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Int\tJ\tEndocrinol\n\t2011:269853,\t2011;\tWu\tG\tet\tal:\n\tBiological\tmechanisms\tfor\tnutritional\tregulation\tof\nmaternal\thealth\tand\tfetal\tdevelopment,\t\nPaediatr\tPerinat\tEpidemiol\n\t26:4,\t2012a.\nIn\taddition\tto\tfetal\tgrowth\trestriction,\tany\tadverse\tmaternal\tcondition,\tincluding\tpoor\tnutritional
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status,\tputs\tthe\tfetus\tat\trisk\tfor\tbeing\tdelivered\tpreterm.\tPrematurity\tleads\tto\tincreased\trisk\tof\nneonatal\tmorbidity\tand\tmortality,\tespecially\tif\tthe\tbaby\n\tis\talso\tgrowth\trestricted.\tPreterm\tdelivery\nrates\tare\trising\tin\tdeveloped\tcountries\tand\tare\thigher\tin\tthe\tUnited\tStates\tthan\tin\tEurope\n(\nBloomfield,\t2011
|
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] |
(\nBloomfield,\t2011\n).\tIn\tthe\tUnited\tStates\trates\tare\thighest\tamong\tnon-Hispanic\tblack\twomen,\tand\tit\nis\tunclear\tif\tearly\tfetal\tdevelopmental\tprogramming\tis\tplaying\ta\trole.\tPreterm\tdelivery\trates\tare\nhigher\twith\tART,\tamong\tboth\tsingletons\tand\tmultiples,\tpossibly\texplained\n\tin\tpart\tby\tthe\tunderlying\nmedical\tconditions\tthat\talso\tincrease\tinfertility\t(
|
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] |
medical\tconditions\tthat\talso\tincrease\tinfertility\t(\nACOG,\t2016a\n).\nAlthough\tobesity\tdoes\tnot\tpredict\toptimal\tnutrition,\tit\tis\tsomewhat\tprotective\tfor\tpreterm\tdelivery.\nHowever,\tprepregnant\tunderweight,\tcombined\twith\tlow\tweight\tgain\tduring\tpregnancy,\thas\tan\nadditive\teffect\ton\tpreterm\tdelivery\tand\tLBW\trisk.\tEven\tfor\tthose\twomen\tof\tnormal\tweight,\tlow
|
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weight\tgain\tdoubles\tthe\n\trisk\tof\tpreterm\tdelivery,\twhile\tweight\tloss\ttriples\tthe\trisk\t(\nBloomfield,\n2011\n).\tShort\tinterconceptual\tperiods\tare\tassociated\twith\tincreased\trates\tof\tpreterm\tbirths.\tIn\ta\nrecent\tstudy,\tthose\twomen\twho\twere\tunderweight,\twith\tan\tinterconceptual\tperiod\tof\tless\tthan\t6
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months,\tand\twho\thad\tinadequate\tweight\tgain\thad\tan\tincreased\trisk\tof\tnearly\t3.5\ttimes,\tresulting\tin\nover\t25%\trate\tof\tpreterm\tdelivery\n\t(\nLengyel\tet\tal,\t2017\n).\nOxidative\tstress,\tmetabolic\tstress,\tand\tinflammation\tmay\tall\tbe\timportant\tfactors\tin\tincreasing\trisk
|
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] |
but\tthere\tare\tno\npreconceptual\tstudies.\tSupplementation\twith\tLCPUFAs,\tprotein,\tand\tvitamins\tE\tand\tC\tare\tnot\neffective\t(\nACOG,\t2012\n).\tAlthough\tno\tideal\tdiet\thas\tbeen\tidentified,\tone\tcontaining\tfruits,\tvegetables,\nwhole\tgrains,\tand\tfish\thas\tbeen\tobserved\tto\tbe\tassociated\twith\tlower\trisk\tof\tpreterm\tdelivery.\nProbiotics\tmight\tbe\thelpful\t(
|
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0.05050622671842575,
0.0458548404276371,
0.09262191504240036,
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] |
Probiotics\tmight\tbe\thelpful\t(\nEnglund-Ögge\tet\tal,\t2014\n)\tand\tsmoking\tcessation\tis\thelpful\t(\nACOG,\n2012\n).\tParticular\ttoxins\tmay\tincrease\tthe\trisk\tof\tprematurity.\tOne\tstudy\tfound\tnearly\tdouble\tthe\trisk\nof\tpreterm\tdelivery\tif\twomen\tconsumed\tmore\tthan\tfour\tservings\tof\tdiet\tsoda\tper\tday\t(\nBloomfield,\n2011\n),\talthough\tthat\tfinding\thas\tbeen\tdisputed\t(
|
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] |
Bloomfield,\n2011\n),\talthough\tthat\tfinding\thas\tbeen\tdisputed\t(\nLa\tVecchia,\t2013\n).\tLicorice\t(\nGlycyrrhiza\tglabra\n\troot)\nblocks\tthe\tenzyme\tthat\tinactivates\tcortisol,\tand\tthe\teffect\ton\tpreterm\tdelivery\trisk\tis\tdose-related.\nSimilar\tresults\tare\tseen\twhen\tthe\tmother\tis\texposed\tto\tpsychological\tstress\t(see\t\nClinical\tInsight:\nStress\tduring\tPregnancy
|
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] |
Clinical\tInsight:\nStress\tduring\tPregnancy\n).\tThe\trole\tof\tpaternal\tnutrition\tin\tpreterm\tdelivery\trisk\tis\tunexplored\n(\nBloomfield,\t2011\n).\nThe\teffect\tof\tpoor\tmaternal\tnutrition\tor\texposure\tto\ttoxins\tmay\tfollow\tthe\tinfant\tfor\tdecades.\tA\nvery\tpreterm,\tgrowth-restricted\tbaby\tmay\tsuffer\tpermanent\tbrain\tdamage.\t\nNeural\ttube\tdefects\n(NTDs)
|
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] |
Neural\ttube\tdefects\n(NTDs)\n\tmay\tcause\tlifelong\tproblems\twith\tmobility\tand\tbodily\tfunctions.\tFetal\talcohol\tsyndrome\n(FAS)\tis\ta\tmajor\tcause\tof\tintellectual\tdevelopmental\tdisability.\tHowever,\teven\tthose\tbabies\twho\tare\nborn\twith\tno\tapparent\tdefects\tmay\tsuffer\tincreased\trisk\tof\tchronic\tdiseases\tbecause\tof\ta\tless-than-\noptimal\tprenatal\tenvironment.\tSee
|
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] |
optimal\tprenatal\tenvironment.\tSee\t\nFig.\t14.3\n\tfor\ta\tsummary\tof\tthe\teffects\tof\tmaternal\tmalnutrition.
|
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] |
FIG.\t14.3\nMajor\tnegative\teffects\tof\tmaternal\tmalnutrition\t(both\tunder-\tand\tovernutrition)\ton\tmother\tand\tinfant.\nEpigenetic\teffects\nCompromises\tin\tstructural\tor\tcognitive\tpotential\tmay\tnot\tbe\tevident\twhen\tan\tinfant\tis\tborn\tbut\tmay\nmanifest\tlater\tin\tlife.\tA\tchild\twith\tIUGR,\toften\tresulting\tfrom\tmaternal\thypertension\tor\tsevere
|
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] |
malnutrition\tor\tanemia,\tmay\thave\tpermanent\tmild\tneurodevelopmental\n\tcognitive\tabnormalities.\nBabies\tborn\tpreterm\tor\tgrowth\trestricted\tare\tmore\tlikely\tto\thave\ta\thigher\trisk\tof\tobesity,\ttype\t2\ndiabetes,\thypertension,\tand\tcardiovascular\tdisease\t(CVD)\tlater\tin\tlife\t(\nSimeoni\tet\tal,\t2018\n).\tThose
|
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Simeoni\tet\tal,\t2018\n).\tThose\nbabies\texposed\tto\tthe\tDutch\tfamine\tearly\tin\tgestation\twere\tat\thighest\trisk\tof\tCVD\tand\thad\tdouble\nthe\trisk\tfor\tschizophrenia,\tas\twell\tas\tan\tincreased\trisk\tof\tstress\tsensitivity\n\tand\tbreast\tcancer.\tThose\nexposed\tmidpregnancy\twere\tthree\ttimes\tmore\tlikely\tto\tdevelop\tmicroalbuminuria\tand\tdecreased
|
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] |
creatinine\tclearance,\tas\twell\tas\thaving\tan\tincreased\trisk\tfor\tobstructive\tairway\tdisease;\tgrowth\nrestriction\twas\tcommon\tamong\tthose\taffected\tin\tthe\tlater\ttrimesters\t(\nRoseboom\tet\tal,\t2011\n;\nMatusiak\tet\tal,\t2014\n).\nGirls\tborn\tpreterm\tare\tmore\tlikely\tto\tdeliver\tpreterm\twith\ttheir\town\n\tpregnancies\tand\tmore\tlikely\nto\tdevelop\tanorexia\tnervosa\t(
|
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] |
pregnancies\tand\tmore\tlikely\nto\tdevelop\tanorexia\tnervosa\t(\nBloomfield,\t2011\n).\tImmune\tfunction,\tlearning\tability,\tmental\thealth,\ncancer,\tand\taging\tare\tlikely\taffected\tby\tLBW.\tFunctional\tneural\tpathways\tcontrolling\tappetite\tand\nsatiety\tlikely\tdevelop\tin\tthe\tthird\ttrimester,\tso\tpreterm\tinfants\tmay\texperience\tdisruptions\tin\ttheir\ndevelopment.
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development.\nThose\tbabies\tborn\t\nlarge\tfor\tgestational\tage\t(LGA)\n\tor\texposed\n\tto\tmaternal\thyperglycemia\tor\nmaternal\tobesity\tare\tat\tincreased\trisk\tof\tchronic\tdiseases,\tlikely\tthrough\tmultiple\tmechanisms\t(see\nFocus\tOn:\n\tSpecial\tCase\tof\tObesity\n).\nBirth\tweight\tmay\tnot\tbe\tthe\tonly\tpredictor\tfor\tthe\tpropensity\tfor\tadult\tdisease.\tExposure\tto\thigh
|
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] |
folate\tduring\tpregnancy\tis\tassociated\twith\tinsulin\tresistance\tand\tobesity\tin\tlater\tlife\tif\tcombined\nwith\tlow\tvitamin\tB\n12\n\tlevels,\tand\n\tincreased\trates\tof\tcancer\tare\tassociated\twith\tsupraphysiologic\nintakes\tof\tmethyl\tdonors\t(\nMilagro\tet\tal,\t2013\n;\tsee\t\nChapter\t6\n).\tMaternal\tand\tpaternal\tnutritional
|
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] |
;\tsee\t\nChapter\t6\n).\tMaternal\tand\tpaternal\tnutritional\nimbalances\tare\tlikely\tto\tincrease\tthe\trisk\tof\tmetabolic\tsyndrome\t(\nDelCurto\tet\tal,\t2013\n).\nExposure\tto\tendocrine-disrupting\tchemicals\t(substances\tfound\tin\tthe\tenvironment\tthat\tinterfere\nwith\tthe\tsynthesis,\tmetabolism,\tor\taction\tof\tthe\tbody’s\n\thormones)\tmay\tmodify\tgene\texpression\tand
|
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hormones)\tmay\tmodify\tgene\texpression\tand\nthe\teffects,\tincluding\tincreased\trisk\tof\tobesity,\tinsulin\tresistance,\tand\ttype\t2\tdiabetes,\tmay\tbe\nnonlinear\t(i.e.,\tlow\tdoses\tmay\tbe\tmore\tharmful\tthan\thigh\tdoses)\t(\nBarouki\tet\tal,\t2012\n).\tIn\tone\tstudy,\nmothers\twho\tate\tan\tunbalanced\thigh-protein\tdiet\t(1\tpound\tred\tmeat/day,\tno\tcarbohydrate)\tduring
|
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late\tpregnancy\tproduced\toffspring\twho\texperienced\thigher\tcortisol\n\tlevels\twhen\texposed\tto\tstress\tas\nadults\t(\nBloomfield,\t2011\n).\nThis\tdevelopmental\tplasticity\tcan\tbe\thelpful.\tHowever,\twhen\tthere\tis\ta\tmismatch\tbetween\tin\tutero\nprogramming\tand\tthe\tlater\tenvironment,\tthe\trisk\tof\tchronic\tdisease\trises.\tA\tfetus\tmay\tdevelop\ta
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“thrifty\tphenotype,”\tadapting\tto\tpoor\tnutritional\tconditions\tby\tbeing\tmore\tefficient\tin\tacquiring\tand\nconserving\tenergy.\tHowever,\twhen\tlater\texposed\n\tto\tan\tenvironment\twith\thigher\tavailability,\tthis\n“thrifty”\tadaptation\tmay\tpredispose\tthe\toffspring\tto\tthe\tdiseases\tof\taffluence,\tincluding\tobesity\tand
|
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] |
type\t2\tdiabetes.\tIn\taddition,\tharm\tmay\talso\tbe\tcaused\tby\tovercompensation\tlater\twith\texcessive\ncatch-up\tgrowth.\tAltered\torgan\tstructure,\tcell\tnumbers,\tand\tmetabolic\tfunctioning,\tincluding\npremature\taging\tof\ttissues,\tall\tappear\timportant\t(\nBurton\tet\tal,\t2016\n).\nExposure\tof\tthe\tembryo\tor\tfetus\tto\tspecific\tmaternal\tnutrients,\tas\twell\tas\tenvironmental
|
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] |
contaminants,\tcan\tturn\tthe\timprinting\tgenes\tthat\tcontrol\tgrowth\tand\tdevelopment\ton\tor\toff,\tbut\tthe\namounts,\ttiming,\tand\teffects\tare\tstill\tbeing\tinvestigated.\tPaternal\tnutrient\timbalance\tand\tgene-\nenvironment\tinteractions\tare\talso\tlikely\timportant\t(\nBarouki\tet\tal,\t2012\n;\t\nDelCurto\tet\tal,\t2013\n).\nAlthough\tthe
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] |
Barouki\tet\tal,\t2012\n;\t\nDelCurto\tet\tal,\t2013\n).\nAlthough\tthe\n\tconcept\tof\tthe\tDOHaD\toriginally\tfocused\ton\tundernutrition,\tovernutrition\talso\tis\tbeing\nstudied.\tEffects\tof\tmacro-\tand\tmicronutrients,\tas\twell\tas\tphytonutrients\tand\thypoxia,\tare\tbeing\nexamined,\tprimarily\tthrough\tanimal\tstudies\tso\tfar,\tand\tthe\tideal\tmaternal\tand\tpaternal\tdiet\tfor
|
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] |
epigenetic\teffects\thas\tnot\tyet\tbeen\testablished\t(\nVanhees\tet\tal,\t2014\n).\tIt\tappears\tthat\tthe\tepigenetic\neffect\tof\tpreconceptual\n\tobesity\tis\tstronger\tfor\tmaternal\tthan\tpaternal\tobesity\t(\nGodfrey\tet\tal,\t2017b\n).\nHowever,\tthe\tpaternal\tdiet\tbefore\tconception\tdoes\tappear\tto\taffect\tthe\toffspring\tepigenetically\tand
|
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] |
there\tis\tevidence\tthat\tthe\tsperm\tepigenome\tis\trapidly\tremodeled\tafter\tweight\tloss\tfollowing\tbariatric\nsurgery\t(\nBlock\tand\tEl-Osta,\t2017\n).\tParental\tdiet,\tbody\tcomposition,\tmetabolism,\tand\tstress\texposure\nall\tappear\timportant,\n\tbut\tthe\teffects\tare\tsex-specific.\tMechanisms\tinclude\tepigenetic,\tcellular,\nphysiologic,\tand\tmetabolic\tchanges\t(
|
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] |
physiologic,\tand\tmetabolic\tchanges\t(\nFleming\tet\tal,\t2018\n).\nNew\tresearch\talso\tis\tfocusing\ton\tthe\tgrandchildren\tof\tpeople\taffected\tby\tthe\tDutch\tfamine
|
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] |
(\nRoseboom\tet\tal,\t2011\n)\tto\tdocument\tthe\tlong-term\tepigenetic\teffects\t(\nFig.\t14.4)\n.\tPreliminary\tresults\nshow\tthat\tunder-\tand\tovernutrition\tare\timportant\tissues,\tbut\tthere\tare\n\tdifferences\tin\tresponse\tby\nsex,\tand\tthe\ttiming\tof\tthe\tinsult\tmatters\t(\nVanhees\tet\tal,\t2014\n;\t\nPreston\tet\tal,\t2018\n).\nFIG.\t14.4
|
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] |
Vanhees\tet\tal,\t2014\n;\t\nPreston\tet\tal,\t2018\n).\nFIG.\t14.4\nTransgenerational\tinheritance\tof\tepigenetic\tmodifications\tinduced\tby\texposure\tto\tmacro-\tand\nmicronutrients.\n\tSource:\t(Adapted\tfrom\tVanhees\tK,\tVonhögen\tIG,\tvan\tSchooten\tFJ\tet\tal:\tYou\tare\twhat\tyou\teat,\tand\tso\tare\tyour
|
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] |
on\tthe\tlifetime\thealth\tof\tthe\toffspring,\nthere\tare\tcalls\tfor\tmuch\tbetter\tguidance\tand\tparental\tpreparation\tbefore\tconception\t(\nFleming\tet\tal,\n2018\n)\t(see\t\nChapter\t6\n).\nNutrient\trequirements\tduring\tpregnancy\nNutrition\tduring\tpregnancy\toften\tis\tequated\twith\tweight\tgain\tbecause\tweight\tis\tmost\teasily\tand
|
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] |
consistently\tmeasured.\tHowever,\tmaternal\tweight\tgain\tis\tnot\tnecessarily\tpredictive\tof\thealth\noutcomes,\tespecially\tfor\theavier\twomen.\tIn\tgeneral,\talthough\tthe\tmother\tneeds\tto\teat\ta\tlittle\tmore\nwhen\tshe\tis\tpregnant\tor\tbreastfeeding,\tshe\tneeds\tto\teat\tmore\tcarefully\tbecause\tmost\tnutrient
|
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] |
requirements\tincrease\tmore\tduring\tpregnancy\tand\tlactation\tthan\tdo\tthe\tcalorie\trequirements\t(\nFig.\n14.5\n).\tThe\tU.S.\tdietary\treference\tintakes\t(DRIs)\tare\tfound\ton\tthe\tinside\tcover.\tEstimated\nrequirements\tduring\n\tpregnancy\tand\tlactation\tvary\tbetween\tcountries\t(see\tadditional\tinformation\ton
|
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the\tEvolve\twebsite\tfor\trecommendations\tfrom\tWHO\tand\t16\tgovernments\tor\tregions\tworldwide)\tbut\nthere\tis\ta\tcall\tto\timprove\tthe\tconsistency\tin\tthe\tdevelopment\tof\tthese\tvalues\tacross\tcultures\n(\nNational\tAcademies\tof\tSciences,\tEngineering,\tand\tMedicine,\t2018\n).\tFor\tmost\tnutrients,\tthere\tis\nlittle\tguidance\tby\ttrimester\tor\tfor
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third\ttrimester\tand\tlactation\tin\tthe\tfirst\t6\tmonths.\nEnergy\nAdditional\tenergy\tis\trequired\tduring\tpregnancy\tto\tsupport\tthe\tmetabolic\tdemands\tof\tpregnancy\tand\nfetal\tgrowth.\tMetabolism\n\tincreases\tby\tan\taverage\tof\t15%\tin\tthe\tsingleton\tpregnancy,\tbut\twith\twide
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] |
variability\tespecially\tin\tthe\tthird\ttrimester.\tThe\tDRI\tfor\tenergy\tincreases\tby\tonly\t340\tkcal/day\tduring\nthe\tsecond\ttrimester\tand\tby\t452\tkcal/day\tin\tthe\tthird\ttrimester.\tIf\tmaternal\tweight\tgain\tis\twithin\tthe\ndesirable\tlimits,\tthe\trange\tof\tacceptable\tenergy\tintakes\tvaries\twidely,\tgiven\tlarge\tindividual\ndifferences\tin\tenergy
|
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] |
differences\tin\tenergy\n\toutput\tand\tbasal\tmetabolic\trate.\tModifying\tintakes\tto\tachieve\trecommended\nweight\tgain\t(see\t\nPregnancy\tWeight\tGain\tRecommendations\n)\tis\tmore\tuseful\tthan\tcalculating\tcaloric\nrequirements.\nExercise.\nEnergy\texpended\tin\tvoluntary\tphysical\tactivity\tis\tthe\tlargest\tvariable\tin\toverall\tenergy\texpenditure.
|
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] |
Physical\tactivity\tincreases\tenergy\texpenditure\tproportional\tto\tbody\tweight.\tHowever,\tmost\tpregnant\nwomen\tcompensate\tfor\tincreased\tweight\tgain\tby\tslowing\ttheir\twork\tand\tmovement\tpace.\tTherefore\ntotal\tdaily\tenergy\texpenditure\tmay\tnot\tbe\tsubstantially\tgreater\tthan\tbefore\tpregnancy.
|
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] |
The\tACOG\trecommends\tat\tleast\t20\tto\t30\tminutes\tof\tmoderate\tintensity\texercise\ton\tmost,\tif\tnot\tall,\ndays\tfor\tpregnant\twomen\twithout\tcontraindications\t(\nACOG,\t2015a\n).\tShort\tduration\tstrenuous\nexercise\tappears\tunconcerning,\n\tbut\tthe\timpact\tof\tlong\tduration\tstrenuous\texercise\ton\tthe\tfetus\tis\nunknown\t(\nSzymanski\tand\tSatin,\t2012
|
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] |
unknown\t(\nSzymanski\tand\tSatin,\t2012\n).\tElite\tathletes\tmay\tneed\tto\tmodify\ttheir\texercise\troutines\t(\nBø\net\tal,\t2018\n).\tExcessive\texercise,\tcombined\twith\tinadequate\tenergy\tintake,\tmay\tlead\tto\tsuboptimal\nmaternal\tweight\tgain\tand\tpoor\tfetal\tgrowth.\tTherefore\ta\tpregnant\twoman\tshould\talways\tdiscuss\nexercise\twith\ther\thealth\tpractitioner.\tAlthough
|
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] |
exercise\twith\ther\thealth\tpractitioner.\tAlthough\n\tthere\tis\tlimited\tevidence\tthat\texercise\thelps\tmodify\ngestational\tweight\tgain,\tthere\tis\talso\tno\tevidence\tof\tharm\tand\tin\tobservational\tstudies\texercise\thas\nbeen\tassociated\twith\tlower\trisk\tof\tgestational\tdiabetes,\tpregnancy-induced\thypertension,\tand\npreeclampsia\t(\nSeneviratne\tet\tal,\t2015
|
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] |
preeclampsia\t(\nSeneviratne\tet\tal,\t2015\n).\tThe\teffect\tof\tmaternal\texercise\ton\toffspring\tsusceptibility\tto\nchronic\tdiseases\tis\tbeing\texplored\tin\tanimal\tresearch\n\tbut\tresults\tare\tmixed\tand\tthe\ttype,\ttiming,\nintensity,\tand\tdose\tof\toptimal\texercise\tare\tall\tunknowns\t(\nBlaize\tet\tal,\t2015\n).\tHowever,\tnot\tall
|
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] |
Blaize\tet\tal,\t2015\n).\tHowever,\tnot\tall\nepigenetic\teffects\tmay\tbe\tpositive.\tThere\tis\tlimited\tevidence\tthat\texcessive\tpaternal\texercise\tis\nassociated\twith\tan\toffspring’s\tthrifty\tphenotype\t(\nDhasarathy\tet\tal,\t2017\n).\nProtein\nAdditional\tprotein\tis\trequired\tto\tsupport\tthe\tsynthesis\tof\tmaternal\tand\n\tfetal\ttissues.\tThis\tdemand
|
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fetal\ttissues.\tThis\tdemand\nincreases\tthroughout\tgestation\tand\tis\tmaximized\tduring\tthe\tthird\ttrimester.\tCaution\tis\tadvised\twhen\nreading\tthe\tDRI\ttables.\tThe\tbaseline\tprotein\tRDA\tof\t0.8\tg/kg\tcurrent\tbody\tweight/day\tfor\tpregnant\nwomen\tis\t46\tg\tonly\tfor\tsomeone\twith\ta\tprepregnant\tweight\tof\t126\tpounds.\tThe\tprotein\tcalculation\tin
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] |
also\tgaining\tweight\tappropriately.\tFor\tmany\twomen,\tthe\tprotein\trequirement\tis\thigher.\tFor\teach\nadditional\tfetus,\tthe\tInstitute\tof\tMedicine\t(IOM)\trecommends\tan\tadditional\t50\tg/day\tstarting\n\tin\tthe\nsecond\ttrimester\t(\nOtten\tet\tal,\t2006\n),\tbut\tbecause\tprotein\tis\talso\tused\tas\tan\tenergy\tsource,\tthe\ttotal
|
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] |
),\tbut\tbecause\tprotein\tis\talso\tused\tas\tan\tenergy\tsource,\tthe\ttotal\nmay\tbe\tas\tmuch\tas\t175\tg/day\tfor\tthe\tnormal-weight\twoman\tcarrying\ta\ttwin\tgestation\twho\tis\nconsuming\t3500\tkcal/day\t(\nGoodnight\tand\tNewman,\t2009\n).\nThe\tWHO\tuses\tslightly\tdifferent\tcalculations.\tThey\talso\tcalculate\ta\tbaseline\trequirement\tusing
|
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] |
current\tbody\tweight.\tHowever,\tthe\testimates\tof\tincreased\n\tneeds\tare\tpresented\tas\tstandard\namounts/day\tfor\teveryone.\tThe\t2007\trecommendations\tare\tdesigned\tto\tsupport\ta\ttotal\t13.8\tkg\nweight\tgain.\tHowever,\tsome\tresearchers\trecommend\tthe\tolder\t(1985)\tand\tmore\tconservative\nguidelines\t(\nMillward,\t2012\n)\t(\nTable\t14.8\n).\nTABLE\t14.8
|
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0.04497574642300606,
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0.005752029828727245,
0.027452096343040466,
0.05548235774040222,
0.09300781786441803,
0.044762011617422104,
-6.698125076809447e-8,
-0.006186018232256174,
0.0008111325441859663,
-0.008924206718802452,
0.008081113919615746,
0.049862489104270935,
0.0005348124541342258,
0.04736711457371712,
0.013510475866496563,
-0.020374562591314316,
-0.038510214537382126,
0.1471906453371048,
-0.01804175227880478,
-0.07573657482862473,
-0.04907624423503876,
0.03145869821310043,
-0.021075624972581863,
-0.05537106841802597,
0.14715003967285156,
-0.05460626259446144,
-0.09741495549678802,
0.016823912039399147,
0.08871661871671677,
0.02972855232656002,
-0.04117165505886078,
-0.050999194383621216,
0.02433980628848076,
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0.0015597924357280135,
-0.02255507931113243,
0.05776653811335564,
0.03266085684299469,
0.006895645521581173,
0.03676679730415344,
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0.065252885222435,
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-0.02266955003142357,
-0.04118731990456581,
0.09763839840888977,
-0.02661428414285183,
0.007115781307220459,
-0.028663674369454384,
0.10297926515340805,
0.11190871149301529,
-0.06116914004087448,
-0.04787147417664528,
0.02521885372698307,
-0.017227886244654655,
-0.0585721917450428,
0.03098486177623272,
0.05728147178888321,
0.028989285230636597,
0.002693494316190481,
-0.06565206497907639,
0.05991800129413605,
0.024844970554113388,
0.07653681933879852,
-0.050102803856134415,
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0.0881916731595993,
0.01797904446721077,
0.014833515509963036,
0.0103013776242733
] |
guidelines\t(\nMillward,\t2012\n)\t(\nTable\t14.8\n).\nTABLE\t14.8\nProtein\tIntake\tRecommendations\nPrepregnancy\nFirst\nTrimester\nSecond\tTrimester\nThird\nTrimester\nNotes\nU.S.\nDRIs\n0.8\tg/kg\ncurrent\nbody\nweight/day\n0.8\tg/kg\ncurrent\nweight/day\n1.1\tg/kg\tcurrent\tweight/day\nstarting\tin\tthe\tsecond\nhalf\tof\tpregnancy\n1.1\tg/kg\ncurrent\nweight/day\nWHO,\n2007\n0.83\tg/kg
|
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0.05561751127243042,
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0.009642391465604305,
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-0.07738503813743591,
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-0.014776512049138546,
0.16697989404201508,
-0.010286572389304638,
-0.04687095806002617,
0.022667352110147476,
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0.023916643112897873,
0.02935127541422844,
0.04133091866970062,
0.00766058498993516,
0.0313899889588356,
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0.062196094542741776,
0.08312346041202545,
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0.03717736154794693,
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-0.04406798630952835,
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-0.07088255882263184,
0.05066966265439987,
0.002580690663307905,
0.0906880795955658,
0.002775647444650531,
-0.05630399286746979,
0.01854168251156807,
0.04591084644198418,
0.09285923093557358,
-0.010096837766468525,
-0.04752621054649353,
0.05445954576134682,
-0.001177355065010488,
0.005601000040769577,
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-0.03932779282331467,
-0.0033542185556143522,
-0.03307260572910309,
-0.04518481716513634,
0.09959083050489426,
0.046484772115945816,
-0.047704730182886124,
0.011974797584116459,
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0.010882299393415451,
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0.011108649894595146,
-0.00241461000405252
] |
half\tof\tpregnancy\n1.1\tg/kg\ncurrent\nweight/day\nWHO,\n2007\n0.83\tg/kg\ncurrent\nbody\nweight/day\nBaseline\t+\n0.7\tg/day\nBaseline\t+\t9.6\tg/day\nBaseline\t+\n31.2\tg/day\nWHO,\n1985\n0.83\tg/kg\ncurrent\nbody\nweight/day\nBaseline\t+\n1.2\tg/day\nBaseline\t+\t6.1\tg/day\nBaseline\t+\n10.7\tg/day\nAverage\tincrease\t6\ng/day\tabove\nbaseline\nrequirements
|
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10.7\tg/day\nAverage\tincrease\t6\ng/day\tabove\nbaseline\nrequirements\nAdapted\tfrom\tMillward\tDJ:\tIdentifying\trecommended\tdietary\tallowances\tfor\tprotein\tand\tamino\tacids:\ta\tcritique\tof\tthe\t2007\tWHO/FAO/UNU\treport,\nBr\tJ\tNutr\n\t108(Suppl\t2):S3,\t2012.\nThere\tis\tconcern\tthat\tnitrogen\tbalance\tstudies\tmay\tunderestimate\tprotein\tneeds,\tespecially\twhen\nconsidering
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] |
considering\n\tthat\tthe\tincreased\trequirements\tof\tspecific\tamino\tacids\tmay\tbe\tdisproportionately\nhigher\taccording\tto\tanimal\tresearch\t(\nElango\tand\tBall,\t2016\n).\tThere\tis\tsome\tcall\tto\tincrease\tprotein\nrequirements,\tincluding\tincreasing\tthe\tprotein\tintake\tearlier\tin\tpregnancy.\tRecent\tresearch\tfound
|
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] |
optimal\tintake\twas\t1.2\tg/kg/day\tat\t16\tweeks\tand\t1.52\tg/kg/day\tat\t36\tweeks\twhen\testimated\tby\nindicator\tamino\tacid\toxidation.\n\tHowever,\tthe\tmethod\tis\tnot\tuniversally\taccepted\tand\tfurther\nresearch\tis\tnecessary.\tProtein\tdeficiency\tduring\tpregnancy\thas\tadverse\tconsequences,\tincluding
|
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paid,\tincluding\tthose\tconsuming\ta\tvegetarian\tdiet,\tthose\twho\tare\tstill\tgrowing\tthemselves,\tor\tthose\nwho\tare\tpregnant\twith\tmultiples.\tThe\toptimal\tbalance\tof\tprotein\tto\ttotal\tcalories\thas\tyet\tto\tbe\ndetermined\tand\trecommendations,\tas\twell\tas\tintakes,\tvary\n\tacross\tcultures\t(\nBlumfield\tand\tCollins,\n2014
|
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] |
across\tcultures\t(\nBlumfield\tand\tCollins,\n2014\n).\tCaution\tis\tadvised\twhen\tconsidering\tvery\thigh\tprotein\tsupplements.\tIntakes\tat\tthe\thigh\tend\nof\tthe\tacceptable\tmacronutrient\tdistribution\tranges\t(AMDR)\t(i.e.,\t30%\tto\t35%\tof\tcalories\tfrom\nprotein)\thave\tbeen\tassociated\twith\tan\tincreased\trisk\tof\tpoor\tfetal\tgrowth\tin\tsome\tstudies,\talthough
|
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] |
the\tmechanism\tis\tunclear.\tCurrent\tU.S.\tpractice\toften\ttargets\tprotein\n\tintakes\tat\t20%\tof\ttotal\ncalories,\tpossibly\thigher\tfor\tmultiples.\tWHO\trecommends\t23%\tof\tcalories\tcome\tfrom\tprotein\n(\nMillward,\t2012\n).\tSupplementation,\tif\tnecessary,\tshould\tbe\tdone\twith\tfood\trather\tthan\twith\tprotein
|
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supplements.\tFor\texample,\tsomeone\tconsuming\t2240\tkcal\tfrom\t6\tcups/day\tof\t2%\tmilk,\t8\toz\tof\tmeat,\nsix\tservings\tof\tstarch,\tthree\tvegetable\tservings,\ttwo\tfruit\tservings,\tand\tsix\tfat\tservings\n\tgets\t23%\tof\ncalories\tfrom\tprotein\t(128\tg).\tIf\tusing\tskim\tmilk,\tthe\ttotal\tis\t1970\tkcal\twith\t26%\tfrom\tprotein.\nCarbohydrates
|
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0.05318073183298111,
0.03113630786538124,
0.04538941755890846,
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] |
Carbohydrates\nThe\tRDA\tfor\tcarbohydrates\tincreases\tslightly,\thelping\tmaintain\tappropriate\tblood\tglucose\tand\nprevent\tketosis.\tIntakes\tmay\tbe\tgreater\tin\twomen\tconsuming\tmore\tcalories,\tbut\tcareful\ncarbohydrate\tchoices\tare\tneeded\tto\tinclude\tall\tthe\tdaily\tnutrients\tfor\tpregnancy.\tPriority\n\tshould\tbe
|
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] |
should\tbe\ngiven\tto\tcomplex\tcarbohydrates\tfrom\twhole\tgrains,\tfruits,\tand\tvegetables\trather\tthan\tjust\tsimple\nsugars,\tincluding\trefined\tliquid\tsugars,\twhether\tnatural\t(juices)\tor\tindustrially\tproduced\t(soda).\nFiber\nDaily\tconsumption\tof\twhole-grain\tbreads\tand\tcereals,\tleafy\tgreen\tand\tyellow\tvegetables,\tand\tfresh
|
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] |
and\tdried\tfruits\tshould\tbe\tencouraged\tto\tprovide\tadditional\tminerals,\tvitamins,\tand\n\tfiber.\tThe\tDRI\nfor\tfiber\tduring\tpregnancy\tis\t14\tg/day/1000\tkcal\tand,\tif\tmet,\twill\thelp\ta\tgreat\tdeal\tin\tmanaging\tthe\nconstipation\tthat\toften\taccompanies\tpregnancy.\nLipids
|
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] |
constipation\tthat\toften\taccompanies\tpregnancy.\nLipids\nAs\twith\tnonpregnant\twomen,\tthere\tis\tno\tDRI\tfor\ttotal\tlipids\tduring\tpregnancy.\tThe\tamount\tof\tfat\tin\nthe\tdiet\tshould\tdepend\ton\tenergy\trequirements\tfor\tproper\tweight\tgain.\tHowever,\trecommendations\nfor\tomega-6\tpolyunsaturated\n\tfatty\tacid\t(PUFA)\t(linoleic\tacid)\tand\tomega-3\tPUFA\t(alpha-linolenic
|
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] |
fatty\tacid\t(PUFA)\t(linoleic\tacid)\tand\tomega-3\tPUFA\t(alpha-linolenic\nacid)\tincrease\tslightly.\tAlthough\tnot\ta\tDRI,\tthe\trecommended\tintake\tof\tDHA\tis\t200\tmg/day\tand\tcan\nbe\tmet\tby\tone\tto\ttwo\tportions\tof\tfish\tper\tweek\t(\nCarlson\tet\tal,\t2017\n)\t(see\t\nFocus\tOn:\n\tOmega-3\tFatty\nAcids\tin\tPregnancy\tand\tLactation\n).\nVitamins
|
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] |
Focus\tOn:\n\tOmega-3\tFatty\nAcids\tin\tPregnancy\tand\tLactation\n).\nVitamins\nAll\tvitamins\tand\tminerals\tare\tneeded\tfor\toptimal\tpregnancy\toutcome.\tIn\tsome\tinstances\nrequirements\tmay\tbe\tmet\tthrough\tdiet.\tFor\tothers\ta\tsupplement,\tstarted\tpreconceptually,\tis\toften
|
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] |
necessary.\tMany,\tbut\tnot\tall,\tvitamin\tand\tmineral\trecommendations\tincrease\twith\tpregnancy,\tbut\tthe\nmagnitude\tof\tthe\tincrease\tvaries\tby\tnutrient\t(see\tthe\tDRI\ttables\ton\tthe\tinside\tcover\tand\t\nFig.\t14.5\n).\nFolate.\nThe\tRDA\tfor\tdietary\tfolate\tequivalents\tincreases\tto\tsupport\tmaternal\terythropoiesis,\tDNA\n\tsynthesis,
|
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] |
synthesis,\nand\tfetal\tand\tplacental\tgrowth.\tLow\tfolate\tlevels\tare\tassociated\twith\tmiscarriages,\tLBW,\tand\npreterm\tbirth.\tEarly\tmaternal\tfolate\tdeficiency\tis\tassociated\twith\tan\tincreased\tincidence\tof\ncongenital\tmalformations,\tincluding\tNTDs,\torofacial\tclefts,\tand\tcongenital\theart\tdefects\t(\nObeid\tet\tal,\n2013
|
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] |
Obeid\tet\tal,\n2013\n).\tApproximately\t3000\tnew\tcases\tof\tNTDs\toccur\tin\tthe\tUnited\tStates\tannually\tand\tover\t300,000\nbabies\tare\tborn\tworldwide\twith\tNTDs\t(\nCDC,\t2018a\n),\tbut\tprevalence\tvaries\twidely,\tfrom\t6.9/10,000\nbirths\tin\tthe\tWestern\tPacific\tto\t21.9/10,000\tbirths\tin\tthe\tMiddle\tEast\t(\nACOG,\t2017b\n).\tAlthough\tspina
|
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0.0019954275339841843
] |
ACOG,\t2017b\n).\tAlthough\tspina\nbifida\tand\tanencephaly\tare\tthe\tmost\tcommon,\tother\tNTDs\tcan\talso\toccur\t(\nTable\t14.9\n).\tThe\tneural\ntube\tcloses\tby\t28\tdays\tof\tgestation,\tbefore\tmost\twomen\trealize\tthey\tare\tpregnant.\tIn\taddition,\tmore\nthan\n\thalf\tof\tall\tU.S.\tpregnancies\tare\tunplanned.\tTherefore\tthe\tCDC\trecommends\tthat\tall\twomen\tof
|
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] |
childbearing\tage,\tin\tanticipation\tof\tpossible\tpregnancy,\tincrease\ttheir\tintake\tof\tfolic\tacid\tby\t400\nmcg/day,\tthe\tsynthetic\tversion\tthat\tis\tavailable\tin\tsupplements\tand\tfortified\tfoods,\tespecially\tsome\nbreakfast\tcereals\t(\nCDC,\t2018a\n).\tThe\tU.S.\tPreventive\tServices\tTask\tForce\t(USPSTF)\trecommends\t400\nto\t800\tmcg/day
|
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] |
to\t800\tmcg/day\n\tof\tfolic\tacid\tpreconceptually.\tWomen\twho\thave\thad\ta\tprevious\tNTD-affected\npregnancy\tshould\tconsume\t400\tmcg/day\twhen\tnot\tplanning\tto\tconceive\tand\tthose\tplanning\npregnancy\tshould\tconsider\t4000\tmcg/day\t(4\tmg/day)\tfrom\t3\tmonths\tbefore\tto\t3\tmonths\tafter\nconception\t(\nACOG,\t2017b
|
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] |
conception\t(\nACOG,\t2017b\n).\tOther\tsituations\tthat\tmay\tmerit\tthe\thigher\tsupplementation\tlevels\ninclude\twomen\twho\thave\tan\tNTD\tthemselves,\twhose\tpartner\n\thas\tan\tNTD,\tor\twhose\tpartner\thas\ta\npreviously\taffected\tchild.\tThese\thigher\tdoses\tshould\tbe\ttaken\tas\ta\tseparate\tsupplement\tand\tnot\tas
|
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part\tof\ta\tmultivitamin\tsupplement\tto\tavoid\texcess\tintakes\tof\tother\tnutrients\tin\tthe\tmultivitamin.\nAlthough\tthis\tlevel\tis\trecommended\tby\tmany\tmedical\tproviders,\tthere\tare\tcalls\tto\treevaluate\tthese\nhigher\trecommendations\tbecause\tof\tevidence\tthat\tthe\tlower\tdoses\tmay\tbe\n\tequally\teffective\tin\npreventing\trecurrent\tNTDs\t(\nDolin\tet\tal,\t2018
|
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] |
equally\teffective\tin\npreventing\trecurrent\tNTDs\t(\nDolin\tet\tal,\t2018\n).\tSupplementation\trecommendations\tvary\tby\tcountry\n(\nMoussa\tet\tal,\t2016\n)\tand\tmay\ttake\tthe\tgenetic\tsusceptibility\tto\tlow\tfolate\tstatus\tinto\taccount\t(\nColson\net\tal,\t2017\n)\tso\tlocal\tguidelines\tshould\tbe\tfollowed.\tAlthough\tthe\t800-mcg\tdose\tachieves
|
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] |
recommended\tblood\tlevels\tin\t4\tweeks,\tthe\t400-mcg\tdose\trequires\t8\tto\t12\tweeks\tto\treach\tthese\nlevels\t(\nBerti\tet\tal,\t2011\n).\tAlso\tavailable\tis\t5-methyltetrahydrofolate,\tthe\tprimary\tcirculating\tform\tof\nfolate.\tIt\tis\tproposed\tto\tbe\tbetter\tused,\tespecially\tby\tthose\twith\tpolymorphisms\t(see\t\nChapter\t6\n),\tand
|
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] |
Chapter\t6\n),\tand\nwithout\tthe\tdetrimental\trise\tin\tunmetabolized\tfolic\tacid.\tHowever,\tits\trole\tin\tpreventing\tNTDs\tor\nother\tbirth\tdefects\tis\tuntested\tin\tclinical\ttrials\t(\nObeid\tet\tal,\t2013\n).\tIn\taddition,\tconcern\n\tabout\nunmetabolized\tfolic\tacid\tmay\tbe\tunwarranted\tin\tsome\tcases,\tas\tit\twas\tfound\tto\tbe\tundetectable\tif
|
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] |
pregnant\twomen\ttook\t400\tmcg/day\tthroughout\tthe\tpregnancy,\tin\taddition\tto\tconsuming\t100\tmcg/day\nfrom\tfortified\tgrains,\teven\tamong\tthose\twith\tthe\tC677T\tpolymorphism\t(\nPentieva\tet\tal,\t2016\n).\tThe\nimpact\tof\thigher\tdoses\tof\tfolic\tacid\tcausing\thigher,\tand\tconcerning,\tlevels\tof\tunmetabolized\tfolic\tacid\nis\tnot\twell-established\tbut\tis\tbeing\tstudied\t(
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] |
is\tnot\twell-established\tbut\tis\tbeing\tstudied\t(\nPlumptre\tet\tal,\t2015\n).\nTABLE\t14.9\nNeural\tTube\tDefects\nNeural\tTube\nDefect\nMalformation\nCranial\nAnencephaly\nFailure\tof\tfusion\tof\tcephalic\tportion\tof\tneural\tfolds;\tabsence\tof\tall\tor\tpart\tof\tbrain,\nskull,\tand\tskin\nEncephalocele
|
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] |
skull,\tand\tskin\nEncephalocele\nFailure\tof\tcomplete\tskull\tformation;\textrusion\tof\tbrain\ttissue\tinto\tmembranous\tsac\nExencephaly\nFailure\tof\tscalp\tand\tskull\tformation;\texteriorization\tof\tabnormally\tformed\tbrain\nIniencephaly\nDefect\tof\tcervical\n\tand\tupper\tthoracic\tvertebrae;\tabnormally\tformed\tbrain\ttissue\tand\nextreme\tretroflexion\tof\tupper\tspine\nSpinal
|
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] |
extreme\tretroflexion\tof\tupper\tspine\nSpinal\nCraniorachischisis\nCoexisting\tanencephaly\tand\topen\tneural\ttube\tdefect,\toften\tin\tthe\tcervical–thoracic\nregion\nHolorachischisis\nFailure\tof\tfusion\tof\tvertebral\tarches;\tentire\tspinal\tcord\texposed\nMeningocele\nFailure\tof\tfusion\tof\tcaudal\tportion\tof\tneural\ttube;\tmeninges\texposed\nMyelomeningocele
|
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] |
Myelomeningocele\nFailure\tof\tfusion\tof\tcaudal\tportion\tof\tneural\ttube;\tmeninges\tand\tneural\ttissue\texposed\nMyeloschisis\nFailure\tof\tfusion\tof\tcaudal\tportion\tof\tneural\ttube;\tflattened\tmass\tof\tneural\ttissue\nexposed\nSpina\tbifida\nFailure\tof\tfusion\tof\tcaudal\tportion\tof\tneural\ttube,\tusually\tof\t3-5\tcontiguous\tvertebrae;
|
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] |
spinal\tcord\tor\tmeninges,\tor\tboth,\texposed\tto\tamniotic\tfluid\nAdapted\tfrom\tAmerican\tCollege\tof\tObstetricians\n\tand\tGynecologists\tCommittee\ton\tPractice\tBulletins-Obstetrics:\tPractice\tBulletin\tNo.\t187:\tNeural\nTube\tDefects,\t\nObstet\tGynecol\n\t130:e279,\t2017b.\nRed\tblood\tcell\tfolate\tlevels\texceeding\t906\tnmol/L\t(400\tng/mL)\thave\tbeen\tassociated\twith\tthe
|
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] |
fewest\tNTDs\t(\nObeid\tet\tal,\t2013\n),\talthough\tthe\tmechanism\tof\tfolic\tacid\tis\tstill\tunknown\t(\nACOG,\n2017b\n).\tNatural\tfolate\tis\tless\tbioavailable\tand\thas\tnot\tbeen\tshown\n\tto\traise\tblood\tlevels\tas\twell\tas\tthe\nsynthetic\tfolic\tacid\tor\tto\tlower\tthe\trisk\tof\tNTDs.\tAlthough\ttheoretically\tnatural\tfolate\tcould\tbe
|
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] |
effective,\t6\tto\t12\tcups\tof\traw\tspinach\t(more\tthan\t2\tcups\tcooked)\tdaily\tis\tthe\tbioequivalent\tlevel\tof\nnatural\tfolate\tthat\tis\tfound\tin\tone\tbowl\tof\tfortified\tbreakfast\tcereal.\tLook\tfor\t100%\tof\tthe\tdaily\nvalue/serving.\nWomen\twho\tare\tobese\tor\twho\tsmoke,\tconsume\talcohol\n\tmoderately\tor\theavily,\tor\tuse\trecreational
|
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] |
moderately\tor\theavily,\tor\tuse\trecreational\ndrugs\tare\tat\trisk\tfor\tmarginal\tfolate\tstatus,\tas\tare\tthose\twith\tmalabsorption\tsyndromes\tor\tgenetic\ndifferences\trelated\tto\tmethylation\tand\tthe\tmetabolic\tuse\tof\tdietary\tfolate,\tincluding\tthe\testimated\n11%\tof\tthe\tU.S.\tpopulation\twith\tthe\tMTHFR\t677\tC\tto\tT\tvariation\t(\nCaudill,\t2010\n).\tEuropean
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] |
Caudill,\t2010\n).\tEuropean\nprevalence\tis\testimated\tto\tbe\t10%\tto\t22%\t(\nObeid\tet\tal,\t2013\n),\tbut\n\tnot\tall\tpopulations\twith\tthe\tC677T\npolymorphism\tshow\thigher\trates\tof\tNTDs\t(\nACOG,\t2017b\n).\tOther\tpolymorphisms\tare\talso\tbeing\ninvestigated\tfor\tincreased\trisk\tfor\tNTDs.\tAlthough\tincreased\tfolate\tintake\tmay\tbe\thelpful\tin\tsome
|
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0.0998321920633316,
0.06616948544979095,
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] |
situations,\tadded\triboflavin\talso\tmay\tbe\tbeneficial\t(see\t\nChapters\t5\n\tand\t\n6\n).\tWomen\tusing\tantiseizure\nmedications\tmust\tbe\tmonitored\tclosely\twhen\tstarting\tfolic\tacid\tbecause\tit\n\tcan\treduce\ttheir\tseizure\ncontrol.\nEnriched\tgrain\tproducts\tin\tthe\tUnited\tStates\tare\tfortified\twith\tfolic\tacid\tand\tare\testimated\tto
|
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] |
provide\tan\taverage\t200\tmcg/day,\twith\tresulting\thigher\tblood\tfolate\tlevels\tand\treduced\t(19%\tto\t54%)\nNTD\trates\t(\nCaudill,\t2010\n).\tHowever,\twith\tthe\tincreased\tpopularity\tof\tthe\tlow\tcarbohydrate\tdiets,\nestimated\tintake\thas\tbeen\treduced\trecently\tand\tis\tassociated\twith\tincreased\n\trisk\tof\tNTDs\n(\nDesrosiers\tet\tal,\t2018
|
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] |
risk\tof\tNTDs\n(\nDesrosiers\tet\tal,\t2018\n).\tBecause\tNTD\trates\tremain\thigher\tamong\tthe\tHispanic\tpopulation\tin\tthe\nUnited\tStates,\tfortification\tof\tcorn\tmasa\tflour\tis\tnow\tapproved\tby\tthe\tFDA\tbut\timplementation\tis\nvoluntary\tand\tnot\twidespread.\nOver\t70\tcountries\tnow\tfortify\tgrain\tproducts\tbut\tthis\tfortification\tis\tnot\tuniversally\tpracticed
|
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] |
because\tof\tconcerns\tabout\texposing\tthe\tentire\tpopulation\tto\textra\n\tfolic\tacid.\tPossible\tadverse\teffects\nof\tincreased\tfolic\tacid\tintake\tinclude\tmasking\tof\tvitamin\tB\n12\n\tdeficiency,\ttumor\tpromotion,\tepigenetic\nhypermethylation,\tinterference\twith\tantifolate\ttreatments,\tand\tan\tincrease\tin\tmiscarriages\tand
|
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] |
multiple\tbirths.\tWidespread\tproblems\thave\tnot\tbeen\tseen.\tHowever,\thigh\tintakes\tof\tfolic\tacid\talso\nhave\tpotential\tepigenetic\teffects,\tbut\tdata\tare\tfragmentary\tand\n\tsometimes\tconflicting.\tCaution\tis\nadvised\twith\tthe\tuse\tof\tpharmacologic\tdoses.\tFor\texample,\talthough\tsome\tstudies\thave\tseen\tno
|
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] |
negative\teffects\ton\tDNA\tmethylation\tat\tdoses\tup\tto\t4000\tmcg/day\t(\nCrider\tet\tal,\t2011\n),\tother\tstudies\nhave\tfound\tthat,\tin\tthe\tcontext\tof\tlow\tvitamin\tB\n12\n\tstatus,\tsupplementing\tpregnant\twomen\twith\tjust\n500\tmcg/day\twas\tassociated\twith\tan\tincreased\trisk\tof\tdiabetes\tamong\tthe\n\twomen\t(\nPaul\tand\tSelhub,\n2017
|
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] |
women\t(\nPaul\tand\tSelhub,\n2017\n)\tand\tof\toffspring\tadiposity\tand\tinsulin\tresistance\tat\tage\t6\t(\nYajnik\tet\tal,\t2008\n).\nOn\tthe\tother\thand,\tadequate\tfolic\tacid\tin\tthe\tsecond\ttrimester\tmay\tdecrease\tinflammation,\tand\nfolate\tstatus\tis\tassociated\tinversely\twith\tthe\tseverity\tof\tbacterial\tvaginosis,\ta\tdocumented\trisk\tfactor\nfor\tpreterm\tdelivery\t(
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for\tpreterm\tdelivery\t(\nDunlop\tet\tal,\t2011\n).\tMurine\tstudies\thave\tfound\tthat\tthe\tnegative\n\teffect\tof\nmaternal\texposure\tto\tbisphenol-A\tis\teffectively\tneutralized\tby\tmaternal\tsupplementation\twith\tfolic\nacid,\tbetaine,\tand\tcholine\t(\nGuéant\tet\tal,\t2013\n).\tSupplementation\twith\tmethyl\tdonors,\tsuch\tas\tfolic
|
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] |
acid,\talso\tmay\treduce\tthe\tharmful\teffects\tof\tfumonisin\t(a\tmycotoxin\tproduced\tby\t\nFusarium\n\tmolds\nthat\tgrow\ton\tagricultural\tcommodities,\tespecially\tcorn,\tthat\thas\tbeen\tassociated\twith\tincreased\n\trisk\nof\tNTDs)\tcontamination.\tSpermatozoid\tfolate\tdeficiency\tamong\tmen\texposed\tto\tdioxins\tmay\tincrease
|
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] |
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