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Nutrition in Pregnancy
Cape Town Oct 2015
GOES
Nutrition in Pregnancyhttpwwwwhointpublicationsguidelinesnutritionen
Nutrition in pregnancy YES but whorsquos pregnancy
When wasis our future shaped
Index caseIndex case
Timing of nutritional effects
Trasgenerationaleffect
Periconception Pregnancy The first 1000 days
Transgenerational effectsThe epigenetic inheritance
ldquoGrandgrand- and Grandmother effectrdquo
Trasgenerationaleffect
Changes in long-term health outcomes in the first generation
The change is also passed on to future generations
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Nutrition in Pregnancyhttpwwwwhointpublicationsguidelinesnutritionen
Nutrition in pregnancy YES but whorsquos pregnancy
When wasis our future shaped
Index caseIndex case
Timing of nutritional effects
Trasgenerationaleffect
Periconception Pregnancy The first 1000 days
Transgenerational effectsThe epigenetic inheritance
ldquoGrandgrand- and Grandmother effectrdquo
Trasgenerationaleffect
Changes in long-term health outcomes in the first generation
The change is also passed on to future generations
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Nutrition in pregnancy YES but whorsquos pregnancy
When wasis our future shaped
Index caseIndex case
Timing of nutritional effects
Trasgenerationaleffect
Periconception Pregnancy The first 1000 days
Transgenerational effectsThe epigenetic inheritance
ldquoGrandgrand- and Grandmother effectrdquo
Trasgenerationaleffect
Changes in long-term health outcomes in the first generation
The change is also passed on to future generations
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
When wasis our future shaped
Index caseIndex case
Timing of nutritional effects
Trasgenerationaleffect
Periconception Pregnancy The first 1000 days
Transgenerational effectsThe epigenetic inheritance
ldquoGrandgrand- and Grandmother effectrdquo
Trasgenerationaleffect
Changes in long-term health outcomes in the first generation
The change is also passed on to future generations
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Timing of nutritional effects
Trasgenerationaleffect
Periconception Pregnancy The first 1000 days
Transgenerational effectsThe epigenetic inheritance
ldquoGrandgrand- and Grandmother effectrdquo
Trasgenerationaleffect
Changes in long-term health outcomes in the first generation
The change is also passed on to future generations
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Transgenerational effectsThe epigenetic inheritance
ldquoGrandgrand- and Grandmother effectrdquo
Trasgenerationaleffect
Changes in long-term health outcomes in the first generation
The change is also passed on to future generations
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Transgenerational effectsldquoGrandgrand and Grandmother effectrdquo
bull Animal studies
Trasgenerationaleffect
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Transgenerational effectsldquoThe Grandfather effectrdquo
bull Observational studies in human ldquoWinterhongerrdquo
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
The germ cells epigenome a messenger of ancestral exposures
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
DNA methylation
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Histone modification
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
non-protein-coding RNA
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Epigenetic nutrients
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Developmental origin of health and disease
Barker ldquoprogramming hypothesisrdquo ldquoThrifting hypothesisrdquo
Barker DJ Osmond C Lancet 1986 May 101(8489)1077-81Infant mortality childhood nutrition and ischemic heart disease in England and Wales
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Birth of a Novel ConceptThe Fetal Origins of Adult Diseases
Future DiseasePrenatalInsult
Fetal adaptivechanges
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Evolution of an Idea
James Neel (1962) ldquothe thrifty genotyperdquo
During evolution when food was scarce efficient fat storage enhanced survival
With poor nutrition the fetus makes adaptations to enhance its survival
During abundance such genes cause obesity insulin resistance diabetes and heart disease
With abundance later in life such adaptations result in chronic diseases
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Fetal Origins of Adult DiseaseMetabolic Programming
lsquoDevelopmental origins of health and diseasersquo or lsquodevelopmental programmingrsquo reflect the concept whereby a stimulus or insult during a critical period of growth and development has entrained long-term developmental and physiological changes in
key tissues or organ systems
Barker D J Br Med Bull 2001605ndash20
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Critical periods of change
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Critical periods of changePreconception
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Periconception and pre-implantation
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Dutch famine1st generation offsprings outcome
Babies conceived during the hunger period
Lower birth weight by 200 grams
Higher infantile mortality
Later brain damage and poor mental performance
Higher obesity and MS rates as adults
Roseboom T et alEarly Hum Dev 2006 82485ndash91
Smith C Am J Obstet Gynecol 194753599
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull 20 of maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull Pre-eclampsia by128
bull GDM by 91
bull Cesarian delivery by 42
bull LGA by 63
bull Stillbirths fetal and neonatal death
bull NTD and CHD by 15
bull Child obesity
Maternal undernutrition Maternal short stature Maternal overweight
Preconception maternal nutritional status
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull Folic acid supplementation for NTD prophylaxis
bull Iron supplementation effect on fetus weight and neonate Hb
bull Calcium and zinc supplementation
bull Vitamins B
Preconception maternal micronutrients status
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Am J Clin Nutr 20141001257ndash68
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Am J Clin Nutr 20141001257ndash68
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Critical periods of changeGestation time
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Nutrition and maternal nutritional status during pregnancy
bull Maternal deaths
bull Stillbirths
bull Preterm births risk by 32
bull SGA by 64
bull Labor complications
bull Maternal mortality
bull Birth asphyxia leading to neonatal death
bull
bull IUGR
bull Perinatal mortality
Maternal health Pregnancy outcome Offspring outcome
Nutrition and nutritional status of the mother during pregnancy
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Weight status of women WW
Lancet 371 (2008) pp 243ndash621Lancet 377 (2011) pp 557ndash567Bull World Health Organ 73 (suppl) (1995) pp S1ndash98Postgrad Med J 86 (2010) pp 617ndash623Proc Nutr Soc 70 (2011) pp 450ndash456
Africa Prevalence of underweight gt 10Prevalence of overweight and obesity gt 40
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Maternal nutritional risk factors for small for gestational age births
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Maternal stature and pregnancy outcome
bull 109 Demographic Health Surveys analyses adjusted
bull The risk of dying for children lt5 yearsndash Children born to the tallest mothers 0middot073 (CI 0middot072ndash0middot074)
ndash For the shortest mothers (lt145 cm) was 0middot128 (0middot126ndash0middot130) (x2)
bull The corresponding absolute risk for a child being stunted was
ndash 0middot194 (0middot192ndash0middot196) for the tallest mothers
ndash 0middot682 (0middot673ndash0middot690) for the shortest (x5)
UNICEF WHO World Bank UNPD
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Weight gain (pounds)
Weight gain (kg)Prepregnancy weight category
28-40125-180BMI lt 198
25-35115-160BMI 198 to 260
15-2570-115BMI gt 260 to 290
Weight Gain Recommendations for Pregnancy
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Gestational Weight Gain Charts
wwwperinatalservicesbcca
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Adverse perinatal outcomes relatedto mothersrsquo GWG
Spontaneouspreterm birth
Indicatedpreterm birth
SGA
LGA
Unplanned cesarian
normal-weight (n = 27585) overweight (n =10989)
Am J Clin Nutr 2014100701ndash7
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Micronutrientsrsquo deficiencies of women 20-49 years and pregnant women
Vitamin A deficiency
Iodine deficiency
Zinc deficiency
Iron deficiencyHblt 11gdl
Global 78 (153) 285 173 192
Africa 94(143)
400 239 203
Micronutrients deficiencies in women of reproductive age and pregnant women
Lancet 371 (2008) pp 243Lancet 377 (2011) pp 557
Bull World Health Organ 73 (suppl) (1995) pp S
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull Highly prevalent during pregnancy
bull Africa has the highest prevalence
bull Increased the risk of maternal mortality by 15-40
bull Iron supplementation during pregnancyndash 20 (10 to 29) reduction of IUGR risk
ndash 34 (19 to 47) reduction of death risk in children lt 5 yearsbull Studies in Indonezia China Nepal
ndash Improve in maternal health fatigues distress
ndash Better general intelligence and cognitive functioning at age 7ndash9 years in offspring
Am J Clin Nutr 78 (2003) pp 673ndash674Cochrane Database Syst Rev 7 (2012) CD009997Am J Clin Nutr 95 (2012) pp 220ndash230BMJ 337 (2008) p a2001JAMA 304 (2010) pp 2716ndash2723
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull Inadequate consumption of folic acid around the time of conception has been associated with an increased risk of NTD
bull Cochrane review in 2010 folic supplementation reduced by 72 (RR 0middot28 95 CI 0middot15ndash0middot52) the risk of NTD
Cochrane Database Syst Rev 10 (2010) CD007950
WHO nutrition during pregnancy Iron and folic acid supplementation
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight maternal anemia and iron deficiency (strong recommendation)
WHO nutrition during pregnancy Iron and folic acid supplementation
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Vitamin A status during pregnancy
bull Vitamin A deficiency night blindness or serum or plasma retinol
concentrations of less than 0middot70 μmolL (subclinical vitamin A deficiency)
bull Maternal night blindnessndash Increased low birth weight
ndash Higher risk of infant mortality
bull Vitamin A supplementation during pregnancy ndash Improved mothers night blindness
ndash No significant effects on infant outcomes
A J Nutr 138 (2008) pp 787ndash792 J Nutr 131 (2001) pp 1510ndash1512 JAMA 305 (2011) pp 1986ndash1995Am J Clin Nutr 97 (2013) pp 188ndash194 Am J Clin Nutr 71 (2000) pp 1570ndash1576
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull Vitamin A supplementation is not recommended during pregnancy as part of routine antenatal care for the prevention of maternal and infant morbidity and mortality (strong recommendation)
bull In areas where there is a severe public health problem related to vitamin Adeficiency vitamin A supplementation during pregnancy is recommended for the prevention of night blindness (strong recommendation)
WHO nutrition during pregnancy Vitamin A supplementation
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Zinc status during pregnancy
bull Based on the analysis of staple diets 17 of world population is at risk of zinc deficiency
bull Subclinical zinc deficiency during pregnancy ndash AE to infant effects on growth immunity metabolic status survival
ndash AE high risk of preterm and prolonged labour post-partum haemorrhage
bull Zinc supplementation during pregnancy ndash 14 reduction in preterm births in women in low-income settings not for BW
ndash No effect on affluent setting
Clin Sci 68 (1985) pp 395ndash399Cochrane Database Syst Rev 7 (2012) CD000230JAMA 305 (2011) pp 1986ndash1995
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Iodine status during pregnancy
bull Iodine deficiency affects 28middot5 of the worlds population
bull Severe iodine deficiency in pregnancy causes cretinism and average deficits of 12middot5ndash13middot5 IQ
bull Effects of mild or moderate iodine deficiency on brain development are not well established
bull Iodine supplementation in deficient populations showed a small increase in BW
Nutr Rev 70 (2012) pp 553ndash570Lancet 297 (1971) pp 308ndash310Paediatr Perinat Epidemiol 26 (S1) (2012) pp 108ndash117Nutrients 3 (2011) pp 265ndash273
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
WHO nutrition during pregnancy Calcium supplementation
In populations where calcium intake is low calcium supplementation as part of the antenatal care is recommended for the prevention of preeclampsia in pregnant women particularly among those at higher risk of developing hypertension (strong recommendation)
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
bull There is limited evidence available that directly assessed the benefits and harms of the use of vitamin D supplementation alone in pregnancy for improving maternal and infant health outcomes the use of this intervention during pregnancy as part of routine antenatal care is also not recommended (conditional recommendation)
WHO nutrition during pregnancy Vitamin D supplementation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Summary of Increased Nutritional Needs during Pregnancy and Lactation
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Environmental and Dietary IssuesFoodborne Illness during Pregnancy
Benefits and Concerns RegardingFish and Seafood Consumption
Non-Nutritive SweetenersSugar-Sweetened Drinks
Alcohol useCaffeine consumption
Hydration and Water Needs
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Conclusions
bull There is now substantial evidence demonstrating the importance of the intrauterine environment
bull The majority of investigations into the mechanisms underlying the developmental origins of health and disease have been investigated in animal models
bull They include permanent structural changes epigenetic modifications leading to permanent changes in gene expression
bull The relative contribution of these various mechanisms still remains to be established
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
Conclusions
bull Once we have reached a comprehensive understanding of the mechanisms underlying developmental programming of disease focus can then be directed towards strategies for therapeutic intervention
You are what you eat but alsohellip
You are what you eat but alsohellip
