E

Figure 4 The relative concentration of nutrients in the maternal and fetal circulations. The concentration differences for each nutrient class are represented by the area of the circle in the fetal circulation relative to the maternal circulation. Apart from glucose the relative concentrations of individual nutrients within the nutrient groups are shown as segments of the circle. For triglyceride the fractions are saturated (SFA) monounsaturated (MUFA), essential (EFA), and long-chain polyunsaturated fatty acids (LCPUFA). For vitamin E the fractions are «-tocopherol (a-toc), 7-tocopherol (7-toc), and ¿-tocopherol (<5-toc). For vitamin A the abbreviated fractions are ^-carotene (,3-car) and a-carotene (a-car). (Reproduced with permission from: Berghaus TM, Demmelmair H, and Koletzko B (1998) Fatty acid composition of lipid classes in maternal and cord plasma at birth. European Journal of Pediatrics 157: 763-768; Kiely M, Cogan PF, Kearney PJ and Morrissey PA (1999) Concentrations of tocopherols and carotenoids in maternal and cord blood plasma. European Journal of Clinical Nutrition 53: 711-715; Cetin I., Marconi AM, Bozzetti P, Sereni LP, Corbetta C, Pardi G, and Battaglia FC (1988) Umbilical amino acid concentrations in appropriate and small for gestational age infants: a biochemical difference present in utero. American Journal of Obstetrics and Gynecology 158: 120-126; Bozzetti P, Ferrari MM, Marconi AM, Ferrazzi E, Pardi G, Makowski EL, and Battaglia FC (1988) The relationship of maternal and fetal glucose concentrations in the human from midgestation until term. Metabolism 37: 358-363.)

maternal side at term. The fat-soluble vitamins (A, E, and D) are also present in the fetal circulation in lower concentrations than in the maternal circulation. These materno-fetal concentration differences for the macronutrients develop gradually throughout gestation.

It is less easy to generalize about the trans-placental gradient for minerals as some are at a

(small but normal) t risk of adult disease

Adverse outcome t risk of perinatal death t risk of preterm delivery t risk of cognitive deficit

Placental insuffiency

Occurs in a subset of IUGR fetuses. Identified by abnormal umbilical flow. Associated with changes in cord blood nutrient levels; * amino acids, * glucose, * lipids

Birth weight linked to adult risk of CVD, diabetes, and hypertension

* risk of induction

* risk of obstetric complications

(small but normal) t risk of adult disease

Adverse outcome t risk of perinatal death t risk of preterm delivery t risk of cognitive deficit

Placental insuffiency

Occurs in a subset of IUGR fetuses. Identified by abnormal umbilical flow. Associated with changes in cord blood nutrient levels; * amino acids, * glucose, * lipids

Birth weight linked to adult risk of CVD, diabetes, and hypertension

* risk of induction

* risk of obstetric complications

Figure 5 The normal distribution of birth weights and relative risks associated with babies that are small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and those subjected to intrauterine growth retardation (IUGR), and the relationship to placental insufficiency.

lower concentration in the fetal circulation (Se, Cu, Ba), some are higher (Ca, Zn, Be, Rb), and some are about the same (Co, Mg, Mo, Sn, Bi, Cd, Cs, La, Li, Pb). Iron is particularly important during pregnancy and its concentration in the fetal venous blood leaving the placenta is almost 3 times that of the maternal serum. Iron is transported in the serum on the transport protein transferrin and, like the fats and fat-soluble vitamins, its rate of transfer may be influenced by the availability of free binding sites.

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