PROFILO NUTRIZIONALE E DISTURBI GASTROINTESTINALI FUNZIONALI IN GRAVIDANZA: CORRELAZIONE CON I MARKERS INFIAMMATORI ED ANTROPOMETRICI MATERNI NEI TRE TRIMESTRI DI GESTAZIONE E CON IL PESO NEONATALE IN UNA POPOLAZIONE DI GRAVIDE A BASSO RISCHIO.

Nutritional profile and functional gastrointestinal disorders in pregnancy: effects on inflammatory markers, maternal anthropometry and neonatal birth weight Anna Lucia Mastricci Purpose The deep impact of pregnancy on digestive functions and the frequent related unwanted symptoms, together with the compliance of pregnant women toward good medical advice, offer a formidable chance to induce proper nutritional habits and identify latent gastrointestinal disorders. Functional gastrointestinal disorders' (FGIDs) associations with dietary habits and body mass index (BMI) have not been thoroughly investigated in the general population and in particular in pregnant women. Epidemiological studies have associated the increase in chronic inflammatory bowel disease to the spread of the so-called “Western diet”. The Mediterranean diet has increasingly been regarded as the gold-standard diet for human health. The nutrients exert their effects on tissue inflammation because they modified the composition of the intestinal microbiota, impaired mucosal barrier function and induce a state of low grade inflammation. Gastrointestinal disorders are not only the effect of progesterone on smooth muscle, but, alternatively, these symptoms could be interpreted as preexisting subclinical condition transformed into symptomatic conditions by pregnancy. Aim The aim of this study was to investigate the nutritional profile of Caucasian pregnant women without any previous medical condition and to evaluate its impact on weight gain, digestive and immune system, and neonatal outcome. Methods A total of 126 pregnant women were enrolled for this study. Dietary habits and gastrointestinal abnormal symptoms were assessed via two validated self-administrated questionnaire during each trimester of pregnancy. Anthropometric measurements, stool test, immune profile blood tests, socio-demographical and lifestyle data were collected during pregnancy. Associations between socio-demographic characteristics, BMI, food intake frequencies, eating habits and FGIDs were investigated with univariate logistic regression. Results High adherence to Mediterranean diet (MeD score ≥ 9) was demonstrated in only 15% of patients enrolled into study group and this trend was constant during pregnancy. Mean ± SD Med-score in each trimester of pregnancy were 7.2 ± 1.4, 7.0 ± 1.2 and 7.3 ± 1.2, respectively. Among food group items, it was noted a low consumption of fish (only 4.4% reported consuming at least 3 times a week), legumes (only 9.6% reported consuming at least three times a week) and nuts (only 24.6% reported consuming at least once a week). Mean ± SD age and pre-gestational BMI of study group were 33±3.95 and 21.82 ±3.09, respectively. Only 11.9% of patients were overweight (BMI 25-29.9) and 1.6% obese (BMI ≥ 30) before pregnancy. The study participants with higher BMI, subscapularis and total skinfold measurement had significantly lower serum adiponectin levels (r= -0,3, p= 0.007 and r= -0.2, p= 0.003, respectively). In the first trimester, the most prevalent FGIDs using ROME III questionnaire was unspecified irritable bowel syndrome (IBS) (43%), followed by bloating + constipation (4%) and positive red flags (10%). There was any significantly difference in incidence of FGIDs during pregnancy. Pregnant women affected by bloating and constipation during the second trimester showed significantly lower med score ( 5.66 ± 0.57 vs 7.37 ± 1.46, p= 0.048); a negative association between mediterranean score and homocysteinemia was observed during second trimester (r= -0.2601, p= 0.028). In contrast to study group with no gastro-intestinal symptoms, pregnant women affected by unspecified IBS and more likely to have red flags during second trimester had significantly higher serum C3 levels and hyperomocisteinemia, respectively (1.46 ±0.16 vs 1.33±0.19, p= 0.007; 7.63 ± 1.36 vs 6.55 ±1.31, p=0.014). A positive association was observed between maternal weight gain, abdominal circumference, and red flags during third trimester (75.8 ± 11.69 vs 69.7 ± 9.66, p=0.04) (109.61 ±7.95 vs 104.08 ±7.06, p=0.013). Finally, positive red flags showed during third trimester were significantly associated to increased neonatal birth weight (3581.15 ±336.14 vs 3306.11 ±412.82, p=0.026). Conclusions Nutritional components have profound effects on digestive and immune systems. The different components of a “global unbalanced diet”, added to chemicals and pollutes substances might interfere with the balance between human genome and inherited microbioma, and gastrointestinal symptoms , such as constipation, bloating and cramping, appear. So far these disorders had been correlated to the effect of progesterone on smooth muscle during pregnancy; nowdays thy could be interpreted as pre-existing condition transformed into symptomatic condition by pregnancy. The findings suggest that a correct nutritional profile could prevent gastrointestinal disorders during pregnancy and prevent metabolic syndrome in the future.