Home > Children's Health, Nutrition, Women's Health > Prenatal Nutrition

Prenatal Nutrition

August 9, 2010 Written by JP    [Font too small?]

The topic of breastfeeding and infant formula has been on my mind lately. Perhaps it’s because a colleague and friend recently had a baby. My brother-in-law and his wife are also expecting. With all of the contradictory information out there about prenatal nutrition, I wonder how they and other parents-to-be decide on what’s best for the babies. Thankfully, it seems that at least one area of prenatal care isn’t widely contested – breastfeeding. If a mother is healthy and capable of providing adequate breast milk, it is generally considered the optimal source of nourishment. But much like infant formula, the quality of breast milk is largely dependent upon what ingredients it contains. This is why what a mother eats and supplements with during pregnancy and while breastfeeding is vitally important. My Healthy Monday tip of the week is for expectant mothers to discuss essential fatty acid supplementation with their physicians.

Women of child bearing age are often advised to take a prenatal supplement or at least a multivitamin that contains added folic acid and iron. Doing so dramatically reduces the risk of birth defects such as neural tube disorders, low birth weight and even neonatal death in areas where inadequate nutrition is common. (1,2,3)

After a baby is born, parents must decide whether they want to feed their newborn breast milk, infant formula or a combination of both. Infant formula manufacturers are keenly aware of this decision making process. That’s why they’re constantly trying to improve formulas by adding ingredients which help them more closely resemble the nutritional composition of human breast milk. Fortifying such products with essential fatty acids is one way in which they accomplish this goal. Even ardent breastfeeding advocates, such as, Dr. Allen Greene support this trend in infant nutrition. (4,5,6)

The most cutting edge infant formulas typically contain specific quantities of select fatty acids including DHA (docosahexaenoic acid) from algae or fish sources. But not all breast milk can be counted on to provide that same level of nutrition. DHA levels in breast milk are dependent upon the diet of mothers. Meal plans that are low in fish and high in refined foods have been documented as deficient in DHA. But as expected, the opposite is true of women who eat DHA-fortified foods or supplement with fish oil. Their lactation is much higher in DHA. (7,8,9)

Several new studies support a strong rationale for expectant mothers to ensure optimal DHA intake. My hope is that the following research will encourage more physicians to ask their patients whether they’re doing so and vice versa. The July issue of the Journal of Pediatrics describes a study in which breastfeeding women were given either a placebo or 200 mg of DHA from algae (algal oil) “from delivery until 4 months postpartum”. At the age of 5, the same children were assessed medically to determine whether there were any meaningful differences in terms of mental or visual performance. An advantage was found in the DHA children with respect to “sustained attention”. According to the authors of the study, this suggests that prenatal exposure to DHA via breastmilk may confer “long-term benefits on specific aspects of neurodevelopment”. (10)

A more direct link between fatty acids in breast milk and infant health was reported on in the July 2010 edition of the journal Allergy. In the study, the fatty acid content of breast milk from 310 mothers was examined and compared to the likelihood of atopic eczema in their infants. The infants were subsequently followed over a 2 year period in order to establish a reliable picture of allergic predisposition and atopic outcomes. Higher levels of omega-3 fatty acids, as found in fish oil, were deemed to reduce the risk of atopic dermatitis, “parent-reported eczema” and allergic reactions to a variety of foods including cow’s milk, hen’s egg and peanuts. Similar benefits were recently found when breastfeeding mothers were administered blackcurrant seed oil (BCSO) as well. BCSO provides a unique fatty acid known as gamma-linolenic acid (GLA) which may also decrease the odds of allergic skin conditions at the 2 year mark of life. (11,12,13)

Fish Oil and Olive Oil May Reduce Allergies and Asthma in Early Life
Source: American Journal of Clinical Nutrition, Vol. 88, No. 1, 167-175, July 2008 (link)

Several recent reviews in the medical literature set out to establish the current state of knowledge about fatty acid exposure in early life. When viewed in totality, researchers tend to agree that wide sweeping generalizations about the health benefits of supplementing with omega-3 and omega-6 PUFAs cannot be made at present. However, they generally concur that these essential fats are likely helpful in several key categories: allergic and atopic conditions – including asthma and food allergies, immunologic status, infant growth, neurodevelopment and visual function. More research is clearly called for, but the evidence thus far is quite compelling. (14,15,16)

The reason I’ve focused on algal or fish oil rather than fish is because of widespread concerns about the variable mercury content of seafood. There is little doubt that indiscriminate intake of fish increases the levels of mercury in pregnant women. However, the net effect of such exposure often yields inconsistent findings. A case in point is a newly published study from France. The conclusion, which was published in the British Journal of Nutrition, states that maternal seafood intake was indeed associated with mercury levels. However, there was no association found between seafood intake and fetal growth. Nonetheless, I think it’s best to err on the side of caution and avoid fish that are known to contain high concentrations of mercury. The following list, adapted from Environmental Protection Agency and the Natural Resources Defense Council, can be used as a general guide. Please click on the footnotes proceeding this paragraph for more detailed lists. Also, please be aware that data about the mercury and PCB content of fish isn’t set in stone. Only the most current facts and figures are relevant. So do check back regularly in order to find the most recent figures available. (17,18,19)

High Mercury Fish – Bluefish, Grouper, Mackerel, Marlin, Swordfish and Tuna (Ahi, canned Albacore, Bigeye and Yellowfin).

Low Mercury Fish – Anchovies, Flounder, Salmon, Scallops, Shrimp, Tilapia, Trout (freshwater) and Whitefish.

It’s quite common to find prenatal supplements that include supplemental DHA these days. If you haven’t seen them around, you may be looking in the wrong places. The supplement aisles of many markets and pharmacies tend to be behind the curve when it comes to progressive nutritional formulations. On the other hand, you’ll probably find one or more options such as those I’ve described at your local health food. If that’s not the case, simply search online for a reliable vendor. I can tell you from experience that maternal DHA products can be found if you know where to look.

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!

Be well!


Tags: , ,
Posted in Children's Health, Nutrition, Women's Health

20 Comments & Updates to “Prenatal Nutrition”

  1. Melissa G. Says:

    I am wondering if someone can give me some guidance regarding prenatal vitamins. I have been taking new chapter organics perfect prenatal and wholemega prenatal and have a few questions…. also I have had an interesting experience with headaches and need to ask a question…

    thank you!
    Melissa G.

  2. JP Says:


    Feel free to ask your questions here. Hopefully I can help. Also, it would be helpful to have the input of other readers who may see your questions as well.

    Be well!


  3. JP Says:

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


    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!


  4. JP Says:

    Updated 09/06/15:


    PLoS One. 2015 Sep 4;10(9):e0137309.

    Dietary Omega-3 Fatty Acid Supplementation Reduces Inflammation in Obese Pregnant Women: A Randomized Double-Blind Controlled Clinical Trial.

    OBJECTIVE: Long-chain omega 3 fatty acids, eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) exert potent anti-inflammatory properties in humans. This study characterized the effects of omega-3 ω-3 fatty acids supplements (ω-3 FA) on the inflammatory status in the placenta and adipose tissue of overweight/obese pregnant women.

    STUDY DESIGN: A randomized, double-masked controlled trial was conducted in overweight/obese pregnant women that were randomly assigned to receive DHA plus EPA (2g/day) or the equivalent of a placebo twice a day from week 10-16 to term. Inflammatory pathways were characterized in: 1) adipose tissue and placenta of treated vs. untreated women; and 2) adipose and trophoblast cells cultured with long chain FAs.

    RESULTS: The sum of plasma DHA and EPA increased by 5.8 fold and ω-3 FA/ ω-6 FA ratio was 1.5 in treated vs. untreated women (p< 0.005). Plasma CRP concentrations were reduced (p<0.001). The adipose tissue and placenta of treated women exhibited a significant decrease in TLR4 adipose and placental expression as well as IL6, IL8, and TNFα In vitro, EPA and DHA suppressed the activation of TLR4, IL6, IL8 induced by palmitate in culture of adipose and trophoblast cells. CONCLUSION: Supplementation of overweight/obese pregnant women with dietary ω-3 FAs for >25 weeks reduced inflammation in maternal adipose and the placental tissue. TLR4 appears as a central target of the anti-inflammatory effects at the cellular level.

    Be well!


  5. JP Says:

    Updated 1/17/16:


    Eur J Obstet Gynecol Reprod Biol. 2015 Nov 30;198:40-46.

    Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies.

    OBJECTIVE: Preterm birth continues to be the one of the leading causes of infant deaths worldwide. There is a need for effective, easily available, safe and acceptable interventions to prevent preterm delivery, especially before 34 weeks of gestation. Omega-3 fatty acids such as EPA (eicosapentanoic acid) and DHA (docosahexanoic acid) are available as over the counter nutritional supplements, and are taken by women to improve pregnancy outcomes, without any clear recommendations. We undertook a systematic review to assess the effects of omega-3 fatty acids on early (<34 weeks) and any (<37 weeks) preterm delivery.

    METHODS: We searched MEDLINE, EMBASE and Cochrane Library from inception to 2014 without any language restrictions. Study selection, quality assessment and data extraction were done by two independent reviewers. Results were summarized as relative risks and 95% confidence intervals for dichotomous outcomes and mean differences for continuous outcomes.

    RESULTS: Of the nine included trials (5980 women), six (4193 women) evaluated the effects of omega-3 fatty acids on early preterm delivery. The risk of early preterm delivery was reduced by 58% (RR 0.42; 95% CI 0.27-0.66; I2=0%; p=0.0002) and any preterm delivery by 17% (RR 0.83; 95% CI 0.70-0.98; I2=0%; p=0.03) with the intervention. There was a significant increase in the mean gestational age by 1.95 weeks (95% CI 0.42-3.48 weeks; I2=0.47; p=0.01) and mean birth weight by 122.1g (95% CI 47.4-196.8; I2=0.84; p=0.001) in the intervention group compared to the controls. Subgroup analysis showed no significant differences in the effects between the groups according to the risk status, dose and timing of the intervention.

    CONCLUSION: Omega-3 fatty acids are effective in preventing early and any preterm delivery. The intervention is simple and easily available and has the potential to influence population based strategies in the prevention of preterm birth.

    Be well!


  6. JP Says:

    Updated 06/04/16:


    Int J Hyg Environ Health. 2016 May 18.

    Blood mercury levels and fish consumption in pregnancy: Risks and benefits for birth outcomes in a prospective observational birth cohort.

    BACKGROUND: To avoid exposure to mercury, government advice on fish consumption during pregnancy includes information on fish species to avoid and to limit, while encouraging consumption of least two portions of fish per week. Some women may, however, chose to avoid fish completely during pregnancy despite potential benefits to the fetus.

    OBJECTIVES: Our aims were to evaluate the effects of blood mercury levels in pregnant women on birth outcomes in the UK, and to compare outcomes in those who ate fish with those who did not.

    METHODS: Pregnant women were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples for singleton pregnancies with a live birth were analysed for Hg by inductively coupled plasma dynamic reaction cell mass spectrometry (n=4044). Fish intake was determined by a food frequency questionnaire during pregnancy. Data collected on the infants included anthropometric variables and gestational age at delivery. Regression models were adjusted for covariates using SPSS v23.

    RESULTS: There were no significant associations of maternal blood Hg level with birthweight, head circumference or crown-heel length in adjusted linear regression models. Similarly, there were no increased odds of low birthweight or preterm delivery in adjusted logistic regression models. When the models were repeated after stratification into fish-eaters and there were no associations except for a negative association with birthweight in non-fish-eaters (unstandardised B coefficient -58.4 (95% confidence interval -113.8, -3.0) g, p=0.039).

    CONCLUSION: Moderate mercury levels in pregnancy were not associated with anthropometric variables, or on the odds of low birthweight or preterm birth. Fish consumption may have a protective effect on birthweight. Consumption of fish in line with government guidelines during pregnancy should be encouraged.

    Be well!


  7. JP Says:

    Updated 07/26/16:


    Nutrients. 2016 May 21;8(5).

    The Role of Avocados in Maternal Diets during the Periconceptional Period, Pregnancy, and Lactation.

    Maternal nutrition plays a crucial role in influencing fertility, fetal development, birth outcomes, and breast milk composition. During the critical window of time from conception through the initiation of complementary feeding, the nutrition of the mother is the nutrition of the offspring-and a mother’s dietary choices can affect both the early health status and lifelong disease risk of the offspring. Most health expert recommendations and government-sponsored dietary guidelines agree that a healthy diet for children and adults (including those who are pregnant and/or lactating) should include an abundance of nutrient-rich foods such as fruits and vegetables. These foods should contain a variety of essential nutrients as well as other compounds that are associated with lower disease risk such as fiber and bioactives. However, the number and amounts of nutrients varies considerably among fruits and vegetables, and not all fruit and vegetable options are considered “nutrient-rich”. Avocados are unique among fruits and vegetables in that, by weight, they contain much higher amounts of the key nutrients folate and potassium, which are normally under-consumed in maternal diets. Avocados also contain higher amounts of several non-essential compounds, such as fiber, monounsaturated fats, and lipid-soluble antioxidants, which have all been linked to improvements in maternal health, birth outcomes and/or breast milk quality. The objective of this report is to review the evidence that avocados may be a unique nutrition source for pregnant and lactating women and, thus, should be considered for inclusion in future dietary recommendations for expecting and new mothers.

    Be well!


  8. JP Says:

    Updated 09/09/16:


    Am J Clin Nutr. 2016 Sep 7.

    Prenatal supplementation with DHA improves attention at 5 y of age: a randomized controlled trial.

    BACKGROUND: Docosahexanoic acid (DHA) is an important constituent of the brain. Evidence from well-designed intervention trials of the long-term benefits of increasing DHA intake during pregnancy has been sparse.

    OBJECTIVE: We evaluated global cognition, behavior, and attention at age 5 y in the offspring of Mexican women who participated in a randomized controlled trial of prenatal DHA supplementation.

    DESIGN: A total of 1094 women were randomly assigned to receive 400 mg of either DHA or placebo/d from 18 to 22 wk of pregnancy until delivery. We assessed cognitive development and behavioral and executive functioning, including attention, in 797 offspring at age 5 y (82% of 973 live births) with the use of the McCarthy Scales of Children’s Abilities (MSCA), the parental scale of the Behavioral Assessment System for Children, Second Edition (BASC-2), and the Conners’ Kiddie Continuous Performance Test (K-CPT). We compared the groups on raw scores, T-scores, and standardized scores, as appropriate. We examined heterogeneity by the quality of the home environment, maternal intelligence, and socioeconomic status.

    RESULTS: There were no group differences for MSCA scores (P > 0.05), but the positive effect of the home environment at 12 mo on general cognitive abilities was attenuated in the DHA group compared with in the placebo group (P-interaction < 0.05). There were no differences between groups on the BASC-2. On the K-CPT, offspring in the DHA group showed improved mean ± SD T-scores compared with those of the placebo group for omissions (DHA: 47.6 ± 10.3; placebo: 49.6 ± 11.2; P < 0.01) with no differences (P > 0.05) for the other K-CPT scores or of the proportion who were clinically at risk of attention deficit hyperactivity disorders after Bonferroni correction for multiple comparisons.

    CONCLUSION: Prenatal exposure to DHA may contribute to improved sustained attention in preschool children.

    Be well!


  9. JP Says:

    Updated 09/18/16:


    Prostaglandins Leukot Essent Fatty Acids. 2016 Sep;112:44-9.

    Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials.

    Yelland LN1, Gajewski BJ2, Colombo J3, Gibson RA4, Makrides M5, Carlson SE6.

    The DHA to Optimize Mother Infant Outcome (DOMInO) and Kansas DHA Outcomes Study (KUDOS) were randomized controlled trials that supplemented mothers with 800 and 600mg DHA/day, respectively, or a placebo during pregnancy. DOMInO was conducted in Australia and KUDOS in the United States. Both trials found an unanticipated and statistically significant reduction in early preterm birth (ePTB; i.e., birth before 34 weeks gestation). However, in each trial, the number of ePTBs were small. We used a novel Bayesian approach to estimate statistically derived low, moderate or high risk for ePTB, and to test for differences between the DHA and placebo groups. In both trials, the model predicted DHA would significantly reduce the expected proportion of deliveries in the high risk group under the trial conditions of the parent studies. Among the next 300,000 births in Australia we estimated that 1112 ePTB (95% credible interval 51-2189) could be avoided by providing DHA. And in the USA we estimated that 106,030 ePTB (95% credible interval 6400 to 175,700) could be avoided with DHA.

    Be well!


  10. JP Says:

    Updated 09/19/16:


    Prostaglandins Leukot Essent Fatty Acids. 2016 Sep;112:44-9.

    Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials.

    The DHA to Optimize Mother Infant Outcome (DOMInO) and Kansas DHA Outcomes Study (KUDOS) were randomized controlled trials that supplemented mothers with 800 and 600mg DHA/day, respectively, or a placebo during pregnancy. DOMInO was conducted in Australia and KUDOS in the United States. Both trials found an unanticipated and statistically significant reduction in early preterm birth (ePTB; i.e., birth before 34 weeks gestation). However, in each trial, the number of ePTBs were small. We used a novel Bayesian approach to estimate statistically derived low, moderate or high risk for ePTB, and to test for differences between the DHA and placebo groups. In both trials, the model predicted DHA would significantly reduce the expected proportion of deliveries in the high risk group under the trial conditions of the parent studies. Among the next 300,000 births in Australia we estimated that 1112 ePTB (95% credible interval 51-2189) could be avoided by providing DHA. And in the USA we estimated that 106,030 ePTB (95% credible interval 6400 to 175,700) could be avoided with DHA.

    Be well!


  11. JP Says:

    Updated 09/23/16:


    J Nutr. 2016 Sep 21.

    Daily Cholecalciferol Supplementation during Pregnancy Alters Markers of Regulatory Immunity, Inflammation, and Clinical Outcomes in a Randomized Controlled Trial.

    BACKGROUND: Vitamin D deficiency is widespread in pregnancy and has been associated with adverse health conditions in mothers and infants. Vitamin D supplementation in pregnancy may support the maintenance of pregnancy by its effects on innate and adaptive immunity.

    OBJECTIVE: We assessed the effects of vitamin D supplementation during pregnancy on vitamin D status and markers of immune function associated with adverse pregnancy outcomes.

    METHODS: We conducted a randomized, controlled, double-blind intervention of 2 doses of cholecalciferol (400 and 2000 IU/d) from <20 wk to delivery in 57 pregnant women. Vitamin D status, regulatory and inflammatory T cells, markers of innate immunity and systemic inflammation, and clinical outcomes including maternal blood pressure and birth weight were assessed at 26 and 36 wk of pregnancy.

    RESULTS: Supplementation with 2000 IU/d vitamin D had a greater effect on the change in vitamin D status over pregnancy (P < 0.0001) and the final value at 36 wk (P < 0.0001) than 400 IU/d, increasing serum 25-hydroxyvitamin D from 81.1 nmol/L at baseline to 116 nmol/L at 36 wk and from 69.6 nmol/L at baseline to 85.6 nmol/L at 36 wk, respectively. The 2000-IU/d group had 36% more interleukin-10+ regulatory CD4+ T cells at 36 wk than did the 400-IU/d group (P < 0.007). The daily intake of 2000 compared with 400 IU/d tended to dampen the pregnancy-related increase in diastolic blood pressure by 1.3-fold (P = 0.06) and increase birth weight by 8.6% (P = 0.06), but these differences were not statistically significant. CONCLUSIONS: Supplementation with 2000 IU/d is more effective at increasing vitamin D status in pregnant women than 400 IU/d and is associated with increased regulatory T cell immunity that may prevent adverse outcomes caused by excess inflammation. Be well! JP

  12. JP Says:

    Updated 01/23/17:


    Matern Child Health J. 2017 Jan 12.

    Association Between Fruit and Vegetable Consumption and Sleep Quantity in Pregnant Women.

    Introduction To determine the association of fruit and vegetable consumption with overall sleep duration among pregnant women. Methods Data from the 2011 and 2012 Behavioral Risk Factors Surveillance System (BRFSS) were used. All women (n = 2951) of childbearing age (18-44 years) who were pregnant and responded to all fruit and vegetable consumption and sleep duration questions were included. Covariates included age, race, education level, exercise, and marital status. Data were analyzed using linear and ordinal logistic regression. Results Total daily fruit and vegetable consumption was not associated with sleep duration among pregnant women, controlling for confounders [β = -0.03, (-0.07, 0.00)]. Orange and green vegetable consumption were both inversely associated with sleep duration [β = -0.19, (-0.38, -0.01) and β = -0.20, (-0.33, -0.08) respectively]. Ordinal logistic regression found that the odds of meeting or exceeding sleep time recommendations increased slightly with each unit increase in total fruit and vegetable consumption [OR = 1.05 (1.003, 1.092)] and for every unit increase in fruit consumption [OR = 1.12 (1.038, 1.208)]. Women who exercised within the past 30 days reported approximately 20 min of additional sleep compared to those who did not [β = 0.32 (0.16, 0.49)]. Age, employment status, and marital status were also independently associated with sleep duration. Discussion Sleep duration in pregnant women was associated with exercise and other demographic factors, but only mildly associated with fruit and vegetable consumption. Future research should investigate the effects of additional factors including sleep quality, gestational age, family status and other medications as potential confounders.

    Be well!


  13. JP Says:

    Updated 02/06/17:


    Pediatr Obes. 2017 Feb 3.

    Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood.

    BACKGROUND: In adults, adherence to the Mediterranean diet has been inversely associated with cardiovascular risk, but the extent to which diet in pregnancy is associated with offspring adiposity is unclear. We aimed to investigate the association between adherence to Mediterranean diet in pregnancy and offspring cardiometabolic traits in two pregnancy cohorts.

    METHODS: We studied 997 mother-child pairs from Project Viva in Massachusetts, USA, and 569 pairs from the Rhea study in Crete, Greece. We estimated adherence to the Mediterranean diet with an a priori defined score (MDS) of nine foods and nutrients (0 to 9). We measured child weight, height, waist circumference, skin-fold thicknesses, blood pressure, and blood levels of lipids, c-reactive protein and adipokines in mid-childhood (median 7.7 years) in Viva, and in early childhood (median 4.2 years) in Rhea. We calculated cohort-specific effects and pooled effects estimates with random-effects models for cohort and child age.

    RESULTS: In Project Viva, the mean (SD, standard deviation) MDS was 2.7 (1.6); in Rhea it was 3.8 (1.7). In the pooled analysis, for each 3-point increment in the MDS, offspring BMI z-score was lower by 0.14 units (95% CI, -0.15 to -0.13), waist circumference by 0.39 cm (95% CI, -0.64 to -0.14), and the sum of skin-fold thicknesses by 0.63 mm (95% CI, -0.98 to -0.28). We also observed lower offspring systolic (-1.03 mmHg; 95% CI, -1.65 to -0.42) and diastolic blood pressure (-0.57 mmHg; 95% CI, -0.98 to -0.16).

    CONCLUSION: Greater adherence to Mediterranean diet during pregnancy may protect against excess offspring cardiometabolic risk.

    Be well!


  14. JP Says:

    Updated 02/06/17:


    Nutrients 2017, 9(2), 107

    Early Taste Experiences and Later Food Choices

    Background. Nutrition in early life is increasingly considered to be an important factor influencing later health. Food preferences are formed in infancy, are tracked into childhood and beyond, and complementary feeding practices are crucial to prevent obesity later in life. Methods. Through a literature search strategy, we have investigated the role of breastfeeding, of complementary feeding, and the parental and sociocultural factors which contribute to set food preferences early in life. Results. Children are predisposed to prefer high-energy, -sugar, and -salt foods, and in pre-school age to reject new foods (food neophobia). While genetically determined individual differences exist, repeated offering of foods can modify innate preferences. Conclusions. Starting in the prenatal period, a varied exposure through amniotic fluid and repeated experiences with novel flavors during breastfeeding and complementary feeding increase children’s willingness to try new foods within a positive social environment.

    Be well!


  15. JP Says:

    Updated 03/25/17:


    Arch Iran Med. 2016 Oct;19(10):687-682.

    Effects of Probiotic Supplementation on Metabolic Status in Pregnant Women: a Randomized, Double-blind, Placebo-Controlled Trial.

    BACKGROUND: Limited data is available on the effects of multispecies probiotic supplementation on metabolic status in pregnant women in the first half of pregnancy. The current study was carried out to determine the effects of multispecies probiotic capsule supplementation on metabolic status among pregnant women in the first half of pregnancy.

    METHODS: A randomized clinical trial was conducted among 60 pregnant women aged 18-37 years. The participants were randomly divided into two groups: group A (n = 30) received multispecies probiotic supplements containing three probiotic bacteria spices Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum (2 × 109 CFU/g each) and group B (n = 30) received placebo from 9 weeks of gestation for a duration of 12 weeks. Fasting blood samples were taken at the beginning of the study and after 12 weeks of intervention to determine metabolic profiles, inflammatory cytokines and biomarkers of oxidative stress.

    RESULTS: After 12 weeks of intervention, compared to the placebo group, the pregnant women who consumed probiotic capsule had significantly decreased serum insulin concentrations (-1.5 ± 4.8 vs. +1.3 ± 5.2 µIU/mL, P = 0.03), the homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (-0.3 ± 0.9 vs. +0.3 ± 1.1, P = 0.04), the homeostasis model of assessment-estimated b cell function (HOMA-B) (-7.2 ± 23.1 vs. +5.3 ± 22.6, P = 0.03) and increased quantitative insulin sensitivity check index (QUICKI) (+0.01 ± 0.05 vs. -0.01 ± 0.02, P = 0.03). In addition, changes in serum triglycerides levels (-14.7 ± 46.5 vs. +37.3 ± 74.2 mg/dL, P = 0.002), high-sensitivity C-reactive protein (hs-CRP) (-1.0 ± 2.6 vs. +1.7 ± 4.3 mg/L, P = 0.004), plasma nitric oxide (NO) (+6.8 ± 9.3 vs. -4.7 ± 7.4 µmol/L, P < 0.001), total antioxidant capacity (TAC) (+171.9 ± 187.6 vs. -51.9 ± 208.8 mmol/L, P < 0.001) and glutathione (GSH) concentrations (+34.3 ± 71.6 vs. -36.9 ± 108.3 µmol/L, P = 0.004) in supplemented women were significantly different from those of the placebo group. However, after controlling for baseline levels, age and BMI at the study baseline, the changes in plasma GSH were not significantly different between the groups. CONCLUSION: Overall, probiotic supplementation for 12 weeks among pregnant women in the first half of pregnancy had beneficial effects on markers of insulin metabolism, triglycerides, biomarkers of inflammation and oxidative stress. Be well! JP

  16. JP Says:

    Updated 03/30/17:


    J Matern Fetal Neonatal Med. 2017 Mar 22:1-29.

    The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes.

    OBJECTIVE: This study was designed to evaluate the effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes among subjects with gestational diabetes (GDM).

    METHODS: This randomized, double-blind, placebo-controlled clinical trial was done among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly allocated to intake either probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2 × 109 CFU/g each) (n = 30) or placebo (n = 30) for 6 weeks.

    RESULTS: Compared with the placebo, probiotic supplementation resulted in significant decreases in fasting plasma glucose (FPG) (-5.3±6.7 vs. +0.03±9.0 mg/dL, P = 0.01), serum high-sensitivity C-reactive protein (hs-CRP) (-2.2±2.7 vs. +0.5±2.4 µg/mL, P < 0.001), plasma malondialdehyde (MDA) concentrations (-0.1±0.8 vs. +0.5±1.5 µmol/L, P = 0.03) and MDA/TAC ratio (-0.0003±0.0008 vs. +0.0009±0.002, P = 0.004), and a significant increase in total antioxidant capacity (TAC) levels (+65.4±103.3 vs. -37.2±143.7 mmol/L, P = 0.002). Probiotic supplementation did not affect pregnancy outcomes. CONCLUSIONS: Overall, probiotic supplementation among women with GDM for 6 weeks had beneficial effects on FPG, serum hs-CRP, plasma TAC, MDA and oxidative stress index, but did not affect pregnancy outcomes. Be well! JP

  17. JP Says:

    Updated 04/15/17:


    Ann Nutr Metab. 2017 Apr 8;70(2):147-153.

    Mothers’ Consumption of Soy Drink But Not Black Tea Increases the Flavonoid Content of Term Breast Milk: A Pilot Randomized, Controlled Intervention Study.

    OBJECTIVE: We performed a pilot RCT to prove the hypothesis that a controlled ingestion of polyphenol-rich beverages (soy drink, decaffeinated black tea) in nutritive dosages by nursing women has an effect on the composition (flavonoid concentration, total antioxidant capacity) of breast milk.

    METHODS: Healthy nursing women were supplemented with either 250 mL of a soy drink (12 mg isoflavones; n = 18), 300 mL decaffeinated black tea (67 mg catechins; n = 18), or 300 mL water (n = 8, control) for 6 days. Milk samples were collected before, during, and after intervention. Flavonoid content (isoflavones/catechins, HPLC) and total antioxidant capacity of milk and test drinks in milk specimens were assessed.

    RESULTS: Isoflavone content (genistein and daidzein) in breast milk increased up to 12 nmol/L after soy drink consumption; the major flavonoids constituents of black tea (catechin, epicatechin, and respective conjugates) could not be detected in milk samples. With both interventions, the total antioxidant capacity of breast milk was not affected.

    CONCLUSIONS: Mothers’ daily consumption of a soy drink considerably increases isoflavone content of breast milk resulting in an estimated daily exposure of 9.6 nmol isoflavones in a 4-month-old suckling infant. Luminal flavanol uptake from black tea consumed by the nursing mother may be too low to affect flavanol concentrations in breast milk.

    Be well!


  18. JP Says:

    Updated 04/16/17:


    BMJ Open Diabetes Res Care. 2017 Mar 29;5(1):e000351.

    Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes.

    OBJECTIVE: Maternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in women at risk of gestational diabetes mellitus (GDM).

    RESEARCH DESIGN AND METHODS: A crossover study of 17 women (mean±SD age 34.8±4 years; gestational weeks 29.3±1.3; body mass index 23.8±4.7 kg/m2) who consumed a low GL or a high GL diet in random order, 1-day each, over 2 consecutive days. Diets were energy-matched and fiber-matched with 5 meals per 24 hours. All food was provided. Continuous glucose monitoring was used to assess diurnal glycemia.

    RESULTS: Maternal glucose levels were 51% lower on the low GL day with lower incremental area under the curve (iAUC±SEM 549±109 vs 1120±198 mmol/L min, p=0.015). Glycemic variability was significantly lower on the low GL day, as demonstrated by a lower average SD (0.7±0.1 vs 0.9±0.1, p<0.001) and lower mean amplitude of glycemic excursions (2.1±0.2 vs 2.7±0.2 mmol/L, p<0.001).

    CONCLUSIONS: A lower GL meal plan in pregnancy acutely halves day-long maternal glucose levels and reduces glucose variability, providing further evidence to support the utility of a low GL diet in pregnancy.

    Be well!


  19. JP Says:

    Updated 06/10/17:


    Matern Child Nutr. 2017 Jun 9.

    Higher maternal vitamin D concentrations are associated with longer leukocyte telomeres in newborns.

    Gestational vitamin D insufficiency is related with increased risks of various diseases and poor health outcomes later in life. Telomere length at birth or early in life is known to be a predictor of individual health. Both vitamin D and telomere length are related with various health conditions, and vitamin D concentrations are associated with leukocyte telomere lengths in women. We investigated the association between maternal vitamin D concentrations and newborn leukocyte telomere lengths. This cross-sectional study included 106 healthy pregnant women without adverse obstetric outcomes and their offspring. We examined the maternal age, weight before pregnancy, health behaviours, and nutritional intakes, along with each newborn’s sex and birthweight, and we measured maternal height, telomere length, total white blood cell count, and glycosylated haemoglobin as covariates. Pearson’s correlation coefficients were calculated to evaluate the relationship between the baseline variables and newborn leukocyte telomere lengths. To confirm that there was an independent association between newborn leukocyte telomere lengths and maternal vitamin D concentrations, we performed a stepwise multiple linear regression analysis. Newborn leukocyte telomere lengths correlated positively with maternal leukocyte telomere lengths (r = .76, p < .01), maternal 25-hydroxyvitamin D concentrations (r = .72, p < .01), maternal energy intakes (r = .22, p = .03), and newborn body weights (r = .51, p < .01). In the multivariate model, newborn leukocyte telomere lengths were associated with maternal vitamin D concentrations (β = .33, p < .01). These findings suggest that the maternal vitamin D concentration during pregnancy may be a significant determinant of the offspring's telomere length. Be well! JP

  20. JP Says:

    Updated 2/4/18:


    Diabetes Metab Res Rev. 2018 Feb 2.

    Gluten-free diet exclusively during pregnancy alleviates the signs of diabetes and celiac disease in NOD mouse offspring.

    BACKGROUND: Gluten-free (GF) diet during pregnancy ameliorates autoimmune diabetes in non-obese diabetic (NOD) mouse offspring. Due to comorbidity of celiac disease in type 1 diabetes, we hypothesized that GF diet in utero alleviates the humoral and histopathological signs of celiac disease in NOD mice. We aimed to establish the mechanisms behind the diabetes-protective effect of GF diet in utero.

    METHODS: Breeding pairs of NOD mice were fed a GF or gluten-containing standard (STD) diet until parturition. The offspring were nursed by mothers on STD diet and continued on this diet until ages 4 and 13 weeks. Analyses of serum anti-tissue transglutaminase (anti-tTG), intestine and islet histology, islet transglutaminase (TG) activity and cytokine expression in T cells from lymphoid organs were performed.

    RESULTS: GF versus STD diet in utero led to reduced serum anti-tTG titer and increased villus-to-crypt ratio at both ages. Insulitis along with systemic and local inflammation were decreased, but islet TG activity was unchanged in 13-week-old GF mice. These mice had unchanged beta-cell volumes, but increased islet numbers throughout the prediabetic period.

    CONCLUSIONS: Collectively, GF diet administered during pregnancy improves signs of celiac disease and autoimmune diabetes in the offspring. The diabetes-ameliorative effect of GF diet in utero is followed by dampening of inflammation, unchanged beta-cell volume, but increased islet numbers.

    Be well!


Leave a Comment