Nutritional Recommendations for the Perinatal Period and Influence on Infant Gut Microbiota Development

Written by
Fathalla Ali, Bsc MSc, MPH and PHD student UNSW

Purpose of the reviewed article:

  • Highlight the nutritional recommendations for perinatal period (perinatal period starts at 22 completed weeks of gestation and ends 7 completed days after birth)
  • The influence of maternal microbiome and nutrition on infant gut microbiota development

Microbiome, diet and human health:

  • Disturbance in microbiota composition and decrease in microbial diversity is associated with increased risk of developing disease such as allergies, diabetes, obesity, irritable bowel syndrome and metabolic syndrome.
  • What we eat has a strong influence on the balance and diversity of microbiota we harbour.
  • An unbalanced diet could lead to specific dietary components that promote microbiota disturbance and that can be associated with the pathogenesis of many diseases.
  • A significant difference was observed in microbiota composition between people who follow a Western-type diet and those who follow a more ancestral diet and lifestyle.
  • Over and under nutrition found to impact on microbiota composition which could lead to increase the risk of inflammation and related metabolic disorder
  • A more balanced diet could promote a well-balanced and diverse microbiota that would play a vital role in health status

 

Relevance of perinatal nutrition and microbial environment for human health:

  • Changes in foetal physiology that lead to increasing the risk of developing obesity, diabetes and cardiovascular diseases during adulthood could be attributed to the combination of nutrition and microbiota diversity in perinatal period.
  • Maternal microbiota was recognised as one of the key elements in determining maternal-child health outcomes.
  • Microbiota are the among the most important factors that contribute to the foetal immune system development and maturation.
  • Diet was found to modulate either the gut microbiota composition or the metabolic/immunological activity.
  • Adequate perinatal nutrition and diverse microbiota ecosystem may provide a window of opportunity to decrease the risk of disease. 

Nutrition in pre-gestational, gestational and lactation stages:
Preconception nutrition

  • Preconception nutrition care is “any intervention provided to women of childbearing age, regardless of pregnancy status or desire, before pregnancy, to improve health outcomes for women, newborns and children”.
  • Undernutrition could negatively influence foetal growth and nutrition, immune and neurological status of newborn.
  • Preconception nutrition intervention was found to be effective in undernourished women.
  • Among the preconception nutrition care that help to prevent severe disease deficiencies are
    • (1) Promoting food fortification and (2) nutritional supplementation for women in childbearing age.
  • The World Health Organization recommend supplementation of iron and folic acid for 3 months, followed with 3 months of no supplementation in all women of childbearing age.

Maternal nutrition during gestation

  • Dietary counselling and provision of appropriate food products was identified to be effective in promoting food and nutrients intake with potential health benefits for pregnant women.
  • The Dietary Guidelines Advisory Committee 2010 found that obesity before pregnancy and excessive weight gain during pregnancy found harmful to the mother and the fetus.
  • One of the Millennium Development Goals for WHO to reduce child mortality and to promote maternal health is iron and folic acid supplementation during pregnancy.
  • The daily iron and folic acid oral supplementation (30-60 mg of elemental iron and 0.4 mg of folic acid) as part of antenatal care were found to reduce the risk of low birth weight, maternal anaemia and iron deficiency.
  • Vitamin A supplementation is also important for women during childbearing age in high risk areas such Africa and South East Asia. Vitamin A supplementation was found to reduce the risk of foetal growth retardation, night blindness and infection severity.
  • The Perinatal Lipid Intake Working Group of several nutrition societies proposed the intake of a minimum 200 mg/day of Polyunsaturated Fatty Acids during the 3rd trimester of pregnancy. Polyunsaturated Fatty Acids is important for brain development.

Maternal nutrition during lactation

  • Breastfeeding has many benefits to the mother and her infants. However, breastfeeding certainly places the mothers under need of nutritional supplement to help synthesize the milk.
  • The nutrients and energy that the mother needs to lactate her baby is higher than that she requires during pregnancy.
  • Human milk is the main source of energy and nutrients and considered to provide the ideal food for the baby.
  • Human milk contains multiple biocomponents that protect babies from nutritional and infectious diseases. Among these biocomponents are Immunoglobulin A, lysozyme, mucine, lactadherin, anti-inflammatory and antioxidant components, oligosaccharides, glycoconjugates and growth and antimicrobial factors.
  • The composition of human milk is not the same during the lactation period. It can be differentiated into three stages: (1) colostrum (1st – 7th day), (2) transitional milk (8th – 15th day) and (3) mature milk (16th day onwards).
  • The composition of mature human milk remains constant during the whole period of lactation regardless of maternal nutritional status. However, acute malnutrition could negatively affect the production of human milk.
  • Evidence showed that the percentage of Long Chain Poly Unsaturated fatty acids (LCPUFAs) such as Omega-3 alpha linolenic, Omega-6 linoleic acid and DHA acid in the human milk is influenced by the mother’s diet.
  • LCPUFAs are one of the main components of neuronal membrane and play a vital role in brain development.
  • It has been found that lactating women who consume fish on regular basis have higher DHA PUFA than those that do not eat fish.

Maternal microbiome and nutrition influence on the infant’s early microbial colonization:

  • Emerging evidences suggested that microbial colonization starts prior to birth and is shaped by the maternal microbiota.
  • It is likely that the colonization process is initiated in utero. After birth, the complex colonization process is influenced by host genetics as well as internal factors such as gestational age and external factors such as type of feeding (breast milk versus formula), mode of delivery (caesarean versus vaginal) and antibiotic exposure.
  • Maternal microbiota represents the infant’s first contact with microorganisms, which is considered a crucial step toward immune system development.
  • Exclusive breastfeeding found to promote Bifidobacterium-dominated microbiota environment.
  • Higher colonization rate of Bifidobacteria during infancy could provide protection against overweight and obesity development.
  • Higher levels of Bifidobacteria were associated with normal weight gain during pregnancy. This bacterial group was also found to protect infant weight development when transferred from mothers to their offspring.
  • Mode of delivery has a strong influence on early gut microbiota colonization. This is evident by a strong correlation between the first microbial communities that appear in the infants’ gut and the microbial communities of the mother’s vagina, where the infant was vaginally delivered or the mother’s skin, where the infant was delivered by C-section.
  • Vaginally delivered infants acquire a bacterial composition similar to that in their mother vagina, skin and faeces, such as Lactobacillus and Bifidobacterium groups.
  • Caesarean Section delivered infants will initially be exposed to non–maternal derived environments such as delivery equipment, skin microbiota from health care staff and other infants which serve as the main vector for microbiota transfer.
  • Babies born vaginally showed lower morbidity (asthma, allergy, respiratory problems, type-1 diabetes and obesity) compared to C-section delivered babies.

Breastfeeding impact on the infant’s early microbial colonization:

  • Exclusive breastfeeding practice provide exceptional protective health effects during infancy and reduce the risk of diseases in later life.
  • Breast milk is the postnatal link between the mother and it’s infants, and continue driving microbiota colonization during lactation.
  • Breast Milk contains a complex microbiome community and other growth promoting substances, led by Human Milk Oligosaccharides (HOMs) that sustain specific microbiota establishment.
  • Exclusive breastfeeding promotes the growth of specific bacteria called Bifidobacteria.
  • Breast milk microbiome may also be affected by mode of delivery.
  • Breast milk of virginal deliveries contains higher Bifidobacteria than caesarean section deliveries.
  • Maternal obesity, overweight and weight gain during pregnancy also affect the milk microbiota composition.
  • A lower count of Bifidobacteria and higher count of Staphylococcus were detected in overweigh than normal weigh breastfeeding mothers.
  • Breast milk is also influenced by gestational age. A higher count of Bifidobacteria and lower count of Enterococcus were detected in the breast milk from term deliveries.
  • Mothers of preterm infants produce breast milk that is slightly different in composition, which is designed to meet their baby’s specific needs.
  • Breast milk from mothers of preterm delivery contains specific microbiota characteristics that may have an important role in preterm infants.

Keywords: perinatal, diet, nutrition, preconception, gestation, pregnancy, lactation, breastfeeding, microbiota

Reference:

García-Mantrana, I., Bertua, B., Martínez-Costa, C., Collado, M. C., (2016), Perinatal nutrition: How to take care of the gut microbiota?, Clinical Nutrition Experimental, 6:3-16. Click here.