Groente congres Donderdag 26 maart 2015, WTC Rotterdam
Het belang van groente eten vóór en tijdens de zwangerschap
Department of Obstetrics and Gynaecology Dutch Association of Parent and Patient Organizations University of Southampton, Southampton, UK
Sophia Children's Hospital
Régine P.M. Steegers-Theunissen MD PhD Professor in Periconception Epidemiology 1
3
Preconception
Pregnancy Birth
1
10
20
40
80 years
Preconception
Pregnancy Birth
1
10
20
40
80 years
Periconceptie periode
Steegers-Theunissen et al, Hum Reprod Update 2013, 19(6):640-55
I
-14 wk
X
X
Subfertiliteit 15% (45.106)
Miskraam 25-50% (50.106)
I conceptie
Cong afwijking 5% (8.106)
SGA 10% (5.106)
I
10 wk
Steegers-Theunissen, 2011
Foliumzuurbronnen
Extra foliumzuur: Verlaagd het risico op spina bifida, hartafwijkingen en lip- en gehemeltespleten met 50% tot 70% Verhoogd het geboortegewicht Prof. R.W. Smithells 1924-2003
Verhoogd aantal zaadcellen, embryo kwaliteit en zwangerschapskans
200% lip en/of gehemelte spleet
Vujkovic et al, Hum Reprod 2007
280% laag geboortegewicht 70% spina bifida 60% congenitale hartafwijkingen 40% zwangerschapskans Timmermans et al, Br J Nutr 2012 28;108(8):1399-409, Vujkovic et al, BJOG 2009, 116(3):408-15; Obermann-Borst et al, BJOG 2011;118(10):1205-15, Vujkovic et al, Fertil Steril. 2010;94(6):2096-101, Vujkovic et al, Hum Reprod. 2009 Jun;24(6):1304-12
40% million sperm count
Chavarro et al, 2011
50% miljoen zaadcellen
Vujkovic et al, Hum Reprod 2007
Rotterdam periconceptie cohort
4D-view
Barco I-Space Embryo at 9+1 weeks gestational age
• Serial first trimester 3D ultrasound measurements (6-12 weeks gestational age) • Projection of 3D-US on three walls and the floor by 8 different projectors in Barco I-space • Enables more precise measurements using third dimension
Embryonale gezondheid Maternale foliumzuur concentratie
Q3 vs Q4 -4.5 mm (-7.5%)
CRL (in mm)
RBC folate in quartiles (nmol/L) Q1 800 - 1200 Q2 1200 - 1500
Q3 vs Q4 -1.3 mm (-23.5%)
Q3 1500 - 1800 Q4 1800 - 3000
poverall=0.004 pQ4-Q3=0.0097 Gestational age in weeks
Van Uitert et al, Hum Reprod 2013
Voeding en leefstijl en het 1-C metabolism Groenten zijn essentieel voor groei en ontwikkeling DNA-synthesis Nucleotide excision repair
Synthesis of dTMP
-proteins -lipids
FOLATE DHF
TS
Synthesis of
THF
dUMP
methionine NO //
5,10-methylene-THF
MTHFR
DMG
[vitamin B12] MS MTRR TC2 ROS
5-methyl-THF Oxydative pathway Apoptosis pathway -NMDA receptor Inflammatory pathway
Methyl acceptor
SAM
BHMT
Chromatin-methylation
NNMT nicotinamide
Betaine SAH
Methylated acceptor
HOMOCYSTEINE homocysteine
[vitamin B6] CBS
-choline, phospholipids -neurotransmitters, adrenaline -proteins, DNA, creatinine
DNA methylation Glutamate
Intracelllular signalling retinal retinoic acid Glutathione
cystathionine [vitamin B6] cysteine Oxydative pathway Apoptosis pathway -NMDA receptor Inflammatory pathway
Free radicals ROOH+
ROH
GSSG
Ongezonde voeding en leefstijl verstoren 1C-stofwisseling, groei en ontwikkeling
2 ) 4D view
2 )
3 )
I Space
I Space
METHYL -
METHYL -
EPIGENETICA: Programmering van het erfelijk materiaal
Preconception
Pregnancy Birth
1
10
20
40
80 years
Hoe zorgen we voor een gezonde voeding en leefstijl vóór en tijdens de zwangerschap?
©Eric Steegers & Anjo Geluk, 2012
©Eric Steegers & Anjo Geluk. Gezond zwanger worden. Atlas Contact, 2012
Smarter Pregnancy Platform 3.0 CE1 Personal lifestyle coaching Couples and health care professionals
www.slimmerzwanger.nl
www.slimmerzwanger.nl/nl/demo-en.php www.smarterpregnancy.uk.org
Multifunctional device independent platform: • Folic acid, vegetables, fruits, smoking, alcohol • Modules for safe medication use (IVF, CVD..) hospital appointments, physical exercise • Vitamine D • 3 recipes/week, vouchers folic acid, pregnancy test
www.slimmerzwanger.nl/onderzoek www.slimmerzwangerworden.nl
Survey results 2012-2013 Compliance and usability
60
1 (disagree)
50
40 30
2 %
Evaluation (pre)pregnancy clinics 86% participation 6% no smartphone 8% other reasons
3
20 10
4
0 Screening
Coaching
General
5 (agree)
Survey 65% compliance 26 weeks coaching 49-74% positive usability
Survey results 2012-2013
% increase of adequate vegetable intake compared to baseline
35 Total (n=1473)
30 25
Women (n=1201)
20 Men (n=272)
15 10
Couples (n=299)
5 Obese women (n=495)
0 6
12
18
24 (weeks)
Survey results 2012-2013
% increase of adequate folic acid supplement use compared to baseline 80 Women (n=250)
70 60
Men (n.a.)
50 40
Couples (n=63)
30 20
Obese women (n=126)
10 0 6
12
18
24 (weeks)
Resultaten: Zwangerschapskans
Zwangeren (n=603) Baseline risicoscore, median (range)
3 (0-14)
Baseline risicoscore: 9 6 3
+ 19% + 36%
Niet-zwangeren (n=922) 4 (0-18)
www.slimmeretenmetjekind.nl
Gezonde voeding en leefstijl vanaf het vroegste begin in het leven Social media
Health Lifestyle Environment Occupation Income
Health Biomarkers DNA Lifestyle
Behavior Parents
Marketing
Gen practitioner Midwife Gynecologist Geneticists
Child Health Lifestyle Behavior Anthropometrics
Stakeholders
Public health
Health professional Education
Consumption Behavior
Health data Biomarkers DNA Lifestyle
