Healthcare costs are rising at an exponential rate. Given the constraints of limited resources, it is essential to make informed decisions about priorities to ensure the best possible health outcomes globally. The history of medicine illustrates how these priorities have shifted over time - from early focus on infectious diseases to later emphasis on noncommunicable conditions such as metabolic disorders. Today, neurodegenerative diseases and aging brain are the forefront of medical research, as these conditions profoundly affect individuals, families, and society. One in three people will experience a mental health disorder in their lifetime, yet it is not widely recognized that many of these conditions may have origins in pre-birth experiences and early life influences. Disruptions in progenitor proliferation, neuronal and glial migration, and differentiation during prenatal development can contribute to lifelong neurodevelopmental abnormalities. Despite the fundamental importance of brain development, most of the neuroscience funding is allocated to studying neurodegeneration, such as dementia and Parkinson's disease, while early life influences remain underexplored. Crucially, the impact of developmental factors begins even before conception. Environmental risks extend beyond direct maternal exposures during pregnancy; they include cumulative parental exposure to teratogenic agents affecting both male and female gametes, as well as early life environmental exposures affecting newborns, infants, and children. These influences are complex yet highly relevant to long-term health outcomes. We urge greater recognition of the developmental origins of disease and advocate for increased investment in preventive strategies. These include lifestyle modifications, dietary improvements, targeted supplementation, regular exercise, and minimizing exposure to environmental pollutants. Addressing these factors proactively could yield profound benefits for both individual and public health.

Micronutrients are fundamental in maintaining the general health of a woman and play a pivotal role in reproductive health, with heightened importance during pregnancy and lactation. Deficiencies in vitamins and minerals-common globally-are associated with adverse maternal and fetal outcomes such as anemia, preeclampsia, gestational diabetes, neural tube defects (NTDs), and intrauterine growth restriction. Micronutrients may affect the programming of fetal origin of adult diseases. Micronutrient deficiency also plays a part in gynecological disorders such as polycystic ovary syndrome, infertility, endometriosis, fibroids and certain gynecological malignancies. A systematic review of 31 recent articles, including cohort studies and meta-analyses, was conducted through databases such as PubMed, Google Scholar and ScienceDirect. Twenty-five articles were selected based on relevance and methodological rigor. Deficiencies in iron, folate, vitamin D, zinc, iodine, and vitamin B12 are prevalent among pregnant women, particularly in India. Iron supplementation reduces anemia, but its broader impact remains inconclusive. Folic acid prevents up to 70% of NTDs when started preconceptionally. Calcium and vitamin D lower the risk of preeclampsia. Zinc and iodine deficiencies contribute to poor pregnancy outcomes. Multiple micronutrient supplementation (MMS) has shown superior efficacy compared to iron-folic acid alone in reducing low birth weight and small-for-gestational-age outcomes, though optimal formulations require further study. Adequate micronutrient intake is essential for optimal maternal and fetal health. MMS offers a promising intervention but should be tailored to individual needs to prevent over-supplementation. Future research must address micronutrient interactions, population-specific needs, and personalized nutrition strategies.

Objectives: This study aimed to test the extra-thyroidal impacts of maternal serum iodine concentrations (SICs) on metabolic factors and subsequent pregnancy outcomes. Methods: Single pregnant women aged 18-49 years were recruited during their first prenatal visits. SICs at first trimester (T1) were tested by ICP-MS. Metabolic factors [body mass index (BMI), fat %, glucose, lipids, uric acid, and blood pressure] were measured, and composite indices [the triglyceride-glucose (TyG) index, TyG-BMI, and the Framingham steatosis index (FSI)] were estimated. Obstetric and birth outcomes were retrieved from the hospital information system, including gestational diabetes (GDM), gestational hypertension (GH), fetal distress, postpartum hemorrhage, premature rupture of membrane, small and large for gestational age (SGA and LGA), preterm birth, and low birth weight. Multivariable linear and logistic regression models were applied to explore the associations between maternal SIC, metabolic factors, and pregnancy outcomes. Results: A total of 1456 mothers were included for analysis. Maternal LgSIC values at T1 were inversely associated with early gestational weight gain (β = -0.113, p < 0.001) and BMI at T1 (β = -0.070, p = 0.006), but they were positively associated with triglycerides (β = 0.142, p < 0.001), the TyG index (β = 0.137, p < 0.001), and uric acid (β = 0.060, p = 0.018). However, upon further adjustment for thyroid hormones, the associations were attenuated. The joint effects of high SIC and metabolic conditions (hyperlipidemia, high FSI, and GH) suggested increased adverse pregnancy outcomes (increased postpartum bleeding, reduced birth length, and reduced delivery weeks). Conclusions: Our prospective data in the iodine replete region indicated that high SICs at T1 were associated with increased risk of metabolic conditions and adverse birth outcomes, with the associations being independent of thyroid hormones.

Pregnancy simulates a metabolic syndrome-like state and predisposes to iodine deficiency and hypothyroidism through increased iodine renal loss and transplacental transfer to the fetus. Iodine deficiency is thought to predispose to dyslipidemia through elevation of serum TSH. Obesity, dyslipidemia, and hypothyroidism are established risk factors of preeclampsia. Hence, pregnant women with iodine deficiency are likely to be at increased risk of dyslipidemia and preeclampsia. We investigated the pattern of dyslipidemia among preeclamptic and normotensive pregnant women with and without iodine deficiency. The pathophysiological mechanisms linking iodine deficiency and dyslipidemia were delineated using bivariate correlations, logistic regression, and exploratory factor analysis of anthropometric, lipid profile, urine iodine concentration (UIC), and thyroid function data from 240 women with preeclampsia and 120 normotensive pregnant controls at term who attended Lomo Medical Centre, Democratic Republic of Congo (DRC). Preeclamptic women with iodine deficiency had significantly lower HDL-C but higher triglyceride levels than those with sufficient iodine intake. Both normotensive and preeclamptic participants with elevated TSH had high serum oxidized LDL-C but low NO, p < 0.001. SCH, secondary to iodine deficiency, is associated with elevated serum oxidized LDL and decreased Nitric Oxide (NO) among both normotensive and preeclamptic women, while insufficient iodine nutrition among preeclamptic women predisposes to reduced HDL-C and increased serum Triglycerides, which are risk factors of atherosclerosis and cardiovascular disease.

Growing evidence demonstrates that maternal nutrition is crucial for the health of the mother-to-be, and early life course of the offspring. However, for most micronutrients, guidelines are inconsistent. This Delphi study aimed to investigate the level of expert consensus on maternal nutrition and micronutrient needs during preconception, pregnancy and lactation. We conducted a two-round web-based Delphi survey on various topics including general approaches to diet and supplement use, and existing guidelines. For the periods of preconception, pregnancy and lactation, questions focused on the importance and strength of evidence for supplement use with the following micronutrients for low- and high-risk populations: folic acid, choline, iodine, magnesium, calcium, iron, selenium, docosahexaenoic acid (DHA), and vitamins B1, B2, B6, B12, D and K. Thirty-five experts participated in the panel, who were healthcare professionals (HCPs), researchers and joint HCP-researchers with expertise in nutrition, gynaecology and/or obstetrics. Panellists reached consensus on the importance of diet and dietary supplement use during pregnancy and agreed on the lack of clarity and consistency in current guidelines, and the need for education in these areas for HCPs, pregnant people and the general population. For general low-risk populations, there was consensus on the importance of supplement use with iron and vitamin D from preconception through lactation, with folic acid and iodine from preconception through the second and third trimesters, respectively, with DHA from the first trimester through lactation and with calcium during lactation. Panellists agreed that the evidence for supplement use with each of these micronutrients during these phases to improve outcomes and/or foetal development is strong, except for vitamin D (preconception), DHA (first trimester), and iron (both periods). There was also consensus that supplement use advice should be tailored for people following vegan/vegetarian diets, restricted diets due to food intolerances, obesity, polycystic ovary syndrome, diabetes mellitus, and previous nutrition-related pregnancy complications. The findings revealed robust consensus on various aspects of maternal nutrition, including the need for education, the lack of consistency in current guidelines on supplement use, the importance of supplement use across specific phases of pregnancy and the at-risk groups requiring tailored approaches.