Presenters:

Presenters:
Nguyen Phu Hoang Anh, Naomi Paul, Yajie Zhao
Nguyen Phu Hoang Anh, Naomi Paul, Yajie Zhao
BACKGROUND
O F M AT E R N A L • Females have evolved mechanisms that help
BUFFERING
buffer the fetus against fluctuations in
maternal diet
• This review paper discusses the evolution of
elaborate vertebrate strategies of buffering
offspring → environmental fluctuations
during development
BACKGROUND Maternal Nutritional Buffering Model:
O F M AT E R N A L
BUFFERING • In contrast to many micronutrients that must be derived
from dietary sources, effect of short-term changes in
maternal macronutrients due to deficit
supplementation
• Will be minimized by internal buffering mechanisms to
ensure a stable supply of essential resources
• The model proposed in the paper → Predicts that birth
weight will be more influenced by mother’s chronic
pre-pregnancy nutrition than pregnancy diet
 ① I N T R O D U C T I O N T O M AT E R N A L B U F F E R I N G

• Low birth weight (BW) is used as a proxy for prenatal

undernutrition or stress → Linked to cardiovascular diseases and
other degenerative conditions
• Developmental and epigenetic sensitivity lasts the lifespan, but
many systems have periods of stronger sensitivity → Long lasting
effects
• Public and health policy perspective: Reduce the burden of disease
in future generations by improving health and nutritional status of
pregnant women
 Micronutrient Macronutrient
supplementations supplementations
Vitamin B, Folic
Fat, carbohydrates,
acid, iron
protein

Improve birth Improve maternal

outcomes nutritional status
Increase BW and Reduce risk of
neonatal survival stillbirth and
rates (population neonatal death
with imbalanced or Modest impacted on
deficient diets) offspring BW
The Maternal Nutritional Buffering Model
• An evolutionary and physiological framework for stimulating
new approaches to public health interventions aimed at
improving fetal nutrition and downstream health outcomes
• Helps explain several observations
• (i) The increased efficiency of micronutrient as opposed to
macronutrient supplementations in pregnancy on BW
• (ii) The finding that longer-term macronutrient
supplementations are more effective than those that occur only
during pregnancy
 ② EVOLUTION OF
M AT E R N A L
BUFFERING

● Mammalian strategy of
buffering→ Further
augmented with the
evolution of chorionic
placentation 
● Allowed for extended
periods of gestation
 THE INNOVATION OF THE PLACENTA

● In placental mammals, the fetal compartment is embedded within the

mother’s homeostatically regulated supply of nutrients
● Role of placenta:
○ Facilitate transport of essential resources like nutrients and gases
○ Remove waste products generated through the fetoplacental
unit’s metabolic activities
○ Help shield fetus from exposure to potentially harmful
compounds
 Jansson and Powell proposed that the
placenta functions as
• a “nutrient sensor” that responds
TH
THEE IIN
NNNOOVAT
VATIIO
ONNOOFF T
THHE
E to maternal nutrient supply and
PPLA
LACCEN
ENTA
TA fetal nutrient demand→
• placenta senses the nutrient
needs of fetus and nutrient
availability of mother 
PATHWAYS LINKING MATERNAL AND FETAL ENVIRONMENTS
 ESSENTIAL NUTRIENT

•Maternal micronutrient supplementation during pregnancy

improve maternal and child health outcomes.
•Pregnancy induces changes in maternal metabolism that
increase efficiency of certain essential nutrients extracted from
the diet and utilized, which can further augment the
effectiveness of interventions (ex: Vit B12)
 MACRONUTRIENTS

•Although maternal protein requirement increased 30-50%, reduced or

elevated transported across the placenta is associated with intrauterine
growth restriction or macrosomia in infants.
•FFAs are essential to structures like cellular membranes and
deposited a large store of body fat in newborn. Some FFA like
Dosahexaenoic acids (DHA) required for brain growth can be
mobilized from maternal or fetal fat stores if dietary intake below the
requirement.
MACRONUTRIENTS
TO SUMMARIZE

Pregnancy requires an increase in

dietary consumption of
micronutrients. Mother is a
critical resources which depends
on storage capacity, maternal
dietary intake and cumulative
deficits entering pregnancy.
TO SUMMARIZE

Macronutrient are delivered to

maternal peripheral tissue as
backup sources and mobilized for
meeting supply-demand
imbalances. As a result of these
various self-regulating systems,
supplementing maternal diet
during pregnancy is unlikely to
result in large effects on the fetus
 I M P L I C AT I O N S F O R N U T R I T I O N A L
I N T E RV E N T I O N D E S I G N

• Macronutrient supplementation benefits both fetal and maternal

nutrition
• However, increased maternal caloric intake seems to primarily
benefit mothers during pregnancy
• Pathway B shows that the short-term supplementation does not
benefit the “buffering system”
• Policies must take a long-term view to optimize early life nutrition
 I M P O RTA N C E O F P R E - L I F E N U T R I T I O N :
EVIDENCES

Clear evidence of clear links between pre-life nutrition and infant BW

• Fetal nutrition is influenced by the pre-pregnancy weight and early life
nutrition conditions of the mother
• Mothers’ pelvic dimensions is also a predictor of infant weight
• Postnatal leg length has a greater impact on the offspring BW than
adult size
• Intergenerational BW correlation lies in infant growth rate rather than
sizes
• Epigenetic contributions could be part of the explanations (e.x. IGF2
controls metabolism and fetal growth)
• The flow of macronutrients to the fetus provides a
long-term average index of maternal nutritional
experience. LINKAGE OF
• Mother’s growth rate and offspring BW are both M AT E R N A L - F E TA L
NUTRITION:
products of the mother’s metabolic productivity PHENOTYPIC
which supported her own growth in early life I N E RT I A

• Fetus who were nutritionally stressed in utero

tend to deposit more abdominal fat, which could
be advantages if the postnatal environment is also
nutritionally stressful
P H E N O T Y P I C I N E RT I A : B I O L O G I C A L E X P L A N AT I O N S
• Regardless of the specific mechanisms,
natural selection has likely shaped
maternal and placental physiology to
provide more reliable information to guide
offspring development. LINKAGE OF
M AT E R N A L - F E TA L
• Maternal biology could buffer the fetus NUTRITION:
against not only nutritional stress but also an PHENOTYPIC
I N E RT I A
unusual and transient improvement in
nutrition
• Measures of chronic, developmental
nutritional sufficiency in maternal biology
will be stronger predictors of offspring BW
 CONCLUSIONS

This model points to the need to tailor interventions based on different

pathways:
• Supplementing essential micronutrients to pregnant mothers has
an immediate and sufficient benefit to offspring
• Supplementation of macronutrients alone is unlikely to achieve
the full benefit because of the maternal metabolism buffering
system and the evolutionary background
 CONCLUSIONS
This model points to the need to target interventions beyond pregnancy
itself:
• Mothers’ early development is also important in terms of predicting
the offspring nutrition
• Importance of sustained long-term interventions in maternal
nutrition
• Promote political will and financial commitments that focus on
achieving the long-term public health goals
 CONCLUSIONS

This study points to the need for further research:

• Explore the multigenerational benefits of parenteral
nutrition?
• Addressing the modern epidemics of obesity and
overnutrition might also help to speak to the power
of maternal metabolism as a driver of offspring BW
 REFERENCES

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