Maternal Low Quality Protein Diet Alters Plasma Amino Acid Concentrations of Weaning Rats

Several studies have indicated the influence of a maternal low protein diet on the fetus. However, the effect of a maternal low quality protein diet on fetal growth and development is largely unknown. Wistar rats (11 weeks old) were mated and maintained on either a chow diet with 20% casein (n = 6) as the control group (C), or a low quality protein diet with 20% wheat gluten (n = 7) as the experimental group (WG) through gestation and lactation. Maternal body weights were similar in both groups throughout the study. Birth weights were not influenced by maternal diet and offspring body weights during lactation were similar between the groups. Offspring’s plasma amino acid profiles showed that plasma methionine, glutamine and lysine were significantly lower and aspartic acid, ornithine and glycine-proline were significantly higher in the WG. Plant based protein comprises an important part of protein intake in developing countries. It is well-known that these diets can be inadequate in terms of essential amino acids. The current study shows differential effects of a maternal low quality protein diet on the offspring’s plasma amino acids. Future studies will examine further aspects of the influence of maternal low quality protein diets on fetal growth and development.     

Ramadan Fasting during Pregnancy and Health Outcomes in Offspring: A Systematic Review

Ramadan is one of the five pillars of Islam, during which fasting is obligatory for all healthy individuals. Although pregnant women are exempt from this Islamic law, the majority nevertheless choose to fast. This review aims to identify the effects of Ramadan fasting on the offspring of Muslim mothers, particularly on fetal growth, birth indices, cognitive effects and long-term effects. A systematic literature search was conducted until March 2020 in Web of Science, Pubmed, Cochrane Library, Embase and Google Scholar. Studies were evaluated based on a pre-defined quality score ranging from 0 (low quality) to 10 (high quality), and 43 articles were included. The study quality ranged from 2 to 9 with a mean quality score of 5.4. Only 3 studies had a high quality score (>7), of which one found a lower birth weight among fasting women. Few medium quality studies found a significant negative effect on fetal growth or birth indices. The quality of articles that investigated cognitive and long-term effects was poor. The association between Ramadan fasting and health outcomes of offspring is not supported by strong evidence. To further elucidate the effects of Ramadan fasting, larger prospective and retrospective studies with novel designs are needed.     

Fetal Adrenal Demedullation Lowers Circulating Norepinephrine and Attenuates Growth Restriction but not Reduction of Endocrine Cell Mass in an Ovine Model of Intrauterine Growth Restriction

Placental insufficiency is associated with fetal hypoglycemia, hypoxemia, and elevated plasma norepinephrine (NE) that become increasingly pronounced throughout the third trimester and contribute to intrauterine growth restriction (IUGR). This study evaluated the effect of fetal adrenal demedullation (AD) on growth and pancreatic endocrine cell mass. Placental insufficiency-induced IUGR was created by exposing pregnant ewes to elevated ambient temperatures during mid-gestation. Treatment groups consisted of control and IUGR fetuses with either surgical sham or AD at 98 days gestational age (dGA; term = 147 dGA), a time-point that precedes IUGR. Samples were collected at 134 dGA. IUGR-sham fetuses were hypoxemic, hypoglycemic, and hypoinsulinemic, and values were similar in IUGR-AD fetuses. Plasma NE concentrations were ~5-fold greater in IUGR-sham compared to control-sham, control-AD, and IUGR-AD fetuses. IUGR-sham and IUGR-AD fetuses weighed less than controls. Compared to IUGR-sham fetuses, IUGR-AD fetuses weighed more and asymmetrical organ growth was absent. Pancreatic β-cell mass and α-cell mass were lower in both IUGR-sham and IUGR-AD fetuses compared to controls, however, pancreatic endocrine cell mass relative to fetal mass was lower in IUGR-AD fetuses. These findings indicate that NE, independently of hypoxemia, hypoglycemia and hypoinsulinemia, influence growth and asymmetry of growth but not pancreatic endocrine cell mass in IUGR fetuses.     

孕期摄入热量、胆固醇、甘油三脂和空腹血糖在胎儿生长发育中的作用及相关性研究

目的探讨孕期摄入热量、胆固醇、甘油三脂和空腹血糖在胎儿宫内生长发育中的重要性和饮食控制的临床应用价值。方法将67例超重肥胖进行饮食控制的孕妇作为研究组,63例超重肥胖未控制饮食的孕妇作为对照组,59例正常体重孕妇作为正常体重组。检测3组孕妇孕早、中、晚期摄入的热量、胆固醇、甘油三脂和空腹血糖水平。结果研究组孕中、晚期摄入热量、胆固醇、甘油三脂和空腹血糖明显低于对照组及正常体重组,差异有统计学意义(P<0.05)。3组孕早、中、晚期摄入热量、胆固醇、甘油三酯水平,与新生儿生长指数呈明显正相关,3组孕妇孕中、晚期空腹血糖水平与新生儿生长指数呈明显正相关。结论孕前超重肥胖孕妇存在脂肪堆积,孕期可进行饮食控制,加强脂肪动员,促进胎儿的生长。     

Calcium intake in normotensive and hypertensive pregnant women

The present study was undertaken to investigate the dietary intakes of protein, fat, CHO, total calories and calcium in normotensive pregnant females and patients with pregnancy induced hypertension. A significantly higher intake of protein and calcium was found in normotensive females. The relationship also held true when the dietary intake of a subset of 13 hypertensive women was compared with normotensive women matched for age, parity and socio-economic status.     

Acetaldehyde and alcohol levels in pregnant rats and their fetuses

Alcohol and acetaldehyde blood levels were measured in chronic alcoholic pregnant rats and their fetuses at 15, 19 and 21 days of gestation. Similar ethanol concentrations were found in fetal and maternal blood in all gestation periods studied, however levels in amniotic fluid were higher than in mother's blood, especially in the early stages of gestation. Acetaldehyde concentrations were always lower in fetal than in maternal blood although increasing throughout gestation. The levels in fetal blood and amniotic fluid compared to maternal blood, were ca. 40, 50 and 70% at 15, 19 and 21 days of gestation, respectively; those for the placenta and fetal tissues were lower, i.e., 25, 40 and 50%. Similar alcohol and acetaldehyde ratios (fetus/mother's concentration) were obtained when pregnant non-alcoholic rats were administered cyanamide and ethanol (2 g/kg) at 11, 15, 19 and 21 days of gestation. These results demonstrate that ethanol freely crosses the placental barrier, but there is a concentration gradient of acetaldehyde between mother and fetus which varies with gestation age.     

Maternal Diet Influences Fetal Growth but Not Fetal Kidney Volume in an Australian Indigenous Pregnancy Cohort

Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.     

妊娠亚临床甲减对胎儿发育及妊娠结局的影响

目的：探讨妊娠期合并亚临床甲状腺功能减退（ SCH）对胎儿宫内发育及妊娠结局的影响。方法以在榆林市第一医院妇产科进行孕期体检确诊为SCH的孕妇96例为研究对象,其中56例接受左旋甲状腺素治疗的孕妇设为观察组,40例未接受治疗的孕妇设为对照组,随机抽取同期孕检的60例健康孕妇设为健康对照组,分别于孕期进行监测,并比较3组孕妇血清促甲状腺激素（TSH）及胎儿双顶径发育情况,比较3组母婴并发症发生情况。结果观察组孕后期TSH低于对照组（t＝0．723,P＜0．05）,胎儿双顶径大于对照组（t＝1．673,P＜0．05）,妊娠期高血压、妊娠期贫血、胎盘早剥及早产发生率低于对照组（χ2值分别为6．748、6．181、9．412、7．001,均P＜0．05）,观察组胎儿宫内窘迫、低出生体质量儿发生率低于对照组（χ2值分别为2．551、5．325,均P＜0．05）。观察组妊娠期高血压、妊娠期贫血、胎盘早剥及早产发生率与健康对照组比较各项指标差异均无统计学意义（χ2值分别为0．139、0．254、0．102、0．002,均P＞0．05）。对照组孕后期TSH高于健康对照组（t＝0．851,P＜0．05）,胎儿双顶径低于健康对照组（t＝1．355,P＜0．05）;胎儿宫内窘迫、低出生体质量儿发生率均高于健康对照组（χ2值分别为2．927、4．166,均P＜0．05）。结论 SCH可影响胎儿宫内发育,易引发母婴并发症的发生,早期进行左旋甲状腺素治疗可改善胎儿宫内发育,降低母婴并发症的发生,改善妊娠结局。     

阿昔洛韦口服治疗晚期妊娠生殖器疱疹的血药浓度和疗效评价

目的：评价妊娠晚期孕妇口服阿昔洛韦治疗生殖器疱疹的临床疗效和分娩期血药浓度。方法选择2010年3月至2015年12月上海市公共卫生临床中心就诊的复发性生殖器疱疹23例,从孕期32～36w起口服阿昔洛韦片0．4g／次,3次／d,疗程至分娩结束,胎儿娩出后抽取脐静脉血、脐动脉血和母体静脉血检测阿昔洛韦血药浓度。结果20例患者阴道顺产,1例胎位不正和2例胎儿宫内窘迫改为剖宫产,无1例患者分娩期出现疱疹活动,也无1例新生儿发生HSV感染。脐静脉血阿昔洛韦血药浓度浓度为251．38ng／mL,脐动脉血为231．57ng／mL,母体静脉血药浓度为430．64ng／mL;有60．87％（14／23）的脐静脉血,47．83％（11／23）脐动脉血和17．39％（4／23）母体静脉血样本低于阿昔洛韦稳态血药浓度180ng／mL;母体体重与脐静脉血、脐动脉血和母体静脉血血药浓度均无明显相关（r值分别为－0．207、0．130、0．164,P值分别为0．381、0．876、0．773,均P＞0．05）;分娩时程与脐静脉血、脐动脉血和母体静脉血血药浓度也无相关性（ r值分别为－0．382、0．264、0．139,P值分别为0．076、0．533、0．413,均P＞0．05）;末次服药间隔时间与脐静脉血、脐动脉血和母体静脉血血药浓度均呈负相关（ r值分别为－0．584、－0．624、－0．613,P值分别为0．003、0．001、0．002,均P＜0．05）。结论口服阿昔洛韦无法保证分娩期有效的血药浓度,而合适的给药方法和剂量仍需要大量研究。     

Biopsychosocial determinants of pregnancy length and fetal growth

The causes and mechanisms related to preterm delivery and intrauterine growth restriction are poorly understood. Our objective was to assess the direct and indirect effects of psychosocial and biomedical factors on the duration of pregnancy and fetal growth. A self-administered questionnaire was distributed to pregnant women attending prenatal ultrasound clinics in nine hospitals in the Montérégie region in the province of Quebec, Canada, from November 1997 to May 1998. Prenatal questionnaires were linked with birth certificates. Theoretical models explaining pregnancy length and fetal growth were developed and tested, using path analysis. In order to reduce the number of variables from the questionnaire, a principal component analysis was performed, and the three most important new dimensions were retained as explanatory variables in the final models. Data were available for 1602 singleton pregnancies. The biophysical score, covering both maternal age and the pre-pregnancy body mass index, was the only variable statistically associated with pregnancy length. Smoking, obstetric history, maternal health and biophysical indices were direct predictors of fetal growth. Perceived stress, social support and self-esteem were not directly related to pregnancy outcomes, but were determinants of smoking and the above-mentioned biomedical variables. More studies are needed to identify the mechanisms by which adverse psychosocial factors are translated into adverse biological effects.     

地塞米松治疗妊娠期肝内胆汁淤积症动物实验研究

目的 研究地塞米松治疗妊娠肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的疗效,观察地塞米松对胎鼠垂体-肾上腺的影响.方法 妊娠15d大鼠皮下注射乙炔雌二醇(17-α-ethinylestradial,EE))建立ICP动物模型,并给予地塞米松治疗;检测各组孕鼠血浆皮质醇、垂体促肾上腺皮质激素(adrenoeorticotropic hormone,ACTH)、胆酸(glycocholic acid,GC)、碱性磷酸酶(alkaline phosphatase,ALP)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)及总胆红素(total blirubin,TBiL)的变化.结果 地塞米松治疗ICP大鼠后,有效地降低了血胆汁酸浓度和胎鼠死亡率,降低了胎鼠血皮质醇和ACTH浓度.结论 地塞米松治疗ICP有效,对胎鼠可能存在潜在影响.     

妊娠期高血压疾病伴发胎儿生长受限的研究

目的研究妊娠期高血压疾病发病时间、严重程度与胎儿生长受限(FGR)的关系,为早期干预治疗降低FGR发病率提供依据。方法选取2017年11月至2018年4月在陕西省人民医院分娩的妊高病孕妇110例为研究组,选取同期分娩的健康孕妇110例为对照组,分别比较妊高病组(妊娠期高血压、子痫前期)与正常孕妇组FGR、死胎的发生率。结果妊娠期高血压疾病组FGR发生率为21.80%(χ^2=6.03,P <0.05)。其中子痫前期重度FGR发病率(34.50%),显著高于子痫前期轻度(13.30%)及妊娠期高血压(8.00%)的发病率(χ^2值分别为5.94、9.31,均P <0.05);发病孕周<28周者FGR发病率最高(38.00%),显著高于对照组FGR的2.70%(χ^2=4.23,P<0.05)。子痫前期重度死胎发生率最高(7.30%),正常妊娠组死胎发生率为0.00%(χ^2=3.35,P <0.05)。结论妊娠期高血压疾病发病孕周以及严重程度与FGR的发生呈正相关,发病孕周越早,病情越重,FGR的发生率越高。故建议尽早干预,预防子痫前期的发生,减少并发症,延长孕周,降低FGR的发生率,减少围产儿不良结局。     

Gestational Diabetes Mellitus: Predictive Value of Fetal Growth Measurements by Ultrasonography at 22–24 Weeks: A Retrospective Cohort Study of Medical Records

Early intervention of gestational diabetes mellitus (GDM) is effective in reducing pregnancy disorders. Fetal growth, measured by routine ultrasound scan a few weeks earlier before GDM diagnosis, might be useful to identify women at high risk of GDM. In the study, generalized estimating equations were applied to examine the associations between ultrasonic indicators of abnormal fetal growth at 22–24 weeks and the risk of subsequent GDM diagnosis. Of 44,179 deliveries, 8324 (18.8%) were diagnosed with GDM between 24 and 28 weeks. At 22–24 weeks, fetal head circumference (HC) < 10th, fetal femur length (FL) < 10th, and estimated fetal weight (EFW) < 10th percentile were associated with 13% to 17% increased risks of maternal GDM diagnosis. Small fetal size appeared to be especially predictive of GDM among women who were parous. Fetal growth in the highest decile of abdominal circumference (AC), HC, FL and EFW was not associated with risk of subsequent GDM. The observed mean difference in fetal size across gestation by GDM was small; there was less than 1 mm difference for AC, HC, and FL, and less than 5 g for EFW before 24 weeks. Despite similar mean fetal growth among women who were and were not later diagnosed with GDM, mothers with fetuses in the lowest decile of HC, FL and EFW at 22–24 weeks tended to have higher risk of GDM.     

平均红细胞体积在筛查孕妇地中海贫血中的临床应用分析

目的:探讨平均红细胞体积在筛查孕妇地中海贫血中的临床应用及意义。方法:选取中山市中医院2006～2010年5 000例开展地中海贫血筛查的孕妇,观察平均红细胞体积在筛查中的检测率,并参照基因诊断得出该指标的特异性。结果:依据平均红细胞体积参数指标,5 000例孕妇地中海贫血筛查后检出468例,检出率为9.36%。460例得到确诊,特异性为98.29%。结论:平均红细胞体积在筛查孕妇地中海贫血中具有积极的临床意义,能提高产前检查和孕期体检中疾病检出率,减少重型地贫儿的出生率、降低围生儿病死率,减少孕妇并发症。     

Relationship between dietary folate intakes,maternal plasma total homocysteine and B-vitamins during pregnancy and fetal growth in Japan

Background Adequate folate status in pregnancy is important for satisfactory pregnancy outcome. Aim of the Study The objective of the present study was to evaluate folate status in healthy pregnant women by assessing dietary folate intakes and measuring changes in folate-related biomarkers including plasma tHcy, serum vitamin B₁₂ (B₁₂), and serum and RBC folate concentrations in each trimester and to examine their relation to fetal growth. Methods From 94 pregnant women, 3-day-dietary records were obtained and blood was collected for plasma total homocysteine (tHcy), serum B₁₂, and serum and red-blood cell (RBC) folate measurements. Infant anthropometric measurements were made immediately after birth. Results Average folate intake was less than 300 μg/day with a mean energy intake of about 1800 kcal. Mean serum and RBC folate concentrations declined significantly during gestation (p < 0.05). Mean serum B₁₂ also significantly decreased (p < 0.01), whereas plasma tHcy increased from 5.1 in the first trimester to 5.9 μmol/l in the third trimester (p < 0.01). Multiple regression analyses, after controlling for maternal age, parity and pre-pregnancy body-mass index indicated that a 1.0 μmol/l increase in plasma tHcy in the third trimester corresponded to a 151 g decrease in birth weight (p < 0.01). Neither B₁₂ nor folate concentrations in all three trimesters showed any significant associations with birthweight. Plasma pyridoxal-5′-phosphate concentrations were markedly low, and were consistent with low intake of vitamin B₆ in our population. Conclusion Our data suggest that higher plasma tHcy in the third trimester is a predictor of lower birth weight. In general, the dietary intake of B-vitamins and energy may be inadequate in our population, suggesting intervention is necessary.     

Reduced obligatory nitrogen loss in rats made obese by cafeteria feeding

Rats made obese by fat feeding have been shown to have a lower urinary mitrogen excretion when fasting than non-obese animals (1). However, it is not clear whether this reduced metabolism of protien is the effect (2) or the cause (3) of the obese state nor are its implications understood. We report here that the induction of obesity by cafeteria feeding in rats is also assosited with a lower fasting urinary nitrogen loss (FUNL) than relative to matched non-obese controls and that these changes are paralled by changes in obligatory nitrogen loss (ONL) of the animals when fed a protein free diet. Our results suggest that the reduced net nitrogen losses are a consequence of obesity and, since ONL is the dominant component of the protein requirements, that obese subjects may have a reduced protein requirement as well as a lower propensity to catabolise protein when fasting. Thus, the adiposity of the subject may need to be considered when estimates of protein requirement are made.     

The effect of ambient air pollution during early pregnancy on fetal ultrasonic measurements during mid-pregnancy

BACKGROUND: Over the past decade there has been mounting evidence that ambient air pollution during pregnancy influences fetal growth. OBJECTIVES: This study was designed to examine possible associations between fetal ultrasonic measurements collected from 15,623 scans (13-26 weeks gestation) and ambient air pollution during early pregnancy. METHODS: We calculated mothers' average monthly exposures over the first 4 months of pregnancy for the following pollutants: particulate matter < 10 microm aerodynamic diameter (PM10), ozone, nitrogen dioxide, and sulfur dioxide. We examined associations with fetal femur length (FL), biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). Final analyses included scans from only those women within 2 km of an air pollution monitoring site. We controlled for long-term trend, season, temperature, gestation, mother's age, socioeconomic status, and fetal sex. RESULTS: A reduction in fetal AC was associated with O3 during days 31-60 [-1.42 mm; 95% confidence interval (CI), -2.74 to -0.09], SO2 during days 61-90 (-1.67 mm; 95% CI, -2.94 to -0.40), and PM10 during days 91-120 (-0.78 mm; 95% CI, -1.49 to -0.08). Other results showed a reduction in BPD (-0.68 mm; 95% CI, -1.09 to -0.27) associated with SO2 during days 0-30, a reduction in HC (-1.02 mm; 95% CI, -1.78 to -0.26) associated with PM10 during days 91-120, and a reduction in FL associated with PM10 during days 0-30 (-0.28 mm; 95% CI, -0.48 to -0.08) and 91-120 (-0.23; 95% CI, -0.42 to -0.04). CONCLUSION: We found strong effects of ambient air pollution on ultrasound measures. Future research, including more individually detailed data, is needed to confirm our results.     

孕早期糖脂水平与新生儿出生体重相关性的研究

目的 探讨孕早期血糖血脂水平与新生儿出生体重的关系.方法 回顾性分析2011年8月至2012年2月在北京妇产医院进行常规产前检查的孕妇临床资料,记录首次产检空腹血清葡萄糖(FPG)和血脂[包括甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TC)]的检测孕周及实验室结果,并按所有研究对象的第75百分位数分组,并对资料进行统计分析.结果 孕早期的FPG(r=0.064,P<0.01)、TC(r=0.055,P=0.01)、TG(r=0.063,P<0.01)和LDL-C(r=0.078,P<0.01)水平均分别与新生儿出生体重显著正相关.TG≥1.49mmol/L组的新生儿出生体重(3472.4±427.7g)明显高于TG<1.49mmol/L组(3427.4±388.9g),并且巨大儿所占比例也高于TG<1.49mmol/L组(11.2%vs 7.2%),差异均有统计学意义(t=2.11,P<0.05;χ2=8.43,P<0.05).结论 孕早期的TG水平与新生儿的出生体重和巨大儿发生相关.因此,临床上应关注孕早期的糖脂代谢,特别是确定不同孕期的血脂指标适宜范围,以便及早对代谢异常的孕妇进行生活方式指导和相关干预,从而改善妊娠结局.