Nutrition and Metabolic Adaptations in Physiological and Complicated Pregnancy: Focus on Obesity and Gestational Diabetes

Abstract

Pregnancy offers a window of opportunity to program the future health of both mothers and offspring. During gestation, women experience a series of physical and metabolic modifications and adaptations, which aim to protect the fetus development and are closely related to both pre-gestational nutritional status and gestational weight gain. Moreover, pre-gestational obesity represents a challenge of treatment, and nowadays there are new evidence as regard its management, especially the adequate weight gain. Recent evidence has highlighted the determinant role of nutritional status and maternal diet on both pregnancy outcomes and long-term risk of chronic diseases, through a transgenerational flow, conceptualized by the Development Origin of Health and Diseases (Dohad) theory. In this review we will analyse the physiological and endocrine adaptation in pregnancy, and the metabolic complications, thus the focal points for nutritional and therapeutic strategies that we must early implement, virtually before conception, to safeguard the health of both mother and progeny. We will summarize the current nutritional recommendations and the use of nutraceuticals in pregnancy, with a focus on the management of pregnancy complicated by obesity and hyperglycemia, assessing the most recent evidence about the effects of ante-natal nutrition on the long-term, on either maternal health or metabolic risk of the offspring.

Multidimensional Approach to Assess Nutrition and Lifestyle in Breastfeeding Women during the First Month of Lactation

“…During pregnancy, the maternal body undergoes several metabolic adaptations, such as increased fat mass, as a reserve of energy stores to supply the increased energy demand for the developing fetus, and for mammary gland growth to ensure and maintain lactation [ 1 , 51 ]. Therefore, pregnancy and postpartum are periods of increased vulnerability for the retention of excess body fat.…”

Placental Endocrine Activity: Adaptation and Disruption of Maternal Glucose Metabolism in Pregnancy and the Influence of Fetal Sex

“…Maternal insulin resistance is physiological in pregnancy, mostly expressed at skeletal muscle and adipose tissue level. It is critically important for maintenance of maternal fuel supply to support the growing fetus, especially during the third trimester [ 12 ]. The physiologic factors underlying the decrease of insulin sensitivity are not fully elucidated.…”

“…However, they seem to be associated with the metabolic effects of several hormones and bioactive proteins derived from the placenta and elevated in the maternal circulation during pregnancy. This speaks to a pivotal role of the placenta in the development of insulin resistance in pregnancy [ 5 , 12 ].…”

Insulin Resistance and Diabetes Mellitus in Alzheimer’s Disease

“…GDM is the appearance of insulin resistance during pregnancy and its maintenance after delivery. During gestation, all women suffer a series of both physical and metabolic changes, which make them more susceptible to develop insulin resistance [ 12 ]. Since GDM facilitates the development of T2DM after delivery, women with a GDM diagnose should be monitored for prediabetes and T2DM.…”