Elsevier

Placenta

Volume 27, Issues 6–7, June–July 2006, Pages 527-534
Placenta

Current topic
Influence of Endurance Exercise and Diet on Human Placental Development and Fetal Growth

https://doi.org/10.1016/j.placenta.2005.07.010Get rights and content

The delivery of oxygen and substrate to the maternal–fetal interphase is the major maternal environmental stimulus which either up- or down-regulates feto-placental growth. During pregnancy, sustained exercise sessions cause an intermittent reduction in oxygen and substrate delivery to the interphase that may exceed 50% during the exercise but, it is probable that regular bouts of sustained exercise or exercise training may improve oxygen and substrate delivery at rest. The type of maternal carbohydrate intake (low- versus high-glycemic sources) and food intake frequency also influence substrate availability through their effects on maternal blood glucose levels and insulin sensitivity.

As a result, different exercise regimens and/or different types of carbohydrate intake modify feto-placental growth. The magnitude and direction of the effect is determined by their average 24-h effect on oxygen and substrate availability at different time-points in pregnancy. In general, exercise in early and mid pregnancy stimulates placental growth while the relative amount of exercise in late pregnancy determines its effect on late fetal growth. Low-glycemic food sources in the diet decrease growth rate and size at birth while high-glycemic food sources increase it. Thus, it may be possible to improve pregnancy outcomes in both healthy, low-risk women and a variety of high-risk populaces by simply modifying maternal physical activity and dietary carbohydrate intake during pregnancy.

Introduction

In recent years it has become apparent that both the maternal environment and maternal lifestyle factors influence many of the maternal physiological adaptations to pregnancy that regulate feto-placental growth. The purpose of this paper is to review what is known about the interaction amongst two maternal lifestyle variables (specific types of physical activity and dietary intake) and feto-placental growth in the human. It begins with a brief discussion of current growth-regulatory concepts and mechanisms that may mediate these interactions. This is followed by a review of the effects of maternal exercise and diet on the physiological variables of interest. Then, some of the descriptive and intervention studies, which address the effects of exercise and diet on feto-placental growth, will be discussed. Finally, the potential preventive and/or therapeutic value of maternal exercise and diet in the health care of those at risk for disorders of placentation or growth in utero due to social, environmental or medical circumstance is addressed. The review ends with a brief discussion of exercise prescription for healthy women experiencing uncomplicated pregnancies.

Section snippets

Mechanism of feto-placental growth regulation

A large amount of experimental data reviewed elsewhere [1], [2], [3], [4], [5], indicates that the availability and rate of delivery of oxygen and nutrient at the maternal–fetal interphase are major regulators of feto-placental growth in multiple animal species and the human. For instance, the early observations of Ziegler [6] suggested that increased maternal intake of processed carbohydrate stimulated fetal growth rate in the human. This hypothesis was tested experimentally by Mellor [7]. In

Maternal physiological variables of interest

The rate of placental bed blood flow, hemoglobin content, the partial pressure of oxygen and the concentration of nutrient in maternal arterial blood are the basic physiological determinants of the availability or rate of delivery of oxygen and substrate at the maternal–fetal interphase.

Normal pregnancy adaptations that increase placental bed blood flow include hormonally mediated vascular growth and remodeling, changes in vascular tone and distensibility, trophoblastic invasion, decreased

Acute and chronic effects of exercise and diet on placental bed blood flow and nutrient delivery

During acute exercise the rate of visceral blood flow decreases as flow rate to the exercising muscle and skin increases [24], [25]. The magnitude of the decrease varies with the type (intermittent versus sustained, weight bearing versus non-weight bearing, muscle mass utilized, etc.), intensity and duration of the exercise. The magnitude of the exercise-associated decrease in the rate of placental bed blood flow during human pregnancy has not been directly ascertained. However, animal studies,

Effect of maternal exercise on placental growth and development

Studies assessing the effect of maternal exercise on placental growth and functional capacity are limited but all indicate that regular weight-bearing forms of exercise influence placental growth and anatomic indices of functional capacity [36], [37], [38], [39], [40]. The exact reason for this remains unclear but, as discussed earlier, it is likely that the exercise-induced intermittent fluctuations in substrate and oxygen delivery produce a recurrent stimulus which evokes a different overall

Effect of maternal exercise on size at birth and neonatal lean body mass and fat mass

The placental effects detailed above would be expected to alter nutrient transfer, fetal growth rate, size at birth and neonatal morphometrics. Our experience indicates that is indeed the case. Although many studies reviewed elsewhere have not identified an effect on size at birth [3], [34], [43], our experience indicates that these specific effects on growth are obvious at birth. The results of our prospective, randomized studies indicate that the reasons for this discrepancy are threefold.

Effect of diet on maternal blood glucose levels, placental development, size at birth, neonatal fat mass and lean body mass

Our studies on the effects of maternal sustained, weight-bearing exercise on fetal growth and development began over 20 years ago. Initially, we attributed the exercise effects on maternal weight gain and size at birth entirely to excessive energy expenditure and the recurrent exercise-induced decreases in maternal blood glucose levels and placental bed blood flow which limited delivery of oxygen and substrate to the placental site [47], [48]. After 10 years experience, however, it became clear

The potential clinical value of modifying maternal exercise and diet

Exercise and diet are two easily modifiable lifestyle variables that have been shown to influence various aspects of feto-placental growth and to specifically reduce the risk of small-for-gestational age newborns in an at-risk populace [4], [30], [31], [38], [39], [40], [43], [56]. Furthermore, maternal benefits are clear and follow-up studies have demonstrated that both have either neutral or positive effects on neurodevelopment and growth in infancy and childhood [43], [58], [59], [60].

Thus,

Summary

In summary, these findings indicate that both maternal physical activity and dietary glycemic load modify several of the physiological adaptations to pregnancy that are coincidentally important acute and chronic regulators of the availability of oxygen and substrate at the maternal–fetal interphase. The latter appears to be the major factor that initiates a growth-regulatory sequence which balances feto-placental growth rate with the availability of substrate and oxygen from the maternal

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