Presented by Miriam Erick, MS RDN. Boston, Mass. Oct 2019. ICHG 2019. Amsterdam.
Adequate maternal nutrition optimizes pregnancy outcomes. Maternal deficiencies during critical phrases of fetal development are associated with adversity. Relationships between of maternal deficiencies and fetal consequences are presented here.
Maternal Energy Deprivation
↓ protein → ↓ amino acids, poor muscle maintenance, including heart and major organs (Kim H et al. 2015)
↓ protein → ↓ amino acids, poor muscle maintenance, including heart and major organs (Kim H et al. 2015)
↓ energy → death due to loss of critical lean body mass (heart, brain, lungs, kidneys, enzyme systems, immune factors) (Sinha N et al. 2014) (Wigglesworth JS. 1996) (Kelly R et al. 2017) (Metzer BE et al. 1982) (Falzi G et al. 1990) (MacGibbon KW et al. 2015) (Meguid M. 2015)
↓ carbohydrates with thiamine ( vitamin B 1) → Wernicke’s Encephalopathy, also wet (cardiac) and dry (neurological) infantile beriberi (Choissi G et al. 2006) (Espay AJ, 2014)
↓ energy → ketone development → acidemia / reduced oxygen delivery → ↓ IQ in offspring (Rao R et al. 2012)
↓ energy (via placental insufficiency or maternal food deprivation) → IUGR and/or SGA → ↑ neonatal morbidity (Kelly R et al. 2017)
Maternal Vitamin and Mineral Deprivation
↓ vitamin A à ↓ fetal retinal, renal and pulmonary development (Schwartz E et al. 2017) (Timoneda J et al. 2018)
↓ vitamin A → ↓ fetal retinal, renal and pulmonary development (Schwartz E et al. 2017) (Timoneda J et al. 2018)
↓ vitamin D → ↓ fetal skeletal metabolism, lung fibrosis, dilated cardiomyopathy, also ↓ fetal thymus development (Glackin S et al. 2017) (Elidrissy AT, 2016) (Gur ED et al. 2016) (Shi Y et al. 2017) (Omotobara-Yabe T et al. 2018)
↓ vitamin K → ↓ fetal skeletal maturation, fetal subdural hematoma, intraventricular hemorrhage (Toriello HV et al. 2013) (Sasaki Y et al. 2017)
↓ phosphorus, potassium, magnesium → ↓ fetal cardiac and respiratory muscle contractility (Ariyoshi N et al. 2017) (Khandelwal K et al. 2016)
↓ thiamine → ↑ Wernicke’s encephalopathy in the mother → ↑ maternal death (Choissi G et al. 2006). IUFD (Majumdar S et al. 2010) (Mayer KH et al. 2019)
↓ vitamin B 12 → ↑ neurological failure in fetus, documented FTT (failure to thrive) in neonates (Akcaboy M et al. 2015) (Halicioglu O et al. 2011)
↓ iron ↓ oxygen-carrying capacity to fetus; and ↓ fetal nerve myelination (60 Georgieff MK, 2008) (Bastian TW et al. 2016)
↓ vitamin C → ↓ fetal collagen development, including vascular integrity, neurological development, placental growth (Schjoldager JG et al. 2015) (Ahn YM et al. 2017) (Sotiriou S et al. 2002) (Bohles H. 1997) (Hill KE et al. 2006)
↓ choline → ↓ acetylcholine, an important neurotransmitter for mother and fetus (Zeisel SH. 2006)
↓ selenium → ↑ myocardial necrosis (Oropeza-Moe M et al. 2015)
↓ phosphorus → ↓ maternal/ fetal brain ATP (Pesta DH et al. 2016)
↓ DHA and arachidonic acid (which account for 30-50% total phospholipids in the retina and gray matter in the fetal brain) ↓ neurogenesis and migration, → hypomyelination in the brain → ↓ visual acuity and attention span. (Piwko J et al. 2013) (Helland IB et al. 2003)
Maternal Hydration Deficiency (resulting in oligohydramnios, reduced amniotic fluid volume)
↓ dehydration à á amniotic fluid osmolality (Ross MG. 1990) (Schreyer P et al. 1990) (Ross MG et al. 1988)
↓ dehydration → ↑ amniotic fluid osmolality (Ross MG. 1990) (Schreyer P et al. 1990) (Ross MG et al. 1988)
↓ amniotic fluid volume → ↓ fetal movement via ↑ constriction (Moessinger AC et al. 1987) also → impaired fetal lung development (Cho FN et al. 2015)
↓ brain angiotensin system which contributes to dipsogenic changes (Zhang H et al. 2011)
↓ risk for umbilical cord compression → ↓ O₂ delivery to fetus → ↑ acidemia (lowered pH) (Schreyer P et al. 1990) (Gur ED et al.2016) (Bastian TW et al. 2016) (Myers RE. 1975)
↓ risk for deep vein thrombosis (DVT) (Lock C et al. 2010); lethal renal venous thrombosis (Byard RW, 2019)
Adapted from: Erick, M. Long term consequences of severe hyperemesis gravidarum including possible intrauterine fetal demise. SO Gyn Ob Women’s Health. Sept 2018. ISSN: 2381-2915.
Presented by Miriam Erick, MS RDN. Boston, Mass. Oct 2019. ICHG 2019. Amsterdam. www.morningsickness.net