INTRODUCTION
Starting with the Barker’s hypothesis in the early 90’, maternal
nutrition during pregnancy has been recognized as a crucial determinant
of placental function and intrauterine growth, with long-lasting and
intergenerational effects on future disease risk profile of the
offspring (1-4). This long-term “programming” of future health status
has been related to maternal nutritional exposures mainly through
epigenetic modifications, that could realize both before conception -by
affecting the process of gametogenesis- and during pregnancy (5,6).
Currently, the adherence to nutritional guidelines is dangerously low,
with alarming rates of obesity worldwide and micronutrient deficiencies
that have been documented even in industrialized countries (7-10).
Therefore, a universal nutritional counselling and screening represent a
pivotal issue in early pregnancy, requiring proper evaluations in order
to improve both individual and population health. In this setting, the
development of a simple and reproducible nutritional checklist is of
utmost importance.
In this context, a pilot study on 112 healthy women with singleton
pregnancies and non-malformed outcome demonstrated that a first
trimester nutritional score measuring the adherence to a healthy diet
and lifestyle in early pregnancy was significantly associated with first
trimester biochemical and ultrasound markers of placental function (11).
In particular, higher maternal nutritional scores were associated with
increased serum pregnancy-associated plasma protein-A (PAPP-A)
concentrations, lower uterine artery mean pulsatility index, and
decreased placental volume at the first trimester screening ultrasound,
whereas no associations were detected with free β-human chorionic
gonadotropin (free β-HCG). The analysis on birth outcomes additionally
showed a significant positive association between first trimester
maternal nutritional score and gestational age at birth. These results
provided the evidence of a strong association between maternal
nutritional habits and pregnancy outcomes, possibly mediated by early
impacts on placental function and development. Furthermore, this study
possibly provided a simple clinical tool for an early nutritional
screening deeply impacting on pregnancy outcome and clinical practice.
The Simple Study is a longitudinal prospective multicenter study
designed to identify possible associations between first trimester
maternal nutritional score, early markers of placental function, and
pregnancy outcome on a large population of singleton pregnancies in
Italy. In particular, the aims of the study are:
- to assess first trimester nutritional score and nutritional adequacy
in a large population of singleton pregnancies;
- to investigate associations between first trimester maternal
nutritional score and early markers of placental function and fetal
growth;
- to evaluate associations between first trimester nutritional score and
maternal, fetal and neonatal outcomes, including: birthweight,
gestational age at birth, blood loss at delivery, gestational weight
gain, adverse maternal (hypertensive disorders, gestational diabetes and
cesarean section) and feto-neonatal outcomes (intrauterine growth
restriction, preterm delivery).