Background: During a woman's pregnant state, a diet that is adequate in nutrition is critical to the developing fetus, especially in the lower socioeconomic status population. The healthcare provider is charged with the acute fundamental awareness of this additional factor that can grossly impact pregnancy. Nutritional advice from the health care provider is one of many key points that contribute to the successful outcome of the pregnancy. Purpose: The purpose of this quality improvement project was to develop a standardized, evidence-based practice (EBP) protocol for the management of maternal nutrition, gestational weight gain, and physical activity for provider use at an LSE community clinic. Theoretical Framework: Theory of Planned Behavior Methods: After receiving institutional support for the implementation of the protocol presentation and instruction of the Maternal Nutrition Guideline, pre- and post-surveys were administered to eligible participants. A quantitative descriptive design was used for the project. Results: There were twenty-six respondents for both the pre-and post-survey. The data analysis revealed that two questions revealed the most significant increase between the pre-and post-survey occasions utilizing the Mann-Whitney test and related to physical activity during pregnancy and dietary intake. An independent sample t-test was performed to compare the two occasions. There was a tendency for an increase in the the total score between the pre-and post-surveys, but the difference did not reach statistical significance, which may be related to sample size (t24df = 1.782, p =0.087). Conclusion: A standardized, evidence-based nutritional guideline is a necessary tool to serve as a consistent resource and empower all health care providers to bring awareness and understanding to facilitate positive outcomes to the obstetric patient population for which they care.

Introdução - Ao longo das últimas décadas o mundo vivenciou grandes mudanças no padrão alimentar da população mundial, que resultou no aumento do consumo de produtos ultraprocessados e redução do consumo de frutas e hortaliças. No período gestacional, a nutrição materna exerce papel importante tanto em desfechos obstétricos como perinatais. O ganho de peso excessivo ou insuficiente e a deficiência de micronutrientes contribuem para complicações de curto e longo prazo para a mãe e para o bebê. Objetivo - Investigar a associação entre frequência de consumo de frutas, hortaliças e produtos ultraprocessados e indicadores do estado nutricional em gestantes de Cruzeiro do Sul. Métodos Trata-se de uma análise transversal dos dados de estudo de coorte de gestantes inscritas no pré-natal da atenção básica à saúde na área urbana da cidade de Cruzeiro do Sul, estado do Acre, Amazônia Ocidental Brasileira. Entre fevereiro de 2015 a janeiro de 2016 foram coletados dados socioeconômicos e obstétricos (obtidos por entrevista domiciliar até a 20ª semana gestacional) e antropométricos, bioquímicos e dietéticos maternos (obtidos na 1ª avaliação clínica, entre a 16ª e 20ª semana de gestação, realizada na unidade de saúde). O estado nutricional foi avaliado pela frequência de anemia (hemoglobina sanguínea < 110 g/L), deficiência de vitamina A (retinol sérico < 0,70 mol/L), concentrações séricas de vitamina E, ácido fólico e -caroteno e índice de massa corporal (IMC, kg/m2) pré-gestacional autoreferido. A associação entre variáveis categóricas foi investigada por meio do teste do Qui- Quadrado de Pearson e comparações entre variáveis contínuas foram realizadas pelo teste de Mann Whitney. Resultados Dentre as 860 gestantes rastreadas, 183 eram não elegíveis e 171 houve perda de contato para o estudo. Portanto, para a presente análise, foram incluídas 506 gestantes, das quais 26 por cento eram adolescentes (< 20 anos), 44 por cento primigestas e 76 por cento referiram cor de pele parda. Anemia e deficiência de vitamina A foram observadas em 15,4 por cento e 10,9 por cento das gestantes estudadas, respectivamente. No total, as frequências de baixo peso (IMC< 18,5kg/m²) e excesso de peso (IMC 25 kg/m²) segundo IMC pré-gestacional foram 10,1 por cento e 30,7 por cento , respectivamente. Concentrações séricas abaixo das medianas de -caroteno, vitamina E e folato foram associadas à menor idade (< 20 anos), menor escolaridade (< 10 anos), ser beneficiária do programa bolsa família e ser chefe de família. Anemia e deficiência de vitamina A foram também associadas à menor idade, menor escolaridade e menor IMC pré-gestacional. Gestantes com consumo diário de frutas e hortaliças apresentaram maiores concentrações séricas (mediana; intervalo interquartil em mol/L) de -caroteno (0,50; 0,30- 0,84) e vitamina A (1,90; 1,10-2,70) quando comparadas às gestantes sem consumo diário desses alimentos, para -caroteno (0.40; 022-0.76) e vitamina A séricos (1,70; 1,00-2,50). Não houve associação entre consumo de produtos ultraprocessados e os indicadores bioquímicos avaliados. Conclusões - Na presente população de estudo, características sócio demográficas foram associadas ao estado nutricional no segundo trimestre gestacional. O consumo diário de frutas e hortaliças influenciou positivamente as concentrações séricas de - caroteno e vitamina A das gestantes. Esses resultados reforçam a importância de programas de promoção social integrados `as ações para incentivo à alimentação saudável visando à melhoria das condições de saúde materna. / Introduction - Over the past decades we have seen major changes in dietary patterns of the worldwide population, with an increasing consumption of ultra-processed products and low consumption of fruits and vegetables. During pregnancy, maternal nutrition plays an important role on both obstetric and perinatal health outcomes. Excessive or insufficient weight gain and micronutrient deficiencies also contribute to short and long-term complications for both mother and baby. Objective To investigate the association among frequency of consumption of fruits, vegetables and ultra-processed products and nutritional status indicators of pregnant women in Cruzeiro do Sul. Methods - This is a cross-sectional data analysis of pregnant women, who were part of a cohort study of prenatal at primary health care in the urban area of Cruzeiro do Sul, Acre state, Brazilian Western Amazon. From February 2015 to January 2016 socioeconomic and obstetric data were collected through home interviews and anthropometric, biochemical and maternal diet were obtained on the 1st clinical evaluation, amongst 16th and 20th pregnancy weeks, conducted in local health unit. Nutritional status was assessed through prevalence of anemia (blood hemoglobin < 110 g/L), vitamin A deficiency (serum retinol < 0,70 mol/L), serum concentrations of vitamin E, folic acid and -carotene and self-reported pre-pregnancy Body Mass Index (BMI, kg/m2). The association between categorical variables was considered by using the chi-square test of Pearson and comparisons between continuous variables were conducted using the Mann Whitney test. Results: Overall, 860 pregnant women were screened; of them, 183 was ineligible for the study and 171 were lost during follow-up. Thus, the final number for this analysis was 506 pregnant women: 26% were adolescents (<20 years), 44% were at firstpregnancy and 76% reported brown skin color. Anemia and vitamin A deficiency were observed in 15.4% and 10.9% in the sample, respectively. The frequency of low body weight (BMI< 18,5kg/m²) and overweight (BMI 25 kg/m²) according to the pre-pregnancy BMI were 10.1% and 30.7%, respectively. Serum concentrations below the median values for - carotene, vitamin E and folate were associated with younger age (<20 years), lower schooling years (<10 years), beneficiary of the Cash Transfer Program (Bolsa Família), and when the pregnant woman is the householder of the family. Anemia and vitamin A deficiency were associated with younger age, less education and lower pre-pregnancy BMI. Pregnant women with daily consumption of fruits and vegetables had higher serum concentrations (median, interquartile range in mmol / L) of -carotene (0.50, 0.30 to 0.84) and vitamin A (1.90, 1.10 - 2.70) compared with those who did not have daily consumption of these foods, for both serum concentrations of -carotene (0:40; 022-0.76) and vitamin A (1.70; 1.00 to 2.50). There was no association between consumption of ultra-processed products and biochemical indicators. Conclusions In this study population, sociodemographic characteristics were associated with nutritional status in the second trimester of pregnancy. The daily consumption of fruits and vegetables positively influenced serum concentrations of -carotene and vitamin A in pregnant women. These results emphasize the importance of social support programs for scaling up nutrition interventions in order to improve maternal health status.

Objetivos: Estimar a prevalência de inadequação da ingestão de folato alimentar, assim como analisar esta prevalência considerando o ácido fólico proveniente da fortificação de alimentos em gestantes adultas. Casuística e métodos: Estudo observacional, com análise secundária de dados provenientes de um estudo prospectivo conduzido entre 103 gestantes usuárias de Unidades Básicas de Saúde (UBS) do município de Ribeirão Preto, SP. Foram incluídas no presente estudo todas as gestantes que apresentaram dados completos referentes ao consumo alimentar ao longo da gestação, totalizando 82 mulheres. Os dados dietéticos foram obtidos por meio de três inquéritos recordatórios de 24 horas (IR24H), durante a gravidez. A distribuição da ingestão habitual do folato alimentar e folato dietético, que corresponde ao folato alimentar adicionado ao ácido fólico proveniente da fortificação dos alimentos, foi ajustada pelo método do National Research Council (1986). Para estimar a prevalência de inadequação do nutriente empregou-se o método do requerimento médio estimado - Estimated Average Requirement (EAR) como ponto de corte. Resultados: Verificou-se que 100% das gestantes avaliadas não atingiram as recomendações nutricionais estabelecidas para o nutriente (EAR = 520 g DFE), quando foi considerado somente o folato alimentar. Ao analisar a ingestão do folato dietético, a prevalência de inadequação observada foi de 94%. Conclusão: As prevalências de inadequação da ingestão de folato alimentar, assim como a do folato dietético mostraram-se elevadas, identificando-se que a fortificação das farinhas com ácido fólico não repercutiu em melhoria da disponibilidade desta vitamina. / Objectives: To estimate the prevalence of inadequacy intake of food folate as well as analyze this prevalence considering the folic acid from flour fortification in pregnant woman. Methods: Observational study, with secondary analysis of data from a prospective study conducted among 103 pregnant women users of the Basic Health Units (BHU) of Ribeirão Preto, Brazil. Were included in this study all women who had complete data on the dietary intake during pregnancy, on total 82 women. Dietary data were obtained using three 24-hour dietary recalls (IR24H) during pregnancy. The distribution of the usual dietary intake of food folate and dietary folate, which corresponds to food folate added to the folic acid from the flour fortification, has been adjusted by the method of the National Research Council (1986). To estimate the prevalence of nutrient inadequacy employed the method of the estimated average requirement - Estimated Average Requirement (EAR) as the cutoff point. Results: It was found that 100% of pregnant women reported inadequate dietary intakes of food folate. Considering the intake of dietary folate, the prevalence of inadequacy observed was 94%. Conclusion: The prevalence of inadequacy intake of food folate, as well as the dietary folate were high, identifying the fortification of flour with folic acid did had little impact in improving the availability of this vitamin.

Objetivos: Estimar a prevalência de inadequação da ingestão de folato alimentar, assim como analisar esta prevalência considerando o ácido fólico proveniente da fortificação de alimentos em gestantes adultas. Casuística e métodos: Estudo observacional, com análise secundária de dados provenientes de um estudo prospectivo conduzido entre 103 gestantes usuárias de Unidades Básicas de Saúde (UBS) do município de Ribeirão Preto, SP. Foram incluídas no presente estudo todas as gestantes que apresentaram dados completos referentes ao consumo alimentar ao longo da gestação, totalizando 82 mulheres. Os dados dietéticos foram obtidos por meio de três inquéritos recordatórios de 24 horas (IR24H), durante a gravidez. A distribuição da ingestão habitual do folato alimentar e folato dietético, que corresponde ao folato alimentar adicionado ao ácido fólico proveniente da fortificação dos alimentos, foi ajustada pelo método do National Research Council (1986). Para estimar a prevalência de inadequação do nutriente empregou-se o método do requerimento médio estimado - Estimated Average Requirement (EAR) como ponto de corte. Resultados: Verificou-se que 100% das gestantes avaliadas não atingiram as recomendações nutricionais estabelecidas para o nutriente (EAR = 520 g DFE), quando foi considerado somente o folato alimentar. Ao analisar a ingestão do folato dietético, a prevalência de inadequação observada foi de 94%. Conclusão: As prevalências de inadequação da ingestão de folato alimentar, assim como a do folato dietético mostraram-se elevadas, identificando-se que a fortificação das farinhas com ácido fólico não repercutiu em melhoria da disponibilidade desta vitamina. / Objectives: To estimate the prevalence of inadequacy intake of food folate as well as analyze this prevalence considering the folic acid from flour fortification in pregnant woman. Methods: Observational study, with secondary analysis of data from a prospective study conducted among 103 pregnant women users of the Basic Health Units (BHU) of Ribeirão Preto, Brazil. Were included in this study all women who had complete data on the dietary intake during pregnancy, on total 82 women. Dietary data were obtained using three 24-hour dietary recalls (IR24H) during pregnancy. The distribution of the usual dietary intake of food folate and dietary folate, which corresponds to food folate added to the folic acid from the flour fortification, has been adjusted by the method of the National Research Council (1986). To estimate the prevalence of nutrient inadequacy employed the method of the estimated average requirement - Estimated Average Requirement (EAR) as the cutoff point. Results: It was found that 100% of pregnant women reported inadequate dietary intakes of food folate. Considering the intake of dietary folate, the prevalence of inadequacy observed was 94%. Conclusion: The prevalence of inadequacy intake of food folate, as well as the dietary folate were high, identifying the fortification of flour with folic acid did had little impact in improving the availability of this vitamin.

Introdução - Ao longo das últimas décadas o mundo vivenciou grandes mudanças no padrão alimentar da população mundial, que resultou no aumento do consumo de produtos ultraprocessados e redução do consumo de frutas e hortaliças. No período gestacional, a nutrição materna exerce papel importante tanto em desfechos obstétricos como perinatais. O ganho de peso excessivo ou insuficiente e a deficiência de micronutrientes contribuem para complicações de curto e longo prazo para a mãe e para o bebê. Objetivo - Investigar a associação entre frequência de consumo de frutas, hortaliças e produtos ultraprocessados e indicadores do estado nutricional em gestantes de Cruzeiro do Sul. Métodos Trata-se de uma análise transversal dos dados de estudo de coorte de gestantes inscritas no pré-natal da atenção básica à saúde na área urbana da cidade de Cruzeiro do Sul, estado do Acre, Amazônia Ocidental Brasileira. Entre fevereiro de 2015 a janeiro de 2016 foram coletados dados socioeconômicos e obstétricos (obtidos por entrevista domiciliar até a 20ª semana gestacional) e antropométricos, bioquímicos e dietéticos maternos (obtidos na 1ª avaliação clínica, entre a 16ª e 20ª semana de gestação, realizada na unidade de saúde). O estado nutricional foi avaliado pela frequência de anemia (hemoglobina sanguínea < 110 g/L), deficiência de vitamina A (retinol sérico < 0,70 mol/L), concentrações séricas de vitamina E, ácido fólico e -caroteno e índice de massa corporal (IMC, kg/m2) pré-gestacional autoreferido. A associação entre variáveis categóricas foi investigada por meio do teste do Qui- Quadrado de Pearson e comparações entre variáveis contínuas foram realizadas pelo teste de Mann Whitney. Resultados Dentre as 860 gestantes rastreadas, 183 eram não elegíveis e 171 houve perda de contato para o estudo. Portanto, para a presente análise, foram incluídas 506 gestantes, das quais 26 por cento eram adolescentes (< 20 anos), 44 por cento primigestas e 76 por cento referiram cor de pele parda. Anemia e deficiência de vitamina A foram observadas em 15,4 por cento e 10,9 por cento das gestantes estudadas, respectivamente. No total, as frequências de baixo peso (IMC< 18,5kg/m²) e excesso de peso (IMC 25 kg/m²) segundo IMC pré-gestacional foram 10,1 por cento e 30,7 por cento , respectivamente. Concentrações séricas abaixo das medianas de -caroteno, vitamina E e folato foram associadas à menor idade (< 20 anos), menor escolaridade (< 10 anos), ser beneficiária do programa bolsa família e ser chefe de família. Anemia e deficiência de vitamina A foram também associadas à menor idade, menor escolaridade e menor IMC pré-gestacional. Gestantes com consumo diário de frutas e hortaliças apresentaram maiores concentrações séricas (mediana; intervalo interquartil em mol/L) de -caroteno (0,50; 0,30- 0,84) e vitamina A (1,90; 1,10-2,70) quando comparadas às gestantes sem consumo diário desses alimentos, para -caroteno (0.40; 022-0.76) e vitamina A séricos (1,70; 1,00-2,50). Não houve associação entre consumo de produtos ultraprocessados e os indicadores bioquímicos avaliados. Conclusões - Na presente população de estudo, características sócio demográficas foram associadas ao estado nutricional no segundo trimestre gestacional. O consumo diário de frutas e hortaliças influenciou positivamente as concentrações séricas de - caroteno e vitamina A das gestantes. Esses resultados reforçam a importância de programas de promoção social integrados `as ações para incentivo à alimentação saudável visando à melhoria das condições de saúde materna. / Introduction - Over the past decades we have seen major changes in dietary patterns of the worldwide population, with an increasing consumption of ultra-processed products and low consumption of fruits and vegetables. During pregnancy, maternal nutrition plays an important role on both obstetric and perinatal health outcomes. Excessive or insufficient weight gain and micronutrient deficiencies also contribute to short and long-term complications for both mother and baby. Objective To investigate the association among frequency of consumption of fruits, vegetables and ultra-processed products and nutritional status indicators of pregnant women in Cruzeiro do Sul. Methods - This is a cross-sectional data analysis of pregnant women, who were part of a cohort study of prenatal at primary health care in the urban area of Cruzeiro do Sul, Acre state, Brazilian Western Amazon. From February 2015 to January 2016 socioeconomic and obstetric data were collected through home interviews and anthropometric, biochemical and maternal diet were obtained on the 1st clinical evaluation, amongst 16th and 20th pregnancy weeks, conducted in local health unit. Nutritional status was assessed through prevalence of anemia (blood hemoglobin < 110 g/L), vitamin A deficiency (serum retinol < 0,70 mol/L), serum concentrations of vitamin E, folic acid and -carotene and self-reported pre-pregnancy Body Mass Index (BMI, kg/m2). The association between categorical variables was considered by using the chi-square test of Pearson and comparisons between continuous variables were conducted using the Mann Whitney test. Results: Overall, 860 pregnant women were screened; of them, 183 was ineligible for the study and 171 were lost during follow-up. Thus, the final number for this analysis was 506 pregnant women: 26% were adolescents (<20 years), 44% were at firstpregnancy and 76% reported brown skin color. Anemia and vitamin A deficiency were observed in 15.4% and 10.9% in the sample, respectively. The frequency of low body weight (BMI< 18,5kg/m²) and overweight (BMI 25 kg/m²) according to the pre-pregnancy BMI were 10.1% and 30.7%, respectively. Serum concentrations below the median values for - carotene, vitamin E and folate were associated with younger age (<20 years), lower schooling years (<10 years), beneficiary of the Cash Transfer Program (Bolsa Família), and when the pregnant woman is the householder of the family. Anemia and vitamin A deficiency were associated with younger age, less education and lower pre-pregnancy BMI. Pregnant women with daily consumption of fruits and vegetables had higher serum concentrations (median, interquartile range in mmol / L) of -carotene (0.50, 0.30 to 0.84) and vitamin A (1.90, 1.10 - 2.70) compared with those who did not have daily consumption of these foods, for both serum concentrations of -carotene (0:40; 022-0.76) and vitamin A (1.70; 1.00 to 2.50). There was no association between consumption of ultra-processed products and biochemical indicators. Conclusions In this study population, sociodemographic characteristics were associated with nutritional status in the second trimester of pregnancy. The daily consumption of fruits and vegetables positively influenced serum concentrations of -carotene and vitamin A in pregnant women. These results emphasize the importance of social support programs for scaling up nutrition interventions in order to improve maternal health status.

Fetal programming is a relatively new and quickly growing field of research in the livestock industry. The concept of fetal programming is simply defined as the effects a change in maternal nutritional intake has on offspring, whether it be a genetic or physical change. The intention of this study was to specifically look at the effects of nutrient restriction of cows during the second trimester of gestation on the growth and performance of the resulting calves. In this study, thirty-two cows of predominantly angus influence from the Utah state university herd were chosen, naturally bred to a pure bred angus sire, and then allocated into two treatments: maintenance and restricted. These groups were treated uniformly for first and third trimesters of gestation, while in the second trimester, they were managed in a way that the maintenance group maintained a greater level of body condition and weight compared with the restricted group. Calf growth and performance was measured and compared for effects of fetal programming. Previous studies in beef found positive effects on carcass characteristics. However, little work has been done to ensure that fetal programming is not detrimental to calves early in life. Though this study did find that nutrient restriction resulted in more excitable cattle, no negative effects caused by programming were found in growth and performance of the offspring.

Vitamins are readily available in the modern diet due to liberalized fortification and supplementation policies. This research tested the hypothesis that high multi-vitamin intake by Wistar rats during pregnancy leads to the development of obesity and characteristics of the metabolic syndrome in the offspring. Pregnant Wistar rats were fed the AIN-93G diet containing either the recommended (RV) or 10-fold increase (HV) in vitamin content. Pups were weaned to the RV diet (Study 1), an obesogenic liquid diet (Ob, Study 2), low vitamin diets (1/3RV or 1/6RV, Study 3), or a nutrient selection paradigm (NSP) with 10% and 60% casein diets (Study 4). Body weight (BW), food intake (FI), glucose and insulin responses, appetite hormones, abdominal fat pad mass (FPM) and systolic blood pressure (SBP) was measured. Expressions of mRNA for hypothalamic serotonin (5-HT) receptors and proopiomelanocortin (POMC) were measured in Study 4. Males, but not females, born to HV dams had higher post-weaning BW and FI when weaned to the RV or 1/3RV diet, and exhibited components of metabolic syndrome, including higher FPM, hyperglycemia, insulin resistance and elevated SBP compared with those born to RV dams. The Ob diet led to exaggerated weight gain and expressions of components of metabolic syndrome in both sexes born to dams fed the HV diet. Female pups on the 1/6RV diet from HV dams had two-fold higher glucose response and lower insulin response, but no difference in post-weaning BW and daily FI compared to those from RV dams. In contrast to the pups born to HV dams and fed a single diet, those from the HV dams and on the NSP gained less weight and ate less, and had lower hypothalamic mRNA expressions of 5-HT receptors and POMC. In conclusion, high multi-vitamin intake during pregnancy may lead to obesity, and result in a higher risk of developing characteristics of metabolic syndrome in the offspring. However, sex, weaning diet composition, and the presence of diet choice alter the outcomes.

Vitamins are readily available in the modern diet due to liberalized fortification and supplementation policies. This research tested the hypothesis that high multi-vitamin intake by Wistar rats during pregnancy leads to the development of obesity and characteristics of the metabolic syndrome in the offspring. Pregnant Wistar rats were fed the AIN-93G diet containing either the recommended (RV) or 10-fold increase (HV) in vitamin content. Pups were weaned to the RV diet (Study 1), an obesogenic liquid diet (Ob, Study 2), low vitamin diets (1/3RV or 1/6RV, Study 3), or a nutrient selection paradigm (NSP) with 10% and 60% casein diets (Study 4). Body weight (BW), food intake (FI), glucose and insulin responses, appetite hormones, abdominal fat pad mass (FPM) and systolic blood pressure (SBP) was measured. Expressions of mRNA for hypothalamic serotonin (5-HT) receptors and proopiomelanocortin (POMC) were measured in Study 4. Males, but not females, born to HV dams had higher post-weaning BW and FI when weaned to the RV or 1/3RV diet, and exhibited components of metabolic syndrome, including higher FPM, hyperglycemia, insulin resistance and elevated SBP compared with those born to RV dams. The Ob diet led to exaggerated weight gain and expressions of components of metabolic syndrome in both sexes born to dams fed the HV diet. Female pups on the 1/6RV diet from HV dams had two-fold higher glucose response and lower insulin response, but no difference in post-weaning BW and daily FI compared to those from RV dams. In contrast to the pups born to HV dams and fed a single diet, those from the HV dams and on the NSP gained less weight and ate less, and had lower hypothalamic mRNA expressions of 5-HT receptors and POMC. In conclusion, high multi-vitamin intake during pregnancy may lead to obesity, and result in a higher risk of developing characteristics of metabolic syndrome in the offspring. However, sex, weaning diet composition, and the presence of diet choice alter the outcomes.

More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is known about the effect fruit and vegetable intake on perinatal outcomes. Omega-3 (n-3) fatty acids are essential dietary components and are known to affect inflammatory state, but little is known about how they affect inflammation in pregnancy. As current evidence is lacking, further research is needed to investigate the relationships between maternal nutrition in pregnancy, inflammation and birth outcomes. The purposes of this dissertation were to: 1) to review and evaluate the current evidence on the relationship between n-3 fatty acids and inflammation in pregnancy; 2) to evaluate the current state of the science on the impact of maternal dietary consumption of fruits and vegetables on preterm birth, gestational diabetes, preeclampsia, small for gestational age, gestational weight gain and measures of inflammation or oxidative stress in pregnancy; and 3) to examine relationships between maternal dietary intake of fruits and vegetables, cytokine expression in early and mid-pregnancy, preterm birth and gestational hypertension. A critical review of literature examining the relationship between inflammation and n-3 intake during pregnancy found that multiple inflammatory cytokines in maternal and fetal tissues were lower in women who received n-3 supplements. A second review of literature review supported an inverse relationship between fruit and vegetables and risk of preeclampsia and suboptimal fetal growth. The available evidence was insufficient to establish relationships between fruit and vegetable intake and gestational diabetes, preterm birth or inflammation. A study evaluating the relationships between maternal fruit and vegetable intake, inflammation and birth outcomes was conducted. This study provided evidence supporting a relationship between first and second trimester cytokine expression and maternal dietary intake of fruits and vegetables. Those who met recommended vegetable intake in the first trimester had higher first trimester serum CRP, IL1-α, IL-6 and TNF-α and lower first trimester cervicovaginal IL-6 levels. Those who met recommendations for first trimester fruit intake had 56% lower risk for preterm birth. Those who met second trimester vegetable intake recommendations had more than twice the risk of developing gestational hypertension. The results of this dissertation provide support for the beneficial effects of omega-3 fatty acids and fruit and vegetable intake in pregnancy. Maternal intake of these dietary components may promote optimal immune status during pregnancy. Supplementation of maternal omega-3 fatty acids may help regulate inflammation via the anti-inflammatory effects their bioactive eicosanoids exert. Fruit and vegetables have antioxidant and anti-inflammatory effects that may also help balance the inflammatory state during pregnancy. These dietary components may help promote favorable immune status during pregnancy and reduce risk of adverse perinatal outcomes such as poor fetal growth, hypertensive disorders of pregnancy and preterm birth.

This research investigates maternal nutritional status through the analysis of young infants (N=27) that are likely pre-weaned from two Roman occupational periods at Put Dragulina. Because young infants are solely dependent on the nutritional status of their mother while in utero and postpartum through the consumption of breast milk, the presence of skeletal pathologies positively associated to nutritional deficiencies on the remains of young infants can be analyzed to reconstruct the nutritional status of the infant’s mother. This study finds that 89% (N=24) of young infants, regardless of occupational period, presented with skeletal pathologies consistent with nutritional deficiencies. These results suggest that the mothers who are absent from the Put Dragulina cemetery would have likely had poor nutritional statuses due to the high frequencies of nutritional stress indicators present on the skeletal remains of their infants.