Does Fetal Growth Adequacy Affect the Nutritional Composition of Mothers' Milk?: A Historical Cohort Study

Lia Correia; Manuela Cardoso; Ana Luísa Papoila; Marta Alves; Daniel Virella; Renata Ramalho; Paula Pereira; Israel Macedo; Teresa Tomé; Álvaro Cohen; Luís Pereira-da-Silva

doi:10.1055/s-0041-1727278

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(02): 163-171
DOI: 10.1055/s-0041-1727278

Original Article

Does Fetal Growth Adequacy Affect the Nutritional Composition of Mothers' Milk?: A Historical Cohort Study

Lia Correia

¹Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group (G.E.N.A.-IUEM), Egas Moniz Higher Education School, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal

,

Manuela Cardoso

¹Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group (G.E.N.A.-IUEM), Egas Moniz Higher Education School, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal

²Nutrition Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Ana Luísa Papoila

³Research Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Marta Alves

³Research Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Daniel Virella

³Research Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

⁴Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Renata Ramalho

¹Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group (G.E.N.A.-IUEM), Egas Moniz Higher Education School, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal

,

Paula Pereira

¹Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group (G.E.N.A.-IUEM), Egas Moniz Higher Education School, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal

,

Israel Macedo

⁵Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Teresa Tomé

⁵Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Álvaro Cohen

⁶Prenatal Diagnosis, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

,

Luís Pereira-da-Silva

⁴Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

⁷Comprehensive Health Research Centre, Medicine of Woman, Children, and Adolescent, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

› Author Affiliations

Abstract

Objective The study aimed to assess the association between intrauterine growth of preterm infants and energy and macronutrient contents in their mothers' milk.

Study Design A historical cohort of mothers of preterm infants was assessed according to offspring's intrauterine growth. Fetal growth restriction (FGR) was defined as small-for-gestational age or appropriate for gestational age with fetal growth deceleration. During the first 4 weeks after delivery, the composition of daily pool samples of mothers' milk was measured by using a mid-infrared human milk analyzer. Explanatory models for milk energy, true protein, total carbohydrate, and fat contents were obtained by generalized additive mixed effects regression models.

Results In total, 127 milk samples were analyzed from 73 mothers who delivered 92 neonates. Energy content was significantly higher in mothers with chronic hypertension (average: +6.28 kcal/dL; 95% confidence interval [CI]: 0.54–12.01; p = 0.034) and for extremely preterm compared with very preterm infants (average: +5.95 kcal/dL; 95% CI: 2.16–9.73; p = 0.003), and weakly associated with single pregnancies (average: +3.38 kcal/dL; 95% CI: 0.07–6.83; p = 0.057). True protein content was significantly higher in mothers with chronic hypertension (average: +0.91 g/dL; 95% CI: 0.63–1.19; p < 0.001) and with hypertension induced by pregnancy (average: +0.25 g/dL, 95% CI: 0.07–0.44; p = 0.007), and for extremely preterm compared with very and moderate preterm infants (average: +0.19; 95% CI: 0.01–0.38; p = 0.043 and +0.28 g/dL; 95% CI: 0.05–0.51; p = 0.017, respectively). Fat content was weakly and negatively associated with FGR, both in SGA infants and AGA infants with fetal growth deceleration (average: −0.44 g/dL; 95% CI: −0.92 to −0.05; p = 0.079 and average: −0.36 g/dL; 95% CI: −0.74 to −0.02; p = 0.066, respectively).

Conclusion Energy and macronutrient contents in mothers' milk of preterm infants was significantly and positively associated with the degree of prematurity and hypertension. The hypothesis that the composition of milk is associated with FGR was not demonstrated.

Key Points

Energy and protein are higher for more immature infants.
Energy and/or protein is higher in hypertension.
Fat may be lower for infants with intrauterine growth restriction.

Keywords

fetal growth restriction - maternal hypertension - mothers' milk composition - prematurity - twin pregnancy

Full Text

References

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Supplementary Material

Supplementary Material