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Interventions to Prevent Adverse Fetal Programming Due to Maternal Obesity During Pregnancy

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Interventions to Prevent Adverse Fetal Programming Due to Maternal Obesity During Pregnancy bs_bs_banner Supplement Article Interventions to prevent adverse fetal programming due to maternal obesity during pregnancy Peter W Nathanielsz, Stephen P Ford, Nathan M Long, Claudia C Vega, Luis A Reyes-Castro, and Elena Zambrano Maternal obesity is a global epidemic affecting both developed and developing countries. Human and animal studies indicate that maternal obesity adversely programs the development of offspring, predisposing them to chronic diseases later in life. Several mechanisms act together to produce these adverse health effects. There is a consequent need for effective interventions that can be used in the management of human pregnancy to prevent these outcomes. The present review analyzes the dietary and exercise intervention studies performed to date in both altricial and precocial animals, rats and sheep, with the aim of preventing adverse offspring outcomes. The results of these interventions present exciting opportunities to prevent, at least in part, adverse metabolic and other outcomes in obese mothers and their offspring. © 2013 International Life Sciences Institute INTRODUCTION diseases through fetal programming.11 In order to gain a better understanding of such developmental program- Worldwide,nearly 1.5 billion people are overweight (body ming, investigation of the various factors involved in its mass index [BMI] >25 kg/m2) or obese (BMI >30 kg/m2),1 challenges, mechanisms, and outcomes is required. and the distribution among countries is broad. For Reports of experimental interventions in animal models example, in Mexico, 32% of women of reproductive years in the setting of obesity are scarce.12,13 In some experi- are obese2,3; in the United States, 35% of women of repro- mental animal models, the use of nutritional or targeted ductiveyearsareobese4; in Brazil,50% of the population is therapeutic interventions during windows of develop- overweight or obese5,6; in the United Kingdom, 33% of mental programming has shown the potential to reverse pregnant women are overweight or obese7;in India,26% of unwanted metabolic outcomes in offspring.13 For women of reproductive years are overweight and 8% are example, in neonatal female rats born to undernourished obese8; in China, 16% of women are overweight or obese9; mothers, treatment with leptin prevented development of and in Ghana, 64.7% of women are either overweight or metabolic compromise in adulthood14; maternal antioxi- obese.10 The World Health Organization has declared dant supplementation in rats fed a Western diet partially obesity one of the top ten adverse health risk conditions in prevented adiposity and normalized glucose tolerance in the world and one of the top five in developed nations. offspring.15 In other studies, genistein supplementation in As noted in another review in the present supple- mice during gestation was shown to protect offspring ment, animal studies indicate maternal obesity predis- from susceptibility to obesity.16 This review focuses on poses offspring to a wide variety of chronic, later-life animal studies in which interventions were designed to Affiliations: PW Nathanielsz is with the Center for Pregnancy and Newborn Research, Department of Obstetrics, University of Texas Health Sciences Center San Antonio, San Antonio, Texas, USA. SP Ford is with the Department of Animal Science, University of Wyoming Laramie, Laramie, Wyoming, USA. NM Long is with the Department of Animal and Veterinary Sciences, Clemson University, Clemson, South Carolina, USA. CC Vega, LA Reyes-Castro, and E Zambrano are with the Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, D.F., México. Correspondence: E Zambrano, Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14000 México City, D.F., México. E-mail: [email protected]. Phone: +52-55-5487-0900 ext 2417. Fax: +52-55-5655-9859. Key words: diet intervention, exercise intervention, fetal programming, maternal obesity doi:10.1111/nure.12062 S78 Nutrition Reviews® Vol. 71(Suppl. 1):S78–S87 illuminate mechanisms by which a change in maternal PREPREGNANCY DIETARY INTERVENTION STUDIES diet or level of exercise may act to improve maternal and IN THE OBESE RAT offspring outcomes. There are many reasons why animal intervention studies are needed. Importantly, animal studies are much Methods more controllable than human clinical interventions, which is the parallel human approach to hypothesis- Investigations of adverse offspring programming due to driven animal research. In addition, a greater depth of maternal obesity requires that investigators ensure mechanistic interrogation is possible,resulting from tissue initial phenotypic homogeneity within the different retrieval and multiple rounds and forms of testing, and groups of mothers studied, i.e., controls, obese mothers, results are obtained much more quickly than in human and mothers in which interventions are introduced. studies. Reproducibility and independent confirmation, Care is necessary to achieve this important goal when the indispensable requirements of scientific certainty, are females who will be the study mothers are purchased also generally easier to achieve in animal studies. from commercial vendors. Specific information should Carefully designed clinical trials to determine the be obtained as to the lineage of all females purchased to effects of interventions and to improve maternal health in avoid the inclusion of sibling females in the same sub- pregnancy and offspring outcomes are now in progress.17 group. The following procedures used in previous However, in addition to the length of time needed to studies can help to avoid this and related problems. The obtain the required data, clinical trials have to contend first requirement is to maintain a colony of nonpreg- with multiple confounds related to the mother’s socio- nant females, which are then bred to deliver the female economic status and prepregnancy health; this not only pups that will be recruited as mothers into future makes analysis and interpretation difficult, it may also studies. All rats should be maintained on the same labo- limit the usefulness of findings for determining mecha- ratory chow unless they are being exposed to an experi- nisms. There is a pressing need, as a recent report from mental diet.25 At delivery (postnatal day [PND] 0), litters the Institute of Medicine indicates, for the development should be culled to 10 pups, with each litter containing of evidence-based interventions that both inform and at least four female pups. This standardization is impor- motivate pregnant women to adopt a healthy lifestyle tant since programming effects have been shown in off- before and during pregnancy.18 Currently, there is much spring according to the different sizes of litters being interest in both maternal diet and exercise as potentially reared by mothers during lactation.26 modifiable factors to target through interventions.19–21 At weaning (PND 21), female offspring were ran- The optimal timing and extent to which the adverse domly assigned either a control (C) group fed normal effects of the maternal metabolic phenotype, resulting laboratory chow or to a maternal obesity group (MO) from maternal obesity and associated high-calorie diets, fed a high-energy, obesogenic diet containing 23.5% can be prevented and/or possibly reversed by these inter- protein, 20% animal lard, 5% fat, 20.2% polysaccharide, ventions remain to be determined, and are of consider- 20.2% simple sugars, 5% fiber, 5% mineral mix, 1% able physiological interest and importance in clinical vitamin mix (w/w), and energy 4.9 Kcal/g. Only one obstetric management. Most authorities believe that female from any one litter was assigned to any study interventions introduced before conception will have the group. At PND 90, 1 month before breeding, half of the best results. However, it should always be born in mind obese females were selected at random for the dietary that poor maternal nutrition also programs adverse off- intervention (DINT) group and placed back on the C spring outcomes22–24 and sudden and excessive restriction diet for the rest of the study, including during preg- of maternal and fetal nutrient availability may well intro- nancy and lactation. The remaining obese females con- duce new dangers. Thus, firm scientific data are needed to tinued on the high-fat diet during pregnancy and guide interventions. lactation. Females were bred at 120 days as it has been When considering the goals of specific interventions shown that at younger breeding ages the mothers are to beneficially impact developmental programming out- still growing, albeit not as fast as earlier in life, and key comes, a distinction must always be made between inter- components of offspring outcomes, such as growth, tri- ventions designed to prevent negative offspring outcomes glyceride levels, and leptin levels, are affected by mater- and interventions conducted at later stages of an off- nal age as well as the nutritional challenge (unpublished spring’s life to reverse adverse health outcomes. Clearly, data). At PND 120, all three groups, C, MO, and DINT, prevention is a better strategy than reversal. The present were bred and fed their prepregnancy diet throughout review focuses on animal studies that have evaluated pregnancy and lactation. All mothers delivered by spon- maternal interventions to prevent negative offspring out- taneous vaginal delivery. Day of delivery was considered comes due to maternal obesity. as PND 025,27 (Figure 1). Nutrition Reviews® Vol. 71(Suppl. 1):S78–S87 S79 Group MATERNAL DIET PUP DIET PND PND growth 21-90 90-120 Pregnancy Lactation Weaning PND 21 Adult life Control (C) Chow diet Maternal obesity High-fatHigh-fat ddietiet Chow diet (MO) High-High- Dietary intervention Chow diet fatfat (DINT) Figure 1 Feeding schedule for dietary intervention studies in obese maternal rats. Changes in maternal and offspring phenotypes diet. Thus, there was no opportunity for any post- resulting from maternal obesity and weaning increase in offspring dietary intake to act as a dietary intervention second hit in addition to the developmental program- ming that had already occurred.
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