Transcription
Proper MaternalNutrition duringPregnancy Planningand Pregnancy:a Healthy Start in LifeRecommendations forhealth care professionals– the experience from Latvia
thcarespecialists20171
n2016forgoodmaternalnutrition.2
ctofmaternaldietbeforeandduringpregnancyonthelife- ofrecommendations11.Bibliography3
withlow( 2500g)andhighbirthweight( 4000g)inLatvia,2008–20144
anthe5
ogrammingandthepossibletriggeringmechanisms.6
“2nd hit”Lipid accumulationLipid oxidationInsulin sensitivityAltered fibre typeMuscle massSKELETALMUSCLELeptin resistanceNephrogenesisAltered neuronaldevelopmentPANCREASFat cell hypertrophyLipid accumulationVasculogenesisGlucose uptakeCell cycle abnormalitiesBONESuppression ofosteocalsinSkeletal acquisition(bone mineral densityand content)Altered bone turnoverEGWGal. [56]; Palinski et al. [57].Endothelial dysfunctionCardiac hypertrophyHypertensionAngiogenesisNo. of cardiomyocytesGluconeogenesisHepatic steatosisCARDIOVASCULARSYSTEM”1st hit”Maternal obesityLIVERObesity, impaired glucose tolerance, insulin resistance, T2DM, metabolic syndrome, CVD, renal disease,osteoporosis, some types of cancer, and asthmaInflammationand secretion ofinflammatory factorsHyperleptinaemiaEndoplasmic reticulumstressFat storageInflammationInsulin secretion orhyperinsulinaemiaβ-Cell dysfunctionInsulin-stimulatedglucose uptakeADIPOSE TISSUEProgramming of tissues and organs inadaption to intrauterine environmentPerturbed maternal–fetalenvironmentGestational diabetes mellitusβ-Cell mass or isletfunctionContinued programming owing to a mismatchbetween fetal and postnatal environmentsAltered food choicebehaviourHyperphagiaAltered reninangiotensin systemactivitiesGlomular filtration rateKIDNEYMacro- and micronutrientrestrictionBRAINLipid accumulationInadequate placentalnutrient supplyNutritional stressors involved in metabolic programming of obesity and NCDsSources: adapted from Koletzko et al. [7]; Martin-Gronert & Ozanne [24]; Li, Sloboda & Vickers [30]; Devlin & Bouxsein [42]; Warner & Ozanne [47]; Knudson [54]; Fainberg, Budge & Symonds [55]; Viljakainen etEpigeneticmodificatonsFig. 4.
life- laterlife,includinginsulin- totheclassificationadoptedbyWHOin1995:BMI �29.9g/m2:overweight;and ngobeseduringadulthoodincreasesby8%.Ahighpre- cidsduringpregnancyIntakeofw - s,whereasintakeofw - ‐6fattyacidshasincreased.Themaindietarysourceofw - sprats),andthoseofw - ownapositiveeffectofw - humans,w - ‐3fattyacidsreducedtheriskforthepre- ver,ledtotheconclusionthatahighintakeofw - sm.8
rientcontent.Thismayhavelong- fanaemiainthisgroup(haemoglobin eassociatedwithahigherlife- on.9
equirevitaminD(whichisfat- sueandcauselong- ciencyisassociatedwithrisksforpre- able,nutrition- nfantandtheyoungchild.10
regnancyAvailabilityofe- ‐healthtohealthcareprofessionalstoresolvemulti- ialguaranteestoenablemotherstotakepre- otionofchild- ntationoftheInternationalCodeofMarketingofBreast- 2017)WeightoptimizationforwomenwithaBMI 18.5kg/m2or ssistance(CabinetregulationNo.611)11
eightoptimizationforwomenwithaBMI 18.5or lifestyleinthelong- iventopregnantwomeninthefollowingcases:- maternalobesity(BMI forthenewborn;- us;- sesofanumberofhealthrisksforthemotherandchild;- lordrugs;- multi- ensurethatthenutritionalneedsaremet;12
- nceddiet;- ency;- ilability;and- orgestationaldiabetesandpre- ho- uringpregnancy(http://www.vsmc.gov.lv/wp- itionalenergy.Therecommendedincreasedepends13
drangeof10–16;thisrangeisbasedon normalpre- sthatfornon- tdeep- reasetherisksforpre- sneednotchangetheirintakeoffats.The14
Thechoiceoffats,however,isvital.Bothw - theriskofthemotherforperinataldepression.w - ed:fishshouldbebroiled,steamedoroven- egion.Ifawomandoesnoteatfish,sheshouldchooseanw - ‐3fattyacidofplantorigin,e.g.α- inseedandhemp.Onlypartofα- antmothersrequirew - dsthatcontainw - atandpalmoilshouldberestricted,andtrans- ionaldiabetesandpre- ‐eclampsia.Furthermore,fibre- ypregnancy.15
HO- lcium,g1.5- iconvulsants)shouldbe16
ncyordeficit.Womenwhotakemulti- ysourcesoffolicacidaregreen- littletimeoutdoors,donoteatfish,haveaBMI 0µg/day;adosage ntsinthefoodindustryanduseofiodine- ‐containingfertilizersinagriculture.17
airyproducts.Useofiodizedsaltincookingf
a Healthy Start in Life Recommendations for health care professionals – the experience from Latvia. . ndex"(BMI)"before"pregnancy,"excessive" . unbalanced" maternal" diet and" mic
