Published on 4 September 2022

    A longitudinal study concerned with improving the nutritional status of mothers could potentially help to reduce pregnancy complications as well as help future generations lead healthier lives.

    There’s no doubt that a mother’s exposure to various elements during her pregnancy can affect her baby’s well-being.

    As such, behaviour such as avoiding raw seafood and alcohol, going on special diets, and taking supplements is typical for new mothers. But what about before pregnancy? Could an enhanced dietary plan on the mother’s part, even before she gets pregnant, help to bolster the health of her offspring? 

    To answer this question, an international group has embarked on a clinical trial to test if a specific blend of nutrients and probiotics – consumed prior to conception and throughout pregnancy – could positively target the long-term health of babies. 

    This is with a particular interest in diminishing obesity and diabetes rates in future generations, with the researchers also positing that this intervention, by inducing a good nutritional status, could even reduce the risk of pregnancy complications.

    “The importance of the preconception period on maternal and offspring health is being increasingly recognised, but there are very few randomised control trials seeking to optimise preconception nutrition,” said principal investigator Prof Wayne Cutfield, from the University of Auckland in New Zealand.

    The NiPPeR trial

    Known as NiPPeR (Nutritional Intervention Preconception and during Pregnancy to maintain healthy glucosE levels and offspRing health), the study aims to fill that gap by presenting for the first time a clinical trial of a novel non-pharmacological approach, starting prior to conception and extending throughout pregnancy, said Prof Keith Godfrey, Chief Investigator of the trial from the MRC Lifecourse Epidemiology Unit at the University of Southampton. 

    Evidence has shown that if the mother has particularly high blood sugar levels during pregnancy, she runs the risk of predisposing the baby to increased body fat, and even diabetes later on in life. This could pose serious consequences to future generations. 

    Furthermore, according to the International Diabetes Federation (IDF), Singapore has the second-highest prevalence rate of diabetes amongst developed nations. Approximately 15% of Singaporean women in their 20s and 30s also possess a pre-diabetic condition known as impaired glucose intolerance, which means a greater risk of developing gestational diabetes during pregnancy and type 2 diabetes in future.  

    “It is truly an exciting prospect if this innovative supplement taken by women could lead to the ‘programming’ of better metabolic health in the next generation. It could significantly dampen the rising trend of diabetes in our nation,” said the principal investigator of this trial in Singapore, A/Prof Chan Shiao-Yng, Senior Consultant, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynaecology, National University Hospital (NUH).

    The study also sought to find out if consuming a nutritional blend pre-conception could reduce the rate of pregnancy complications – in particular, preterm labour. Such complications, along with gestational diabetes, are of special concern as they can have far-reaching effects, potentially affecting the life-long health of the offspring’s health, said A/Prof Chan. 

    In order to draw out long-term results, the women were followed from pre-conception all the way till their baby’s first year of life, with follow-up of the children (now aged 2 and 3 years) currently ongoing. There are also plans for further follow-up in future. 

    So far, the nutritional intervention has not been found to influence the mother’s blood sugar levels during pregnancy or the babies’ birth weights. However, it did decrease the incidence of preterm births, especially in cases where there were preterm pre-labour rupture of membranes. 

    “Preterm delivery is a serious, common and costly public health problem worldwide that continues to increase in incidence,” said Prof Godfrey. “Preterm pre-labour rupture of membranes is a major cause of preterm birth. The study findings highlight the potential value of the mix of nutrients and probiotics in reducing the risk of preterm birth and supporting a timely delivery.”

    If validated and applied, the study’s findings could be a step towards easing this global problem. To this end, the team highlighted the importance of the trial’s multinational aspect, noting that more than five ethnic groups were recruited into the study for greater generalisability across the board.

    “One of the strengths of our study is the diversity of its participants as we have involved women of multiple ethnicities from the general population across three countries, which means that the outcomes have wide relevance to women planning for pregnancy,” said A/Prof Chan. “Additionally, the study included blinded intervention and control groups, so bias is minimised.”

    The primary outcome paper was published in the journal Diabetes Care earlier this year. The study was developed and led by investigators of the multi-national EpiGen Academic Research Consortium – which counts among its members NUH as well as the National University of Singapore and the Singapore Institute for Clinical Sciences, A*STAR – in collaboration with Nestlé Research. 

    More outcomes in both the mothers and infants will be published as the study continues. 

    Written in consultation with A/Prof Chan Shiao-Yng, Senior Consultant, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynaecology, NUH.

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