Het belang van groente eten vóór en tijdens de zwangerschap

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1 Groente congres Donderdag 26 maart 2015, WTC Rotterdam Het belang van groente eten vóór en tijdens de zwangerschap Sophia Children's Hospital Department of Obstetrics and Gynaecology Dutch Association of Parent and Patient Organizations University of Southampton, Southampton, UK Régine P.M. Steegers-Theunissen MD PhD Professor in Periconception Epidemiology 1

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4 Preconception Pregnancy Birth years

5 Preconception Pregnancy Birth years

6 Periconceptie periode Steegers-Theunissen et al, Hum Reprod Update 2013, 19(6):640-55

7 X X Subfertiliteit Miskraam Cong afwijking SGA 15% ( ) 25-50% ( ) 5% ( ) 10% ( ) I I -14 wk conceptie 10 wk I Steegers-Theunissen, 2011

8 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 Verhoogd aantal zaadcellen, embryo kwaliteit en zwangerschapskans

9 200% lip en/of gehemelte spleet Vujkovic et al, Hum Reprod 2007

10 280% laag geboortegewicht 70% spina bifida 60% congenitale hartafwijkingen 40% zwangerschapskans Timmermans et al, Br J Nutr ;108(8): , Vujkovic et al, BJOG 2009, 116(3):408-15; Obermann-Borst et al, BJOG 2011;118(10): , Vujkovic et al, Fertil Steril. 2010;94(6): , Vujkovic et al, Hum Reprod Jun;24(6):

11 40% million sperm count Chavarro et al, 2011

12 50% miljoen zaadcellen Vujkovic et al, Hum Reprod 2007

13 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

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15 CRL (in mm) Embryonale gezondheid Maternale foliumzuur concentratie Q3 vs Q4-4.5 mm (-7.5%) RBC folate in quartiles (nmol/l) Q Q Q3 vs Q4-1.3 mm (-23.5%) Q Q p overall =0.004 p Q4-Q3 = Gestational age in weeks Van Uitert et al, Hum Reprod 2013

16 Voeding en leefstijl en het 1-C metabolism Groenten zijn essentieel voor groei en ontwikkeling DNA-synthesis Nucleotide excision repair dump dtmp TS 5,10-methylene-THF MTHFR FOLATE DHF THF [vitamin B 12 ] MTRR TC2 NO // 5-methyl-THF MS ROS Synthesis of -proteins -lipids methionine BHMT DMG Betaine homocysteine SAM SAH HOMOCYSTEINE Methyl acceptor NNMT nicotinamide Methylated acceptor Synthesis of -choline, phospholipids -neurotransmitters, adrenaline -proteins, DNA, creatinine Chromatin-methylation Glutamate DNA methylation Oxydative pathway Apoptosis pathway -NMDA receptor Inflammatory pathway [vitamin B 6 ] CBS cystathionine [vitamin B6] cysteine Intracelllular signalling retinal retinoic acid Glutathione Free radicals ROOH+ Oxydative pathway Apoptosis pathway -NMDA receptor Inflammatory pathway GSSG ROH

17 Ongezonde voeding en leefstijl verstoren 1C-stofwisseling, groei en ontwikkeling 2 ) 4D view I Space I Space 2 ) 3 )

18 METHYL - METHYL - EPIGENETICA: Programmering van het erfelijk materiaal

19 Preconception Pregnancy Birth years

20 Hoe zorgen we voor een gezonde voeding en leefstijl vóór en tijdens de zwangerschap?

21 Eric Steegers & Anjo Geluk, 2012

22 Eric Steegers & Anjo Geluk. Gezond zwanger worden. Atlas Contact, 2012

23 Smarter Pregnancy Platform 3.0 CE1 Personal lifestyle coaching Couples and health care professionals 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

24 Survey results Compliance and usability % Screening Coaching General 1 (disagree) (agree) Evaluation (pre)pregnancy clinics 86% participation 6% no smartphone 8% other reasons Survey 65% compliance 26 weeks coaching 49-74% positive usability

25 Survey results % increase of adequate vegetable intake compared to baseline (weeks) Total (n=1473) Women (n=1201) Men (n=272) Couples (n=299) Obese women (n=495)

26 Survey results % increase of adequate folic acid supplement use compared to baseline (weeks) Women (n=250) Men (n.a.) Couples (n=63) Obese women (n=126)

27 Resultaten: Zwangerschapskans Zwangeren (n=603) Niet-zwangeren (n=922) Baseline risicoscore, median (range) 3 (0-14) 4 (0-18) Baseline risicoscore: % %

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29 Gezonde voeding en leefstijl vanaf het vroegste begin in het leven Health Lifestyle Environment Social media Behavior Occupation Income Parents Marketing Gen Health Biomarkers DNA Lifestyle practitioner Midwife Gynecologist Geneticists Stakeholders Consumption Behavior Public Child Health Lifestyle Behavior Anthropometrics health Education Health professional Health data Biomarkers DNA Lifestyle