The mechanisms linking maternal nutrition to fetal growth and programming of adult disease remain to be fully established. We review data on changes in placental transport in response to altered maternal nutrition, including compromised utero-placental blood flow. In human intrauterine growth restriction and in most animal models involving maternal under-nutrition or restricted placental blood flow the activity of placental transporters, in particular for amino acids, is decreased in late pregnancy. The effect of maternal over-nutrition on placental transport remains largely unexplored. However some, but not all, studies in women with diabetes giving birth to large babies indicate an up-regulation of placental transporters for amino acids, glucose and fatty acids. These data support the concept that the placenta responds to maternal nutritional cues by altering placental function to match fetal growth to the ability of the maternal supply line to allocate resources to the fetus. On the other hand, some findings in humans and mice suggest that placental transporters are regulated in response to fetal demand signals. These observations are consistent with the idea that fetal signals regulate placental function to compensate for changes in nutrient availability. We propose that the placenta integrates maternal and fetal nutritional cues with information from intrinsic nutrient sensors. Together these signals regulate placental growth and nutrient transport to balance fetal demand with the ability of the mother to support pregnancy. Thus...
Increasing epidemiological evidence suggests that maternal nutrition and environmental exposure early in development play an important role in susceptibility to disease in later life. In addition, these disease outcomes seem to pass through subsequent generations. Epigenetic modifications provide a potential link between the nutrition status during critical periods in development and changes in gene expression that may lead to disease phenotypes. An increasing body of evidence from experimental animal studies supports the role of epigenetics in disease susceptibility during critical developmental periods, including periconceptional period, gestation, and early postnatal period. The rapid improvements in genetic and epigenetic technologies will allow comprehensive investigations of the relevance of these epigenetic phenomena in human diseases.
La prééclampsie est responsable du quart des mortalités maternelles et est la deuxième cause de décès maternels associés à la grossesse au Canada et dans le monde. L’identification d’une stratégie efficace pour la prévention de la prééclampsie est une priorité et un défi primordial dans les milieux de recherche en obstétrique. Le rôle des éléments nutritifs dans le développement de la prééclampsie a récemment reçu davantage d’attention. Plusieurs études cliniques et épidémiologiques ont été menées pour déterminer les facteurs de risque alimentaires potentiels et examiner les effets d’une supplémentation nutritive dans le développement de troubles hypertensifs de la grossesse.
Pour déterminer les effets de suppléments antioxydants pris pendant la grossesse sur le risque d’hypertension gestationnelle (HG) et de prééclampsie, un essai multicentrique contrôlé à double insu a été mené au Canada et au Mexique (An International Trial of Antioxidants in the Prevention of Preeclampsia – INTAPP). Les femmes, stratifiées par risque, étaient assignées au traitement expérimental quotidien (1 gramme de vitamine C et 400 UI de vitamine E) ou au placebo. En raison des effets secondaires potentiels...
This report explores the importance of
nutrition for Tanzania. It demonstrates that the prevalence
of malnutrition is very high. In fact, Tanzania appears to
be affected by a double burden of malnutrition, with a very
high incidence of undernourished children, but with a high
prevalence of overweight and obese adults as well,
particularly in urban areas. The report highlights the high
(economic and welfare) costs associated to such high rates
of malnutrition by discussing the consequence of
malnutrition for infant mortality, education outcomes, the
health system and labor productivity. For nutrition to be
successfully advanced high level support is needed. Efforts
to advance nutrition in Tanzania have made before, with the
earliest attempts dating back to the late 1970s. Most have
not been very successful. To enhance the likelihood of
success this time, commitment from all stakeholders is
needed. A social contract that is announced at a public
event by a high level policy maker may be one way to commit
the actors to change. Such a social contract would have to
set clear objectives and a timeline...
Undernutrition in Tajikistan remains an
important public health challenge, albeit a hidden problem.
Stunting, iodine deficiency, and maternal and child anemia
represent the largest burden of undernutrition in
Tajikistan. In 2009, around 29 percent of children in all
regions of the country were stunted. Iodine deficiency was
observed in 53 percent of children and in 58.6 percent of
women. The national prevalence of anemia in children was
28.8 percent; however, rates were as high as 39.8 percent in
Ghorno-Badakhshan Autonomous Province and in 32 percent
directly ruled districts (DRD). The prevalence of anemia
among mothers was 24.2 percent. The long-term effects of
these conditions negatively affect the health of adults
throughout their life, as well as their potential
productivity in the work force and possible economic
contribution to the nation. The highest priority
interventions will improve infant and young child feeding.
Strengthening and scaling up breastfeeding promotion will
save lives and help to reduce stunting as would
complementary feeding for babies six months and older.
Promoting exclusive breastfeeding for infants under six
months is the most efficacious intervention to save lives...
This study discusses how to effectively
engage in community-based nutrition and health programs
aimed to improve maternal, newborn, and child nutrition and
health outcomes, particularly in Northern Nigeria. It
provides the comparative synthesis of four case studies,
each of which included a community action component for
improving nutrition and health outcomes. It provides a
normative base for designing and planning government
programs that support reforms in outcome-based programming
for maternal, newborn, and child nutrition and health
through program support and investment lending. Central to
the report is the discussion on the roles played by various
stakeholders - state and local government, NGOs, traditional
and religious leaders, and communities themselves - in
creating and sustaining community mobilization. The factors
considered essential or useful contributors to community
mobilization are analyzed. The history of government s role
in Nigerian health care is discussed, as well as the current
situation and future possibilities...
This paper examines promising approaches
from a wide array of literatures to improve gender-inclusive
nutrition interventions in South Asia. It is the second of a
series on gender and nutrition in South Asia. The first
paper explored why gender matters for undernutrition in the
region and conducted a mapping of regional nutrition
initiatives to find that gender is too narrowly addressed in
most programs if at all. Adequately addressing gender2
requires nutrition programs to focus not only on health
services and information for the mother and her children,
but also on her autonomy and the support she receives from
her partner, other household members, and the broader
community. This focus is especially important for adolescent
mothers in the region, who have very low status. The present
study drew from the conceptual framework of the previous
paper and investigated four types of innovations in
nutrition initiatives that address gender. These entail
promoting: (1) women s household autonomy; (2) household
support for the woman and her own and her children s
nutrition; (3) community support for the woman and her own
and her children s nutrition; and (4) help for adolescent
girls. Though the ideal "gender-inclusive nutrition
interventions" package (GINI for short) was never
The report consists of the following
seven chapters. The present chapter provides the context and
the rationale for the study, and outlines the methodology.
Chapter two describes the nutrition system in detail and
discusses the capacity issues related to the division of
labor (DoL) between the two primary programs of the
nutrition system and within the Integrated Child Development
Services, or ICDS. Chapter three delves into the factors
that constrain leadership capacity at all levels chapter
four discusses the key capacity constraints related to HR
that limit the effective delivery of nutrition services.
Chapter five discusses the training system as a sub-system
of HR and its capacity constraints, and Chapter six covers
the capacity assessment pertaining to monitoring, evaluation
and management of information in the nutrition system.
Chapter seven discusses the capacity constraints related to
General Management Practices, or GMPs in the ICDS,
especially focusing on supervision, accountability and work
practices and procedures.
India is the third largest economy
and has the second largest population in the world. It
achieved millennium development goal (MDG) on poverty
reduction; however, gender inequality still persists.
Maternal mortality rate is 190 deaths per 100,000 live
births, representing a 65 percent decline from 1990.
Fertility fell to 2.5, while contraceptive prevalence rate
increased to nearly 55 percent. Seventy-four percent of
women sought antenatal care (ANC) from a qualified provider
and 52 percent of births were attended by qualified
providers. Wide gaps in contraceptive prevalence rate (CPR)
and access to skilled-birth attendance remain by geography
and wealth quintile. India will focus on preventing unwanted
pregnancies especially among adolescents; improving
demand-side strategies; strengthening access and quality in
public and private sectors; improving antenatal, intranatal,
and postnatal care; strengthening monitoring and evaluation
(M and E) systems and reducing inequities; and improving nutrition.
Maternal nutrition and growth hormone (GH) treatment during early- to mid-pregnancy can each alter the subsequent growth and differentiation of muscle in progeny. We have investigated the effects of varying maternal nutrition and maternal treatment with porcine (p) GH during the second quarter of pregnancy in gilts on semitendinosus muscle cross-sectional area and fibre composition of progeny, and relationships between maternal and progeny measures and progeny muscularity. Fifty-three Large White×Landrace gilts, pregnant to Large White×Duroc boars, were fed either 2·2 kg (about 35 % ad libitum intake) or 3·0 kg commercial ration (13·5 MJ digestible energy, 150 g crude protein (N×6·25)/kg DM)/d and injected with 0, 4 or 8 mg pGH/d from day 25 to 50 of pregnancy, then all were fed 2·2 kg/d for the remainder of pregnancy. The higher maternal feed allowance from day 25 to 50 of pregnancy increased the densities of total and secondary fibres and the secondary:primary fibre ratio in semitendinosus muscles of their female progeny at 61 d of age postnatally. The densities of secondary and total muscle fibres in semitendinosus muscles of progeny were predicted by maternal weight before treatment and maternal plasma insulin-like growth factor-II during treatment. Maternal pGH treatment from day 25 to day 50 of pregnancy did not alter fibre densities...
Individuals exposed to an increased nutrient supply before birth have a high risk of becoming obese children and adults. It has been proposed that exposure of the fetus to high maternal nutrient intake results in permanent changes within the central appetite regulatory network. No studies, however, have investigated the impact of increased maternal nutrition on the appetite regulatory network in species in which this network develops before birth, as in the human. In the present study, pregnant ewes were fed a diet which provided 100% (control, n =8) or ∼160% (well-fed, n=8) of metabolizable energy requirements. Ewes were allowed to lamb spontaneously, and lambs were sacrificed at 30 days of postnatal age. All fat depots were dissected and weighed, and expression of the appetite-regulating neuropeptides and the leptin receptor (OBRb) were determined by in situ hybridization. Lambs of well-fed ewes had higher glucose (Glc) concentrations during early postnatal life (F=5.93, P<0.01) and a higher relative subcutaneous (s.c.) fat mass at 30 days of age (34.9±4.7 g/kg vs. 22.8±3.3 g/kg; P<0.05). The hypothalamic expression of pro-opiomelanocortin was higher in lambs of well-fed ewes (0.48±0.09 vs. 0.28±0.04, P<0.05). In lambs of overnourished mothers...
During fetal life, adipose tissue is predominantly comprised of brown or thermogenic adipocytes and there is a transition to white, lipid-storing adipocytes after birth concomitant with the onset of suckling. In pregnancies complicated by gestational diabetes, the fetus is hyperglycemic, has an increased fat mass, and is at increased risk of obesity in later life. In the present study, we have investigated the hypothesis that exposure to increased maternal nutrition during late gestation results in increased expression of genes that regulate adipogenesis and lipogenesis in perirenal fat in fetal sheep. Pregnant ewes were fed either at or approximately 55% above maintenance energy requirements during late pregnancy and quantitative RT-PCR was used to measure peroxisome proliferator-activated receptor , lipoprotein lipase, glycerol-3-phosphate dehydrogenase, adiponectin, and leptin mRNA expression. We report that exposure to metabolic and hormonal signals of increased nutrition before birth results in an increase in the expression of the adipogenic factor, peroxisome proliferator-activated receptor , and in lipoprotein lipase, adiponectin, and leptin mRNA expression in fetal perirenal fat. We propose that an increase in maternal, and hence fetal...
The present study tested the hypothesis that exposure to an increased level of maternal nutrition before birth results in altered expression of adipogenic, lipogenic, and adipokine genes in adipose tissue in early postnatal life. Pregnant ewes were fed either at or approximately 50% above maintenance energy requirements during late pregnancy, and quantitative RT-PCR was used to measure peroxisome proliferator-activated receptor (PPAR)-, lipoprotein lipase (LPL), glycerol-3-phosphate-dehydrogenase (G3PDH), adiponectin, and leptin mRNA expression in perirenal (PAT) and sc adipose tissue (SCAT) in the offspring on postnatal d 30. Relative SCAT mass was higher in lambs of well-fed ewes (40.0 ± 4.0 vs. 22.8 ± 3.3 g/kg, P < 0.05) and was directly related to plasma insulin in the first 24 h after birth and to G3PDH and LPL expression. The expression of leptin mRNA in both the SCAT and PAT depots was higher (P < 0.05) in lambs of well-fed ewes. PPAR adiponectin, LPL, and G3PDH mRNA expression were not, however, different between well-fed and control groups in either depot. Relative PPAR expression in SCAT was directly related to plasma insulin concentrations in the first 24 h after birth (r2 = 0.23; P < 0.05), and G3PDH and LPL expressions were also positively correlated with PPAR expression (r2 = 0.27; P < 0.05). We have demonstrated that exposure to increased prenatal nutrition increases leptin expression at 1 month of age in both PAT and SCAT. The results of this study provide evidence that the nutritional environment before and immediately after birth can influence the development of adipose tissue in early postnatal life.; B. S. Muhlhausler...
Reducing malnutrition is a cornerstone
of poverty reduction. General malnutrition and specific
micronutrient deficiencies contribute to infant, child, and
maternal morbidity; decreased learning capacity; lower
productivity and higher mortality. Because malnutrition is
often due to a combination of inadequate care of women and
children, a comprehensive strategy that cuts across sector
is required. This note summarizes proven effective core
interventions, and suggests ways to choose a set of intervention.
Despite being on-track on the child- and
maternal-health Millennium Development Goals (MDGs), Lao PDR
continues to have some of the worst maternal and child
health (MCH) and nutrition outcome indicators, both globally
as well as in the East Asia and Pacific (EAP) region. This
report presents results from a household, village, and
facility survey on Maternal and Child Health (MCH) and
nutrition in mostly rural areas of six central and southern
provinces of Lao People's Democratic Republic (PDR).
The information in this report localizes MCH and
nutrition-related information that are typical for sampled
catchment areas of selected health centers in six central
and southern provinces of the country. In addition, the
report summarizes data on service availability and readiness
of health centers in terms of their ability to provide key
MCH & nutrition-related services. The results from this
survey thus shed light on what it would take to attain the
health-related MDGs. In order to improve the level and
equity of maternal and child health indicators...
The objective of this review was to
study where community-based family planning and nutrition
programs have been integrated, how this has been
accomplished, and what the results have been. Although
family planning is a nontraditional intervention in
community-based nutrition programs, it can have profound
effects on maternal and child health and nutrition. When
family planning does not occur, short intervals between
pregnancies deplete mothers' reserves of nutrients
needed for pregnancy and later for breastfeeding. As a
result, short birth intervals are associated with higher
maternal and neonatal mortality and malnutrition rates of
infants. Family planning, which promotes contraceptive use
and the lactational amenorrhea method, can thus improve
nutrition outcomes in both mothers and babies. The authors
identified a few studies on integrated services in the
published literature; thus the main part of the review is
built on operational research studies and unpublished
smaller scale intervention studies. However...
The health care system in Brazil has
established the important principle of universal coverage,
yet, it faces several key challenges: its expenditure
patterns favor the regions that are already better off, and
healthier, and, needs to take into account diverse
practices, and cultures, in addition to considerations for
the weak referral system. The report focuses on the health
care system, particularly on enhancing maternal and prenatal
health, certain health care interventions, such as
immunizations, oral rehydration therapy, and case
management. Chapter 1 argues that the major reason for the
maternal and child health risks is the concentration of
illness and death among the poor : infant mortality rates
jump 80-100 percent from the next to lowest income quintile,
to the lowest. Several interventions, such as strategies to
promote productivity, increase economic opportunities, and
enhance maternal education among the poor, could help reduce
inequalities. Chapter 2 uses estimates of avoidable child
deaths to prioritize health interventions in the country...
This report is the first of a series
that will explore how gender can be more comprehensively
incorporated into nutrition interventions in the South Asia
Region in order to improve the effectiveness these programs.
The first section presents the rationale for considering
gender in nutrition programs in the first place, moving
beyond traditional services for mothers and children. It
draws from the literature to describe why gender is an
important factor for the high under-nutrition rates in South
Asia and how a broad range of gender issues, rooted in a
mother's capacity to care for herself and her child,
affect nutritional outcomes of children. The second section
presents the results of a mapping of nutrition programs in
the South Asia Region. The mapping primarily finds that,
despite its importance, gender is too narrowly addressed in
most interventions. Existing programs typically focus on the
first two approaches mentioned above: imparting nutritional
knowledge and skills to the caregiver and improving physical
health through food or micronutrient supplements and health
services. The third section identifies several nutrition and
health projects that have adopted promising approaches to
include gender more comprehensively. To improve household
support for the mother in providing child care...
The Government of The Gambia is implementing the Maternal and Child Nutrition and Health Results Project (MCNHRP) to increase the utilization of community nutrition and primary maternal and child health services. In collaboration with the Government, the World Bank is conducting an impact evaluation (IE) to assess the impact of the project on key aspects of maternal and child nutrition and health. The baseline survey for the MCNHRP IE took place between November 2014 and February 2015. It collected both quantitative and qualitative data and covered three regions: Central River Region (CRR), North Bank Region West (NBR-W) and Upper River Region (URR). Its purpose was to establish a baseline against which project performance will be assessed in the future. This technical brief specifically summarizes the findings of the baseline report related to maternal health and nutrition.
This is the author accepted manuscript. It is currently embargoed pending publication.; BACKGROUND: It is well-established that low birth-weight and accelerated postnatal growth increases risk of liver dysfunction in later life. However, molecular mechanisms underlying such developmental programming are not well-characterised and potential intervention strategies are poorly defined.
OBJECTIVE: We tested the hypothesis that poor maternal nutrition and accelerated postnatal growth would lead to increased hepatic fibrosis (a pathological marker of liver dysfunction) and that postnatal supplementation with the antioxidant coenzyme Q10 (CoQ) would prevent this programmed phenotype.
DESIGN: A rat model of maternal protein-restriction was utilised to generate low birth-weight offspring that underwent suboptimal in-utero nutrition and accelerated postnatal growth (recuperated). These were compared to controls. Offspring were weaned onto standard chow with or without dietary CoQ (1mg/kg of bodyweight/day) supplementation. At 12 months, hepatic fibrosis, indices of inflammation, oxidative-stress, and insulin signalling were measured by histology, Western blot, ELISA and RT-PCR.
RESULTS: Hepatic collagen thickness was increased in recuperated offspring (12 ? 2?m) compared with controls (5 ? 0.5?m) (p<0.001). This was associated with increased inflammation [Interleukin-6 [(138 ? 24% vs. 100 ? 7%)...