Maternal Nutrition

Normal variations in maternal nutrition have relatively little effect on fetal growth, because they do not markedly alter maternal plasma concentrations of nutrient substrates or the rate of uterine blood flow, the principal determinants of nutrient substrate delivery to and transport by the placenta. Human epidemiological data from conditions of prolonged starvation, as well as nutritional deprivation in experimental animals, indicate that even severe limitations in maternal nutrition only limit fetal growth by 10-20%. Restriction of caloric and protein intakes to less than 50% of normal for a considerable portion of gestation are needed before marked reductions in fetal growth are observed; such severe conditions often result in fetal loss before the impact on late gestation fetal growth rate and fetal size at birth are manifested. Similarly, fetal macrosomia is only common in pregnancies complicated by gestational diabetes mellitus in which maternal plasma hyperglycemia and hypertri-glyceridemia, plus fetal hyperinsulinemia, combine to produce excessive fetal adiposity.

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