmol/l (IQR: 3.7–5.5), respectively; p?=?0.016]. Significant correlation was noted and between fetal and maternal Hcy levels (ρ?=?0.50, p?<?0.0001), while fetal Hcy was negatively correlated with maternal B₁₂ concentrations (ρ?=??0.32, p?<?0.001).

Conclusions: Fetal Hcy levels were significantly lower than maternal and neonatal levels and correlated with gestational age across the second half of pregnancy.     

Intake of long chain w3 polyunsaturated fatty acids during pregnancy and the influence of levels in the mother on newborn levels.

OBJECTIVE: To assess the relationship between the free intake of long chain w3 polyunsaturated fatty acid (w3 LCP) during pregnancy and the levels in the mother with the levels in the neonate. DESIGN: Cross-sectional study. SETTING: University hospital. SUBJECTS: One hundred and sixty-two mother-neonate pairs from normal at-term pregnancies. MAIN OUTCOME MEASURE: Dietetic interview in order to assess the w3 LCP intake. w3 LCPs were analyzed by capillary gas chromatography in plasma (expressed as percentage and as total amount) and in erythrocyte phospholipids (expressed as percentage) from mothers and neonates. RESULTS: The w3 LCP intake assessed by the dietetic interview was significantly correlated with w3 LCP levels in the plasma of both mothers and neonates. The levels of w3 LCPs in mothers and neonates were significantly correlated both in plasma fatty acids (expressed both as a percentage and absolute values) and in erythrocyte phospholipids (in percentage) (r=0.49-0.22). CONCLUSION: In an apparently well-nourished population the w3 LCP levels of the newborn infants are clearly influenced by those of their mothers. The higher the levels in mothers, the higher those in the neonates. The w3 LCP intake assessed by an interview also showed a significant influence, but to a lesser extent.     

Assessment of free fetal DNA concentration in maternal plasma during the first trimester of pregnancy: comparative study between EDTA and PPT tubes – pilot study

Objective: To compare ethylenediamine tetraacetic acid (EDTA) tubes and plasma preparation tubes (PPT) for evaluating maternal plasma during the first trimester of pregnancy.

Methods: A cross-sectional study was conducted on 24 male fetuses in women between 6 and 14 weeks of pregnancy. Blood samples (10?mL) were collected and stored in EDTA and PPT tubes. Subsequently, the samples were centrifuged and sent for free fetal DNA extraction by means of the polymerase chain reaction (PCR) technique. The reactions were performed in a real time PCR machine for detecting the amplification products. The genome region chosen for performing the PCR reactions was a target specific for the Y chromosome, in which the DYS-14 marker was amplified only when the DNA was of male sex. The free fetal DNA concentration was given by the threshold cycle (TC). To compare the tubes, the paired Student t-test was used.

Results: The mean gestational age was 11.08?±?2.30 weeks (range: 6–14). The mean TC for PPT was 30.08?±?1.05 (range: 27.08–32.61) and for EDTA, 30.23?±?0.96 (range: 28.01–32.09), but without statistical significance (p?=?0.357).

Conclusion: We did not observe any statistically significant difference in free fetal DNA concentration between the EDTA and PPT tubes.     

Amino acid concentrations in maternal plasma and amniotic fluid in relation to fetal insulin secretion during the last trimester of pregnancy in gestational and type I diabetic women and women with small-for-gestational-age infants

Free amino acid concentrations were determined in maternal plasma and amniotic fluid (AF) under standardized and unstressed conditions in four groups of women comprising 6 gestational and 13 type I diabetics, 10 women with small-for-gestational-age (SGA) infants, and 18 healthy control women between 36 and 39 weeks of gestation. Plasma values for branched chain amino acids (the sum of leucine, isoleucine and valine) did not differ significantly between the four groups. The corresponding values in AF were significantly higher (P less than 0.05) in the type I diabetic group and significantly lower (P less than 0.05) in the gestational diabetic group as compared to the control group. The mean AF C-peptide concentration was elevated but not significantly so in gestational (0.69 nmol/l) or type I diabetic (0.54 nmol/l) pregnancies and significantly lower (P less than 0.05) in women with SGA infants (0.28 nmol/l) as compared to the control group (0.38 nmol/l). There was a significant correlation between C-peptide in AF and branched chain amino acids in maternal plasma (r = 0.63; P less than 0.05) as well as to maternal blood glucose (r = 0.79; P less than 0.01) in the type I diabetic group, which merely suggests a greater beta cell reactivity to insulin secretagogues in offspring of diabetic mothers. The correlation between AF C-peptide and branched chain amino acids in maternal plasma was significantly inverse in women with SGA infants (r = -0.75; P less than 0.05). Both individual, branched chain, or total amino acid concentration in AF were unrelated to AF C-peptide.     

Left-side preference in holding and carrying newborn infants III. Mothers' perception of pregnancy one month prior to delivery and subsequent holding behaviour during the first postnatal week

One month prior to delivery, 82 primigravidae were interviewed during a routine antenatal clinic visit. All the pregnancies were normal and uncomplicated; all the infants were healthy and delivered at term. During the first postnatal week the way mothers held their newborn was studied. Seventy-six per cent of the mothers held the infant on the left side and twenty-four per cent on the right side. Mothers holding on the right had experienced a more negative perception of body changes and had made fewer preparations for delivery of the expected baby during pregnancy. Mothers holding on the left expressed a desire to return to gainful employment sooner after parturition and were married to or living with men of higher educational level. These results suggest that as early as one month before the expected date of delivery, mothers holding the infant on the left side differ from those mothers holding it on the right side during the first postnatal week.