The Dietary Inflammatory Index as a predictor of pregnancy outcomes: Systematic review and meta-analysis

Freitas, Natércia Paula Alves de; Carvalho, Thiago Ribeiro; Gonçalves, Cristiano César Rodrigues Augusto; Silva, Pedro Henrique Alcântara da; Romão, Lourena Guedes de Melo; Kwak‐Kim, Joanne; Cavalcante, Marcelo Borges

doi:10.1016/j.jri.2022.103651

Cited by 9 publications

(5 citation statements)

References 75 publications

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“…Despite the pioneering approach of this exploratory investigation, the observational design with multiple comparisons without corrections for co-morbidities or other confounding variables also constitutes a study limitation that may interfere in the levels of systemic soluble mediators. Moreover, regardless the relevance of nutritional aspects ant the dietary inflammatory indices interfering in the immune response during pregnancy ( 51 ), we did not have the opportunity to address this issue in the present investigation.…”

Section: Discussionmentioning

confidence: 99%

Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

et al. 2023

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IntroductionSARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators.MethodsA sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array.ResultsIn the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester.Discussion and conclusionFrom an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women.

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Section: Discussionmentioning

confidence: 99%

Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

et al. 2023

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“…Although there has been no study exploring the relationship between maternal DII in pregnancy and CHD, previous research has shown that maternal pro-inflammatory diet in pregnancy is associated with adverse birth outcomes, such as premature birth, low birth weight, and small for gestational age [ 17 , 32 , 33 ], which are closely related with birth defects. Moreover, several previous studies have reported CHD risk in association with dietary patterns and dietary quality indices during pregnancy [ 15 , 34 , 35 ], which share some similar dietary components as the DII.…”

Section: Discussionmentioning

confidence: 99%

“…A higher DII score indicates that the diet is pro-inflammatory, while a lower DII score indicates that the diet is anti-inflammatory. The DII has been proven to be of value for the associations with health status in the general population [ 13 ], and has also been increasingly used as a predictor of pregnancy outcomes among pregnant women [ 17 , 18 ]. However, to our knowledge there has been no study assessing the association between DII during pregnancy and CHD risk.…”

Section: Introductionmentioning

confidence: 99%

Dietary Inflammatory Index during Pregnancy and Congenital Heart Defects

Yang

Chang

et al. 2023

Nutrients

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The relationship between diet-related inflammation during pregnancy and congenital heart defects (CHD) is unclear. This study attempted to investigate the association between the dietary inflammation index (DII) during pregnancy, reflecting the overall inflammatory potential of the maternal diet, and CHD in Northwest China. A case-control study with 474 cases and 948 controls was performed in Xi’an City, China. Eligible women awaiting delivery were recruited, and their dietary and other information during pregnancy was collected. Logistic regression models were applied to estimate the risk of CHD in association with DII. The maternal DII ranged from −1.36 to 5.73 in cases, and 0.43 to 5.63 in controls. Pregnant women with per 1 higher DII score were at 31% higher risk of fetal CHD (OR = 1.31, 95%CI = 1.14–1.51), and the adjusted OR (95%CI) comparing the pro-inflammatory diet group with the anti-inflammatory diet group was 2.04 (1.42–2.92). The inverse association of maternal DII score with CHD risk was consistent across various subgroups of maternal characteristics. Maternal DII in pregnancy had good predictive value for CHD in offspring, with the areas under the receiver operating characteristic curve higher than 0.7. These findings suggested that avoiding a pro-inflammatory diet in pregnancy should be emphasized in the prevention of CHD.

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“…Patients with concurrent obesity and RM have a 1.7‐fold higher risk of miscarriage compared with normal patients with RM 8,118 . We had previously observed that a predominantly inflammatory diet is associated with an elevated risk of pregnancy loss and other obstetric and perinatal complications 119 …”

Section: Current Management Of Patients With Rmmentioning

confidence: 99%

“…8,118 We had previously observed that a predominantly inflammatory diet is associated with an elevated risk of pregnancy loss and other obstetric and perinatal complications. 119 Obesity management is overseen by a multidisciplinary team and must offer several therapeutic strategies, such as behavioral support, nutrition therapy, physical activity, psychological interventions, F I G U R E 2 Current management and future perspectives of obese patients with recurrent miscarriage. pharmacotherapy, and bariatric surgery (Figure 2).…”

Section: Current Management Of Patients With Rmmentioning

confidence: 99%

Obesity and recurrent miscarriage: The interconnections between adipose tissue and the immune system

Gonçalves,

Feitosa,

Cavalcante

et al. 2023

American J Rep Immunol

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Currently, obesity is considered a global public health problem. It is the main risk factor for noncommunicable diseases and reproductive complications, such as recurrent miscarriage (RM). RM affects approximately 1% of couples of reproductive age, and recent studies suggest that its prevalence is increasing. Immunological abnormalities may be responsible for a significant number of cases of unexplained RM. Obesity is recognized as a chronic low‐grade inflammatory condition. The accumulation of fat in obese adipose tissue promotes changes in the local and systemic immune response. Adipokines, exosomes, micro‐RNAs, lipids, and other factors released or secreted by adipose tissue are responsible for the interconnection between obesity and the immune system. Obesity‐induced dysregulation of the innate and acquired immune response is also involved in the immunopathology of pregnancy loss in patients with unexplained RM. Therefore, understanding the communication pathways between maternal adipose tissue and the immune response in women living with obesity and RM is an important objective. Thus, diagnostic tools and new immunomodulatory therapies may be proposed for the management of patients with concurrent obesity and RM.

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The Dietary Inflammatory Index as a predictor of pregnancy outcomes: Systematic review and meta-analysis

Cited by 9 publications

References 75 publications

Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

Dietary Inflammatory Index during Pregnancy and Congenital Heart Defects

Obesity and recurrent miscarriage: The interconnections between adipose tissue and the immune system

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