**6. Areas of opportunity in fetal and lactating periods**

There are different ways to gauge the window of opportunity during pregnancy and lactation periods. Firstly, the mother's diet and physical activity during the preconceptional and pregnancy periods can induce favorable epigenetic modifications in early life. Second, the delivery way influences the intestinal microbiota composition of the newborn, where the advantage is vaginal delivery, followed by breastfeeding. At this point is quite important the physical contact between mother and child. Exclusive breastfeeding in the first 6 months, depending on the mother's diet, can stimulate the best epigenetic activity to keep a normal growth rate, avoiding a rapid development by direct action or through the intestinal microbiota functionality. After 6 months, a proper food introduction is essential for promoting present and future child's health, and for inducing a favorable intestinal microbiota balance.

As previously described, DNA methylation is crucial for processes epigenetically regulated. In the early embryogenic stage, most parental gametic methylation signs are erased before the acquisition of marks at implantation and beyond. Just after conception, the external environment influences early embryonic events, which are crucial for the DOHaD concept [79]. Therefore, the mother's diet, energy balance, composition as well as her nutritional status, and physical condition are determinant during the periconceptional period [80]. Depending on the nutrient balance and richness of the women's diet in methyl donor compounds, epigenetics modulation will promote normal growth to prevent accelerated fetal growth.

Dietary recommendations during pregnancy are related to amounts of energy, macro-, and micronutrients, such as vitamins and minerals. Dietary reference intake is 340 extra calories during the 2nd pregnancy trimester and 452 for the third one [81]. Pregnant women require a diverse diet, including fruits, vegetables, legumes, nuts, seeds, grains, and tubers, as well as animal-origin products such as dairy, meat, poultry, fish, and eggs. In contrast, pregnant women should avoid some raw seafood, alcohol, and caffeine.

Often health-related practices of a particular cultural group, based on its beliefs, negatively or positively affect the science-based dietary recommendations. For instance, Western diet patterns can fulfill the extra calories for pregnancy, mainly with animal-based products and supplements of vitamins and minerals. Although animal-origin foods contain enough choline, during pregnancy the folate requirement is 600 ug/d and the fiber recommendation is high (28–30 g/d), so supplements are needed [81]. Plant origin fiber is the best recommendation because fruits and vegetables contain in addition to fiber, some very important compounds with antioxidant activity, as well the methyl donor compounds such as betaine and folates, present in leafy green vegetables, broccoli, beans, and peas.

In addition to a diverse and balanced diet, during pregnancy physical activity is necessary for improving glucose tolerance and insulin activity, preventing excessive weight gain. The mother's emotional well-being is important for the fetus, and fitness promotes an easier delivery.

#### *Could Alterations in the Infant Gut Microbiota Explain the Development of Noncommunicable… DOI: http://dx.doi.org/10.5772/intechopen.105168*

The delivery mode defines the structure of the neonatal microbiota with an advantage of vaginal delivery over C-section delivery, and it is a key factor for the right development of the immune system [82]. The vaginal microbiota is the source of bacterial colonization for the neonate, with implications for the neonate and the mother's health. Before delivery, the vaginal microbiota is mainly dominated by Lactobacillus, and just after delivery, it becomes diverse and similar to the neonatal oral microbiota [83].

In some cases, vaginal delivery is not possible, and C-section is done; additionally, because of strong causes, such as illness and drug treatments, feeding is through milk formulas. Apparently, the window of opportunity is lost, but there are other techniques to ensure healthy microbiota, for example, the use of probiotics, prebiotics, synbiotics, and postbiotics (PPSP) either by the mother or by the newborn. Prebiotics are nondigestible components of food that selectively promote the growth of beneficial bacteria in the intestine; while probiotics are live microorganisms that, administered in adequate amounts, confer a health benefit. On the other hand, synbiotics are a combination of prebiotics and probiotics, while postbiotics are an emerging option, which are soluble products or metabolites (such as SCFA) of commensal bacteria or bacterial components that provide benefits to the host [84]. The use of a combination of strains principally *Bifidobacterium* with or without prebiotics led to an increasing population of bifidobacteria in the newborn microbiota, close to the one of vaginal delivery. Although the effect is larger in breastfeeding children, due to the prebiotic effect of breast milk, even in mixed or formula feeding, there is an additional effect if the intervention begins just after birth [82].

There are still hospitals that pull apart the newborn from the mother if there was a C-section delivery, premature birth, or another reason associated with the mother or newborn's health. Independently of the delivery mode, skin-to-skin contact between mother and child just after the first hour of life improves the possibility of exclusive breastfeeding in the lactation period. This technique helps to reduce neonatal morbidity due to multiple benefits; for instance, stabilizes cardiopulmonary function, and reduces the risk of hypoglycemia, hypothermia, and infections. After delivery, the effect on the mother is a reduction in anxiety and postpartum bleeding [85]. Everywhere, the neonatal intensive care units should promote family participative care, assisting skin-to-skin contact between the mother and newborn as soon as possible, for the establishment of breastfeeding [86].

Regarding general dietary recommendations during breastfeeding, there are higher requirements for carbohydrates and energy intake of up to 500 extra calories, from the beginning to 6 months of lactation. In addition, choline, dietary fiber, and water intake should be higher during the breastfeeding period than during pregnancy [81]. Besides a balanced diet with animal and vegetable sources, mothers should avoid some raw seafood, alcohol, smoking, and caffeine. It is very important to have the best diet for the mother and child's well-being. Installation of breastfeeding is mandatory to induce a good balance of the child's intestinal microbiota, for appropriate immune system development and general child health.

Once and again, microbiota appears in this chapter. It is because the community of different microorganisms in the intestinal tract produces metabolites and cell detritus involved in human metabolic functions. Furthermore, the microbiota influences the immune and central nervous systems; as such, the inhibition of the feeding activity promotes neurons, which ultimately decreases appetite [87]. Therefore, microbiota in dysbiosis could be implicated in metabolic disorders, such as obesity.

A strategy to help the infant to maintain the balance and achieve the stability of its microbiota is to make a correct introduction of solid foods in its diet or complementary feeding. It starts when breast milk or formula composition is not sufficient to accomplish the nutritional requirements of infants, usually from six to 23 months. Breastfeeding can continue at the same time as complementary feeding; the focus is to provide nutrients enough to meet the nutritional requirements of infants. A complementary feeding that is carried out in a staggered manner allows the microbiota to adapt and enrich itself in diversity; thus, it becomes more stable. The problem is that if neglected, complementary feeding has the potential to contribute to childhood overweight and obesity [88].

PPSPs have shown beneficial potential for treating overweight and obesity in children. The proposed mechanism is the modulation of the structure of the microbiota, the profile of microbial metabolites, and the improvement of the intestinal barrier mechanism [84, 89]. In patients with T2D, the use of PPSP decreases fasting blood glucose, total cholesterol, triglycerides, and insulinemia, as demonstrated in the meta-analysis by Bock et al. [90]. However, more studies are still needed to define its role in the prevention and/or treatment of chronic noncommunicable diseases, especially during pregnancy and early childhood.

The task to accomplish a good approach to raising a healthy child across the life course looks so difficult, but any effort pays off with profit. A well-planned pregnancy followed by a balanced and diverse diet, a vaginal delivery with immediate breastfeeding, skin-to-skin contact between mother and newborn, and basic care for the first months is crucial for the metabolic programming of the baby. However, also a carefully complementary feeding from 6 to 24 months, as well as an adequate lifestyle, will help maintain eubiosis, the proper maturation, and functioning of the immune system, and reduce the risk of developing early chronic diseases.

### **7. Conclusion**

There is evidence that demonstrates the relationship between alterations in the intestinal microbiota and the risk of developing chronic noncommunicable diseases throughout life, such as obesity, T2D, and stroke. The involved mechanisms derive from the local and systemic effect of microbiota products, such as SCFAs, indoles, anthocyanins, TMAOs, and BA, as modulators of the inflammatory response and lipid metabolism, among others. Perinatal and early childhood factors modulate the first microbiota and early metabolic programming by epigenetic mechanisms. Thus, the intestinal microbiota is an additional component to the epigenetic mechanisms that strengthen the DOHaD theory and that should be considered in the establishment of preventive measures in the first 1000 days of life.
