The Relationship between Maternal Nutrition during Pregnancy and Offspring Kidney Structure and Function in Humans: A Systematic Review

Abstract

The intrauterine environment is critical for fetal growth and organ development. Evidence from animal models indicates that the developing kidney is vulnerable to suboptimal maternal nutrition and changes in health status. However, evidence from human studies are yet to be synthesised. Therefore, the aim of the current study was to systematically review current research on the relationship between maternal nutrition during pregnancy and offspring kidney structure and function in humans. A search of five databases identified 9501 articles, of which three experimental and seven observational studies met the inclusion criteria. Nutrients reviewed to date included vitamin A (n = 3), folate and vitamin B12 (n = 2), iron (n = 1), vitamin D (n = 1), total energy (n = 2) and protein (n = 1). Seven studies were assessed as being of “positive” and three of “neutral” quality. A variety of populations were studied, with limited studies investigating maternal nutrition during pregnancy, while measurements of offspring kidney outcomes were diverse across studies. There was a lack of consistency in the timing of follow-up for offspring kidney structure and/or function assessments, thus limiting comparability between studies. Deficiencies in maternal folate, vitamin A, and total energy during pregnancy were associated with detrimental impacts on kidney structure and function, measured by kidney volume, proteinuria, eGFRcystC and mean creatinine clearance in the offspring. Additional experimental and longitudinal prospective studies are warranted to confirm this relationship, especially in Indigenous populations where the risk of renal disease is greater.

Vitamin A and Pregnancy: A Narrative Review

“…Newborn babies of the mothers with VAD had significantly lower mean retinol levels and the dimensions of both kidneys were smaller than those of the newborns of mothers with vitamin A sufficiency [63]. A recent systematic review found an association between vitamin A deficiency in pregnancy and a negative effect on kidney function and kidney structure in the child [107].…”

Consequences of Exposure to Prenatal Famine on Estimated Glomerular Filtration Rate and Risk of Chronic Kidney Disease Among Survivors of the Great Ethiopian Famine (1983-85): A Historical Cohort Study

“…A similar nding was also reported from another Chinese study which indicates famine exposure was linked to a greater risk (OR 1.54, 95% CI 1.04, 2.28) of higher protein urea among women rural participants [14]. Corroborating the above ndings, a recent systematic review reported unfavorable changes with kidney structure and function, measured by kidney volume, proteinuria, eGFR and mean creatinine clearance in the offspring of mothers with folate, vitamin A, and total energy de ciencies during pregnancy [29].…”

Vitamin A Requirements in Pregnancy and Lactation

“…A systematic review analyzed the relation between human nutrition during pregnancy and kidney structure and function in offspring. Deficiencies in VA, along with other folate and total energy, were associated with negative outcomes on kidney structure and function using outcomes of kidney volume, proteinuria, glomerular filtration rate, and creatinine clearance ( 146 ). Mouse model investigations of embryological development have provided evidence that maternal VAD can inhibit normal fetal pancreatic ( 147 ) and anorectal ( 148 ) development in utero.…”