Lactation,seasonality, and mother's postpartum weight change in Bangladesh: An analysis of maternal depletion

Longitudinally collected data from rural Bangladesh was used to investigate the effects of lactation, reproductive patterns, and seasonality on maternal weight and postpartum weight change. Results of multivariate analyses demonstrate that weight change exhibits a strong seasonal pattern, with losses in winter (December through March) and the rainy season (July through November) and gains in other months. The rate of weight loss peaks between 5 and 9 months postpartum, declines to near zero by 16 months postpartum, and becomes positive thereafter. However, season and duration interact, so that women who reach the stage of most intensive nutritional demand at a time of low food supply relative to energy output lose considerably more weight than women who reach that stage when food supplies are more adequate. Currently lactating women lose weight more rapidly than nonlactating women. Weight loss is slower among women with low initial weight. Prior reproductive patterns are associated with both weight at the time of conception and weight gain during pregnancy, which together determine weight at the beginning of the lactation interval. Each additional birth is associated with a decrease of 280 g in weight at conception, whereas interpregnancy intervals of < 18 months are associated with an 800-g deficit at the time of that conception compared to longer intervals. Weight gain during pregnancy is greater among women with high parity, short interpregnancy intervals, and lower weight at conception, but not enough to compensate for the prepregnancy deficit. © 1994 Wiley-Liss, Inc.     

Timing of the influence of maternal nutritional status during pregnancy on fetal growth

This study, which used data from a longitudinal nutrition study of mothers and infants in rural Guatemala, tested a hypothesis that the influence of maternal nutritional status on various measurements of fetal growth is trimester-specific. The relationships between various measures of newborn size and the changes of maternal anthropometry at various stages of pregnancy were analyzed by ordinary least squares multiple regression techniques. The sample included 235 mother-infant pairs who had complete anthropometry for both the newborns (weight, length, and head circumference) and their mothers at 3, 6, and 9 months of pregnancy (weight, height, circumferences of mid-upper arm and thigh, skinfold thicknesses at biceps, triceps, calf, thigh, and subscapular sites). Each kilogram of maternal weight gain in the second and third trimester was associated with statistically significant increases in birth weight of 62 g (P < 0.001) and 26 g (P < 0.05), respectively. Newborn length and head circumference were significantly associated with maternal weight gain and the changes in maternal thigh skinfolds in mid-pregnancy only. The overall results suggest that maternal nutritional status in mid-pregnancy rather than in late pregnancy is a more important determinant of fetal growth in weight, length, and head circumference. Am. J. Hum. Biol. 10:529–539, 1998. © 1998 Wiley-Liss, Inc.     

Pattern and predictors of weight gain during pregnancy among HIV-1-infected women from Tanzania

Progression of HIV disease is often accompanied by weight loss and wasting. Gestational weight gain is a strong determinant of maternal and neonatal outcomes; however, the pattern and predictors of weight gain during pregnancy among HIV-positive women are unknown. We obtained monthly anthropometric measurements in a cohort of 957 pregnant women from Tanzania who were HIV infected. We estimated the weekly rate of weight gain at various points during the second and third trimesters of pregnancy and computed rate differences between levels of sociodemographic, nutritional, immunologic, and parasitic variables at the first prenatal visit. The change in mid-upper arm circumference (MUAC) from baseline to delivery was also examined. The rate of weight gain decreased progressively during pregnancy. There was an average decline of 1 cm in MUAC between weeks 12 and 38. Lower level of education and helminthic infections at first visit were associated with decreased adjusted rates of weight gain during the third trimester. High baseline MUAC, not contributing to household income, lower serum retinol and selenium concentrations, advanced clinical stage of HIV disease, and malaria infection were related to decreased rates of weight gain during the second trimester. Low baseline CD4 T-cell counts were related to a poorer pattern of weight gain throughout pregnancy. Prevention and treatment of parasitic infections and improvement of nutritional status are likely to enhance the pattern of gestational weight gain among HIV-infected women.     

Size at birth and growth trajectories to young adulthood.

Few studies in developing countries follow growth trajectories from birth to adulthood. Such studies are important because size at birth and postnatal growth affect risk of chronic disease in adulthood. This study examines the inter-relationships of maternal factors during pregnancy, infant birth weight and length, early postnatal growth, and young adult height, weight, BMI, and skinfold thicknesses, with particular attention to patterns of growth associated with increased chronic disease risk. Women were recruited in pregnancy, and offspring were followed from birth to age 21 in the community-based Cebu (Philippines) Longitudinal Health and Nutrition Survey. Birth weight and length are independently, positively associated with height, BMI and sum of skinfolds in young adult males and females, and inversely associated with the subscapular to triceps ratio in males only. The effects of size at birth on adult size were modified by birth order, and remained significant after adjusting for maternal nutritional status, socioeconomic status at birth and throughout the growth period, and maturation. Early postnatal growth was strongly influenced by BMI at birth, with rapid early infant weight gain associated with thinness. The growth pattern of the at-risk group most often associated with increased risk of chronic disease (small at birth, relatively heavy as an adult), was characterized by more rapid growth in the first 4 postnatal months. The high level of inter-relatedness of maternal nutrition in pregnancy, prenatal growth, and postnatal growth emphasizes the need to consider the full growth trajectory in studies of developmental origins of adult disease.     

The level of bile salt-stimulated lipase in the milk of Chinese women and its association with maternal BMI

This study aimed to investigate the bile salt-stimulated lipase (BSSL) concentration in the milk of Chinese women and its correlation with maternal body mass index (BMI), gestational diabetes mellitus (GDM) and gestational hypertensive disorder (GHD). The BSSL levels in the milk samples were measured by enzyme-linked immunosorbent assay (ELISA). BSSL level in colostrum milk of mothers with full-term infants was positively correlated with pregnancy week and negatively correlated with maternal pre-pregnancy BMI and BMI late in pregnancy. Moreover, the BSSL concentration in mature milk was positively correlated with BMI gain during pregnancy. The BSSL concentration in colostrum milk was lower in GDM mothers than in normal mothers. The BSSL helps infants digest fat in early life and its level was associated with lactation. The changes in BSSL characteristics with maternal BMI and GDM in this study may have clinical implications regarding the effects of pregnancy weight and metabolism on the nutrition and health of the offspring.     

Effects of diet and obesity on body weight regulation during pregnancy and lactation in the rat

The effects of obesity level and cafeteria feeding were studied in rats during pregnancy and lactation. The non-fetal weight gain in pregnancy was three times greater with the cafeteria diet than with chow, indicating that fat deposition is not regulated at an optimal level during pregnancy. There was a strong negative correlation between postpartum weight and weight change during lactation. Obese rats were finicky in that their weight changes in lactation were exaggerated when the diet was changed between pregnancy and lactation. Pup growth rate was proportional to maternal energy intake but in this experiment not related to maternal protein, fat or carbohydrate intake. In obese rats switched to chow, intake was inadequate for normal pup growth. Thus, the weight gains in pregnancy are not regulated at a set level, and the weight change in lactation appears to compensate for the weight gain in pregnancy.     

Pregnancy weight gain and its correlation to birth weight

This study was done to determine whether a relationship existed between maternal weight gain during pregnancy and the birth weight and if such a relationship did exist, to establish the minimum weight gain required for a normal birth weight baby. This was a retrospective study involving an audit of all antenatal records at a rural hospital and health centre. The records reviewed belonged to a period between '86-'99. About 2000 antenatal records were scanned and cases with complications and multiple pregnancy were excluded. The records reviewed pertained only to mothers who had delivered at this rural hospital. The final sample size was 935 mothers. The study revealed that a greater weight gain in second trimester resulted in a better birth weight (P < 0.05). Other factors that influenced the birth weight were: age (P < 0.001), regular antenatal check up (P < 0.05) and parity (P < 0.05).     

Maternal height,pregnancy weight gain,and birthweight

The Institute of Medicine recommends that short women gain less weight during pregnancy than taller women in order to reduce the risk of high birthweight, which can lead to feto-pelvic disproportion. This recommendation, however, is based on clinical judgment rather than on epidemiologic evidence, as few studies have examined the relationships between maternal height, pregnancy weight gain, and infant birthweight. Our objective was to determine whether maternal height is an independent risk factor for infant birthweight and to assess whether maternal height modifies the effect of pregnancy weight gain on infant birthweight. We examined the relationship between maternal height and infant birthweight in a multi-ethnic cohort of 8,870 women with uncomplicated pregnancies who delivered singleton infants at the University of California, San Francisco, 1980–1990. Using multiple linear regression, we modeled the contribution of height and weight gain to birthweight in four different ethnic groups. Increasing maternal height was significantly and positively associated with infant birthweight in White, Black, and Asian women, but not Hispanic women. The relationship between pregnancy weight gain and infant birthweight was not modified by maternal height. Am. J. Hum. Biol. 12:682–687, 2000. © 2000 Wiley-Liss, Inc.     

Do reproductive patterns affect maternal nutritional status?: An analysis of maternal depletion in Lesotho

Poor pregnancy outcomes in developing countries have often been blamed on maternal depletion or on the cumulative nutritional drain of many closely spaced pregnancies. Despite its widespread acceptance, the maternal depletion hypothesis remains unproven. This study examines nutritional status and fertility history for 873 women in highland Lesotho. Parity, age, pregnancy status, length of last closed birth interval, open interval, and median birth interval were used to predict nutritional status (BMI, triceps skinfold, arm muscle area). While there is evidence that both short-term and long-term nutritional depletion are related to lactation and pregnancy spacing, both BMI and triceps fat increase with parity. For this population, then, the assumption of cumulative depletion due simply to high fertility is not supported.     

Soluble Human Leukocyte Antigens,Interleukin-6, and Interferon-γ During Pregnancy

PROBLEM: Soluble human leukocyte antigens (sHLA), interferon-γ (IFN-γ), and interleukin-6 (IL-6) were studied during human pregnancy to test the hypothesis that sHLA concentrations are regulated by these specific cytokines. METHOD OF STUDY: Enzyme-linked immunoadsorbent assays (ELISA) were used to measure sHLA I and II in maternal circulation, cord blood, and placenta effluents of pregnant and nonpregnant women; maternal serum cytokines were also determined. RESULTS: sHLA in maternal and cord blood were equivalent to that in the placenta. By the third trimester, sHLA I concentrations in maternal plasma were significantly reduced compared to the first or second trimesters. sHLA II was increased during the second trimester relative to that postpartum. Maternal IL-6 and IFN-γ concentrations were not statistically different throughout gestation or postpartum. CONCLUSIONS: These data do not suggest a role for maternal plasma IL-6 or IFN-γ in regulation of systemic sHLA class I during pregnancy, but they do not address whether such events take place in local tissues of the maternal-fetal unit.     

Effects of preweaning nutrition on weight gain during pregnancy in mice

Previous work has shown that preweaning litter size affects the response of adult mice to dietary induced obesity, with animals reared in small litters showing increased hyperphagia and weight gain. The present work addressed whether a similar effect would be seen in the weight changes normally accompanying pregnancy and lactation. B6D2F2 mice were reared in small (4), medium (8) and large (12) litters. Adult females from each of these conditions were mated with males from medium litters and their body weight and food intake measured throughout pregnancy and lactation. Food intake increased during pregnancy and correlated with the dams' litter size, but the amounts consumed by all groups appeared similar. This was also true of maternal weight gain during pregnancy, pup weight and litter size. During lactation, the only differences were that animals which had been reared in large litters ate more food and weaned heavier pups than those in medium litters. These results differ from those previously obtained on dietary induced obesity, supporting different regulatory mechanisms in the two conditions.     

Rapid neonatal weight gain in rats results in a renal ubiquinone (CoQ) deficiency associated with premature death

We have recently reported that maternal dietary imbalance during pregnancy and lactation can reduce the lifespan of offspring. Rats that were growth restricted in utero by maternal protein restriction and underwent rapid weight gain when suckled by control fed dams died earlier than animals whose mothers were fed a control diet throughout pregnancy and lactation. We demonstrate here that mitochondrial abnormalities and DNA damage occur in the kidney of offspring who die prematurely. We have established by direct measurement and by in vitro supplementation that mitochondrial abnormalities occur because of a functional deficit of the mitochondrial cofactor coenzyme Q9 (CoQ9). These data provide molecular insight into the association between maternal nutrition and determination of offspring lifespan, and identify, a potential dietary intervention to prevent detrimental consequences of imbalanced maternal nutrition.     

Human breast areolae as scent organs: morphological data and possible involvement in maternal-neonatal coadaptation

In humans, areolar skin glands (AG) enlarge during pregnancy and lactation. Their role in mother-infant interactions may pertain to protective, mechanical, and communicative functions. It was questioned here whether more profuse AG could be related to more optimal adaptation to breastfeeding. A morphological study of the areolae was undertaken between birth and day 3 to assess the number, secretory status, and spatial distribution of AG. These data were related to infants' weight variation, mothers' perception of their infant's behavior at breast, and time between delivery and onset of lactation. AG were seen in virtually all women but with great interindividual variations; their areolar distribution was nonrandom, and about 1/5 of the women had AG giving off a secretion. The AG number was positively related with neonatal weight gain between birth and day 3, and with the mother's perception of infant's latching speed and sucking activity. AG numbers were also positively related with the onset of lactation in first-time mothers. In conclusion, the maternal endowment in AG may contribute to the infants' breastfeeding performance, early growth, and the mother's lactation onset.     

Changes in progressive ratio responding for intravenous cocaine throughout the reproductive process in female rats.

Operant responding on a progressive ratio (PR) schedule for intravenous cocaine as well as sucrose reinforcement was examined in female rats throughout the reproductive process. Self-administration sessions began before mating, and continued throughout pregnancy and until lactational Day 8; following parturition, litters were present with dams during operant sessions. Physiological changes associated with the reproductive process dramatically altered PR responding for cocaine, while PR responding for sucrose was relatively stable throughout pregnancy and lactation. Female animals exhibited the highest number of responses/session for cocaine during estrus and the 1st trimester of pregnancy and the lowest responding near parturition, with levels only partially recovering during lactation. Dams self-administering cocaine exhibited notably different patterns of maternal behavior in the operant chambers than dams responding for sucrose. Thus, cocaine's reinforcing efficacy may be influenced by (a) the changing physiological profile associated with the reproductive process and (b) competition from the reinforcing properties of offspring during lactation.     

Postpartum nutritional status of Filipino women

Postpartum weight, body mass index (BMI), triceps skinfold thicknesses (TSF) and upper arm circumferences (AC) were measured bimonthly for 24 months in a large cohort of urban and rural Filipino women. Weight loss, leading to an increasing prevalence of low BMI (<18.5) is the norm in this population where dietary intakes of energy, calcium, and iron fall below WHO recommended intakes. The effects of lactation on postpartum changes in weight and TSF during 6-month intervals were examined by stratifying women into groups defined by lactation duration. In addition, multivariate models were used to examine the effects of lactation on changes in weight or TSF while controlling for other factors such as energy intake, seasonality, morbidity, pregnancy interval, parity, and age. Lactation was associated with significantly increased weight losses from birth to 18 months postpartum. Furthermore, full lactation (breast-feeding with the addition of less than 20 kcal/day to the infant's diet) also significantly increased weight loss in the first 6 months, when the overall duration of lactation in that interval was controlled. Lactation had a small but statistically significant effect on changes in TSF as well. © 1992 Wiley-Liss, Inc.     

The effect of maternal nutritional variables on birthweight outcomes of infants born to Sherpa women at low and high altitudes in Nepal

A prospective, longitudinal study was conducted in Nepal to investigate the effects of maternal nutrition on the pregnancy outcome of Sherpa women living at low and high altitudes. It was hypothesized that variation in nutrition and energy expenditure of pregnant women would correlate with variation in infant birthweight. Anthropometric dimensions, energy consumption and expenditure, and demographic and migration information were collected on a large sample of women living in two regions of Nepal: the Khumbu region (3480–3930 m) and Kathmandu (1330 m). This paper reports findings for a subset of the sample; 17 women at low altitude and 21 women at high altitude who became pregnant and were followed during pregnancy. The results showed no significant differences for mean birthweights between the low (X = 3069 ± 341 grams) and high (X = 3099 ± 483 grams) altitude samples. Furthermore, larger birthweights were associated with larger weight gains during pregnancy for the high altitude sample. A stepwise regression analysis found a negative association between high energy expenditures during the second trimester and infant birthweight, but positive associations were found between third trimester calcium and second trimester protein intakes and birthweight. Prepregnancy BMI and stature were associated positively with infant birthweight, suggesting that good nutritional status prior to pregnancy may play an important role in pregnancy outcome for this population. Am. J. Hum. Biol. 9:751–763, 1997. © 1997 Wiley-Liss, Inc.     

Influence of protein-calorie malnutrition on reproductive performance of young and mature rats

The effect on reproduction and fetal growth of a protein-deficient diet administration during pregnancy was studied in young and adult rats. Young (50-55 days old) and adult (90-100 days old) pregnant or nonpregnant rats were fed a normal diet (25% protein) or a protein-deficient diet (6% protein) during pregnancy or for a 22-day period (nonpregnant rats). All females were weighed during the experiment and body length measured in the young rats. After parturition, pups were counted, sexed and individually weighed. Litter size, number of stillbirths and presence of body lesions in the neonates were also recorded. Alimentary protein deficiency caused reduction in weight gain during pregnancy and in the postpartum period in young and adult rats. Pups from protein deficient dams weighed less at birth than the pups of control dams, although litter size was unaltered. Pups from young malnourished dams tended to weigh less than those from adult malnourished dams. The incidence of stillbirths was higher in malnourished rats, the highest values occurring in the adult group. These results suggest that alimentary protein deficiency during pregnancy in young rats reduces maternal weight gain, presumably reducing nutrient storage. This may cause fetal/maternal competition for nutrients leading to retardation of both maternal and fetal growth. Growth impairment may be an adaptive process, assuring fetal survival.     

Effects of 2-oxoglutaric acid on bone morphometry,densitometry, mechanics,and immunohistochemistry in 9-month-old boars with prenatal dexamethasone-induced osteopenia

The structural quality of the connective tissue is genetically determined and is influenced by hormonal and nutritional modification. An effect of a 2-Ox-rich diet on bone mineralization and structure and expression of non-collagenous protein in articular and growth cartilages of maternal dexamethasone-treated 9-month-old boars was considered in this study. Sows were treated i.m. with dexamethasone at the dose of 0.03?mg?kg^?1 body weight every second day during the last 45 days of pregnancy. After the birth, the boars were divided into two groups: administered and not supplemented with 2-Ox for 9 months (0.4?g/kg body weight/day). Dexamethasone given during the prenatal time inhibited the growth and negatively influenced the mechanics, geometry and histomorphometrical parameters of long bones and cartilage irrespective of the diet. Moreover, maternal dexamethasone treatment resulted in expression of osteocalcin in the articular cartilage, and the diet rich in 2-Ox limited the OC expression. This study demonstrated that changes observed in adult boars initiated by dexamethasone treatment in the prenatal period were persistent and long-term use of alimentary 2-Ox supplementation can counteract only some of the destructive changes evoked by prenatal dexamethasone excess.     

Changes in serum parathyroid hormone levels during pregnancy

As pregnancy poses a significant challenge to maternal calcium homeostasis, it is interesting to investigate a change in serum parathyroid hormone (PTH) level throughout pregnancy. PTH metabolism in pregnancy has not been clearly defined. We have made an attempt to evaluate changes in serum intact PTH level during pregnancy. Compared with nonpregnant women, serum intact PTH concentrations were decreased significantly in pregnant women during the first and the second trimester, but not during the third trimester. Nephrogenous cyclic AMP excretion, index of parathyroid function has been reported to be decreased in pregnant women during the first and second trimester, but to be in normal range in pregnant women during third trimester. Our finding consisted with these facts.     

Maternal antigen presenting cells are a source of plasmatic HLA-G during pregnancy: longitudinal study during pregnancy

The aim of this work was to investigate the longitudinal evolution of plasmatic soluble HLA-G (sHLA-G: shed HLA-G1 plus HLA-G5) during pregnancy, and if peripheral maternal antigen presenting cells (APC) can be a source of sHLA-G. Blood samples were obtained from 45 volunteers during normal pregnancy, 8 of them monthly; from 8 pregnant volunteers in the first weeks of pregnancy who had later a miscarriage, and from 14 healthy nonpregnant control women. Monocytes obtained during pregnancy showed a moderately HLA-G cell surface expression and stimulation with interferon (IFN)-gamma increased this expression. Monocytes-derived dendritic cells obtained from pregnant women during the first and third trimester of pregnancy secreted more sHLA-G than those obtained from nonpregnant women. Plasmatic sHLA-G concentration in pregnant women was significatively higher than in nonpregnant women, with a peak in the third month. We can conclude that maternal APC are a source of sHLA-G. Women who experienced miscarriage had previously very low or undetectable plasmatic sHLA-G levels in the second month of pregnancy. Data suggest that undetectable sHLA-G could be a risk of complications.