The Impact of Nutritional Supplementation on the Metabolic Environment in Pregnant and Lactating Obese Women
In an effort to improve short- and long-term outcomes of babies and mothers impacted by maternal obesity, neonatologists in the Brigham and Women’s Hospital (BWH) Department of Pediatric Newborn Medicine are devising strategic interventions to address metabolic dysregulation in pregnant and lactating obese women. “Obesity has become one of the most pressing public health issues of our time and is associated with increased risks for preterm birth, birth defects, and the development of significant medical conditions in childhood,” said Sarbattama Sen, MD, a neonatologist in the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital (BWH). “We believe that the abnormal metabolic environment in obesity, which is characterized by increased inflammation and oxidative stress, may improve with tailored nutritional supplementation, thus reducing some risks posed by maternal obesity.”
BMI-based Prenatal Vitamin Study (The PNV Study)
Dr. Sen is the Principal Investigator of a current double-blind randomized control trial including 100 obese women early in pregnancy and 100 obese women planning pregnancy. Trial participants receive either a standard prenatal vitamin and a placebo or a standard prenatal vitamin and a vitamin supplement with additional amounts of specific antioxidant micronutrients.
Primary outcomes of the study include:
Markers of oxidative stress and inflammation in mothers and infants;
Cord blood levels.
Secondary outcomes of the study include:
Infant growth and adiposity via body composition assessment;
Breastfeeding success and breastmilk composition;
As part of the study, monthly urine samples are collected, and blood samples are taken at three points throughout pregnancy. Infant body composition is measured shortly after birth, and the infants will then be followed at six months and at one year with samples to include blood for metabolic assays.
Maternal Obesity and Postnatal Health
The team also is examining the impact of maternal obesity on postnatal health of infants through breastmilk composition. Previously, Dr. Sen and colleagues measured pro-inflammatory nutritional substances in the breastmilk of lean and obese women one-to-two months postpartum and found:
Ratio of omega-6 to omega-3 fatty acids increased as maternal BMI increased (J Perinatal. 2016 Jan 7. doi: 10.1038/jp.2015.199.);
Lower concentrations of the neuroprotective substances DHA, ARA, and lutein (J Perinatal. 2016 Jan 7. doi: 10.1038/jp.2015.199.) in the breastmilk of obese women.
Follow-up research is being planned to assess whether maternal perinatal nutritional supplementation and targeted dietary modification can improve breastmilk composition in obese mothers.
“These studies are designed to test feasible and practical interventions to decrease inflammation pre- and post-natally and, hopefully, improve outcomes in children of obese mothers,” said Dr. Sen.
Sarbattama Sen, MD Neonatologist, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital