Bonnell Victoria, White Marina, Connor Kristin
J Glob Health. 2024 Dec 20;14:04240. doi: 10.7189/jogh.14.04240.
Maternal nutritional interventions aim to address nutrient deficiencies in pregnancy, a leading cause of maternal and neonatal morbidity and mortality worldwide. How these interventions influence the placenta, which plays a vital role in fetal growth and nutrient supply, is not well understood. This leaves a major gap in understanding how such interventions could influence pregnancy outcomes and fetal health. We hypothesised that nutritional interventions influence placental phenotype, and that these placental changes relate to how successful an intervention is in improving pregnancy outcomes.
We searched PubMed, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform using pre-defined search terms for records published from January 2001 to September 2021 that reported on clinical trials in humans, which administered a maternal nutritional intervention during the periconceptional or pregnancy period and reported on placental phenotype (shape and form, function or placental disorders). These records were then screened by two reviewers for eligibility.
Fifty-three eligible articles reported on (multiple) micronutrient- (n = 33 studies), lipid- (n = 11), protein- (n = 2), and diet-/lifestyle-based (n = 8) interventions. Of the micronutrient-based interventions, 16 (48%) were associated with altered placental function, namely altered nutrient transport/metabolism (n = 9). Nine (82%) of the lipid-based interventions were associated with altered placental phenotype, including elevated placental fatty acid levels (n = 5), altered nutrient transport/metabolism gene expression (n = 4), and decreased inflammatory biomarkers (n = 2). Of the protein-based interventions, two (66%) were associated with altered placental phenotype, including increased placental efficiency (n = 1) and decreased preeclampsia risk (n = 1). Three (38%) of diet and lifestyle-based interventions were associated with placental changes, namely placental gene expression (n = 1) and disease (n = 2). In studies with data on maternal (n = 30) or offspring (n = 20) outcomes, interventions that influenced placental phenotype were more likely to have also been associated with improved maternal outcomes (n/N = 11/15, 73%) and offspring birth outcomes (n/N = 6/11, 54%) compared to interventions that did not associate with placental changes (n/N = 2/15 (13%) and n/N = 1/9 (11%) respectively).
Periconceptional and prenatal nutritional interventions to improve maternal/pregnancy health associate with altered placental development and function. These placental adaptations likely benefit the pregnancy and improve offspring outcomes. Understanding the placenta's role in the success of interventions to combat nutrient deficiencies is critical for improving interventions and reducing maternal and neonatal morbidity and mortality globally.
孕产妇营养干预旨在解决孕期营养缺乏问题，而孕期营养缺乏是全球孕产妇和新生儿发病及死亡的主要原因。这些干预措施如何影响对胎儿生长和营养供应起着至关重要作用的胎盘，目前尚不清楚。这在理解此类干预措施如何影响妊娠结局和胎儿健康方面留下了一个重大空白。我们假设营养干预会影响胎盘表型，并且这些胎盘变化与干预措施改善妊娠结局的成功程度有关。
我们使用预定义的搜索词在PubMed、ClinicalTrials.gov和世界卫生组织（WHO）国际临床试验注册平台上进行搜索，以查找2001年1月至2021年9月发表的报告人类临床试验的记录，这些试验在受孕前或孕期实施了孕产妇营养干预，并报告了胎盘表型（形状和形态、功能或胎盘疾病）。然后由两名评审员对这些记录进行筛选以确定其是否符合要求。
53篇符合要求的文章报告了（多种）基于微量营养素的（n = 33项研究）、基于脂质的（n = 11项）、基于蛋白质的（n = 2项）以及基于饮食/生活方式的（n = 8项）干预措施。在基于微量营养素的干预措施中，16项（48%）与胎盘功能改变有关，即营养物质转运/代谢改变（n = 9项）。在基于脂质的干预措施中，9项（82%）与胎盘表型改变有关，包括胎盘脂肪酸水平升高（n = 5项）、营养物质转运/代谢基因表达改变（n = 4项）以及炎症生物标志物降低（n = 2项）。在基于蛋白质的干预措施中，2项（66%）与胎盘表型改变有关，包括胎盘效率提高（n = 1项）和子痫前期风险降低（n = 1项）。在基于饮食和生活方式的干预措施中，3项（38%）与胎盘变化有关，即胎盘基因表达（n = 1项）和疾病（n = 2项）。在有孕产妇（n = 30）或后代（n = 20）结局数据的研究中，与未引起胎盘变化的干预措施相比（分别为n/N = 2/15（13%）和n/N = 1/9（11%）），影响胎盘表型的干预措施更有可能也与孕产妇结局改善（n/N = 11/15，73%）和后代出生结局改善（n/N = 6/11，54%）相关。
改善孕产妇/妊娠健康的受孕前和产前营养干预与胎盘发育和功能改变有关。这些胎盘适应性变化可能有益于妊娠并改善后代结局。了解胎盘在对抗营养缺乏干预措施成功中的作用对于改进干预措施和降低全球孕产妇和新生儿发病率及死亡率至关重要。
