Fetal Sex Modifies the Effect of Maternal Macronutrient Intake on the Incidence of Small-for-gestational-age Births: a Prospective Observational Cohort Study

Overview

Journal Am J Clin Nutr

Publisher Elsevier

Specialty Nutritional Sciences

Date 2018 Sep 22

PMID 30239558

Citations 5

Authors

A Mukhopadhyay

T Thomas

R J Bosch

P Dwarkanath

A Thomas

C P Duggan

A V Kurpad

Affiliations

Soon will be listed here.

Abstract

Background: Maternal macronutrient intake is likely to play a pivotal role in fetoplacental growth. Male fetuses grow faster and their growth is more responsive to maternal size.

Objective: We assessed the role of fetal sex in modifying the effect of maternal macronutrient intake on the risk of small-for-gestational-age (SGA) birth.

Design: This was a prospective, observational cohort study of 2035 births from an urban South Asian Indian population. Maternal intakes of total energy and macronutrients were recorded by validated food-frequency questionnaires. The interaction of trimester 1 macronutrient intake with fetal sex was tested on the outcome of SGA births.

Results: The prevalence of SGA was 28%. Trimester 1 macronutrient composition was high in carbohydrate and low in fat (means ± SDs-carbohydrate: 64.6% ± 5.1%; protein: 11.5% ± 1.1%; and fat: 23.9% ± 4.4% of energy). Higher carbohydrate and lower fat consumption were each associated with an increased risk of SGA [adjusted OR (AOR) per 5% of energy (95% CI): carbohydrate: 1.15 (1.01, 1.32); fat: 0.83 (0.71, 0.97)] specifically among male births (males: n = 1047; females: n = 988). Dietary intake of >70% of energy from carbohydrate was also associated with increased risk (AOR: 1.67; 95% CI: 1.00, 2.78), whereas >25% of energy from fat intake was associated with decreased risk (AOR: 0.61; 95% CI: 0.41, 0.90) of SGA in male births.

Conclusions: Higher carbohydrate and lower fat intakes early in pregnancy were associated with increased risk of male SGA births. Therefore, we speculate that fetal sex acts as a modifier of the role of maternal periconceptional nutrition in optimal fetoplacental growth.

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References

Enninga E, Nevala W, Creedon D, Markovic S, Holtan S . Fetal sex-based differences in maternal hormones, angiogenic factors, and immune mediators during pregnancy and the postpartum period. Am J Reprod Immunol. 2014; 73(3):251-62. PMC: 4317383. DOI: 10.1111/aji.12303. View

Buckberry S, Bianco-Miotto T, Bent S, Dekker G, Roberts C . Integrative transcriptome meta-analysis reveals widespread sex-biased gene expression at the human fetal-maternal interface. Mol Hum Reprod. 2014; 20(8):810-9. PMC: 4106635. DOI: 10.1093/molehr/gau035. View

Lingwood B, Henry A, dEmden M, Fullerton A, Mortimer R, Colditz P . Determinants of body fat in infants of women with gestational diabetes mellitus differ with fetal sex. Diabetes Care. 2011; 34(12):2581-5. PMC: 3220854. DOI: 10.2337/dc11-0728. View

Rao S, Yajnik C, Kanade A, Fall C, Margetts B, Jackson A . Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. J Nutr. 2001; 131(4):1217-24. DOI: 10.1093/jn/131.4.1217. View

Song S . Does famine influence sex ratio at birth? Evidence from the 1959-1961 Great Leap Forward Famine in China. Proc Biol Sci. 2012; 279(1739):2883-90. PMC: 3367790. DOI: 10.1098/rspb.2012.0320. View

Hernandez-Julian R, Mansour H, Peters C . The effects of intrauterine malnutrition on birth and fertility outcomes: evidence from the 1974 Bangladesh famine. Demography. 2014; 51(5):1775-96. DOI: 10.1007/s13524-014-0326-5. View

Ji S, You Y, Kerner J, Hoppel C, Schoeb T, Chick W . Homozygous carnitine palmitoyltransferase 1b (muscle isoform) deficiency is lethal in the mouse. Mol Genet Metab. 2007; 93(3):314-22. PMC: 2270477. DOI: 10.1016/j.ymgme.2007.10.006. View

Broere-Brown Z, Schalekamp-Timmermans S, Hofman A, Jaddoe V, Steegers E . Fetal sex dependency of maternal vascular adaptation to pregnancy: a prospective population-based cohort study. BJOG. 2015; 123(7):1087-95. DOI: 10.1111/1471-0528.13519. View

Arora S, McFarlane S . The case for low carbohydrate diets in diabetes management. Nutr Metab (Lond). 2005; 2:16. PMC: 1188071. DOI: 10.1186/1743-7075-2-16. View

10.

Stevenson D, Verter J, Fanaroff A, Oh W, Ehrenkranz R, Shankaran S . Sex differences in outcomes of very low birthweight infants: the newborn male disadvantage. Arch Dis Child Fetal Neonatal Ed. 2000; 83(3):F182-5. PMC: 1721180. DOI: 10.1136/fn.83.3.f182. View

11.

van Abeelen A, de Rooij S, Osmond C, Painter R, Veenendaal M, Bossuyt P . The sex-specific effects of famine on the association between placental size and later hypertension. Placenta. 2011; 32(9):694-698. DOI: 10.1016/j.placenta.2011.06.012. View

12.

Mukhopadhyay A, Ravikumar G, Dwarkanath P, Meraaj H, Thomas A, Crasta J . Placental expression of the insulin receptor binding protein GRB10: Relation to human fetoplacental growth and fetal gender. Placenta. 2015; 36(11):1225-30. DOI: 10.1016/j.placenta.2015.09.006. View

13.

Chong M, Chia A, Colega M, Tint M, Aris I, Chong Y . Maternal Protein Intake during Pregnancy Is Not Associated with Offspring Birth Weight in a Multiethnic Asian Population. J Nutr. 2015; 145(6):1303-10. DOI: 10.3945/jn.114.205948. View

14.

Godfrey K, Robinson S, Barker D, Osmond C, Cox V . Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ. 1996; 312(7028):410-4. PMC: 2350090. DOI: 10.1136/bmj.312.7028.410. View

15.

. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995; 854:1-452. View

16.

Barker D, Osmond C . Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986; 1(8489):1077-81. DOI: 10.1016/s0140-6736(86)91340-1. View

17.

Muthayya S, Dwarkanath P, Thomas T, Ramprakash S, Mehra R, Mhaskar A . The effect of fish and omega-3 LCPUFA intake on low birth weight in Indian pregnant women. Eur J Clin Nutr. 2007; 63(3):340-6. DOI: 10.1038/sj.ejcn.1602933. View

18.

Mannion C, Gray-Donald K, Koski K . Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. CMAJ. 2006; 174(9):1273-7. PMC: 1435952. DOI: 10.1503/cmaj.1041388. View

19.

Edlow A, Guedj F, Pennings J, Sverdlov D, Neri C, Bianchi D . Males are from Mars, and females are from Venus: sex-specific fetal brain gene expression signatures in a mouse model of maternal diet-induced obesity. Am J Obstet Gynecol. 2016; 214(5):623.e1-623.e10. PMC: 4851594. DOI: 10.1016/j.ajog.2016.02.054. View

20.

Ruckstuhl K, Colijn G, Amiot V, Vinish E . Mother's occupation and sex ratio at birth. BMC Public Health. 2010; 10:269. PMC: 2888741. DOI: 10.1186/1471-2458-10-269. View