Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Department of Pathology, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Clin Nutr. 2024 Nov;43(11):46-53. doi: 10.1016/j.clnu.2024.09.033. Epub 2024 Sep 19.
BACKGROUND & AIMS: The quantity and quality of maternal nutrition in the periconception period is an important determinant for embryonic and foetal development and subsequent pregnancy course and outcome. The intake of ultra-processed foods (UPF) has increased worldwide and adverse health outcomes have been reported. However, the impact of UPF intake on the placenta, essential for prenatal nourishment, is unknown. Therefore, we aim to investigate associations between the periconceptional maternal intake of UPF, energy and related macronutrients, and first-trimester utero-placental vascular development.
We included 214 ongoing pregnancies in the Virtual Placenta study, a subcohort of the Rotterdam periconception cohort. At enrollment, participants filled out a food frequency questionnaire from which we calculated the average daily energy from UPF, total energy intake and macronutrient intake from UPF. At 7-9-11 weeks of gestation, we performed sequential three-dimensional power Doppler ultrasounds of the first-trimester utero-placental vasculature. Virtual Organ Computer-aided AnaLysis (VOCAL) software, Virtual Reality segmentation and a skeletonization algorithm were applied to measure placental volume (PV), utero-placental vascular volume (uPVV) and generate the utero-placental vascular skeleton (uPVS). Absolute vascular morphology was quantified by assigning a morphologic characteristic to each voxel in the uPVS (end-, bifurcation-, crossing- or vessel point) and used to calculate density of vascular branching. Linear mixed models adjusted for confounders were used to investigate associations between maternal intake of UPF, total energy and macronutrients from UPF and PV, uPVV and uPVS characteristics.
Energy intake from UPF and total energy intake were not consistently associated with imaging markers of utero-placental vascular development. Higher carbohydrate intake of 10 g/day from UPF was associated with increased uPVS trajectories (end points (β = 0.34, 95%CI = 0.07; 0.61), bifurcation points (β = 0.38, 95%CI = 0.05; 0.70), vessel points (β = 0.957, 95%CI = 0.21; 1.71). No associations were observed with PV.
Against our hypothesis, periconceptional maternal intake of UPF and total energy were not convincingly associated with impaired first-trimester utero-placental vascular development. Remarkably, the increased intake of carbohydrates from UPF, which is often considered 'unhealthy', is positively associated with first-trimester utero-placental vascular development. Given the complexity of diet, further research should elucidate what underlies these findings to be able to interpret how nutrition may impact utero-placental vascular development in early pregnancy.
This study is registered at the Dutch Trial Register (NTR6854).
围孕期母体营养的数量和质量是胚胎和胎儿发育以及随后妊娠过程和结局的重要决定因素。超加工食品（UPF）的摄入量在全球范围内有所增加，并且已经报道了不良的健康后果。然而，UPF 摄入量对胎盘的影响尚不清楚，胎盘对产前营养至关重要。因此，我们旨在研究围孕期母体摄入 UPF、能量和相关宏量营养素与妊娠早期子宫胎盘血管发育之间的关系。
我们纳入了虚拟胎盘研究中的 214 例正在进行的妊娠，这是鹿特丹围孕期队列的一个亚队列。在入组时，参与者填写了一份食物频率问卷，我们根据该问卷计算了 UPF 的平均日能量、总能量摄入和 UPF 的宏量营养素摄入。在妊娠 7-9-11 周时，我们对妊娠早期子宫胎盘血管进行了连续的三维能量多普勒超声检查。应用虚拟器官计算机辅助分析（VOCAL）软件、虚拟现实分割和骨骼化算法来测量胎盘体积（PV）、子宫胎盘血管体积（uPVV）并生成子宫胎盘血管骨骼（uPVS）。通过为 uPVS 中的每个体素分配形态特征（末端、分叉、交叉或血管点）来量化绝对血管形态，并用于计算血管分支密度。使用线性混合模型调整混杂因素来研究母体 UPF 摄入、总能量和 UPF 摄入的宏量营养素与 PV、uPVV 和 uPVS 特征之间的关系。
UPF 和总能量摄入与子宫胎盘血管发育的影像学标志物没有一致的关联。每天从 UPF 摄入 10 克碳水化合物与 uPVS 轨迹的增加相关（末端点（β=0.34，95%CI=0.07；0.61），分叉点（β=0.38，95%CI=0.05；0.70），血管点（β=0.957，95%CI=0.21；1.71）。与 PV 无关联。
与我们的假设相反，围孕期母体摄入 UPF 和总能量与妊娠早期子宫胎盘血管发育受损没有明显关联。值得注意的是，来自 UPF 的碳水化合物摄入量增加，通常被认为是“不健康的”，与妊娠早期子宫胎盘血管发育呈正相关。鉴于饮食的复杂性，进一步的研究应该阐明这些发现的基础，以便能够解释营养如何影响妊娠早期的子宫胎盘血管发育。
这项研究在荷兰临床试验注册库（NTR6854）注册。
