Nutrient insult in early pregnancy

Abstract

Abbreviations: hCG, human chorionic gonadotrophin; IGF, insulin-like growth factor; IGFBP, insulin-like growth factor-binding protein; NVP, nausea and vomiting in pregnancy. Nutrient insults in early pregnancy, such as nutrient deprivation during famines, are often associated with an unfavourable outcome. Suboptimal nutrition in the early stage of gestation has been linked to a number of adverse effects on fetal growth and development. Historically, nausea and vomiting in pregnancy (NVP) was an important contributor to pregnancy-related mortality; indeed, Charlotte Bronte died from starvation and dehydration after suffering very severe NVP 4 months into her first pregnancy (Gaskell, 1858). Although NVP seldom now progresses to be life-threatening, it affects the majority of pregnant women, and potentially presents a challenge to nutrient intake in the most vulnerable period of development. Symptoms range from mild (nausea only) to severe (a level of vomiting that restricts nutrient intake and ultimately threatens metabolic and electrolyte balance). Although NVP has been documented for thousands of years, its cause has not yet been satisfactorily elucidated, but seems to be related to endocrinological changes. Pregnant women also frequently report dietary cravings and aversions during pregnancy which can be linked to both the incidence and severity of NVP. Paradoxically, NVP appears to be positively associated with a favourable outcome of pregnancy, including increased birth weight and gestational age. The mechanisms by which NVP favours the outcome of pregnancy are not known. They may be related to women increasing their nutrient intake to alleviate symptoms, improving the quality of their diet or reducing energy expenditure. Alternatively, adaptation to a reduced nutrient intake might stimulate the expression of growth factors and affect placentation or metabolism, thus favouring fetal growth when NVP resolves. Nausea and vomiting in pregnancy: Nutrient deprivation: Fetal development:Insulin-like growth factor: Maternal nutrition hCG, human chorionic gonadotrophin; IGF, insulin-like growth factor; IGFBP, insulin-like growth factor-binding protein; NVP, nausea and vomiting in pregnancy. Nausea and vomiting in pregnancyNausea and vomiting in pregnancy (NVP) affects 50-90 % of pregnant women (Broussard & Richter, 1998). It usually presents as one of the first signs of pregnancy, within 2-4 weeks of fertilisation, peaks at the end of the first trimester and resolves by week 20 (Anderson, 1994). NVP is usually experienced as a complication of the first trimester of pregnancy, but a small proportion of women experience symptoms throughout pregnancy (Broussard & Richter, 1998). Although the onset of symptoms occurs typically in the morning, thus generating the term 'morning sickness', many women are affected episodically throughout the day (Gadsby et al. 1993). Our retrospective study in Guildford (Al-Rasasi et al. 2001) shows that 72·6 % of pregnant women reported experiencing NVP, which is similar to the incidence...

Early Life Nutritional Programming of Obesity: Mother-Child Cohort Studies

“…For example, the substantial change in plasma concentration of placental hormones following the establishment of the placenta can be accompanied by the onset of maternal nausea and decline and/or change in her food preferences [55]. Ultimately this is a developmental process in which responses that occur initially within the mother on becoming pregnant can impact on embryogenesis and placentation.…”

Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study

“…In the latter and rarer case, termed hyperemesis gravidarum (HG), the extent of vomiting is so profound that maternal weight loss, electrolyte imbalance, and dehydration requiring hospitalisation may result. [1][2][3] Most studies report approximately 80% of women experience NVP, although no clear underlying mechanism has been demonstrated. [1][2][3][4] Symptoms typically begin in the first trimester, around gestational weeks 5-8, usually peaking around gestational week 9, and subsiding by around gestational week 12.…”

Leptin, Fetal Nutrition, and Long-Term Outcomes for Adult Hypertension

“…The current nutritional environment within developed countries is such that excess dietary intake, with reduced physical activity (Jolliffe 2004), would be predicted to exacerbate the effects of maternal nutrient restriction in early pregnancy, thereby leading to reduced life span (Ozanne and Hales 2004). In fact, in humans, it is the norm for food intake to be reduced in early pregnancy in response to the feeling of nausea that follows the maternal endocrine adaptations to implantation and early placental growth (Coad et al 2002). Indeed, a reduction in maternal food intake in early pregnancy, when the calorific demands of sustaining fetal growth are low, may be of potential benefit to the fetus in reducing potential exposure to harmful or teratogenic substances (Haig 1993).…”