German national consensus recommendations on nutrition and lifestyle in pregnancy by the 'Healthy Start - Young Family Network'.

Diet and physical activity before and during pregnancy affect short- and long-term health of mother and child. The energy needs at the end of pregnancy increase only by about 10% compared to nonpregnant women. An excessive energy intake is undesirable since maternal overweight and excessive weight gain can increase the risks for a high birth weight and later child overweight and diabetes. Maternal weight at the beginning of pregnancy is especially important for pregnancy outcome and child health. Women should strive to achieve normal weight already before pregnancy. Regular physical activity can contribute to a healthy weight and to the health of pregnant women. The need for certain nutrients increases more than energy requirements. Before and during pregnancy, foods with a high content of essential nutrients should be preferentially selected. Supplements should include folic acid and iodine, iron (in case of suboptimal iron stores), the ω-3 fatty acid docosahexaenoic acid (in case of infrequent consumption of ocean fish) and vitamin D (in case of decreased sun exposure and decreased endogenous vitamin D synthesis). Pregnant women should not smoke and not stay in rooms where others smoke or have smoked before (passive smoking). Alcohol consumption should be avoided, since alcohol can harm unborn children.

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"]. / Ernährung in der Schwangerschaft - Teil 1.

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Energy needs increase by only ≈10 % by the end of pregnancy whereas micronutrient needs increase much more. Normal weight should preferably be achieved before pregnancy. Dietary recommendations follow those for the general population. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 2 of the article are practice recommendations on nutrition in pregnancy, especially vegetarian diets, recommendations on micronutrient supplementation, risk reduction of listeriosis and toxoplasmosis, alcohol, tobacco, caffeine and physical activity in pregnancy.

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"]. / Ernährung in der Schwangerschaft - Teil 2. Handlungsempfehlungen des Netzwerks "Gesund ins Leben - Netzwerk Junge Familie".

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Iron supplements should be used based on medical history and blood testing. Vegetarian diets with nutritional supplements can provide adequate nutrition, but counselling is recommended. In contrast, a vegan diet is inadequate and requires additional micronutrient supplementation. For risk reduction of listeriosis and toxoplasmosis, raw animal foods, soft cheeses and packed fresh salads should be avoided; fresh fruit, vegetables and salad should be washed well and consumed promptly. Pregnant women should remain physically active and perform sports with moderate intensity. They should avoid alcohol, active and passive smoking. Up to 3 daily cups of coffee are considered harmless, but energy drinks should be avoided. Childhood allergy is not reduced by avoiding certain foods in pregnancy whereas oily sea fish is recommended. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 1 of the article are practice recommendations on nutrition, on energy needs, micronutrient needs and body weight/weight gain in pregnancy.

[The analgesic effect of exercise during labor]. / Der analgetische Effekt von körperlicher Aktivität auf Wehen unter der Geburt.

OBJECTIVE: The aim of this study was to test for an analgesic effect of exercise during labor. PATIENTS AND METHODS: 50 women in labor exercised continuously with moderate intensity on a bicycle ergometer for 20 minutes. During rest and exercise, they rated their pain on a visual analogue scale (VAS). Venous blood was sampled for beta-endorphin, cortisol and catecholamines during rest and directly after exercise. RESULTS: 84 percent of the women perceived uterine contractions during exercise as less painful than at rest. 76.2 percent objectified the pain relief by a reduction in VAS units 1.67 +/- 1.01. Beta-endorphin levels were much higher after exercise than at rest (P < 0.001). During exercise the fetal heart rate rose slightly within the reference range. Uterine contractions were more frequent during and after exercise than at rest (P < 0.05). CONCLUSION: Exercising on a bicycle ergometer during labor seems to be safe for the fetus, a stimulus to uterine contractions, and a source of analgesia, possibly due to the release of beta-endorphin.

Physical exercise during pregnancy--physiological considerations and recommendations.

Controversial findings in numerous studies involving physiological and endocrinological parameters indicate that physical exercise during pregnancy is complex and somewhat poorly understood. But despite this reservation, it is safe to say that on the basis of the current state of scientific research in this area, physical exercise is to be recommended during pregnancy so long as women are aware of potential dangers and contraindications. Due to thermoregulatory advantages, the beneficials effects of immersion and its joint protective character "aquatic exercise" can be highly recommended during pregnancy. Psychologically speaking, physical exercise offers a variety of benefits such as the encouragement of cooperation and competition which can be experienced as fun and gratifying. The physiological and psychological benefits of physical exercise are not only available to healthy women, but have also proven to be valuable for the prevention and treatment of illnesses such as gestational diabetes. The activation of large groups of muscles allow for an improved glucose utilization by simultaneously increasing insulin sensitivity.

Growth, development and differentiation: a functional food science approach.

Few other aspects of food supply and metabolism are of greater biological importance than the feeding of mothers during pregnancy and lactation, and of their infants and young children. Nutritional factors during early development not only have short-term effects on growth, body composition and body functions but also exert long-term effects on health, disease and mortality risks in adulthood, as well as development of neural functions and behaviour, a phenomenon called 'metabolic programming'. The interaction of nutrients and gene expression may form the basis of many of these programming effects and needs to be investigated in more detail. The relation between availability of food ingredients and cell and tissue differentiation and its possible uses for promoting health and development requires further exploration. The course of pregnancy, childbirth and lactation as well as human milk composition and the short- and long-term outcome of the child are influenced by the intake of foods and particularly micronutrients, e.g. polyunsaturated fatty acids, Fe, Zn and I. Folic acid supplementation from before conception through the first weeks of pregnancy can markedly reduce the occurrence of severe embryonic malformations; other potential benefits of modulating nutrient supply on maternal and child health should be further evaluated. The evaluation of dietary effects on child growth requires epidemiological and field studies as well as evaluation of specific cell and tissue growth. Novel substrates, growth factors and conditionally essential nutrients (e.g. growth factors, amino acids, polyunsaturated fatty acids) may be potentially useful as ingredients in functional foods and need to be assessed carefully. Intestinal growth, maturation, and adaptation as well as long-term function may be influenced by food ingredients such as oligosaccharides, gangliosides, high-molecular-mass glycoproteins, bile salt-activated lipase, pre- and probiotics. There are indications for some beneficial effects of functional foods on the developing immune response, for example induced by antioxidant vitamins, trace elements, fatty acids, arginine, nucleotides, and altered antigen contents in infant foods. Peak bone mass at the end of adolescence can be increased by dietary means, which is expected to be of long-term importance for the prevention of osteoporosis at older ages. Future studies should be directed to the combined effects of Ca and other constituents of growing bone, such as P, Mg and Zn, as well as vitamins D and K, and the trace elements F and B. Pregnancy and the first postnatal months are critical time periods for the growth and development of the human nervous system, processes for which adequate substrate supplies are essential. Early diet seems to have long-term effects on sensory and cognitive abilities as well as behaviour. The potential beneficial effects of a balanced supply of nutrients such as I, Fe, Zn and polyunsaturated fatty acids should be further evaluated. Possible long-term effects of early exposure to tastes and flavours on later food choice preferences may have a major impact on public health and need to be further elucidated. The use of biotechnology and recombinant techniques may offer the opportunity to include various bioactive substances in special dietary products, such as human milk proteins, peptides, growth factors, which may have beneficial physiological effects, particularly in infancy and early childhood.

[Pregnancy and sports--physiologic considerations and practical examples]. / Schwangerschaft und Sport--physiologische Uberlegungen und praktische Beispiele.

Mothers-to-be expect practical and competent consulting from their obstetricians rather than orders or interdictions regarding their way of living. Particularly answering questions concerning physical activity and sports during pregnancy require profound knowledge on the physiological adaptations of the cardiopulmonary system and the anatomical structures and-on the other hand-on performance and sports' physiology. Resuming these alterations through pregnancy there result practical examples and proposals of physical activities in gestation as therapeutic and preventive measures. Moreover risks and contraindications are worked out.

Gestational diabetes and exercise: a survey.

Exercise has long been accepted as an adjunctive nonmedical intervention in the management of diabetes in nonpregnant subjects. It is universally accepted that pregnancy is a diabetogenic event which could develop into gestational diabetes mellitus (GDM) in up to 12% of pregnant women. GDM, a carbohydrate intolerance of variable severity with onset or first recognition during pregnancy, involves a relative resistance to insulin. Exercise becomes thus a logical intervention, only recently offered as an adjunctive therapy to pregnant diabetics. This article reviews our current understanding of the role of exercise in the management of GDM.

[Ileus in late pregnancy--sequela of follicle puncture within the scope of in vitro fertilization?]. / Ileus in der Spätschwangerschaft--Folge der Follikelpunktion im Rahmen der In-vitro-Fertilisation?

Complications in connection with the puncture in in-vitro fertilisation (IVF) occur normally relatively soon after the operation. This is a report on a patient in her 28th week of gestation, operated on by laparotomy for ileus. Retrospectively this acute event must be seen as a very rare late complication connected with the puncture. It must be stressed that patients should be informed about this eventually.

Micronutrients during pregnancy: the nutritive situation in Germany.

During pregnancy the demands for energy and nutrients are increased. Despite increasing awareness about nutrition in the population of a western country like Germany, there is a discrepancy between actual food intake and recommended quantities of certain nutrients, particularly during pregnancy. There are correlations between deficiencies in micro-nutrients such as iodine, iron and folic acid and the course and outcome of pregnancy. The consequences of an insufficient supply of these micronutrients during pregnancy are described and high-risk-groups for an inadequate supply are defined. Recommendations for nutrition counselling during this period of life are given.

An orthostatic uterovascular syndrome--a prospective, longitudinal study.

OBJECTIVE: The interaction between maternal hemodynamics and uterine activity in the upright position was investigated longitudinally (358 measurements) in 40 healthy pregnant women from 20 gestational weeks to term. STUDY DESIGN: Maternal-fetal hemodynamic parameters and uterine contractions were measured noninvasively in four different postures. RESULTS: Hemodynamic disturbances caused by compression of pelvic vessels by the gravid uterus in the upright position were detected in two of 40 (5%) women as early as 24 weeks' gestation; a peak was reached at 38 weeks (71%). With a decrease in the stroke volume (22%, p < 0.001) neither the cardiac output (-11%, p < 0.05) nor the systolic blood pressure (-1.4%, p < 0.05) remained constant, although there was a compensatory heart rate increase. CONCLUSION: A significantly increased number of spontaneous uterine contractions in the upright position is associated with release of the blocked venous return flow and restoration of normal maternal hemodynamics.

[Regular exercise therapy in disorders of carbohydrate metabolism in pregnancy--results of a prospective, randomized longitudinal study]. / Regelmässige Bewegungstherapie bei Kohlehydratstoffwechselstörungen in der Schwangerschaft--Ergebnisse einer prospektiven, randomisierten Longitudinalstudie.

Regular exercise has long been known as an adjunct in the therapy of diabetes mellitus. There are, however, only few reports on the impact of this therapy during pregnancy. This study aims at presenting an exercise programme for patients with insulin-requiring gestational diabetes (GDM) and its short-term and long-term effects on carbohydrate metabolism, on the foetus and on the course of pregnancy. Between the 26th and 32nd week of gestation, 41 pregnant subjects were randomised into either an exercise and diet group (EXE) or an Insulin and diet group (INS). The EXE patients (N = 21) trained three times per week at 50% VO2max. For 3 x 15 minutes on a recumbent bicycle ergometer throughout pregnancy with blood glucose monitoring before and after exercise). Blood glucose metabolism was followed by daily home monitoring and weekly fasting blood glucose sampling (FBG). The FBG results were comparable in the study and the control group (< 105 mg/dl); the maternal and foetal complications did not differ significantly between the two groups. The glycaemic parameters indicate a persistent decrease in blood glucose and an increase in insulin sensitivity induced by regular physical activity. We conclude, that such a medically supervised exercise programme can be safely conducted in women with GDM resulting in normoglycaemia for the mother and thus preventing insulin therapy.

[Folic acid supply in pregnancy--results of a prospective longitudinal study]. / Folsäureversorgung in der Schwangerschaft--Ergebnisse einer prospektiven Longitudinalstudie.

After discussing the problem of folic acid requirements and supply during pregnancy, the results of a longitudinal study on 162 pregnant women are presented. By measuring biochemical and morphological changes in two subgroups (non-substituted vs unspecifically substituted), the necessity of a substitution with folic acid is discussed, as there might be additional requirements for the pregnant and the foetal organism. Concentrations of folic acid in the maternal plasma and in the erythrocytes as well as the segmentation rate and hypersegmentation of the granulocytes show a clear decrease in pregnancy. At the same time there was a significant difference between the subjects substituted and not substituted; the foetus and newborn levels were much higher than their mothers' concentrations. Moreover, there was a correlation between red cells folic acid levels in the last trimester and duration and outcome of pregnancy. These results indicate a substitution with folic acid for certain populations in pregnancy, which are highlighted.

Therapeutic exercise for insulin-requiring gestational diabetics: effects on the fetus--results of a randomized prospective longitudinal study.

Regular physical activity is an established therapeutic adjunct in diabetes, but has not been offered to pregnant diabetics in the past; for sports might induce significant cardiovascular and hormonal changes that are able to reduce blood flow to the uterus and thus limit oxygen transfer to the fetus. Studying the impact of a medically supervised exercise program on gestational diabetes mellitus [GDM) in a randomised prospective longitudinal study, this paper aims to assess the effects of maternal moderate and strenuous exercise on the fetus. By evaluating shortterm fetal responses as reflected in heart rate patterns (FHR) and longterm-pregnancy complications and neonatal outcome, our results suggest that--in absence of ominous FHR changes or significant changes in uterine activity following the exercise sessions or increased diabetes-related peri- and neonatal morbidity--regular physical activity seems to be a safe therapeutic option for the fetus of GDM mothers.

[Long-term 24-hour blood pressure measurement in genuine gestosis and hypertensive pregnancy]. / 24-Stunden-Langzeitblutdruckmessung bei genuiner Gestose und Pfropfgestose.

The clinical implications of diminished circadian blood pressure variations during hypertensive pregnancies are not fully understood. We used the COS-INOR-method to quantify circadian blood pressure amplitudes of 32 patients with preeclampsia (GG) and 21 patients with superimposed pre-eclampsia (PG). The two groups did not significantly differ in body weight, age, and gestational date at admission. No differences could be detected in 24-h blood pressure values between the two groups (GG: 127 +/- 14/82 +/- 12 mmHg, PG: 128 +/- 16/86 +/- 9 mmHg). Circadian amplitudes of systolic blood pressure variations (GG: 5.9 +/- 5.5 mmHg, PG: 4.5 +/- 6.9 mmHg) and diastolic blood pressure variations (GG: 3.8 +/- 3.0 mmHg, PG: 5.3 +/- 4.1 mmHg) did not differ significantly. The slope between successive changes of mean arterial blood pressure and successive changes in heart rate was significantly higher in patients with superimposed pre-eclampsia (GG: 0.16 +/- 0.27 mmHg/bpm, PG: 0.36 +/- 0.24 mmHg/bpm, p less than 0.005). We conclude that patients with pre-eclampsia and superimposed pre-eclampsia do not differ in 24-h blood pressure and circadian blood pressure variability, however, if blood-pressure variability is related to heart-rate variability differences become apparent that might be due to altered blood-pressure regulation.