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Prenatal Nutrition News

November 28, 2011 Written by JP       [Font too small?]

A recent study published in the journal Evidence-Based Complementary and Alternative Medicine supports the notion that prenatal nutritional counseling can significantly improve the health of mothers and newborns alike. In the highlighted research, a group of 53 pregnant women took part in a “pragmatic nutrition awareness program”. An equal number of expectant mothers acted as a control group and proceeded without any specific guidance about their unique dietary needs. On average, those receiving nutritional counseling gave birth to babies with a higher birth weight and experienced lower incidence of pregnancy-related complications. But, what exactly constitutes a healthy diet during pregnancy? Of late, several scientific publications have offered specific advice beyond the basic tenants of avoiding “junk food” and taking a prenatal multivitamin.

Some of the more compelling evidence I came across suggests that: 1) Foods rich in healthy bacteria or probiotics may protect mothers against a dangerous and prevalent condition known as preeclampsia – which can lead to dangerous elevations in blood pressure. Yogurt and other cultured dairy products may accomplish this feat, in part, by lowering systemic inflammation that frequently occurs during pregnancy. 2) Iron tablets are commonly prescribed to avoid anemia, low birth weight and preterm delivery. The most current findings support this recommendation, especially for those with suboptimal iron status. However, it may not be necessary to take iron daily. The October 2011 issue of the journal BMC Research Notes informs readers that a thrice-weekly iron regimen can be as effective as daily supplementation. 3) Assessing Vitamin D levels is an important, but often overlooked, aspect of prenatal care. Emerging data indicates that as many as 65% of pregnant women do not have adequate Vitamin D concentrations (25OHD <50 to <75 nmol/L) in their system. What’s more, higher than normally recommended dosages of D (up to 4,000 IUs) may be necessary to safely ensure optimal D status of between 100 and 150 nmol/L. 4) Finally, any pregnant women not taking fish oil ought to consider eating at least two weekly servings of salmon. This applies to both farmed and wild salmon. Doing so has recently been shown to increase circulating omega-3 levels in expectant mothers and umbilical cord blood without increasing oxidative stress.

It’s important to note that other fish cannot be recommended across the board. For instance, sardines are another acceptable choice that’s readily available. But, select seafood options including king mackerel, swordfish and tile fish should to be expressly avoided because of unacceptably high mercury content.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Evaluating the Impact of a Pragmatic Nutrition  Awareness Program (link)

Study 2 - Intake of Probiotic Food and Risk of Preeclampsia in Primiparous (link)

Study 3 - Effects of Daily Consumption of Probiotic Yoghurt on Inflammatory(link)

Study 4 - Pre-Pregnancy Iron Reserves, Iron Supplementation During Pregnancy (link)

Study 5 - Daily Versus Intermittent Iron Supplementation in Pregnant Women … (link)

Study 6 - Suboptimal Vitamin D Levels in Pregnant Women Despite Supplement (link)

Study 7 - Vitamin D Requirements and Supplementation During Pregnancy (link)

Study 8 - The Salmon in Pregnancy Study: Study Design, Subject Characteristics (link)

Study 9 - Does Increased Intake of Salmon Increase Markers of Oxidative Stress (link)

Study 10 - Omega-3 Fatty Acids and Pregnancy (link)

High Carbohydrate Diets May Increase the Risk of Neural Tube Defects


Source: Am J Epidemiol. 2010 Feb 15;171(4):407-14. (link)

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9 Comments & Updates to “Prenatal Nutrition News”

  1. JP Says:

    Update: Higher protein, lower carbs/sugar reduce gestational weight gain …

    http://www.ncbi.nlm.nih.gov/pubmed/25670731

    BMJ Open. 2015 Feb 10;5(2):e005839.

    Dietary protein-to-carbohydrate ratio and added sugar as determinants of excessive gestational weight gain: a prospective cohort study.

    OBJECTIVE:

    To examine the relation between the protein:carbohydrate (P/C) ratio and added sugar intake in pregnancy and gestational weight gain (GWG).
    DESIGN:

    A prebirth cohort including 103 119 pregnancies enrolled between 1996 and 2003.

    SETTING:

    All women in Denmark were eligible to participate if they spoke Danish and were planning to carry to term.The pregnant women were recruited and enrolled during their first antenatal visit (6-10 weeks of gestation).

    PARTICIPANTS:

    Participants included women with live-born singletons and complete data on dietary intake and GWG, leaving 46 262 women for the analysis.

    EXPOSURE:

    Macronutrient intake was quantified using a validated food frequency questionnaire administered in the 25th week of gestation. The P/C ratio and added sugar intake were examined in quintiles.

    PRIMARY OUTCOME MEASURES:

    GWG was based on self-reported weight in gestational weeks 12 and 30 and defined as gain in g/week. We used multivariable linear regression, including adjusting for pre-pregnancy body mass index, to calculate relative change in GWG and 95% CI.

    RESULTS:

    Average GWG was 471(224) g/week. The adjusted weight gain was 16 g/week lower (95% CI 9 to 22, p for trend <0.001) in the highest (Q5) versus lowest (Q1) quintile of the P/C ratio (∼3% average reduction across the entire pregnancy). Weight gain for those with >20%E vs <12%E from protein was 36 g/week lower (95% CI 20 to 53, p for trend <0.0001; ∼8% average reduction). A high P/C ratio was inversely related to intake of added sugars. Added sugar consumption was strongly associated with GWG (Q5 vs Q1: 34, 95% CI 28 to 40 g/week, p for trend <0.0001).

    CONCLUSIONS:

    A high P/C ratio was associated with reduced GWG. This association appeared to be partly driven by a decrease in intake of added sugar. These results are consistent with randomised trials in non-pregnant participants. A dietary intervention targeting an increased P/C ratio with emphasis on reducing added sugar can contribute to reducing excessive GWG.

    Be well!

    JP

  2. JP Says:

    Update: Acupressure supports healthier breast milk production …

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325417/

    Iran J Nurs Midwifery Res. 2015 Jan-Feb;20(1):7-11.

    Effect of acupressure on milk volume of breastfeeding mothers referring to selected health care centers in Tehran.

    BACKGROUND: Breast milk is the main food source for infants’ growth and development. Insufficient milk is one of the obstacles to the adequate use of this substance. One of the treatments to help this issue is acupressure. Therefore, the present study was designed to determine the effect of acupressure on maternal milk volume.

    MATERIALS AND METHODS: This study is a randomized clinical trial in which 60 breastfeeding mothers complaining of hypogalactia and meeting the inclusion criteria were studied. In addition to providing routine education, bilateral acupressure was performed for 12 consequentia l days on the acupoints of SI1, LI4, and GB21 in the intervention group, as three sessions per week with each session conducted 2-5 times. The control group received only routine education. In both groups, breast milk volume before intervention and 2 and 4 weeks after intervention was evaluated by an electric pump. Data were analyzed by descriptive and inferential statistical analysis through SPSS.

    RESULTS: The t-test showed no significant difference in the mean volume of milk in the two groups (P = 0.543). Mean volumes of milk before and 2 and 4 weeks after the intervention were 10.5 (8.3), 33 (13.44), and 36.2 (12.8), respectively, in the acupressure group and 9.5 (7.7), 17.7 (9.4), 18 (9.5), respectively, in the control group. Analysis of variance (ANOVA) test showed a significant difference in the mean volume of milk at 2 and 4 weeks after the intervention (P < 0.001).

    CONCLUSIONS: Both acupressure and general education methods were effective on the milk volume of breastfeeding mothers. Acupressure method was more effective than the other method. Therefore, application of acupressure as a method of alternative medicine to increase breastfeeding is suggested.

    Be well!

    JP

  3. JP Says:

    Update: Fascinating study finds that probiotics increase breast milk mineral concentrations …

    http://www.sciencedirect.com/science/article/pii/S0946672X15000097

    J Trace Elem Med Biol. 2015 Apr;30:25-9.

    A pilot study of synbiotic supplementation on breast milk mineral concentrations and growth of exclusively breast fed infants.

    Despite the crucial role of breast milk mineral contents for health and growth of the infants, they decrease with the duration of lactation. So, this pilot study aimed to determine the effects of synbiotic supplementation on breast milk mineral composition and infants’ growth. In this pilot, randomized, double-blind, placebo-controlled trial, 57 lactating mothers were randomly divided into two groups to receive a daily supplement of synbiotic (n=30) or a placebo (n=27) for 30 days. Breast milk zinc, copper, Iron, magnesium and, calcium concentrations were determined by flame atomic absorption spectrometry. Weight for age Z-score (WAZ) and height for age Z-score (HAZ) were assessed for infants. Dietary intake was collected from lactating women using the 24-h recall method. Data analyses were carried out using nutritionist IV, Epi Info and SPSS soft wares. Synbiotic supplementation led to an insignificant increase of the mean breast milk levels of zinc (from 2.44±0.65 to 2.55±0.55mgL(-1)), copper (from 0.35±0.24 to 0.40±0.26mgL(-1)), iron (from 0.28±0.42 to 0.31±0.38mgL(-1)), magnesium (from 17.14±1.35 to 17.17±1.09mgL(-1)), and calcium (from 189±25.3 to 189.9±21.7mgL(-1)); whilst in the placebo group, these variables decreased significantly (P=0.001). The observed changes between two groups were statistically significant (P<0.05). Although WAZ and HAZ of infants increased slightly in the supplemented group (from 1.19±0.79 to 1.20±0.69 and 0.36±0.86 to 0.37±0.85 respectively), these two parameters decreased in the placebo group which was significant only for WAZ (P=0.01). Moreover, no significant association was found between mineral intake and breast milk mineral contents. It seems, synbiotic supplementation may have positive effects on breast milk mineral contents.

    Be well!

    JP

  4. JP Says:

    Update 05/06/15:

    https://www.thieme-connect.com/DOI/DOI?10.1055/s-0035-1548835

    Horm Metab Res. 2015 May 4.

    Effects of High-Dose Vitamin D Supplementation on Metabolic Status and Pregnancy Outcomes in Pregnant Women at Risk for Pre-Eclampsia.

    This study was designed to assess the beneficial effects of high-dose (cholecalciferol) vitamin D supplementation on metabolic profiles and pregnancy outcomes among pregnant women at risk for pre-eclampsia. This randomized double-blind placebo-controlled clinical trial was performed among 60 pregnant women at risk for pre-eclampsia according to abnormal uterine artery Doppler waveform. Subjects were randomly divided into 2 groups to receive 50 000 IU vitamin D supplements (n=30) or receive placebo (n=30) every 2 weeks from 20 to 32 weeks of gestation. Fasting blood samples were taken at baseline study and 12 weeks after the intervention to quantify relevant variables. Newborn’s anthropometric measurements were determined. Pregnant women who received cholecalciferol supplements had significantly increased serum 25-hydroxyvitamin D concentrations (+17.92±2.28 vs. +0.27±3.19 ng/ml, p<0.001) compared with the placebo. The administration of cholecalciferol supplements, compared with the placebo, resulted in significant differences in serum insulin concentrations (+1.08±6.80 vs. +9.57±10.32 μIU/ml, p<0.001), homeostasis model of assessment-insulin resistance (HOMA-IR) (+0.19±1.47 vs. +2.10±2.67, p<0.001), homeostatic model assessment-beta cell function (HOMA-B) (+5.82±29.58 vs. +39.81±38.00, p<0.001) and quantitative insulin sensitivity check index (QUICKI) score (-0.009±0.03 vs. -0.04±0.03, p=0.004). Furthermore, cholecalciferol-supplemented pregnant women had increased HDL-cholesterol concentrations (+2.67 ± 8.83 vs. -3.23±7.76 mg/dl, p=0.008) compared with the placebo. Finally, cholecalciferol supplementation led to a significant rise in plasma total antioxidant capacity (TAC) concentrations (+79.00±136.69 vs. -66.91±176.02 mmol/l, p=0.001) compared with the placebo. Totally, the administration of cholecalciferol supplements among pregnant women at risk for pre-eclampsia for 12 weeks had favorable effects on insulin metabolism parameters, serum HDL-cholesterol, and plasma TAC concentrations.

    Be well!

    JP

  5. JP Says:

    Update 06/25/15:

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9795997&fileId=S000711451500166X

    Br J Nutr. 2015 Jun 23:1-12.

    The effect of zinc supplementation on pregnancy outcomes: a double-blind, randomised controlled trial, Egypt.

    The present randomised controlled trial (RCT) was conducted to evaluate the effect of two regimens of Zn supplementation on pregnancy outcomes in Alexandria, Egypt. Healthy pregnant women aged 20-45 years and having low serum Zn level below the estimated median for the gestational age were eligible to participate in the trial. Of 1055 pregnant women assessed for the eligibility of low serum Zn level, 675 were eligible. These women were randomly assigned to one of the three groups: the Zn alone group (n 225) received a daily dose of 30 mg ZnSO4, the combined group (n 227) received 30 mg ZnSO4 plus multivitamins (B1, B6, D3, C and E) and the control group (n 223) received placebo (270 mg lactose). They were followed up from the time of recruitment till 1 week after delivery. Overall, there was no detectable difference in the mean birth weight between the three groups (mean 2929·12 (sd 330·28), 2922·22 (sd 324·05) and 2938·48 (sd 317·39) g for the placebo, Zn and Zn plus multivitamin groups, respectively, P= 0·88). Both the single and the combined Zn supplements were almost equally effective in reducing second- and third-stage complications (relative risk (RR) 0·43, 95 % CI 0·31, 0·60 for the Zn group and RR 0·54, 95 % CI 0·40, 0·73 for the combined group). Stillbirth and preterm delivery were significantly lower among the two supplemented groups than the placebo group (P= 0·001). Early neonatal morbidity was also significantly lower in the supplemented groups (RR 0·23, 95 % CI 0·15, 0·35 for the Zn group and RR 0·25, 95 % CI 0·16, 0·37 for the combined group). Collectively, Zn supplementation was effective in reducing pregnancy complications and early neonatal infection among the Zn-deficient women of the present trial.

    Be well!

    JP

  6. JP Says:

    Updated 06/02/16:

    http://e-nrp.org/DOIx.php?id=10.4162/nrp.2016.10.3.328

    Nutr Res Pract. 2016 Jun;10(3):328-35.

    Effects of vitamin D supplementation on metabolic indices and hs-CRP levels in gestational diabetes mellitus patients: a randomized, double-blinded, placebo-controlled clinical trial.

    BACKGROUND/OBJECTIVES: Vitamin D plays an important role in the etiology of gestational diabetes mellitus (GDM). This study evaluated the effect of vitamin D supplementation on metabolic indices and hs-C-reactive protein (CRP) levels in GDM patients.

    SUBJECTS/METHODS: The study was a randomized, placebo-controlled, double-blinded clinical trial. Seventy-six pregnant women with GDM and gestational age between 24-28 weeks were assigned to receive four oral treatments consisting of 50,000 IU of vitamin D3 (n = 38) or placebo (n = 38) once every 2 weeks for 2 months. Fasting blood glucose (FG), insulin, HbA1c, 25-hydroxyvitamin D, lipid profile, hs-CRP, and homeostasis model assessment-insulin resistance (HOMA-IR) were measured before and after treatment. Independent and paired t-tests were used to determine intra- and intergroup differences, respectively. ANCOVA was used to assess the effects of vitamin D supplementation on biochemical parameters.

    RESULTS: Compared with the placebo group, in the vitamin D group, the serum level of 25-hydroxyvitamin D increased (19.15 vs. -0.40 ng/ml; P < 0.01) and that of FG (-4.72 vs. 5.27 mg/dl; P = 0.01) as well as HbA1c (-0.18% vs. 0.17%; P = 0.02) decreased. Improvements in the lipid profiles were observed in the vitamin D group, but without statistical significance. Significant increases in concentrations of hs-CRP, FG, HbA1c, total cholesterol, and LDL cholesterol were observed in the placebo group. No significant change in fasting insulin and HOMA-IR was observed in either group.

    CONCLUSIONS: In GDM patients, vitamin D supplementation improved FG and HbA1c but had no significant effects on lipid profile or hs-CRP.

    Be well!

    JP

  7. JP Says:

    Updated 11/26/16:

    http://www.canadianjournalofdiabetes.com/article/S1499-2671(16)30266-0/abstract

    Can J Diabetes. 2016 Nov 21.

    A Randomized Controlled Clinical Trial Investigating the Effects of Omega-3 Fatty Acids and Vitamin E Co-Supplementation on Biomarkers of Oxidative Stress, Inflammation and Pregnancy Outcomes in Gestational Diabetes.

    OBJECTIVES: Limited data are available for assessing the effects of omega-3 fatty acids and vitamin E co-supplementation on metabolic profiles and pregnancy outcomes in gestational diabetes (GDM). This study was designed to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on biomarkers of oxidative stress, inflammation and pregnancy outcomes in women with GDM.

    METHODS: This randomized, double-blind, placebo-controlled clinical trial was conducted in 60 patients with GDM who were not taking oral hypoglycemic agents. Patients were randomly allocated to intake either 1000 mg omega-3 fatty acids from flaxseed oil plus 400 IU vitamin E supplements (n=30) or placebo (n=30) for 6 weeks. Fasting blood samples were obtained from the women at the beginning of the study and after the 6-week intervention to quantify related markers.

    RESULTS: After 6 weeks of intervention, omega-3 fatty acids and vitamin E co-supplementation, compared with the placebo, resulted in a significant rise in total antioxidant capacity (TAC) (+187.5±224.9 vs. -32.5±136.1 mmol/L; p<0.001); nitric oxide (NO) (+5.0±7.7 vs. -12.0±28.0 µmol/L; p=0.002) and a significant decrease in plasma malondialdehyde (MDA) concentrations (-0.1±0.9 vs. +0.6±1.4 µmol/L; p=0.03). Co-supplementation with omega-3 fatty acids and vitamin E showed no detectable changes in plasma glutathione and serum high-sensitivity C-reactive protein levels. Joint omega-3 fatty acids and vitamin E supplementation resulted in lower incidences of hyperbilirubinemia in newborns (10.3% vs. 33.3%; p=0.03).

    CONCLUSIONS: Overall, omega-3 fatty acids and vitamin E co-supplementation for 6 weeks in women with GDM had beneficial effects on plasma TAC, MDA and NO and on the incidence of the newborns’ hyperbilirubinemia.

    Be well!

    JP

  8. JP Says:

    Updated 06/08/17:

    http://apjcn.nhri.org.tw/server/APJCN/26/4/619.pdf

    Asia Pac J Clin Nutr. 2017;26(4):619-623.

    Lactobacillus intake for 60 days favors antioxidant status of human breast milk: an RCT.

    BACKGROUND AND OBJECTIVES: This study aimed to evaluate the effects of lactobacillus supplementation on trends of breast milk antioxidant parameters.

    METHODS AND STUDY DESIGN: In an interventional study, 50 lactating women were randomly allocated to receive a daily supplement of lactobacillus (n=25) or a placebo (n=25) for 60 days. Daily dietary intake, anthropometric measures and breast milk antioxidant parameters were determined at the onset, and days 30 and 60 of the study. Repeated-measures ANOVA were performed to assess the change over time in the anthropometric and biochemical parameters between the two groups. The main effect of treatment was compared by using Bonferroni’s procedure for CI adjustment. The significance level was set at p<0.05.

    RESULTS: There was a significant increase in breast milk total antioxidant capacity (TAC) between onset of study and day 30 (p=0.01) and day 60 (p=0.001) after lactobacillus supplementation; however, breast milk TAC level did not change significantly between days 30 and 60 (p=0.7). In the placebo group, breast milk TAC levels decreased significantly after 60 days (p=0.001). Breast milk malondialdehyde (MDA) levels decreased progressively during the study in the lactobacillus group (p=0.001); however, there was a significant increase in MDA with time in breast milk samples in the placebo group (p=0.015).

    CONCLUSIONS: Based on the findings, lactobacillus supplementation for 60 days could significantly increase breast milk TAC and decrease breast milk MDA levels, compared with baseline; however, further studies are needed to confirm these results.

    Be well!

    JP

  9. JP Says:

    Updated 08/09/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28786012

    Probiotics Antimicrob Proteins. 2017 Aug 7.

    The Effects of Synbiotic Supplementation on Pregnancy Outcomes in Gestational Diabetes.

    Synbiotics are known to exert multiple beneficial effects, including anti-inflammatory and antioxidative actions. This study was designed to evaluate the effects of synbiotic administration on biomarkers of inflammation, oxidative stress, and pregnancy outcomes among gestational diabetic (GDM) women. This randomized, double-blind, placebo-controlled clinical trial was carried out among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly assigned to consume either one synbiotic capsule containing Lactobacillus acidophilus strain T16 (IBRC-M10785), L. casei strain T2 (IBRC-M10783), and Bifidobacterium bifidum strain T1 (IBRC-M10771) (2 × 109 CFU/g each) plus 800 mg inulin (HPX) (n = 30) or placebo (n = 30) for 6 weeks. Compared with the placebo, synbiotic supplementation significantly decreased serum high-sensitivity C-reactive protein (hs-CRP) (- 1.9 ± 4.2 vs. +1.1 ± 3.5 mg/L, P = 0.004), plasma malondialdehyde (MDA) (- 0.1 ± 0.6 vs. + 0.3 ± 0.7 μmol/L, P = 0.02), and significantly increased total antioxidant capacity (TAC) (+ 70.1 ± 130.9 vs. – 19.7 ± 124.6 mmol/L, P = 0.009) and total glutathione (GSH) levels (+ 28.7 ± 61.5 vs. – 14.9 ± 85.3 μmol/L, P = 0.02). Supplementation with synbiotic had a significant decrease in cesarean section rate (16.7 vs. 40.0%, P = 0.04), lower incidence of hyperbilirubinemic newborns (3.3 vs. 30.0%, P = 0.006), and newborns’ hospitalization (3.3 vs. 30.0%, P = 0.006) compared with the placebo. Synbiotic supplementation did not affect plasma nitric oxide (NO) levels and other pregnancy outcomes. Overall, synbiotic supplementation among GDM women for 6 weeks had beneficial effects on serum hs-CRP, plasma TAC, GSH, and MDA; cesarean section; incidence of newborn’s hyperbilirubinemia; and newborns’ hospitalization but did not affect plasma NO levels and other pregnancy outcomes.

    Be well!

    JP

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