Evidence that fetal nutrition influences adult health has heightened interest in nutritional interventions targeting pregnancy. However, as is true for other placental mammals, human females have evolved mechanisms that help buffer the fetus against short-term fluctuations in maternal diet and energy status. In this review, we first discuss the evolution of increasingly elaborate vertebrate strategies of buffering offspring from environmental fluctuations during development, including the important innovation of the eutherian placenta. We then present the Maternal Nutritional Buffering Model, which argues that, in contrast to many micronutrients that must be derived from dietary sources, the effects of short-term changes in maternal macronutrient intake during pregnancy, whether due to a deficit or supplementation, will be minimized by internal buffering mechanisms that work to ensure a stable supply of essential resources. In contrast to the minimal effects of brief macronutrient supplementation, there is growing evidence that sustained improvements in early life and adult pre-pregnancy nutrition could improve birth outcomes in offspring. Building on these and other observations, we propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself. Our model leads to the prediction that birth weight will be more strongly influenced by the mother's chronic pre-pregnancy nutrition than by pregnancy diet, and highlights the need for policy solutions aimed at optimizing future, intergenerational health outcomes. Lay summary: We propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself.

中文翻译：

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孕产妇营养缓冲模型：孕期营养干预的进化框架。

胎儿营养会影响成人健康的证据引起了人们对针对怀孕的营养干预的浓厚兴趣。但是，正如其他胎盘哺乳动物一样，人类雌性动物已经进化出机制，有助于缓冲胎儿免受孕产妇饮食和能量状况的短期波动。在这篇综述中，我们首先讨论了逐渐复杂的脊椎动物策略在进化过程中缓冲后代免受环境波动影响的演变，包括优色胎盘的重要创新。然后，我们介绍了孕产妇营养缓冲模型，该模型认为，与必须从饮食来源中获取的许多微量营养素相反，孕期孕产妇大量营养素摄入的短期变化（无论是由于营养不足还是由于补充）所产生的影响，内部缓冲机制将最大程度地减少这种缓冲，这些机制可确保稳定地供应重要资源。与短暂补充大量微量营养素的微不足道相反，越来越多的证据表明，早期生活的持续改善和成年前的怀孕营养可以改善后代的出生结局。基于这些和其他观察结果，我们认为，如果通过在受孕之前甚至在早期发育过程中以营养为目标来改变母亲的妊娠代谢，改善胎儿大量营养素输送的策略将是最有效的策略，作为对传统的加强宏观营养素关注的补充怀孕期间本身的摄入量。我们的模型得出的预测是，母亲的长期孕前营养比妊娠饮食对出生体重的影响更大，并强调了旨在优化未来的代际健康结果的政策解决方案的必要性。摘要：我们建议，如果通过在受孕之前甚至在早期发育过程中以营养为目标来改变母亲的妊娠代谢，那么改善胎儿大量营养素输送的策略将是最有效的，作为对传统的在怀孕期间加强营养素摄入的传统方法的补充。