LONGITUDINAL NUTRITIONAL INTAKES IN ITALIAN PREGNANT WOMEN IN COMPARISON WITH NATIONAL NUTRITIONAL GUIDELINES AND PLACENTAL ANTIOXIDANT DEFENSES AND AUTOPHAGY-RELATED GENES IN MATERNAL OBESITY AND GESTATIONAL DIABETES MELLITUS

Nutritional quality during pregnancy is crucial for the health status of mother and child. Maternal obesity and gestational diabetes mellitus (GDM) are increasing worldwide, representing principal risk factors for both mother and child short/long-term outcomes. Oxidative stress, lipotoxicity and altered autophagy have already been reported in obesity, but few studies have focused on obese pregnant women with GDM. The aim of this Doctoral Thesis is to: - evaluate the adherence to pregnancy nutritional recommendations during the three pregnancy trimesters in Italy in pre-gestational Normal Weight and Over Weight women; - evaluate antioxidant and macro/chaperone-mediated autophagy (CMA)-related gene expression in obese and GDM placentas Data presented in the first study derived from the analyses of 176 women (NW=133; OW=43) with a healthy singleton pregnancy, enrolled within 13+6 weeks of gestation. Dietary intake was assessed with a Food Frequency Questionnaire (FFQ) in each trimester. Gestational weight gain (GWG) did not differ between subgroups. Recommendations for caloric intake were never reached from both subgroups in each trimester. Proteins intake was higher than recommendations in first and second trimester for both subgroups. Sugars percentage was always increased in both subgroups while dietary fiber intake decreased in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied in both subgroups, while sodium intake was always greater than suggested. These results indicate that both NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy. Inadequacies in micronutrients intake were also observed. Nutrition in pregnancy needs adequate survey and educational intervention as well as supplementation when indicated. In the second study a total of 47 women with singleton pregnancies delivered by elective cesarean section were enrolled: 16 normal weight (NW), 18 obese with no comorbidities (OB GDM(–)), 13 obese with GDM (OB GDM(+)). Placental gene expression was assessed by real-time PCR. Antioxidant gene expression (CAT, GPX1, GSS) decreased, the pro-autophagic ULK1 gene increased and the chaperone-mediated autophagy regulator PHLPP1 decreased in OB GDM(–) vs. NW. On the other hand, PHLPP1 expression increased in OB GDM(+) vs. OB GDM(–). Sexual dimorphism for both antioxidant and CMA-related gene expressions was found. These preliminary results can pave the way for further analyses aimed at elucidating the placental autophagy role in metabolic pregnancy disorders and its potential targetability for the treatment of diabetes outcomes.