Research Article| Volume 9, ISSUE 3, P145-152, September 1999

Maternal diet and fetal substrate provision

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      The importance of maternal diet on fetal substrate provision has been reviewed. There is significant variation in the energy requirements for pregnancy between populations and individuals. This is particularly noticeable when contrasting and comparing studies from the developed world with those from developing countries. The effects of energy deficit have been illustrated with reference to famine. The somewhat paradoxical situation relating to excess requirements has been demonstrated by reference to excess protein intake and the consequential decrease in birthweight. Further evidence of adverse effects of excess substrate provision is provided by studies of pregnancy complicated by diabetes.
      Qualitative as well as quantitative aspects of maternal diet have been discussed. Current evidence suggests that altering the maternal nutrition influences the substrate mix. In the second half of pregnancy insulin resistance occurs. Insulin's actions on maternal metabolism affect the provision of the main fetal substrate, glucose, but also influence the availability of other substrates. Dietary modifications can result in a state of decreased insulin resistance and this could have important clinical consequences in the obese gravida and in diabetic pregnancy. There have also been suggestions that dietary manipulation may also influence the occurrence of certain adult diseases if Barker's hypothesis is maintained.
      Despite recent additions to the literature controversy still exists with regard to most aspects of fetal substrate provision and further research is needed to address some of these uncertainties.
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        • Campbell Brown M.
        • Hytten F.E.
        in: Chamberlain G. Broughton-Pipkin F. Clinical Physiology in Obstetrics. 3rd edn. Blackwell Science Limited, Oxford1998: 165-191
        • Hytten F.E.
        • Leitch I.
        The Physiology of Human Pregnancy.
        in: 2nd edn. Blackwell Scientific Publications, Oxford1971: 411-412
      1. FAO/WHO. Report of a Joint Expert Consultation: Energy and Protein Requirements. 1985 World Health Organization Tech Rep Ser; No 724. Geneva WHO

        • Department of Health
        3E. Report on Health and Social Subjects, No 41. Dietary References Values for Food Energy and Nutrients for the United Kingdom. HMSO, London1991
        • Durnin J.V.G.A.
        • McKillop F.M.
        • Grant S.
        • Fitzgerald G.
        Is nutritional status endangered by virtually no extra intake during pregnancy?.
        Lancet. 1985; 2: 823-825
        • Durnin J.V.G.A.
        • McKillop F.M.
        • Grant S.
        • Fitzgerald G.
        Energy requirements of pregnancy in Scotland.
        Lancet. 1987; 2: 897-900
        • Van Raaij J.M.A.
        • Vermaat-Meidem S.H.
        • Schonk C.M.
        • Peek M.E.M.
        • Hautvast J.G.A.J.
        Energy requirements of pregnancy in the Netherlands.
        Lancet. 1987; 2: 935-955
        • Lawrence M.
        • Lawrence F.
        • Coward W.A.
        • Cole T.J.
        • Whitehead R.G.
        Energy requirements of pregnancy in the Gambia.
        Lancet. 1987; 2: 1072-1076
        • Throngprasert K.
        • Tanphaichitre V.
        • Valyasevi A.
        • Kittigool J.
        • Durnin J.V.G.A.
        Energy requirements of pregnancy in rural Thailand.
        Lancet. 1987; 2: 1010-1012
        • Tuazon M.A.G.
        • van Raaij J.M.A.
        • Hautvast J.F.A.J.
        • Barba C.V.C.
        Energy requirements of pregnancy in the Phillipines.
        Lancet. 1987; 2: 1129-1131
        • Prentice A.M.
        • Goldberg G.R.
        • Davies H.L.
        • Murgatroyd P.R.
        • Scott W.
        Energy-sparing adaptations in human pregnancy assessed by whole body calorimetry.
        Br J Nutr. 1989; 62: 5-22
        • Goldberg G.R.
        • Prentice Am.
        • Coward W.A.
        • et al.
        Longitudinal assessment of energy expenditure in pregnancy by the doubly labelled water method.
        Am J Clin Nutr. 1993; 57: 494-505
        • Prentice A.M.
        • Spaaij C.J.K.
        • Goldberg G.R.
        • et al.
        Energy requirements of pregnant and lactating women.
        Eur J Clin Nutr. 1996; 50: S82-S111
        • Koop-Hoolihan L.E.
        • Van Loan M.D.
        • Wong W.W.
        • King J.C.
        Longitudinal assessment of energy balance in well-nourished pregnant women.
        Am J Clin Nutr. 1999; 69: 697-704
        • Stein Z.
        • Susser M.
        • Saenger G.
        • Marolla F.
        Famine and Human Development: The Dutch Hunger Winter of 1944–1945.
        Oxford University Press, New York1975
        • Rush D.
        Effects of protein calorie supplementation during pregnancy on the fetus and developing child.
        in: Nutrition in Pregnancy. Proceedings of the Tenth Study Group of the Royal College of Obstetricians and Gynaecologists. RCOG Press, September 1982: 65-83
        • Kramer M.S.
        Effects of energy and protein intakes on pregnancy outcome: an overview of the research evidence from controlled clinical trials.
        Am J Clin Nutrition. 1993; 58: 627-635
        • Fraser R.B.
        Diabetic control in pregnancy and intrauterine growth of the fetus.
        Br J Obstet Gynaecol. 1995; 102: 275-277
        • Barker D.J.P.
        Mothers, Babies and Diseases in Later Life.
        BMJ Publishing, London1992
        • Fraser R.B.
        • Cresswell J.
        What should obstetricians be doing about the Barker hypothesis?.
        Br J Obstet Gynaecol. 1997; 104: 645-647
        • Fraser R.B.
        Insulin resistance in pregnancy.
        Med Biochem. 1999; 1: 155-166
        • Lind T.
        • Billewicz W.Z.
        • Brown G.
        A serial study of changes in the oral glucose tolerance test during pregnancy.
        J Obstet Gynaecol Br Commonw. 1973; 80: 1033-1039
        • Stanley K.
        • Fraser R.
        • Bruce C.
        Physiological changes in insulin resistance in human pregnancy: a longitudinal study with the hyperinsulinaemic euglycaemic clamp technique.
        Br J Obstet Gynaecol. 1998; 105: 756-759
        • Phelps R.L.
        • Metzger B.E.
        • Frienkel N.
        Carbohydrate metabolism in pregnancy. XVIII. Diurnal profiles of plasma glucose, insulin free fatty acids, triglycerides, cholesterol and individual amino acids in late normal pregnancy.
        Am J Obstet Gynaecol. 1981; 140: 730-736
        • Fraser R.B.
        • Ford F.A.
        • Milner R.D.G.
        A controlled trial of high dietary fibre intake in pregnancy — effects on plasma glucose and insulin levels.
        Diabetologia. 1983; 25: 238-241
        • Clapp J.
        Effect of dietary carbohydrate on the glucose and insulin response to mixed calorie intake and exercise in both pregnant and non pregnant women.
        Diabetes Care. 1998; 21: B107-B112
        • Fraser R.B.
        • Ford F.A.
        • Lawrence G.F.
        Insulin sensitivity in the third trimester of pregnancy: a randomised study of dietary effects.
        Br J Obstet Gynaecol. 1988; 95: 223-229
        • Rizzo T.
        • Metzger B.E.
        • Burns W.J.
        • Burns K.
        Correlation between antepartum maternal metabolism and intelligence of offspring.
        N Engl J Med. 1991; 325: 911-916
        • Sattar N.
        • Berry C.
        • Greer I.A.
        Essential fatty acids in relation to pregnancy complications and fetal development.
        Br J Obstet Gynaecol. 1998; 105: 1248-1255
        • Suharno D.
        • West C.E.
        • Muhalil Karyadi D.
        • Hautvast J.G.A.J.
        Supplemnatation with Vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia.
        Lancet. 1993; 342: 1325-1328