Neonatal Follow-up Program, Women & Infants Hospital, Providence, Rhode Island;
Department of Pediatrics, Brown University, Providence, Rhode Island.
Pediatrics. 2017 Apr;139(Suppl 1):S38-S49. doi: 10.1542/peds.2016-2828F.
The rapid pace of fetal development by far exceeds any other stage of the life span, and thus, environmental influences can profoundly alter the developmental course. Stress during the prenatal period, including malnutrition and inflammation, impact maternal and fetal neurodevelopment with long-term consequences for physical and mental health of both the mother and her child. One primary consequence of maternal malnutrition, inflammation, and other sources of prenatal stress is a poor birth outcome, such as prematurity or growth restriction. These phenotypes are often used as indications of prenatal adversity. In fact, the original evidence supporting the fetal programming hypothesis came from studies documenting an association between birth phenotype and the development of subsequent physical and mental health problems. Fetal growth restriction in both term and preterm infants is associated with neonatal morbidities and a wide variety of behavioral and psychological diagnoses in childhood and adolescence, including attention-deficit/hyperactivity disorder, anxiety, depression, internalizing and thought problems, poor social skills, and autism spectrum disorder. Improving maternal-child health requires interventions that begin before pregnancy and continue throughout gestation and into the postpartum period. Such interventions might include supporting pregnancy intention, maternal nutrition, health/medical care, mental health, and providing social support. This article discusses the impact of maternal nutrition and inflammation during preconception and pregnancy among women living in low-resource settings, with an emphasis on key knowledge gaps that need to be addressed to guide program and policy decisions at local, regional and global levels.
胎儿的发育速度远远超过生命过程中的任何其他阶段，因此，环境影响可以深刻改变发育过程。产前时期的压力，包括营养不良和炎症，会对母婴的神经发育产生影响，并对母婴的身心健康产生长期影响。母体营养不良、炎症和其他产前压力源的一个主要后果是不良的出生结局，如早产或生长受限。这些表型通常被用作产前逆境的指标。事实上，支持胎儿编程假说的最初证据来自于研究，这些研究记录了出生表型与随后出现的身心健康问题之间的关联。无论是足月还是早产儿的胎儿生长受限都与新生儿发病率以及儿童和青少年时期的各种行为和心理诊断有关，包括注意力缺陷/多动障碍、焦虑、抑郁、内化和思维问题、社交技能差和自闭症谱系障碍。改善母婴健康需要在怀孕前开始并贯穿整个孕期和产后的干预措施。这些干预措施可能包括支持怀孕意愿、母体营养、健康/医疗保健、心理健康和提供社会支持。本文讨论了生活在资源匮乏环境中的妇女在受孕前和怀孕期间的母体营养和炎症对母婴的影响，并强调了需要解决的关键知识差距，以指导地方、区域和全球各级的规划和政策决策。
