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.\nCardiovascular\tand\tpulmonary\tfunction\nIncreased\tcardiac\toutput\taccompanies\tpregnancy,\tand\tcardiac\tsize\tincreases\tby\t12%.\tBlood\npressure,\tprimarily\tdiastolic,\tdecreases\tduring\tthe\tfirst\ttwo\ttrimesters\tbecause\tof\tperipheral\nvasodilation\tbut\tmay\treturn\tto\tprepregnancy\tvalues\tin\tthe\tthird\ttrimester.\n\tMild\tlower\textremity
|
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] |
exchange\tand\tlarger\tchest\tdiameter.\tIn\tthe\tthird\ttrimester,\tthe\tdiaphragm\tis\tpushed\tupwards\n\tby\tthe\ngrowing\tuterus,\twhich\tmay\talso\tcontribute\tto\tmaternal\tdyspnea.\nGastrointestinal\tfunction\nDuring\tpregnancy\tthe\tfunction\tof\tthe\tgastrointestinal\t(GI)\ttract\tchanges\tin\tseveral\tways\tthat\taffect
|
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] |
nutritional\tstatus.\tGums\tmay\tbleed\tmore\teasily\tbecause\tof\tincreased\tblood\tflow.\tIn\tthe\tfirst\ttrimester\nnausea\tand\tvomiting\tmay\toccur,\tfollowed\tby\ta\treturn\tof\tappetite\tthat\tmay\tbe\travenous\t(see\t\nNausea\nand\tVomiting,\tHyperemesis\tGravidarum,\tand\tPtyalism\n).\tCravings\tfor\tand\taversions\tto\tfoods\tare\ncommon\t(see\t\nCravings,\tAversions,\tand\tPica
|
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] |
common\t(see\t\nCravings,\tAversions,\tand\tPica\n).\tIncreased\tprogesterone\tconcentration\trelaxes\tthe\nuterine\tmuscle\tto\tallow\tfor\tfetal\tgrowth\twhile\talso\tdecreasing\tGI\tmotility\twith\tincreased\nreabsorption\tof\twater.\tThis\toften\tresults\tin\tconstipation.\tHowever,\tearly\thormonal\tchanges\tcan\talso\ncause\tdiarrhea\t(see\t\nConstipation,\tHemorrhoids,\tand\tDiarrhea
|
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] |
cause\tdiarrhea\t(see\t\nConstipation,\tHemorrhoids,\tand\tDiarrhea\n).\tA\trelaxed\n\tlower\tesophageal\tsphincter\nand\tpressure\ton\tthe\tstomach\tfrom\tthe\tgrowing\tuterus\tcan\tcause\tregurgitation\tand\tgastric\treflux\n(see\t\nHeartburn\n).\nGallbladder\temptying\tbecomes\tless\tefficient\tbecause\tof\tthe\teffect\tof\tprogesterone\ton\tmuscle
|
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] |
contractility.\tConstipation,\tdehydration,\tand\ta\tlow-calorie\tdiet\tare\trisk\tfactors\tfor\tgallstone\ndevelopment.\tDuring\tthe\tsecond\tand\tthird\ttrimesters,\tthe\tvolume\tof\tthe\n\tgallbladder\tdoubles\tand\tits\nability\tto\tempty\tefficiently\tis\treduced.\tBile\tcomposition\talso\tchanges,\tbecoming\tmore\tsludge-like,\nincreasing\tthe\tintrinsic\trisk\tof\tgallstones.
|
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increasing\tthe\tintrinsic\trisk\tof\tgallstones.\nImmune\tfunction\nPregnancy\thas\tbeen\tthought\tof\tas\ta\ttime\tof\toverall\timmunosuppression\tbut\tthere\tis\tlittle\tevidence\tto\nsupport\tthat\tidea.\tInstead,\tit\tappears\tto\tbe\ta\ttime\tof\timmunotransformation.\tIt\tis\thypothesized\tthat\nthe
|
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] |
the\n\tslow,\tgradual\trelease\tof\tpaternal/fetal\tantigens\tmay\tsomehow\tinduce\ttolerance\trather\tthan
|
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] |
rejection,\tthus\tnot\trequiring\tthe\tsame\timmunosuppression\tas\tis\tnecessary\tfor\ttransplant\trecipients.\nSome\thumoral\tand\tcell-mediated\timmunologic\tfunctions\tdo\tappear\tto\tbe\tsuppressed,\tlikely\tto\taid\tin\nthe\tacceptance\tof\tthe\t“foreign”\tfetus.\tHowever,\tother\timmunologic\tcells\tappear\tto\tbe\tupregulated.\nThe\tfetal\timmune
|
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] |
The\tfetal\timmune\n\tsystem\tappears\tto\taffect\tthe\tmaternal\tresponse\t(\nMor\tet\tal,\t2011\n).\tThe\tplacenta\tis\nan\teffective\tbarrier\tto\tmany\tpathogens\tbut\talso\tproduces\tsignals\tand\tregulates\tthe\timmune\tresponse\nat\tboth\tthe\timplantation\tsite\tand\talso\tsystemically\t(\nSilasi\tet\tal,\t2015\n)\tand,\tat\tleast\tin\tthe\tmurine
|
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] |
Silasi\tet\tal,\t2015\n)\tand,\tat\tleast\tin\tthe\tmurine\nmodel,\tperipheral\tblood\tmeasures\tof\timmune\tfunction\tmay\tnot\tbe\tappropriate\twindows\ton\tthe\nmaternal-fetal\tinterface\t(\nLewis\tet\tal,\t2018\n).\nPregnancy\thas\tboth\tproinflammatory\tand\tantiinflammatory\tperiods\t(\nMor\tet\tal,\t2011\n).\tIt\tis\tnow
|
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Mor\tet\tal,\t2011\n).\tIt\tis\tnow\nknown\tthat\tthe\tfirst\ttrimester,\tas\twell\tas\tjust\tbefore\tlabor,\tare\tproinflammatory.\tThe\tearly\nproinflammatory\tresponse\tis\tnecessary\tfor\toptimal\tendometrial\tvascularity\tand\tis,\ttherefore,\nassociated\twith\ta\tsuccessful\tpregnancy.\tThe\tsecond\tand\tmost\tof\tthe\tthird\ttrimester\tare\nantiinflammatory\tstates,\twhen
|
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] |
antiinflammatory\tstates,\twhen\n\tthe\tmother\tand\tfetus\tare\tin\trelative\tequilibrium.\tExposure\tto\ninfections,\ttoxins,\tand\tenvironmental\tpollution,\tas\twell\tas\tmaternal\tpsychological\tstress,\tall\taffect\nmaternal\timmune\tfunction\tand\tinflammation\tin\tutero\t(\nClaycombe\tet\tal,\t2015\n).\tWhen\tthe
|
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] |
Claycombe\tet\tal,\t2015\n).\tWhen\tthe\ninflammatory\tresponse\tis\texaggerated,\tas\tin\tthe\tcase\tof\tobesity,\tthe\trisk\tof\tnegative\tconsequences\nincreases,\tincluding\tthe\trisk\tof\tboth\tpreterm\tlabor\n\tand\tpreeclampsia.\tThe\texaggerated\tinflammatory\nresponse\tmay\talso\tnegatively\taffect\tfetal\tbrain\tdevelopment\t(see\t\nNew\tDirections:\n\tImmune\tFunction
|
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] |
New\tDirections:\n\tImmune\tFunction\nand\tBrain\tDevelopment\n).\tThere\tare\talso\tlikely\tnegative\tepigenetic\teffects\t(\nClaycombe\tet\tal,\t2015\n).\nIt\tis\tstill\tnot\tcompletely\tclear\thow\tthe\timmune\tsystem\tand\tpregnancy\taffect\teach\tother\tbut\tthe\ninteraction\tis\tcritical\tfor\tthe\tsurvival\tof\tthis\tmother\tand\n\tchild\tand,\tpossibly,\tfor\tfuture\tpregnancies.
|
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] |
child\tand,\tpossibly,\tfor\tfuture\tpregnancies.\nAlthough\tnutrition\tis\tlikely\timportant\tin\taffecting\tthe\tinflammatory\tresponse\tduring\tpregnancy,\tthe\nextent\tof\tthe\tdietary\tinfluence\t(\nVannuccini\tet\tal,\t2016\n),\tthe\tspecific\tdietary\tpatterns\tand\tcomponents\n(\nClaycombe\tet\tal,\t2015\n),\tand\tthe\timportance\tof\tindividual\tdifferences\t(
|
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] |
),\tand\tthe\timportance\tof\tindividual\tdifferences\t(\nBjørke-Monsen\tet\tal,\t2016\n)\nare\tall\tstill\tunknown\tbut\tare\tcurrently\tunder\tinvestigation\n\t(see\t\nChapter\t7\n).\n\t\nNEW\tDIRECTIONS\nImmune\tFunction\tand\tBrain\tDevelopment\nMaternal\tchronic\tlow-grade\tinflammation,\tcausing\tinflammation\tin\tthe\tfetus,\tappears\tto\taffect
|
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fetal\tbrain\tstructure\tdevelopment,\tnegatively\taffecting\tneurodevelopment\t(\nMiller\tand\tGeorgieff,\n2017\n).\tThis\tinflammation\tmay\tbe\tcaused\tby\tover-\tor\tundernutrition,\n\tbut\talso\tmaternal\tstress\tor\nanxiety.\tFetal\tinflammation\tis\tdirectly\ttoxic\tto\tthe\tdeveloping\tbrain\tbut\talso\treduces\tthe
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availability\tof\tnutrients\tessential\tfor\tneural\tmigration,\tneuronal\tgrowth,\tand\tdifferentiation.\nIn\taddition,\tit\tis\tnow\tthought\tthat\timmune\tmolecules\tare\timportant\tin\tregulating\tthe\ndevelopment\tof\tthe\tbrain\t(\nBilbo\tet\tal,\t2018\n).\tCurrent\tresearch\thas\tbeen\tguided\tby\tthe\tworking\nhypothesis
|
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] |
disorders,\tincluding\tautism\tspectrum\tdisorder.\tCausality\thas\tnot\tyet\tbeen\tdetermined\tand\tmost\tof\nthe\tcurrent\tresearch\n\tis\tstill\twith\tanimal\tmodels.\tWhether\tand\thow\tdietary\tchanges\twould\taffect\nthis\tprocess\tis\talso\tstill\tunknown.\nMetabolic\tresponses\nThe\tmetabolism\tof\tmacronutrients\tchanges\tduring\tpregnancy.\tThis\tresponse\tvaries\tbetween\tnormal
|
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] |
weight\twomen\tand\twomen\twith\tobesity\t(\nTable\t14.6\n).\nTABLE\t14.6\nMetabolic\tChanges\tDuring\tPregnancy\tfor\tWomen\tof\tNormal\tWeight\tand\tObese\nComponent\nNormal\tWeight\nObese\nFat\tdeposition\nwith\ngestational\nweight\tgain\nGestational\tfat\tgain\tis\tprimarily\taccumulated\ncentrally,\tboth\tsubcutaneous\tand\tvisceral\tfat.\nVisceral\taccumulation\tmay\tincrease\tas
|
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Visceral\taccumulation\tmay\tincrease\tas\npregnancy\tprogresses.\nLocations\tare\tsimilar,\tamount\tmay\tbe\nless\nLipid\nmetabolism\n50%\tto\t80%\tincrease\tin\tbasal\tfat\toxidation\tand\tin\nresponse\tto\tglucose,\tmarked\thyperlipidemia\nHyperlipidemia\tis\texaggerated\nAmino\n\tacid\nmetabolism\nProtein\tsynthesis\tincreases\tin\tthe\tsecond\t(15%)\nand\tthird\t(25%)\ttrimesters
|
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and\tthird\t(25%)\ttrimesters\nUnknown,\tbut\tlimited\tevidence\nsuggests\tanabolic\tresponse\tmay\tbe\nimpaired\nGlucose\nmetabolism,\ninsulin\nresistance\nImproved\tfasting\tglucose\tlevels,\tglucose\ttolerance\nand\tinsulin\tsensitivity\tin\tearly\tpregnancy,\tthen\ninsulin\tsensitivity\tdecreases\t50%\tto\t70%\tby\nthird\ttrimester\nEarly\tfasting\tglucose\timproves\n\tless\tif
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third\ttrimester\nEarly\tfasting\tglucose\timproves\n\tless\tif\nat\tall,\tmore\tinsulin\tresistance,\nwhich\tincreases\tserum\tlevels\tof\tall\nmacronutrients\nAdapted\tfrom\tNelson\tSM\tet\tal:\tMaternal\tmetabolism\tand\tobesity:\tmodifiable\tdeterminants\tof\tpregnancy\toutcome,\t\nHuman\tReprod\tUpdate\n\t16:255,\n2010.\nRenal\tfunction
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] |
Human\tReprod\tUpdate\n\t16:255,\n2010.\nRenal\tfunction\nThe\tglomerular\tfiltration\trate\t(GFR)\tincreases\tby\t50%\tduring\tpregnancy,\talthough\tthe\tvolume\tof\nurine\texcreted\teach\tday\tis\tnot\tincreased.\n\tRenal\tplasma\tflow\tincreases\tbecause\tof\tthe\tincreased\tGFR
|
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] |
with\tlower\tserum\tcreatinine\tand\tblood\turea\tnitrogen\tconcentrations.\tRenal\ttubular\tresorption\tis\tless\nefficient\tthan\tin\tthe\tnonpregnant\tstate,\tand\tglucosuria,\tbecause\tof\tincreased\tGFR,\tmay\toccur\talong\nwith\tincreased\texcretion\tof\twater-soluble\tvitamins\tand\tamino\tacids.\tSmall\tamounts\tof\tglucosuria\nincrease\tthe\trisk\tfor\turinary\ttract\tinfections.
|
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increase\tthe\trisk\tfor\turinary\ttract\tinfections.\nPlacenta\tand\tuterine\tenvironment\nThe\tfetus\tis\tnot\tprovided\tnutrients\tand\toxygen\tthrough\tthe\tplacenta\tuntil\tafter\tblood\tflow\tis\nestablished\tto\tthe\tplacenta\tthrough\tthe\tuterine\tspiral\tarteries,\taround\t10\tweeks\tof\tgestation.\tBefore
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] |
that,\tnourishment\tis\tthrough\tsecretions\tfrom\tboth\tthe\tfallopian\ttubes\tand\tthe\tendometrial\tglands,\nalso\tknown\tas\tuterine\tglands.\tThe\tfallopian\ttube\tsecretions\tare\tinitially\n\thigh\tin\tsimple\tcarbohydrates\nbut\tbecome\tmore\tcomplex\tfarther\tdown\tthe\ttubes\t(\nBurton,\t2018\n).\tThese\tsecretions\tare\tmodified\tin\nresponse\tto\tthe\tpresence\tof\tgametes\t(
|
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] |
response\tto\tthe\tpresence\tof\tgametes\t(\nAvilés\tet\tal,\t2010\n)\tand\talso\tafter\tfertilization\t(\nLeese\tet\tal,\n2008\n).\tThey\tinclude\tmany\tgrowth\tfactors,\tcytokines,\tand\tantioxidants\t(\nMénézo\tet\tal,\t2015\n).\tAnimal\nstudies\thave\tshown\tthat\tmany\tnutrients,\tincluding\tamino\tacids,\tpotassium,\n\tand\tlactate,\tare\tpresent
|
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] |
and\tlactate,\tare\tpresent\nin\tconcentrations\thigher\tthan\tin\tmaternal\tplasma,\twhile\tglucose,\tpyruvate,\tand\ttotal\tprotein\nconcentrations\tare\tlower.\tThe\tnutrients\tenter\tthe\tegg\tthrough\tendocytosis\tand,\tin\tboth\tmice\tand\nrats,\ta\tmaternal\tdiet\tlow\tin\tprotein\tnegatively\taffects\tthe\tgrowth\tand\tdevelopment\tof\tthe\tembryo,
|
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-0.02112250216305256,
-0.053654856979846954,
-0.0653228685259819,
0.03360888734459877,
0.08529330044984818,
0.02269888110458851,
-0.0033990368247032166,
0.024643396958708763,
0.0383724570274353,
0.06676898151636124,
0.13035720586776733,
-0.01583646982908249
] |
including\tthe\tcardiovascular\tphenotype\t(\nLeese\tet\tal,\t2008\n).\tThe\tcontents\tof\tthe\tendometrial\nsecretions,\tcalled\t“uterine\tmilk,”\tare\talso\tnot\tcompletely\tunderstood\tbut\tare\trich\tin\tglucose,\tlipids,\nglycoproteins,\tand\tgrowth\tfactors\t(\nBurton,\t2018\n).\tThese\tsecretions\tenter\tthrough\tthe\tintervillous
|
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0.018524885177612305
] |
Burton,\t2018\n).\tThese\tsecretions\tenter\tthrough\tthe\tintervillous\nspaces\tof\tthe\tplacenta,\tgoing\tto\tthe\tyolk\tsac\tand\tfeeding\tthe\tdeveloping\tfetus.\tWhether\tmaternal\ndiet\tor\tobesity\taffects\tthe\tcontents\tof\tthese\tsecretions\tis\tunknown\t(\nBurton\tet\tal,\t2016\n)\tbut\tat\tleast\nglycogen\tis\tstored\tin\tthese\tglands\t(\nJones\tet\tal,\t2015
|
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] |
)\tbut\tat\tleast\nglycogen\tis\tstored\tin\tthese\tglands\t(\nJones\tet\tal,\t2015\n).\tThe\tuterine\tgland\tsecretions\timpact\tuterine\nreceptivity\tand\tblastocyst\timplantation\t(\nKelleher\tet\tal,\t2016\n).\tThe\tgrowth\tfactors\tin\tthe\tsecretions\nthat\tstimulate\tplacental\tgrowth\tmay\tbe\ttriggered\tby\tthe\ttrophoblast\titself\t(\nBurton,\t2018\n).
|
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] |
Burton,\t2018\n).\nMaternal\tnutritional\tstatus\taffects\tplacental\tdevelopment,\tgrowth,\tnutrient\ttransport,\tand\nendocrine\tcapabilities\n\t(\nBurton\tet\tal,\t2016\n).\tSome\tnutrients,\tincluding\tiron,\tiodine,\tzinc,\tfolate,\nselenium,\tand\tvitamin\tA,\tare\tknown\tto\tbe\tcritically\timportant\tpreconceptually.\tOptimal\tmaternal
|
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status\timproves\tpregnancy\toutcomes\tand\treduces\tthe\trisk\tof\tpreeclampsia,\tgestational\tdiabetes\nmellitus\t(GDM),\tand\tpreterm\tdelivery\tpossibly\tby\timproving\tplacental\tfunctioning\tby\treducing\nplacental\toxidative\tstress\tand\tinflammation\n\t(\nRichard\tet\tal,\t2017\n).\tOther\tnutrients,\tincluding
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] |
(\nRichard\tet\tal,\t2017\n).\tOther\tnutrients,\tincluding\nmagnesium,\tappear\tto\tdirectly\taffect\tplacental\tdevelopment.\tHowever,\tvery\tlittle\tis\tknown\tabout\tthe\neffects\tof\tnutritional\tstatus\ton\tthe\tdevelopment\tof\tthe\tplacenta.\tMaternal\tBMI\t(both\thigh\tand\tlow),
|
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] |
body\tcomposition,\tpast\tnutritional\tstatus,\tcurrent\tdiet,\tfuel\treserves,\tand\tepigenetics\tare\tall\tlikely\nimportant\t(\nBurton,\t2018\n).\nPlacental\tweight\n\tis\tnot\ta\tuseful\tproxy\tmeasure\tfor\tplacental\tfunction\t(\nBurton\tet\tal,\t2016\n).\tThe\nplacenta\tgrows\tthroughout\tthe\tpregnancy,\tincluding\texponentially\tin\tthe\tthird\ttrimester,\tbut\tthe
|
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] |
growth\tappears\tto\tbe\ttightly\tregulated\t(\nMyatt\tand\tThornburg,\t2018\n).\tSmall\tplacentas\tcan\tadapt\tto\nincrease\tnutrient\ttransporters.\tHowever,\twhen,\thow,\tand\tby\thow\tmuch\tthe\tplacenta\tadapts\tis\tnot\ncompletely\tclear,\tnor\tis\tthe\n\treserve\tcapacity.\tWhen\tthe\tplacental\tcapacity\tto\tadapt\tis\tlimited,\tor\tif\tthe
|
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] |
placental\tfunction\tis\timpaired,\tfetal\tdevelopment\tmay\tbe\timpaired,\taffecting\tlong-term\thealth\n(\nBurton\tet\tal,\t2016\n).\tFor\texample,\tthe\teffect\tof\tGDM\ton\tplacental\tanatomy\tis\tnot\tfully\tunderstood\tbut\nsex-specific\talterations\tare\tevident\tthat\tmay\taffect\tnutrient\ttransport\t(\nCastillo-Castrejon\tand\tPowell,\n2017\n),\tincluding\tdocosahexaenoic
|
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] |
Castillo-Castrejon\tand\tPowell,\n2017\n),\tincluding\tdocosahexaenoic\n\tacid\t(DHA)\t(\nLéveillé\tet\tal,\t2018\n).\tWhether\tthere\tare\tindependent\neffects\tof\tGDM\tand\tobesity\tis\tnot\tyet\tclear.\tObesity\tappears\tto\taffect\tthe\tplacental\tfunction\tin\ta\tsex-\nspecific\tway,\twhere\tmales\tcontinue\tto\tgrow\tand\tfemales\tadapt\ta\tmore\tconservative\tstrategy,\nensuring\tsurvival\t(
|
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] |
ensuring\tsurvival\t(\nMyatt\tand\tThornburg,\t2018\n).\tHigh\taltitude\talso\taffects\tplacental\tdevelopment\tand\nfunction\t(\nBurton\tet\tal,\t2016\n)\t(\nFig.\t14.1\n).
|
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] |
FIG.\t14.1\nSummary\tof\tpotential\tstressors\tthat\tcan\talter\tthe\tplacental\tstructure\tand\tfunction,\taffecting\tthe\nnutrient\tavailability\tand\ttherefore\tthe\tprogramming\tof\tthe\tfetus.\n\tSource:\t(Adapted\tfrom\tMyatt\tL,\tThornburg\tKL:\tEffects\tof\nPrenatal\tNutrition\tand\tthe\tRole\tof\tthe\tPlacenta\tin\tHealth\tand\tDisease,\t\nMethods\tMol\tBiol\n\t1735:\t19,\t2018.)
|
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] |
Methods\tMol\tBiol\n\t1735:\t19,\t2018.)\nNutrients\tpass\tthrough\tthe\tplacenta\tby\ta\tvariety\tof\tmechanisms.\n\tMaternal\tnutrient\tstatus\twould\ndirectly\taffect\tthose\ttransferred\tthrough\tdiffusion\tor\tendocytosis/exocytosis.\tHowever,\tthe\ttransport\nof\tother\tnutrients\tcan\tbe\tupregulated\tthrough\tfacilitated\ttransport,\texchange\ttransport,\tand\tactive\ntransport\t(
|
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] |
transport\t(\nFig.\t14.2\n).\tTransport\tmechanisms\thave\tnot\tyet\tbeen\tidentified\tfor\tall\tnutrients.\tIn\naddition,\tthe\tplacenta\tcan\tsynthesize\tproteins\tfor\ttransport\tto\tthe\n\tfetus\tand\tmay\talso\tbe\ta\tsource\tof\nglucose,\tcholine,\tand\tfatty\tacids\t(\nBurton\tet\tal,\t2016\n;\t\nNugent\tand\tBale,\t2015\n;\t\nMyatt\tand\tThornburg,\n2018\n).\nFIG.\t14.2
|
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] |
;\t\nNugent\tand\tBale,\t2015\n;\t\nMyatt\tand\tThornburg,\n2018\n).\nFIG.\t14.2\nRepresentation\tof\tthe\tknown\tprocesses\tby\twhich\tmaterials\tcross\tthe\tplacental\nmembrane.\n\tSource:\t(Adapted\tfrom\tBurton\tGJ,\tFowden\tAL,\tThornburg\tKL:\tPlacental\tOrigins\tof\tChronic\tDisease,\t\nPhysiol\tRev
|
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] |
Physiol\tRev\n96:1509,\t2016;\tCao\tC,\tFleming\tMD:\tThe\tplacenta:\tthe\tforgotten\tessential\torgan\tof\tiron\ttransport,\t\nNutr\tRev\n\t74:421,\t2016;\tGrieger\nJA,\tClifton\tVL:\tA\treview\tof\tthe\timpact\tof\tdietary\tintakes\tin\thuman\n\tpregnancy\ton\tinfant\tbirthweight,\t\nNutrients\n\t7:153,\t2014;\tMyatt\tL,
|
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pregnancy\ton\tinfant\tbirthweight,\t\nNutrients\n\t7:153,\t2014;\tMyatt\tL,\nThornburg\tKL:\tEffects\tof\tPrenatal\tNutrition\tand\tthe\tRole\tof\tthe\tPlacenta\tin\tHealth\tand\tDisease,\t\nMethods\tMol\tBiol\n\t1735:\t19,\t2018;\nNugent\tBM,\tBale\tTL:\tThe\tomniscient\tplacenta:\tMetabolic\tand\tepigenetic\tregulation\tof\tfetal\tprogramming,\t\nFront\tNeuroendocrinol
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Front\tNeuroendocrinol\n39:28,\t2015;\tRichard\tK,\tHolland\tO,\tLanders\tK\tet\tal:\tReview:\tEffects\tof\tmaternal\n\tmicronutrient\tsupplementation\ton\tplacental\tfunction,\nPlacenta\n\t54:38,\t2017.)\nThe\tplacenta\tis\tvery\tactive\tmetabolically,\tconsuming\t80%\tof\tthe\toxygen\tit\ttakes\tfrom\tmaternal\ncirculation\tat\tmidgestation\tand\t40%\tto\t60%\tin\tlate\tgestation\t(
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circulation\tat\tmidgestation\tand\t40%\tto\t60%\tin\tlate\tgestation\t(\nZhang\tet\tal,\t2015\n).\tIt\tplays\ta\tdynamic\nrole\tin\toptimizing\tthe\tresource\tallocation\tbetween\tthe\tmother\tand\tthe\tfetus.\tIt\tresponds\tto\tmaternal\nnutrient\tavailability\n\tbut\tpaternal\tgenes\talso\tplay\ta\trole,\tpromoting\tthe\tgrowth\tof\tplacental\ttissues.\tIt
|
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is\tnot\tclear\tif\tobesity\talters\tspecific\tnutrient\ttransporters.\tThe\tsex\tof\tthe\tfetus/placenta\tis\talso\ncritical\tand,\tin\tgeneral,\tplacental\tadaptation\tis\tgreater\twith\tfemale\toffspring\t(\nBrett\tet\tal,\t2014\n).\tHow\nthe\tmother\tand\tfetus\tsignal\teach\tother\tis\tnot\tyet\tclear.\tHowever,\tit\tis\tknown\tthat\tthe\tfetus\tis\tnot\tjust
|
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] |
a\n\tpassive\trecipient\tof\tmaternal\tnutrients\tbut,\tinstead,\tactually\tdirects\thow\tmuch\tis\ttransferred\nthrough\tthe\tplacenta,\tincluding\ttrying\tto\tmatch\tthe\tperceived\tnutrient\tavailability.\tFor\texample,\nthere\tis\ta\tdown-regulation\tof\tprotein\ttransfer\tin\tthe\tcase\tof\t\nintrauterine\tgrowth\trestriction\n(IUGR)
|
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intrauterine\tgrowth\trestriction\n(IUGR)\n.\tWhen\tan\tabnormal\tsituation\tis\tidentified\tand\tinterventions\tare\timplemented,\tit\tis\tunknown\nwhether\tthese\n\ttransport\tmechanisms\tadapt\tto\tthe\tnew\tenvironment\tor,\tonce\tset,\tare\trelatively\npermanent.\nThe\tplacenta\tproduces\tseveral\thormones\tresponsible\tfor\tregulating\tfetal\tgrowth\tand\tthe
|
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] |
development\tof\tmaternal\tsupport\ttissues.\tIt\tis\tthe\tconduit\tfor\tthe\texchange\tof\tnutrients,\toxygen,\tand\nwaste\tproducts.\tThe\tplacenta\talso\tprovides\ta\tselective\tbarrier,\tprotecting\tthe\tfetus\tfrom\tpathogens,\nteratogens,\tand\n\tother\ttoxins\t(see\t\nClinical\tInsight:\tConsumption\tof\tHuman\tPlacenta\n),\tbut\tits\tdefenses
|
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] |
Clinical\tInsight:\tConsumption\tof\tHuman\tPlacenta\n),\tbut\tits\tdefenses\ncan\tbe\toverwhelmed.\tIn\taddition,\tit\tis\tnow\tthought\tthat\tthe\tplacenta\tmay\tcontain\ta\tunique\nmicrobiome,\thypothesized\tto\tbe\timportant\tin\tthe\tdevelopment\tof\tthe\tfetal\timmune\tsystem,\tlowering\nthe\trisk\tof\tallergies\t(\nPrince\tet\tal,\t2015
|
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0.05257081240415573,
0.10273445397615433,
0.07189119607210159,
0.043320395052433014
] |
the\trisk\tof\tallergies\t(\nPrince\tet\tal,\t2015\n).\tIt\tis\talso\tknown\tnow\tthat\tthe\ttrophoblast\tinvades\tthe\nlymphatic\tsystem\t(as\twell\n\tas\tthe\tspiral\tarteries\tand\tuterine\tveins)\tbut\twhether\taccess\tto\tthe\tlymph\ntriggers\tmaternal\timmune\ttolerance\tis\tunknown\t(\nMoser\tet\tal,\t2018\n).\nCLINICAL\tINSIGHT\nConsumption\tof\tHuman\tPlacenta
|
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0.01237545721232891
] |
Moser\tet\tal,\t2018\n).\nCLINICAL\tINSIGHT\nConsumption\tof\tHuman\tPlacenta\nIn\tmany\tareas,\twomen\tare\tnow\tbeing\toffered\ttheir\tplacentas\tafter\tdelivery.\tWhile\tsome\tpeople\nwant\tto\tsave\tit\tfor\tcultural\treasons,\tmany\tare\tnow\tchoosing\tto\teat\ttheir\tplacentas\tfor\tmany\tself-\nreported\tbenefits.
|
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] |
reported\tbenefits.\n\tPlacentophagy\tis\tpromoted\tas\ta\tpotential\tway\tto\tlower\tthe\trisk\tof\tpostpartum\ndepression\tand\timprove\tinfant\tbonding,\tas\twell\tas\treplace\tthe\tiron\tand\tother\tnutrients\tlost\tduring\npregnancy\tand\tdelivery.\tIt\tis\talso\tpromoted\tas\ta\tsource\tof\tenergy,\ta\tlactation\tpromoter,\tan
|
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] |
immune\tsystem\tbooster,\tand\tas\ta\tway\tto\tdecrease\tpain\tand\tbleeding\tafter\tdelivery\t(\nFarr\tet\tal,\n2018\n).\nPlacentas\tdo\tcontain\thormones\n\tthat\tmay\tbe\tbeneficial\tbut\tthe\ttherapeutic\teffect\thas\tnot\tbeen\ndemonstrated\t(\nYoung\tet\tal,\t2016b\n;\t\nYoung\tet\tal,\t2018a\n;\t\nYoung\tet\tal,\t2018b\n).\tThe\tplacenta\tis\ta
|
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] |
;\t\nYoung\tet\tal,\t2018a\n;\t\nYoung\tet\tal,\t2018b\n).\tThe\tplacenta\tis\ta\nsignificant\tsource\tof\tiron\tbut\tnormal\tconsumption\tamounts\tare\tunlikely\tto\tmake\ta\tsignificant\ndifference\tin\tthe\tpostpartum\tiron\tstatus\t(\nGryder\tet\tal,\t2017\n).\tThe\tplacenta\tis\ta\tsource\tof\tother\nnutrients\tas\twell,\tincluding\tselenium,\tprotein,\tand\n\tcholesterol\t(\nChang\tet\tal,\t2017
|
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] |
cholesterol\t(\nChang\tet\tal,\t2017\n).\tHowever,\tthere\nis\twide\tvariability\tbetween\twomen\t(\nYoung\tet\tal,\t2016a\n).\nThe\tplacenta\tis\talso\ta\tpotential\tsource\tof\tpathogens,\ttoxins,\tand\theavy\tmetals,\tdepending\ton\nprenatal\texposure.\tTheoretically,\tmaternal\tconsumption\tcould\ttrigger\talloimmunization,\texposing
|
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] |
her\tto\tgenetically\tdifferent\tcells\tor\ttissues,\ttriggering\tan\timmune\tresponse\tand,\ttherefore,\nharming\tfuture\n\tpregnancies\t(\nFarr\tet\tal,\t2018\n).\tA\trecent\tcase\treport\tcited\tmaternal\tingestion\tof\ndried\tplacenta\tas\ta\tlikely\tsource\tof\tGroup\tB\tstrep\tinfection\tin\ta\tnewborn,\tpossibly\tincreasing
|
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] |
maternal\tintestinal\tand\tskin\tcolonization,\tfacilitating\ttransfer\tto\tthe\tinfant.\tDried\tplacenta\tpowder\nis\tnot\tsterile\tand\twhen\tstored\tover\t6\tmonths,\thas\tbeen\ta\tsource\tof\t\nPaenibacillus\tmacerans\n,\nbacteria\tthat\tproduce\thistamine\n\tin\tpreserved\tfoods,\tpotentially\tcausing\tfoodborne\tchemical\nintoxication\t(\nJohnson\tet\tal,\t2018\n).
|
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0.04491066187620163,
0.06023092567920685,
0.12294355034828186,
0.033672019839286804
] |
intoxication\t(\nJohnson\tet\tal,\t2018\n).\nThe\tprocessing\tis\tnot\tregulated\tby\tthe\tFood\tand\tDrug\tAdministration\t(FDA)\tand\tis\tnot\nstandardized.\tThe\tplacenta\tmust\tbe\thandled\tcarefully,\tincluding\tbeing\trefrigerated\tsoon\tafter\ndelivery.\tThe\tconsumption\tof\tplacenta\tshould\tbe\tdiscouraged\tif\tthe\tmother\tor\tbaby\thas\ta\tviral\ninfection\t(\nJohnson\tet\tal,\t2018
|
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] |
infection\t(\nJohnson\tet\tal,\t2018\n)\tor\tif\tthe\tmother\twas\texposed\tto\theavy\tmetals\tduring\tpregnancy.\tIt\nshould\tnot\tbe\teaten\traw,\tincluding\tin\ta\tsmoothie.\tIf\tdried\tand\tencapsulated,\tit\tshould\tbe\tsteamed\nfirst\tto\tlower\tthe\trisk\tof\tpathogen\ttransmission.\nPlacental\tinsults\tcompromise\tthe\tability\tto\tnourish\tthe\tfetus,\tregardless\tof\thow\twell-nourished\tthe
|
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] |
mother\tis.\tThese\tinsults\tcan\tbe\tthe\tresult\tof\tpoor\tplacentation\tfrom\tearly\tpregnancy\n\tor\tsmall\tinfarcts\nassociated\twith\tpreeclampsia\tand\tother\thypertensive\tdisorders.\tWhen\tthe\tplacenta\thas\ta\treduced\nfunctional\tcapacity\tfor\twhatever\treason,\tthe\tresult\tis\toften\tintrauterine\tgrowth\trestriction\t(IUGR).
|
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] |
However,\tas\tmentioned\tbefore,\tthe\tplacenta\talso\thas\tthe\tability\tto\trespond\tto\ta\tpoor\tenvironment.\nFor\texample,\twomen\taffected\tby\tthe\tWorld\tWar\tII\tDutch\tfamine\tin\ttheir\tfirst\ttrimesters\n\thad\tlarger\nplacentas,\tresulting\tin\tnormal\tweight\tinfants\t(\nBelkacemi\tet\tal,\t2010\n).
|
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Belkacemi\tet\tal,\t2010\n).\nA\tless-than-optimal\tenvironment\tin\tutero\tcan\tlead\tto\ta\tmismatch\tbetween\tavailable\tnutrients\tand\nthe\tgenetically\tdetermined\tfetal\tdrive\tfor\tgrowth.\tThe\tgoal\tis\tto\tsupport\ta\thealthy\tenvironment\nthrough\ta\tproper\tbalance\tof\tnutrients\tand\tthe\tavoidance\tof\tteratogens\t(see\t\nClinical\tInsight\n:\tHigh-
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Clinical\tInsight\n:\tHigh-\nRisk\tPregnancies\twith\tNutritional\tComponents\n).\nCLINICAL\tINSIGHT\nHigh-Risk\tPregnancies\twith\tNutritional\tComponents\nApproximately\t10%\tof\tall\tpregnancies\tare\tconsidered\t“high\trisk,”\tmeaning\tthere\tis\ta\tmaternal\npreexisting\tcomplication\tor\ta\tsituation\tthat\tantedates\tpregnancy\tor\tpresents\tin\tthe\tcurrent
|
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] |
gestation\tthat\tputs\tthe\tmother\tor\tthe\tfetus\tat\trisk\tfor\ta\tpoor\toutcome.\tMany\tof\tthese\tmay\tinclude\nnutritional\tconcerns\tas\twell.\tWomen\twho\n\tpresent\twith\tthe\tfollowing\tissues\tneed\tincreased\nmedical\tsurveillance\tand\tnutrition\tassessment\tto\tensure\tthe\tmost\tfavorable\toutcomes,\tcontrolled\nmedical\tcosts,\tand\tthe\tfewest\tcomplications.
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medical\tcosts,\tand\tthe\tfewest\tcomplications.\nAnemias:\tmicrocytic\tor\tmacrocytic\nCardiovascular\tissues:\tmaternal\tcardiac\tstructural\tdefects,\tpreexisting\tcardiovascular\tdisease\nEndocrine\tissues:\tpolycystic\tovary\tsyndrome,\tthyroid\tdisease,\tgestational\n\tdiabetes,\ttype\t1\tor\t2\ndiabetes
|
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0.009603229351341724,
0.078196220099926,
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] |
Functional\talterations:\tdeafness,\tblindness,\tparalysis,\tparaplegia,\tquadriplegia\nGastrointestinal\tissues:\tfood\tallergies,\tceliac\tdisease,\tCrohn’s\tdisease,\tulcerative\tcolitis,\npostbariatric\tsurgery,\tgallstones\nHyperemesis\tgravidarum\nHypertension:\tpreexisting,\tpregnancy-induced,\tpreeclampsia
|
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] |
Hypertension:\tpreexisting,\tpregnancy-induced,\tpreeclampsia\nInfections:\tHIV\tand\tAIDS,\tmalaria,\tdental\tdisease,\tintestinal\tparasites\nMaternal\tgenetic\tdiseases\tor\tintellectual\tdevelopmental\tdisability\nMedical\tproblems:\tlupus,\tmyasthenia\tgravis,\tcystic\tfibrosis,\tpancreatitis,\tphenylketonuria,\ncancer,\tsickle\tcell\tdisease\nMultiple\tfetuses
|
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] |
cancer,\tsickle\tcell\tdisease\nMultiple\tfetuses\nObesity:\tBMI\t≥30\nPica\nPsychiatric:\teating\tdisorders,\tdepression,\tbipolar\tdisorders,\tMunchausen\tsyndrome,\tsuicidal\nideation,\tsubstance\tabuse\nRespiratory\tissues:\tasthma,\ttuberculosis,\tadult\n\trespiratory\tdistress\tdisorder\nSurgeries:\tcancers,\tgallbladder,\tappendectomy,\ttrauma\nYoung\tage—teenagers\nAIDS
|
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0.03754435479640961
] |
Young\tage—teenagers\nAIDS\n,\tAcquired\timmune\tdeficiency\tsyndrome;\t\nHIV\n,\thuman\timmunodeficiency\tvirus.\nAll\tnutrients\tare\tthought\tto\tbe\timportant,\talthough\tsome\tare\tbetter\tstudied\tthan\tothers.\t\nTable\t14.1\nlists\tsome\tpotential\tfunctions.\tHowever,\tmore\tcomplex\tinteractions\tinvolving\tmultiple\tfunctions\tare\nalso
|
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] |
also\n\tlikely\tcritical.\tFor\texample,\tmultiple\tnutrients\tare\tinvolved\tin\tthe\tcreation\tof\tbone\t(see\t\nChapter\n23\n)\tand\tbrain\t(\nTable\t14.7\n).\tWhen\teither\tmacro-\tor\tmicronutrients\tare\tlacking,\tthe\ttiming\tof\tthe\ndeficit\tis\timportant\tin\tpredicting\tthe\timpact\tof\tthat\tinsult\t(\nMonk\tet\tal,\t2013\n)\tWhen\tcritical\tperiods
|
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] |
Monk\tet\tal,\t2013\n)\tWhen\tcritical\tperiods\nare\tmissed,\tthe\tdamage\twill\tbe\tirreversible,\teven\tif\tthe\tnutrient\tsupply\tlater\tappears\tadequate\n(\nGeorgieff\tet\tal,\t2015\n).\tNutrients\tknown\tto\thave\tcritical\tor\tsensitive\tperiods\tinclude\tprotein,\nLCPUFAs,\tglucose,\tiron,\tzinc,\tcopper,\tiodine,\tselenium,\tand\tvitamins\tB\n6\n,\tB\n12\n,\tA,\tK,\tfolate,\tand
|
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] |
6\n,\tB\n12\n,\tA,\tK,\tfolate,\tand\ncholine.\tIn\tthe\tcase\tof\tfetal\tneurodevelopment,\tthe\tyounger\tthe\tbrain,\tthe\tmore\tit\tis\table\tto\trecover\nfrom\tan\tinsult.\tHowever,\tthe\tbrain\tis\tnot\ta\thomogenous\torgan\tand\tdoes\tnot\tdevelop\tin\ta\tsingle\ntrajectory,\tso\tthe\tspecific\trisks\n\tdepend\ton\tthe\tregion\tof\tthe\tbrain\tas\twell\tas\tthe\ttiming,\tdose,\tand
|
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] |
depend\ton\tthe\tregion\tof\tthe\tbrain\tas\twell\tas\tthe\ttiming,\tdose,\tand\nduration\tof\tthe\tperturbation\t(\nGeorgieff\tet\tal,\t2015\n;\t\nGeorgieff,\t2017\n).
|
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-0.04333791509270668,
-0.07960913330316544,
-0.058282364159822464,
0.07860572636127472,
-0.024245448410511017,
-0.05302851274609566,
-0.0037851817905902863,
0.056067317724227905,
0.06496880203485489,
0.008223435841500759,
-0.06245658919215202,
0.09291674941778183,
0.10768049210309982,
-0.06797797977924347,
-0.04518381506204605,
-0.0033569266088306904,
-0.02360665611922741,
-0.0721166580915451,
-0.009445594623684883,
0.10569419711828232,
-0.005480215884745121,
-0.022249136120080948,
-0.006817265879362822,
0.048869624733924866,
0.018926845863461494,
0.004631701856851578,
-0.02334626391530037,
0.013346758671104908,
0.08142076432704926,
0.0548994205892086,
0.07984902709722519,
-0.05784686282277107
] |
TABLE\t14.7\nKey\tNutrients\tfor\tFetal\tand\tNeonatal\tBrain\tDevelopment\nNutrient\nFunction\tin\tBrain\tDevelopment\nNegative\tEffect\tof\nDeficiency\nLong-chain\npolyunsaturated\nfatty\tacids,\nprimarily\tDHA\nand\tAA\nCell\tmembrane\tformation,\tmyelin,\tsynaptosomes,\nintracellular\n\tcommunication,\tsignal\ttransduction\nNeurodevelopment,\tvisual\ndevelopment\nProtein
|
[
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3.380248249146708e-33,
0.00930115394294262,
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0.020771395415067673,
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0.03971894085407257,
0.0004441464552655816,
0.024840222671628,
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0.0377841554582119,
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0.009142152033746243,
0.004507655743509531,
0.10365717858076096,
0.014746730215847492,
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0.021441876888275146,
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0.05423596128821373,
0.04284892603754997,
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0.057287994772195816,
0.06661190092563629,
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0.08975502103567123,
0.0008728099055588245,
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0.050637878477573395,
0.05899535119533539,
0.04799528047442436,
0.023784900084137917,
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0.10638250410556793,
-0.02555643394589424,
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0.025958934798836708,
0.02280024066567421,
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0.07813096046447754,
0.016662726178765297,
-0.0899021178483963,
0.005854027811437845,
0.02083466947078705,
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0.025972511619329453,
0.008343683555722237,
-0.06963813304901123,
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-0.0039747958071529865,
0.020021352916955948,
0.0158089492470026,
0.10938018560409546,
-0.05024559795856476,
0.01261889934539795,
-0.027918076142668724,
-0.003773539327085018,
0.01758883148431778,
0.0018547436920925975,
-0.045813094824552536,
-0.028180839493870735,
0.11355283111333847,
-0.06332066655158997,
-0.030829548835754395,
-0.019853264093399048,
0.04242639243602753,
0.054374609142541885,
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0.10430118441581726,
0.046999286860227585,
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0.033169426023960114,
-0.02901448681950569,
-0.06118352711200714,
-0.07225393503904343,
0.058039285242557526,
0.050401534885168076,
0.034230686724185944,
0.017127135768532753,
-0.0015612583374604583,
0.014780704863369465,
0.13965538144111633,
0.11348899453878403,
-0.06071186065673828
] |
Neurodevelopment,\tvisual\ndevelopment\nProtein\nNeuronal\tand\tglial\tstructural\tproteins,\tsynaptic\nstructures\tand\tnumbers,\tneurotransmitter\tpeptide\nproduction\tespecially\tin\tcerebellum,\thippocampus,\nand\tcerebral\tcortex\nOverall\tcentral\tnervous\tsystem\ngrowth,\tneurodevelopment\nZinc\nCofactor\tin\tenzymes\tmediating\tprotein\tand\tnucleic
|
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0.039958663284778595,
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Zinc\nCofactor\tin\tenzymes\tmediating\tprotein\tand\tnucleic\nbiochemistry,\tgrowth,\tgene\texpression,\nneurotransmitters,\tespecially\taffecting\ncerebellum,\tlimbic\tsystem,\tcerebral\tcortex,\ntemporal\tlobe,\tfrontal\tlobe\nAttention,\tmotor\tdevelopment\ndelays,\tshort-term\tmemory,\nbrain\tgrowth\nIron\nMyelination,\tdendritogenesis,\tsynaptogenesis,
|
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brain\tgrowth\nIron\nMyelination,\tdendritogenesis,\tsynaptogenesis,\nneurotransmission,\tespecially\tin\tthe\thippocampus,\nstriatum,\tfrontal\tcortex\nGlobal\tintelligence,\tgeneral\nmotor\tdevelopment,\nneurodevelopment,\nattention,\tmemory,\nlanguage,\n\tauditory\nrecognition\nCholine\nMethylation,\tmyelin,\tneurotransmitters,\tespecially
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Choline\nMethylation,\tmyelin,\tneurotransmitters,\tespecially\naffecting\thippocampus,\tseptum,\tstriatum,\tanterior\nneocortex,\tmidposterior\tneocortex\nVisual\tspatial\tand\tauditory\nmemory\tin\trodents\t(no\ninformation\tyet\tavailable\tfor\nhumans)\nCopper\nIron\ttransport,\tantioxidant\tactivity,\tneurotransmitter\nsynthesis,\tneuronal\tand\tglial\tenergy\tmetabolism,
|
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synthesis,\tneuronal\tand\tglial\tenergy\tmetabolism,\nespecially\taffecting\tcerebellum\nMotor\tcontrol,\tcognitive\nfunction\nIodine\nThyroid\tsynthesis,\tneuronal\tsynthesis,\tmyelination\nCognitive\tfunction\nVitamin\tA\nStructural\tdevelopment,\tantioxidant\nVisual\tfunction\nFolate\nOne-carbon\tmetabolism\nNeural\ttube\tdevelopment
|
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] |
Visual\tfunction\nFolate\nOne-carbon\tmetabolism\nNeural\ttube\tdevelopment\nAdapted\tfrom\tMonk\tC\tet\tal:\tResearch\treview:\tmaternal\tprenatal\tdistress\tand\tpoor\tnutrition—mutually\tinfluencing\trisk\tfactors\taffecting\tinfant\nneurocognitive\tdevelopment,\n\t\nJ\tChild\tPsychol\tPsychiatry\n\t54:115,\t2013.\nEffects\tof\tnutritional\tstatus\ton\tpregnancy\toutcome
|
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] |
54:115,\t2013.\nEffects\tof\tnutritional\tstatus\ton\tpregnancy\toutcome\nFetal\tgrowth\tand\tdevelopment\nIn\tthe\tearly\t1900s\tU.S.\twomen\twith\tpoor\tnutritional\tstatus\thad\tadverse\tpregnancy\toutcomes\twith\nhemorrhage\tat\tdelivery,\tprolonged\tlabor,\tand\tLBW\tinfants,\tconditions\tstill\tof\tconcern\ttoday\tin\tmany
|
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developing\tcountries.\tBecause\tof\tblockades\tduring\tWorld\tWar\tII,\tpreviously\n\twell-nourished\tDutch\npopulations\twere\texposed\tto\tsevere\tfood\trestrictions\tfor\t6\tmonths,\twith\tavailable\trations\tas\tlow\tas\n500\tkcals/day\t(\nLumey\tet\tal,\t2007\n).\tHigher\trates\tof\tmiscarriage\t(spontaneous\tabortion\t[SAB]),
|
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).\tHigher\trates\tof\tmiscarriage\t(spontaneous\tabortion\t[SAB]),\nstillbirths,\tneonatal\tdeaths,\tand\tcongenital\tmalformations\twere\tnoted\tin\toffspring\tborn\tto\twomen\nwho\tconceived\tduring\tthe\tfamine.\tSurviving\tinfants\twere\tsmaller\tif\texposed\tto\tfamine\n\tlate\tin\ngestation\t(\nRoseboom\tet\tal,\t2011
|
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late\tin\ngestation\t(\nRoseboom\tet\tal,\t2011\n).\tSimilar\tfindings\thave\tbeen\tfound\tin\tother\tcountries\tas\twell.\tIn\naddition,\tindividuals\tmay\tbe\tat\thigher\trisk\tof\tundernutrition\tbecause\tof\tpreexisting\tmedical\nconditions\tor\tbecause\tof\teither\tphysical\tor\tcultural\tlimitations\ton\tfood\tavailability.
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Even\tif\ta\tmother\tis\tnot\tstarving,\tthe\tdeveloping\tfetus\tmay\tbe\tunable\tto\tobtain\toptimal\tnutrients\nfrom\tsomeone\n\twho\tis\tcompromised\tnutritionally,\tresulting\tin\tgrowth\trestriction.\tThe\tcauses\tof\tIUGR\nare\tmany\tand\tinclude\tmaternal,\tfetal,\tand\tplacental\tfactors\t(\nBox\t14.2\n).\tInfants\tborn\twith\tLBW
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] |
Box\t14.2\n).\tInfants\tborn\twith\tLBW\n(<2500\tg),\tespecially\tthose\twith\tvery\tLBW\t(<1500\tg),\tare\tat\thigher\trisk\tfor\t\nperinatal\tmortality\n(infant\tdeath\toccurring\tbetween\t28\tweeks\tof\tgestation\tand\t4\tweeks\tpostpartum).\tBabies\twho\tare\nborn\twith\tLBW\tmay\tsuffer\tfrom\n\tnecrotizing\tenterocolitis,\trespiratory\tdistress\tsyndrome,
|
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] |
necrotizing\tenterocolitis,\trespiratory\tdistress\tsyndrome,\nintraventricular\themorrhage,\tcerebral\tpalsy,\tor\tretinopathy\tof\tprematurity\t(see\t\nChapter\t41\n).\nBOX\t14.2\nPotential\tCauses\tof\tIntrauterine\tGrowth\tRestriction\t(IUGR)\nMaternal\tfactors\nMedical\tconditions:\tchronic\thypertension,\tpreeclampsia\t(early\tin\tgestation),\tdiabetes,
|
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] |
systemic\tlupus\terythematosus,\tchronic\tkidney\tdisease,\tinflammatory\n\tbowel\tdisease,\tsevere\nlung\tdisease,\tcancer,\thyperemesis\tgravidarum\nInfections:\tsyphilis,\ttoxoplasmosis,\tcytomegalovirus,\trubella,\thepatitis\tB,\therpes\tsimplex\tvirus\n1\tor\t2,\tHIV-1,\t\nHelicobacter\tpylori\n,\tmalaria
|
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Malnutrition:\tlow\tprepregnant\tweight;\tsmall\tmaternal\tsize;\tpoor\tweight\tgain\t(especially\tin\tthe\nlast\thalf\tof\tpregnancy);\tobesity\t(especially\tif\tcombined\twith\tweight\tloss);\tnutrient\ndeficiencies,\n\tincluding\tprotein,\tvitamins\tA,\tB’s,\tC,\tfolic\tacid,\tzinc,\tcalcium,\tiron;\trecent
|
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] |
history\tof\tpregnancy;\thigh\tparity;\tmultiple\tpregnancy;\thistory\tof\tIUGR;\tactive\teating\ndisorders\nSocial\tconditions:\tvery\tyoung\tage;\tpoverty;\tlack\tof\tfood\tbecause\tof\twar,\tfamine,\tnatural\ndisasters\t(earthquake,\ttsunami);\tphysical\tor\tmental\tabuse;\tsubstance\tabuse\t(cigarettes,\nalcohol,\theroin,\tcocaine);\texposure\tto\tteratogens;
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alcohol,\theroin,\tcocaine);\texposure\tto\tteratogens;\n\texposure\tto\ttherapeutic\tmedications\n(antimetabolites,\twarfarin,\tphenytoin)\nFetal\tfactors\nGenetic:\trace,\tethnicity,\tsex,\tgenetic\tdisorders\nParity:\tfirst\tbaby\toften\tweighs\tless\tthan\tsubsequent\tsiblings\nChromosomal\tanomalies:\tchromosomal\tdeletions;\ttrisomy\t13,\t18,\t21
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Chromosomal\tanomalies:\tchromosomal\tdeletions;\ttrisomy\t13,\t18,\t21\nCongenital\tmalformations:\tanencephaly,\tgastrointestinal\tatresia,\tPotter\tsyndrome,\tpancreatic\nagenesis\nPlacental\tfactors\nPlacental\tinsufficiency:\treduced\tblood\tflow,\timpaired\ttransfer\tof\tnutrients
|
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] |
Anatomic\tproblems:\tmultiple\tinfarcts,\taberrant\tcord\tinsertions,\tumbilical\tvascular\tthrombosis\nand\themangiomas,\tpremature\tplacental\tseparation,\tsmall\tplacenta\nAdapted\tfrom\tAlisi\tA\tet\tal:\tIntrauterine\tgrowth\tretardation\tand\tnonalcoholic\tfatty\tliver\tdisease\tin\tchildren,\nInt\tJ\tEndocrinol\n\t2011:269853,\t2011;\tWu\tG\tet\tal:
|
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