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Garmendia ML, Corvalan C, Araya M, Casanello P, Kusanovic JP, Uauy R. Effectiveness of a normative nutrition intervention in Chilean pregnant women on maternal and neonatal outcomes: the CHiMINCs study. Am J Clin Nutr 2020; 112:991-1001. [PMID: 32692805 DOI: 10.1093/ajcn/nqaa185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited. OBJECTIVE We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile. METHODS This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care. RESULTS At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction < 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes. CONCLUSIONS Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.
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Affiliation(s)
- Maria Luisa Garmendia
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Camila Corvalan
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Marcela Araya
- Department of Women and Newborn Health Promotion, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Paola Casanello
- Department of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
| | - Ricardo Uauy
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.,Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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102
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Paulino DSM, Pinho-Pompeu M, Assumpção D, Kasawara KT, Surita FG. Dietary intake profile in high-risk pregnant women according to the degree of food processing. J Matern Fetal Neonatal Med 2020; 35:3330-3336. [PMID: 32924704 DOI: 10.1080/14767058.2020.1818213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVE Studies that address dietary intake theme during pregnancy are generally centered on specific nutrients or on dietary patterns. However, the maternal dietary profile according to the degree of food processing is poorly understood. The purpose of the present study was to describe the dietary profile of high-risk pregnant women according to the degree of food processing. MATERIALS AND METHODS A prospective cohort study was conducted at Prof. Dr. Jose Aristodemo Pinotti Women's Hospital (CAISM), University of Campinas, Brazil, with high-risk pregnant women in the third trimester of gestation. RESULTS Data from 125 high-risk pregnant women were collected between September 2017 and April 2019. The mean total energy intake (EI) was 1778.3 ± 495.79 kcal/day and the majority of the calories was from unprocessed foods (52.42%), followed by ultra-processed foods (25.46%). The consumption of free sugar and sodium exceeded recommendations, while the consumption of fiber, calcium, folate and iron was below recommendations. The ultra-processed foods intake affects dietary patterns negatively. CONCLUSION More than 50% of the EI of high-risk pregnant women is from unprocessed or minimally processed foods, but it is insufficient for meeting dairy fiber, iron, folate and calcium recommendations.
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Affiliation(s)
| | - Maira Pinho-Pompeu
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Daniela Assumpção
- Department of Pediatrics, University of Campinas, Campinas, SP, Brazil
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Hanson MA, McAuliffe FM, Louise Killeen S, Maria Jacob C, Hod M. New guidelines, position paper, and insights from the FIGO Pregnancy Obesity and Nutrition Initiative (PONI). Int J Gynaecol Obstet 2020; 151 Suppl 1:1-3. [PMID: 32894585 DOI: 10.1002/ijgo.13321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mark A Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Moshe Hod
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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104
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McAuliffe FM, Killeen SL, Jacob CM, Hanson MA, Hadar E, McIntyre HD, Kapur A, Kihara AB, Ma RC, Divakar H, Hod M. Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non-Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline. Int J Gynaecol Obstet 2020; 151 Suppl 1:16-36. [PMID: 32894590 PMCID: PMC7590083 DOI: 10.1002/ijgo.13334] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Eran Hadar
- Maternal-Fetal Medicine Unit, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - H David McIntyre
- Mater Research, The University of Queensland, South Brisbane, Qld, Australia
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Anne B Kihara
- African Federation of Obstetricians and Gynaecologists, Khartoum, Sudan.,Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Moshe Hod
- Mor Comprehensive Women's Health Care Center, Tel Aviv, Israel.,FIGO Pregnancy and Non-Communicable Diseases Committee, International Federation of Gynecology and Obstetrics, London, UK
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105
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Jacob CM, Killeen SL, McAuliffe FM, Stephenson J, Hod M, Diaz Yamal I, Malhotra J, Mocanu E, McIntyre HD, Kihara AB, Ma RC, Divakar H, Kapur A, Ferriani R, Ng E, Henry L, Van Der Spuy Z, Rosenwaks Z, Hanson MA. Prevention of noncommunicable diseases by interventions in the preconception period: A FIGO position paper for action by healthcare practitioners. Int J Gynaecol Obstet 2020; 151 Suppl 1:6-15. [PMID: 32894587 PMCID: PMC7590173 DOI: 10.1002/ijgo.13331] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
With the increase in obesity prevalence among women of reproductive age globally, the risks of type 2 diabetes, gestational diabetes, pre-eclampsia, and other conditions are rising, with detrimental effects on maternal and newborn health. The period before pregnancy is increasingly recognized as crucial for addressing weight management and reducing malnutrition (both under- and overnutrition) in both parents to reduce the risk of noncommunicable diseases (NCDs) in the mother as well as the passage of risk to her offspring. Healthcare practitioners, including obstetricians, gynecologists, midwives, and general practitioners, have an important role to play in supporting women in planning a pregnancy and achieving healthy nutrition and weight before pregnancy. In this position paper, the FIGO Pregnancy Obesity and Nutrition Initiative provides an overview of the evidence for preconception clinical guidelines to reduce the risk of NCDs in mothers and their offspring. It encourages healthcare practitioners to initiate a dialogue on women's health, nutrition, and weight management before conception. While acknowledging the fundamental importance of the wider social and environmental determinants of health, this paper focuses on a simple set of recommendations for clinical practice that can be used even in short consultations. The recommendations can be contextualized based on local cultural and dietary practices as part of a system-wide public health approach to influence the wider determinants as well as individual factors influencing preconception health.
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Affiliation(s)
- Chandni Maria Jacob
- Institute of Developmental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital SouthamptonSouthamptonUK
| | - Sarah Louise Killeen
- UCD Perinatal Research CentreSchool of MedicineUniversity College DublinNational Maternity HospitalDublinIreland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research CentreSchool of MedicineUniversity College DublinNational Maternity HospitalDublinIreland
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women’s HealthUniversity College LondonLondonUK
| | - Moshe Hod
- Mor Comprehensive Women’s Health Care CenterTel AvivIsrael
- FIGO Pregnancy and Non‐Communicable Diseases CommitteeInternational Federation of Gynecology and ObstetricsLondonUK
| | - Ivonne Diaz Yamal
- Faculty of MedicineUniversity Militar Nueva GranadaBogotaColombia
- Fertility Center Procreation Medicamente AsistidaBogotaColombia
- FIGO Committee for Reproductive Medicine, Endocrinology, and InfertilityInternational Federation of Gynecology and ObstetricsLondonUK
| | - Jaideep Malhotra
- Malhotra Nursing and Maternity HomeAgraIndia
- Rainbow HospitalAgraIndia
| | - Edgar Mocanu
- RCSI Department of Reproductive MedicineRotunda HospitalDublinIreland
| | - H. David McIntyre
- Mater ResearchThe University of QueenslandSouth BrisbaneQldAustralia
| | - Anne B. Kihara
- African Federation of Obstetricians and GynaecologistsKhartoumSudan
- Department of Obstetrics and GynecologySchool of MedicineUniversity of NairobiNairobiKenya
| | - Ronald C. Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong SARChina
| | | | - Anil Kapur
- World Diabetes FoundationBagsværdDenmark
| | - Rui Ferriani
- Ribeirão Preto Medical SchoolHuman Reproduction SectorDepartment of Gynecology and ObstetricsUniversity of São PauloSão PauloBrazil
| | - Ernest Ng
- Department of Obstetrics and GynecologyLi Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong SARChina
| | - Laurie Henry
- Department of Gynecology and ObstetricsCentre de Procréation Médicalement Assistée (CPMA)University of LiègeCHR de la CitadelleLiègeBelgium
| | - Zephne Van Der Spuy
- Department of Obstetrics and GynecologyUniversity of Cape TownGroote Schuur HospitalCape TownSouth Africa
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Mark A. Hanson
- Institute of Developmental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital SouthamptonSouthamptonUK
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106
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Alam A, Chowdhury M, Dibley MJ, Raynes-Greenow C. How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the "Balanced Plate" Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176289. [PMID: 32872348 PMCID: PMC7503809 DOI: 10.3390/ijerph17176289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observations of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Future implementation of the intervention should tailor the strategies to the local context to ensure optimal adherence to the intervention.
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Affiliation(s)
- Ashraful Alam
- School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.J.D.); (C.R.-G.)
- Correspondence: ; Tel.: +61-2-9351-8925
| | - Morseda Chowdhury
- Health, Nutrition and Population Programme, Bangladesh Rural Advancement Committee (BRAC), Dhaka 1212, Bangladesh;
| | - Michael J. Dibley
- School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.J.D.); (C.R.-G.)
| | - Camille Raynes-Greenow
- School of Public Health, The University of Sydney, Sydney 2006, Australia; (M.J.D.); (C.R.-G.)
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107
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Vitamin D Deficiency in Mexican Pregnant Women: Is Supplementation with ≤400 IU/day Enough? Nutrients 2020; 12:nu12092517. [PMID: 32825265 PMCID: PMC7551079 DOI: 10.3390/nu12092517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023] Open
Abstract
Controversy remains surrounding vitamin D routine supplementation in healthy pregnancy, and the doses are unclear. The aim of this study was to describe maternal vitamin D status throughout pregnancy in a group of Mexican women and evaluate the effect of frequently prescribed doses of vitamin D3 on longitudinal 25-OH-D concentrations, adjusting for obesity, season, and other factors. We conducted a cohort study (Instituto Nacional de Perinatología-INPer) (2017-2020)) of healthy pregnant women without complications. Pregestational overweight/obesity (body mass index ≥ 25), vitamin D3 supplementation (prescribed by physician; 0-250, 250-400, and >400 IU/day), and serum 25-OH-D concentrations (ELISA) were evaluated in each trimester of pregnancy. Vitamin D deficiency or insufficiency was computed (<20 and <30 ng/mL, respectively). We studied 141 adult women; 58.5% had pregestational obesity or overweight. In the first trimester, 45.8% of the women were supplemented with vitamin D3; 51.4% had vitamin D insufficiency and 37.3%, deficiency. In the third trimester, 75.4% of the women were supplemented, and 20% of them still had deficiency. The final general mixed linear model showed that 25-OH-D significantly increased throughout pregnancy (p < 0.001); the highest increase was observed in the third trimester in women with doses >400 IU/day of vitamin D3 (+4 ng/mL, 95% CI: 1.72-8.11 ng/mL). In winter/autumn, 25-OH-D concentrations were also lower (p ≤ 0.05). In this group of pregnant Mexican women, the prevalence of vitamin D deficiency and insufficiency was high. A higher increase in 25-OH-D concentrations during pregnancy was observed when the women were supplemented with >400 IU/day. Common supplementation doses of 250-400 IU/day were insufficient for achieving an adequate maternal vitamin D status.
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108
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Hod M. Connecting maternal and fetal medicine to non-communicable disease prevention. Int J Gynaecol Obstet 2020; 151:315-318. [PMID: 32629524 DOI: 10.1002/ijgo.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 01/28/2023]
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109
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Øverby NC, Hillesund ER, Røed M, Vik FN. Association between parental feeding practices and shared family meals. The Food4toddlers study. Food Nutr Res 2020; 64:4456. [PMID: 32952496 PMCID: PMC7478118 DOI: 10.29219/fnr.v64.4456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/01/2020] [Accepted: 06/24/2020] [Indexed: 02/03/2023] Open
Abstract
Background Parental feeding practices and family meals are important determinants for infants' diet and health. Still, there is no previous research of the association between feeding practices and family meals in infants. Objective Explore potential associations between feeding practices and family meals among infants. Design We present cross-sectional results (baseline) from the Food4toddlers study. In total 298 parents of 1-year-olds, recruited from all over Norway, filled in a questionnaire regarding frequency of shared family meals (breakfast, lunch, dinner) and feeding practices using the validated instrument Comprehensive Feeding Practices Questionnaire. Logistic regression was used to explore the associations between having family meals every day and feeding practices (10 dimensions). Results The children included were about 11 months old, and 55% were boys. Parents were highly educated. Most children had family breakfast and dinner (60-65%), while fewer had family lunch every day (35%). We found that eating family breakfast and lunch every day was associated with use of the positive feeding practices: encourage balance and variety, environment and modelling (ORs ranging from 1.15 to 1.37), while eating family breakfast and family lunch less often was associated with the negative feeding practice pressure to eat (OR, 95% CI: 0.90 (0.83, 0.96) and 0.91 (0.84, 0.97), respectively). Eating family dinner every day was associated with more use of the positive feeding practice balance and variety (OR, 95% CI: 1.21 (1.06, 1.38), while having family dinner less often was associated with use of the negative feeding practices pressure to eat and restriction to health (OR, 95% CI: 0.89 (0.83, 0.96) and 0.94 (0.87, 1.01), respectively). Discussion and conclusion In this group of infants, having family meals every day was associated with positive feeding practices, while having family meals less often was associated with negative feeding practices. Shared family meals provide an important setting for healthy eating, development of feeding skills and dietary habits formation.
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Affiliation(s)
- Nina C Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Elisabet R Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Margrethe Røed
- Department of Nutrition and Public Health, Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Frøydis N Vik
- Department of Nutrition and Public Health, Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
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110
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Brushett S, Sinha T, Reijneveld SA, de Kroon MLA, Zhernakova A. The Effects of Urbanization on the Infant Gut Microbiota and Health Outcomes. Front Pediatr 2020; 8:408. [PMID: 32903831 PMCID: PMC7438894 DOI: 10.3389/fped.2020.00408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022] Open
Abstract
Humans and their gut microbiota have co-evolved over thousands of years, resulting in the establishment of a complex host-microbiota ecosystem. Early life environmental factors, such as delivery mode, nutrition, and medication use, have been shown to substantially affect both host-microbiota interactions and health outcomes. However, the effects of urbanization (characterized by the spectrum of rural and urban populations) on these early life events have been overlooked. A deeper understanding of the relationship between urbanization and microbiota development will allow for the identification of novel biological and social approaches that can be implemented to prevent and treat disease and promote maternal and infant/child health. The aim of this narrative review is to summarize how factors associated with urbanization differentially impact delivery mode, nutrition, and medication use, and how these changes subsequently affect the gut microbiota and health outcomes of infants. This narrative review also describes the important evidence gaps associated with these relationships and recommends actions that can be taken to improve the health of mothers and infants worldwide.
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Affiliation(s)
- Siobhan Brushett
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Trishla Sinha
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marlou L. A. de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexandra Zhernakova
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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111
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Herrera Cuenca M, Proaño GV, Blankenship J, Cano-Gutierrez C, Chew STH, Fracassi P, Keller H, Venkatesh Mannar MG, Mastrilli V, Milewska M, Steiber A. Building Global Nutrition Policies in Health Care: Insights for Tackling Malnutrition from the Academy of Nutrition and Dietetics 2019 Global Nutrition Research and Policy Forum. J Acad Nutr Diet 2020; 120:1407-1416. [PMID: 32711857 DOI: 10.1016/j.jand.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 11/29/2022]
Abstract
Around the world, the burden of malnutrition remains high despite significant efforts to thwart both undernutrition and overnutrition. The links between food security, dietary choices, and health outcomes pose a dilemma: What can nutrition policymakers and health care professionals do to harness the benefits of nutrition to improve health outcomes for young and old? The Academy of Nutrition and Dietetics gathered a group of health care policymakers, physicians, and credentialed nutrition and dietetics practitioners from around the world for a Policy and Nutrition Forum that took place on August 31, 2019 in Krakow, Poland. Participants from countries in Asia, Europe, North America, and Latin America presented on nutrition and policy from their perspective and took part in discussions about the effects of nutrition policies on health and health care. To extend the conversation about food and nutrition and to build a healthier future for people worldwide, this report highlights information from the Forum.
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112
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Reyes-López MA, Piccoli GB, Leone F, Orozco-Guillén A, Perichart-Perera O. Nutrition care for chronic kidney disease during pregnancy: an updated review. Eur J Clin Nutr 2020; 74:983-990. [PMID: 31925336 PMCID: PMC7340623 DOI: 10.1038/s41430-019-0550-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 11/09/2022]
Abstract
Cases of chronic kidney disease (CKD), including CKD in pregnant women, have increased globally in recent years. CKD during pregnancy is associated with a higher risk of adverse outcomes, including gestational hypertension, preeclampsia, intrauterine growth restriction, and preterm birth, among others. Nutrition plays a significant role in many metabolic and physiological changes during pregnancy. Women with CKD are at increased risk of nutrition deficiencies and metabolic issues than women without CKD. Currently, we lack evidence regarding metabolic and nutritional adaptations during pregnancy in women with CKD and how these adaptations relate to perinatal outcomes. In this review, dietary and supplementation recommendations for CKD in adults and pregnant women are summarized from current clinical guidelines. We present the main nutrition care practices that have been studied in CKD pregnancies. This review will be helpful to health professionals as a preliminary reference for nutrition assessment and therapy in pregnant women with CKD.
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Affiliation(s)
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciencies, The University of Torino, Turin, Italy
| | - Filomena Leone
- Hospital Cittá della Salute e della Scienza, Turin, Italy
| | | | - Otilia Perichart-Perera
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico.
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113
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Parisi F, Savasi VM, di Bartolo I, Mandia L, Cetin I. Associations between First Trimester Maternal Nutritional Score, Early Markers of Placental Function, and Pregnancy Outcome. Nutrients 2020; 12:nu12061799. [PMID: 32560356 PMCID: PMC7353423 DOI: 10.3390/nu12061799] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/05/2023] Open
Abstract
This study investigated the associations between maternal adherence to a healthy diet, first trimester placental markers, and pregnancy outcome. Singleton spontaneous pregnancies were enrolled at 11+0-13+6 gestational weeks in a prospective cohort study. A nutritional score (0-10) measuring the adherence to a healthy diet was calculated. A transabdominal ultrasound scan for placental marker assessment was performed (uterine artery (UtA) doppler, placental volume). Biochemical placental markers were recorded (Pregnancy Associated Plasma Protein A (PAPP-A), free β- Human Chorionic Gonadotropin (HCG)). Birth outcomes were obtained from medical records. Associations between the maternal nutritional score, first trimester placental markers, and pregnancy outcome were investigated by using multi-adjusted general linear models. In total, 112 pregnancies were enrolled with a median nutritional score of 7 (range 3-10). Median gestational age at birth was 277 days (range 203-296). The nutritional score was positively associated with PAPP-A concentrations, whereas a negative association was detected with the UtA mean pulsatility index and placental volume. A positive association was detected between nutritional score and gestational age at birth. This study demonstrates that a first trimester nutritional score as a measure of adherence to a healthy diet is significantly associated with early biochemical and ultrasound markers of placental development, with further association with gestational age at birth.
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Affiliation(s)
- Francesca Parisi
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (I.d.B.); (I.C.)
- Correspondence: ; Tel.: +39-02-6363-5369
| | - Valeria M. Savasi
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (V.M.S.); (L.M.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ilenia di Bartolo
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (I.d.B.); (I.C.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luca Mandia
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (V.M.S.); (L.M.)
| | - Irene Cetin
- Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (I.d.B.); (I.C.)
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy; (V.M.S.); (L.M.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy
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Griffith RJ, Alsweiler J, Moore AE, Brown S, Middleton P, Shepherd E, Crowther CA. Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2020; 6:CD012394. [PMID: 32526091 PMCID: PMC7388385 DOI: 10.1002/14651858.cd012394.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is increasing, with approximately 15% of pregnant women affected worldwide, varying by country, ethnicity and diagnostic thresholds. There are associated short- and long-term health risks for women and their babies. OBJECTIVES We aimed to summarise the evidence from Cochrane systematic reviews on the effects of interventions for preventing GDM. METHODS We searched the Cochrane Database of Systematic Reviews (6 August 2019) with key words 'gestational diabetes' OR 'GDM' to identify reviews pre-specifying GDM as an outcome. We included reviews of interventions in women who were pregnant or planning a pregnancy, irrespective of their GDM risk status. Two overview authors independently assessed eligibility, extracted data and assessed quality of evidence using ROBIS and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm (GRADE moderate- or high-quality evidence with a confidence interval (CI) that did not cross the line of no effect); clear evidence of no effect or equivalence (GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect); possible benefit or harm (low-quality evidence with a CI that did not cross the line of no effect or GRADE moderate- or high-quality evidence with a wide CI); or unknown benefit or harm (GRADE low-quality evidence with a wide CI or very low-quality evidence). MAIN RESULTS We included 11 Cochrane Reviews (71 trials, 23,154 women) with data on GDM. Nine additional reviews pre-specified GDM as an outcome, but did not identify GDM data in included trials. Ten of the 11 reviews were judged to be at low risk of bias and one review at unclear risk of bias. Interventions assessed included diet, exercise, a combination of diet and exercise, dietary supplements, pharmaceuticals, and management of other health problems in pregnancy. The quality of evidence ranged from high to very low. Diet Unknown benefit or harm: there was unknown benefit or harm of dietary advice versus standard care, on the risk of GDM: risk ratio (RR) 0.60, 95% CI 0.35 to 1.04; 5 trials; 1279 women; very low-quality evidence. There was unknown benefit or harm of a low glycaemic index diet versus a moderate-high glycaemic index diet on the risk of GDM: RR 0.91, 95% CI 0.63 to 1.31; 4 trials; 912 women; low-quality evidence. Exercise Unknown benefit or harm: there was unknown benefit or harm for exercise interventions versus standard antenatal care on the risk of GDM: RR 1.10, 95% CI 0.66 to 1.84; 3 trials; 826 women; low-quality evidence. Diet and exercise combined Possible benefit: combined diet and exercise interventions during pregnancy versus standard care possibly reduced the risk of GDM: RR 0.85, 95% CI 0.71 to 1.01; 19 trials; 6633 women; moderate-quality evidence. Dietary supplements Clear evidence of no effect: omega-3 fatty acid supplementation versus none in pregnancy had no effect on the risk of GDM: RR 1.02, 95% CI 0.83 to 1.26; 12 trials; 5235 women; high-quality evidence. Possible benefit: myo-inositol supplementation during pregnancy versus control possibly reduced the risk of GDM: RR 0.43, 95% CI 0.29 to 0.64; 3 trials; 502 women; low-quality evidence. Possible benefit: vitamin D supplementation versus placebo or control in pregnancy possibly reduced the risk of GDM: RR 0.51, 95% CI 0.27 to 0.97; 4 trials; 446 women; low-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of probiotic with dietary intervention versus placebo with dietary intervention (RR 0.37, 95% CI 0.15 to 0.89; 1 trial; 114 women; very low-quality evidence), or probiotic with dietary intervention versus control (RR 0.38, 95% CI 0.16 to 0.92; 1 trial; 111 women; very low-quality evidence) on the risk of GDM. There was unknown benefit or harm of vitamin D + calcium supplementation versus placebo (RR 0.33, 95% CI 0.01 to 7.84; 1 trial; 54 women; very low-quality evidence) or vitamin D + calcium + other minerals versus calcium + other minerals (RR 0.42, 95% CI 0.10 to 1.73; 1 trial; 1298 women; very low-quality evidence) on the risk of GDM. Pharmaceutical Possible benefit: metformin versus placebo given to obese pregnant women possibly reduced the risk of GDM: RR 0.85, 95% CI 0.61 to 1.19; 3 trials; 892 women; moderate-quality evidence. Unknown benefit or harm:eight small trials with low- to very low-quality evidence showed unknown benefit or harm for heparin, aspirin, leukocyte immunisation or IgG given to women with a previous stillbirth on the risk of GDM. Management of other health issues Clear evidence of no effect: universal versus risk based screening of pregnant women for thyroid dysfunction had no effect on the risk of GDM: RR 0.93, 95% CI 0.70 to 1.25; 1 trial; 4516 women; moderate-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of using fractional exhaled nitrogen oxide versus a clinical algorithm to adjust asthma therapy on the risk of GDM: RR 0.74, 95% CI 0.31 to 1.77; 1 trial; 210 women; low-quality evidence. There was unknown benefit or harm of pharmacist led multidisciplinary approach to management of maternal asthma versus standard care on the risk of GDM: RR 5.00, 95% CI 0.25 to 99.82; 1 trial; 58 women; low-quality evidence. AUTHORS' CONCLUSIONS No interventions to prevent GDM in 11 systematic reviews were of clear benefit or harm. A combination of exercise and diet, supplementation with myo-inositol, supplementation with vitamin D and metformin were of possible benefit in reducing the risk of GDM, but further high-quality evidence is needed. Omega-3-fatty acid supplementation and universal screening for thyroid dysfunction did not alter the risk of GDM. There was insufficient high-quality evidence to establish the effect on the risk of GDM of diet or exercise alone, probiotics, vitamin D with calcium or other vitamins and minerals, interventions in pregnancy after a previous stillbirth, and different asthma management strategies in pregnancy. There is a lack of trials investigating the effect of interventions prior to or between pregnancies on risk of GDM.
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Affiliation(s)
- Rebecca J Griffith
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Abigail E Moore
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Stephen Brown
- School of Interprofessional Health Studies, Auckland University of Technology, Auckland, New Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Emily Shepherd
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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The effect of consuming milk and related products during human pregnancy over birth weight and perinatal outcomes: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 251:235-245. [PMID: 32554191 DOI: 10.1016/j.ejogrb.2020.05.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Data addressing the effect of milk and related products (M&RPs) on fetal growth are contradictory. The aim was to meta-analyze the effect of consuming M&RPs during human pregnancy over perinatal outcomes. METHOD A systematic literature search was performed in PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Eligibility criteria for selection were: studies evaluating the effect of consuming M&RPs during pregnancy over birth weight and different perinatal outcomes. Random effect models were used for meta-analyses, and effects are reported as mean differences (MD) or odds ratio (OR) and their 95 % confidence intervals (CIs). RESULTS Fourteen studies (111,184 pregnant women) reported on the targeted perinatal outcomes. The meta-analysis of ten studies revealed a positive association between consuming a higher amount of M&RPs and birth weight (MD =51.0 g, 95 % CI 24.7-77.3), whereas in five studies a positive effect was observed on infant length (MD =0.33 cm, 95 % CI: 0.03-0.64). The higher birth weight was detected both in Western world gravids, consuming standard/conventional diets, as well as in vegetarian women from India. There were no significant differences in ultrasound measured fetal head circumference, biparietal diameter, abdominal circumference and femur length. The consumption of a higher amount of M&RPs was associated with a reduced risk of small-for-gestational age (SGA) (OR = 0.69, 95 % CI: 0.56-0.84) and low birth weight infants (OR = 0.63, 95 % CI: 0.48-0.84); in addition to a higher risk of large-for-gestational age (LGA) infants (OR = 1.11, 95 % CI: 1.02-1.21). CONCLUSION The consumption of a higher amount of M&RPs during pregnancy was associated with greater infant birth weight and length; in addition to a lower risk of having SGA and low birth weight infants, and a higher risk of LGA infants.
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Torreggiani M, Fois A, D’Alessandro C, Colucci M, Orozco Guillén AO, Cupisti A, Piccoli GB. Of Mice and Men: The Effect of Maternal Protein Restriction on Offspring's Kidney Health. Are Studies on Rodents Applicable to Chronic Kidney Disease Patients? A Narrative Review. Nutrients 2020; 12:E1614. [PMID: 32486266 PMCID: PMC7352514 DOI: 10.3390/nu12061614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
In the almost 30 years that have passed since the postulation of the "Developmental Origins of Health and Disease" theory, it has been clearly demonstrated that a mother's dietary habits during pregnancy have potential consequences for her offspring that go far beyond in utero development. Protein malnutrition during pregnancy, for instance, can cause severe alterations ranging from intrauterine growth retardation to organ damage and increased susceptibility to hypertension, diabetes mellitus, cardiovascular diseases and chronic kidney disease (CKD) later in life both in experimental animals and humans. Conversely, a balanced mild protein restriction in patients affected by CKD has been shown to mitigate the biochemical derangements associated with kidney disease and even slow its progression. The first reports on the management of pregnant CKD women with a moderately protein-restricted plant-based diet appeared in the literature a few years ago. Today, this approach is still being debated, as is the optimal source of protein during gestation in CKD. The aim of this report is to critically review the available literature on the topic, focusing on the similarities and differences between animal and clinical studies.
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Affiliation(s)
- Massimo Torreggiani
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
| | - Antioco Fois
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
| | - Claudia D’Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.D.); (A.C.)
| | - Marco Colucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A. SB, Via S. Maugeri 10, 27100 Pavia, Italy;
| | | | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.D.); (A.C.)
| | - Giorgina Barbara Piccoli
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy
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Abstract
PURPOSE OF REVIEW Women should enter pregnancy in the best possible health. There is increasing recognition of the importance of nutrition for reproductive health; however, key dietary factors in relation to optimizing fertility are nonexistent. The purpose of this review is to investigate dietary factors, preconception, and the association with fertility and later health in pregnancy. RECENT FINDINGS This article summarizes recent literature assessing preconception dietary intake and the association with fertility, time to pregnancy, and also the relationship with polycystic ovary syndrome and gestational diabetes; these conditions associate with each other, and also with infertility. The impact of paternal diet is also reported. SUMMARY There is recent interest investigating diet and time to pregnancy, suggesting higher intakes of fruit, minimal intake of fast food and sugar sweetened beverages, and a diet lower in glycemic load, may improve time to pregnancy. There is minimal recent literature on paternal diet and impact on fertility. Present advice to women with polycystic ovary syndrome is in line with international recommendations for lifestyle management to improve reproductive outcomes; and for gestational diabetes, prepregnancy may be an optimal time to improve dietary intakes, particularly through consumption of an overall healthy dietary pattern or a Mediterranean-style dietary pattern.
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118
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Bland C, Dalrymple KV, White SL, Moore A, Poston L, Flynn AC. Smartphone applications available to pregnant women in the United Kingdom: An assessment of nutritional information. MATERNAL & CHILD NUTRITION 2020; 16:e12918. [PMID: 31833237 PMCID: PMC7083499 DOI: 10.1111/mcn.12918] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/17/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
The importance of diet during pregnancy is critically important for the short- and long-term health of both mother and child. The number of apps targeting pregnant women is rapidly increasing, yet the nutritional content of these tools remains largely unexplored. This review aimed to evaluate the coverage and content of nutrition information in smartphone apps available to U.K. pregnant women. Keyword searches were conducted in iTunes and Google Play stores in November 2018. Candidate apps were included if they targeted pregnant women, provided pregnancy-specific nutritional information, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. Nutritional content was assessed for accuracy against U.K. recommendations. Behaviour change techniques (BCTs) were also evaluated. Twenty-nine apps were included, seven of which originated in the United Kingdom. There was a large variability in the quality of smartphone app nutritional information. The accuracy of nutrition information varied, and several apps conveyed inappropriate information for pregnancy. On average, 10 BCTs were identified per app (range 2-15). Overall, smartphone apps do not consistently provide accurate and useful nutritional information to pregnant women. This study highlights the need for the integration of evidence-based nutritional information during app development and for increased regulatory oversight. App developers should also make it clear that nutritional content is intended for a specific geographical region or population or modify for the intended audience. These are important considerations for the design of future apps, which are increasingly used to complement existing maternity services.
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Affiliation(s)
- Catherine Bland
- Department of Women and Children's Health, School of Life Course SciencesKing's College LondonLondonUK
| | - Kathryn V. Dalrymple
- Department of Women and Children's Health, School of Life Course SciencesKing's College LondonLondonUK
| | - Sara L. White
- Department of Women and Children's Health, School of Life Course SciencesKing's College LondonLondonUK
| | - Amanda Moore
- Department of Women and Children's Health, School of Life Course SciencesKing's College LondonLondonUK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course SciencesKing's College LondonLondonUK
| | - Angela C. Flynn
- Department of Women and Children's Health, School of Life Course SciencesKing's College LondonLondonUK
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Esposito P, Garibotto G, Picciotto D, Costigliolo F, Viazzi F, Conti NE. Nutritional Challenges in Pregnant Women with Renal Diseases: Relevance to Fetal Outcomes. Nutrients 2020; 12:nu12030873. [PMID: 32213942 PMCID: PMC7146629 DOI: 10.3390/nu12030873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 02/07/2023] Open
Abstract
Pregnancy in women affected by chronic kidney disease (CKD) has become more common in recent years, probably as a consequence of increased CKD prevalence and improvements in the care provided to these patients. Management of this condition requires careful attention since many clinical aspects have to be taken into consideration, including the reciprocal influence of the renal disease and pregnancy, the need for adjustment of the medical treatments and the high risk of maternal and obstetric complications. Nutrition assessment and management is a crucial step in this process, since nutritional status may affect both maternal and fetal health, with potential effects also on the future development of adult diseases in the offspring. Nevertheless, few data are available on the nutritional management of pregnant women with CKD and the main clinical indications are based on small case series or are extrapolated from the general recommendations for non-pregnant CKD patients. In this review, we discuss the main issues regarding the nutritional management of pregnant women with renal diseases, including CKD patients on conservative treatment, patients on dialysis and kidney transplant patients, focusing on their relevance on fetal outcomes and considering the peculiarities of this population and the approaches that could be implemented into clinical practice.
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120
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Øverby NC, Blomkvist EAM, Hillesund ER. Associations between breastfeeding mode and duration and food neophobia in toddlerhood: A cross-sectional study among Norwegian toddlers. Food Nutr Res 2020; 64:3615. [PMID: 32180693 PMCID: PMC7054643 DOI: 10.29219/fnr.v64.3615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/17/2023] Open
Abstract
Background Research on the association between breastfeeding duration and food neophobia is inconclusive. Breastfeeding and measures to reduce food neophobia are highly recommended to ensure a healthy diet early in life. Objective The aim of this study was to evaluate the association between breastfeeding duration and food neophobia in young Norwegian children. Design Participants (n = 246) were recruited through kindergartens in four Norwegian counties in 2017. The parents of 1-year-olds filled in questionnaires, including standardized questions on breastfeeding and food neophobia. Cross-sectional results are presented. Comparisons of child neophobia score at 16 months of age according to breastfeeding status at various timepoints during infancy were explored in linear regression models adjusted for maternal education and parental food neophobia. Results Still being breastfed at 12 months and being exclusively breastfed at 5 months were independently associated with slightly higher food neophobia score at the mean age of 16 months compared to shorter duration of breastfeeding. We found no other associations between breastfeeding duration and child food neophobia. Discussion Our study adds to the somewhat scarce literature regarding associations between breastfeeding mode and duration and later food neophobia; some literature shows protective relations between breastfeeding and food fussiness, and others report opposite or null findings. Conclusion We found that both being breastfed at 12 months and being exclusively breastfed at 5 months were independently associated with slightly higher food neophobia score at the mean age of 16 months compared to shorter duration of breastfeeding. As the data are derived from a cross-sectional study, these findings should be interpreted with caution.
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Affiliation(s)
- Nina Cecilie Øverby
- Faculty of Health and Sport Sciences, Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | - Eli Anne Myrvoll Blomkvist
- Faculty of Health and Sport Sciences, Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | - Elisabet Rudjord Hillesund
- Faculty of Health and Sport Sciences, Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
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Manta-Vogli PD, Schulpis KH, Dotsikas Y, Loukas YL. Nutrition and medical support during pregnancy and lactation in women with inborn errors of intermediary metabolism disorders (IEMDs). J Pediatr Endocrinol Metab 2020; 33:5-20. [PMID: 31804959 DOI: 10.1515/jpem-2019-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022]
Abstract
The establishment of expanded newborn screening (NBS) not only results in the early diagnosis and treatment of neonates with inborn errors of intermediary metabolism disorders (IEMDs) but also helps the affected females to reach the reproductive age under medical and dietetic support, as well as to give birth to normal infants. In this review, we aimed to focus on laboratory investigation tests, dietetic management and medical support for most known IEMD pregnant and lactating women, such as those suffering from aminoacidopathies, carbohydrate metabolic diseases and fatty acid (FAO) oxidation disorders.
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Affiliation(s)
- Penelope D Manta-Vogli
- Department of Clinical Nutrition and Dietetics, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Yannis Dotsikas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274696, Fax: +30 210 7274039
| | - Yannis L Loukas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274224, Fax: +30 211 1826131
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Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr 2020; 8:587. [PMID: 33042925 PMCID: PMC7527592 DOI: 10.3389/fped.2020.00587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
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Affiliation(s)
- Giorgia Sebastiani
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Ana Herranz Barbero
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Xavier Miracle
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Eva Meler Barrabes
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arantxa Balada Ibañez
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Astals-Vizcaino
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Silvia Ferrero-Martínez
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Dolores Gómez-Roig
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Oscar García-Algar
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Nurramadhani SR, Dieny FF, Murbawani EA, Tsani AFA, Fitranti DY, Widyastuti N. Status Besi dan Kualitas Diet pada Wanita Usia Subur Pranikah Obesitas di Kota Semarang. AMERTA NUTRITION 2019. [DOI: 10.20473/amnt.v3i4.2019.247-256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Women of reproductive age are potentially to have double-burden malnutrition due to poor diet quality. Obesity-related anemia affects iron homeostasis (hypoferremia) through low-grade inflammation.Objectives: This study aimed to analyze the differences of iron status among women of reproductive age based on obesity status and diet quality based on iron and obesity status.Methods: A cross-sectional study of female students, aged 18-22 years old that classified as obese (n=25) and non-obese (n=25). Subjects were selected by proportional random sampling. This study used iron status and diet quality as variable datas. Blood samples were taken to determined iron status (Fe serum). Diet quality was analyzed by SQ-FFQ and DQI-I. Statistical analysis using Independent-T Test, One-way ANOVA, Kruskal Wallis, Mann Whitney tests.Results: There were 20% of obese subjects had low iron status and majority (94%) had low diet quality score (52.04±5.2). Iron status of obese women (83.9±20.7 µg/dl) significantly differed to non-obese women (99.2±26.1 µg/dl), p=0.027. Obese group with low iron status had lower diet quality and moderation component score, however adequacy score was higher than other groups, p<0.05. There were no significant differences in variation and overall balance among all groups, p>0.05.Conclusions: Iron status of obese women was significantly different than non-obese women. Obese group with low iron status had lower diet quality and moderation component score, however adequacy score was higher than other groupsABSTRAKLatar Belakang: Wanita Usia Subur (WUS) rentan terkena masalah gizi ganda akibat kualitas diet yang buruk. Obesitas terkait anemia disebabkan inflamasi tingkat rendah yang mempengaruhi homeostasis zat besi (hipoferrimia). Tujuan: Penelitian ini bertujuan untuk menganalisis perbedaan status besi WUS berdasarkan status obesitas, dan perbedaan kualitas diet berdasarkan status besi dan obesitas. Metode: Penelitian ini menggunakan desain cross-sectional, dengan subjek mahasiswi berjumlah 25 orang obesitas dan 25 orang non-obesitas, dipilih menggunakan teknik proportional random sampling. Data yang diambil berupa status besi (kadar Fe serum) melalui pengambilan sampel darah, dan kualitas diet menggunakan wawancara SQ-FFQ dan analisis DQI-I. Analisis menggunakan uji Independent-T Test, One-way ANOVA, Kruskal Wallis, dan Mann Whitney.Hasil: Sebanyak 20% WUS obesitas memiliki status besi rendah dan mayoritas subjek (94%) memiliki kualitas diet rendah (52,04±5,2). Status besi WUS obesitas (83,9±20,7µg/dl) berbeda signifikan dibandingkan WUS non-obesitas (99,2±26,1µg/dl), p=0,027. Kelompok WUS obesitas dengan status besi rendah memiliki skor kualitas diet dan komponen moderasi lebih rendah, namun memiliki skor kecukupan lebih tinggi dibandingkan kelompok lainnya, p<0,05. Komponen variasi dan keseimbangan keseluruhan pada semua kelompok tidak menunjukkan perbedaan signifikan, p>0,05.Kesimpulan: Status besi WUS obesitas signifikan lebih rendah dibandingkan WUS non-obesitas. Kelompok WUS obesitas dengan status besi rendah memiliki skor kualitas diet dan moderasi lebih rendah, namun memiliki skor kecukupan lebih tinggi dibandingkan kelompok lainnya.
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Salavati N, Bakker MK, van der Beek EM, Erwich JHM. Cohort Profile: The Dutch Perined-Lifelines birth cohort. PLoS One 2019; 14:e0225973. [PMID: 31805118 PMCID: PMC6894836 DOI: 10.1371/journal.pone.0225973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Maternal nutrition status (e.g. dietary/nutrient intake) during pregnancy has been associated with pregnancy outcomes including birth weight, infant survival and metabolic health of the offspring during later life. During the past few years, maternal dietary intake, at least three months before conception, has been shown to affect pregnancy outcomes also. However, literature investigating this link is still scarce. The studies that have looked at preconception dietary intake in relation to pregnancy outcome were either animal studies, had small sample sizes or focused on only selected macronutrient intake rather than complete (macro)nutrient composition or dietary intakes (e.g. food groups). Therefore, we aim to investigate the association between preconception diet and pregnancy outcomes in a linked birth cohort. The main objective of this manuscript is to describe the methodology of establishing this birth cohort and to describe both the characteristics of the study population included as well as the representativeness in terms of dietary intake. METHODS We created the birth cohort by linking two existing databases; a large population-based cohort study in the Netherlands (The Lifelines Cohort study) and the Dutch national birth registry (Perined), through a 'trusted third party'. The birth cohort contains information on maternal dietary intake during preconception as well as pregnancy outcomes. RESULTS AND DISCUSSION In the Lifelines Cohort study, 3,418 pregnancies were available for linking with Perined. In total, 2,368 pregnancies (86.9%) were linked with Perined, resulting in the birth cohort. With this linked cohort we are able to provide insights on the associations between dietary intake before conception and pregnancy outcomes. Such data could potentially improve nutritional care for women of childbearing age. Lifestyle changes in the period preceding pregnancy may be most effective in improving pregnancy outcomes. A focus on this window of opportunity may provide both sufficient time, as well as a period when women are potentially motivated to adopt health optimizing behaviours.
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Affiliation(s)
- Nastaran Salavati
- Department of Obstetrics and Gynecology, University Medical Centre of Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Marian K. Bakker
- Department of Obstetrics and Gynecology, University Medical Centre of Groningen, University of Groningen, Groningen, The Netherlands
- Department of Genetics, EUROCAT Registration Northern Netherlands, University Medical Centre of Groningen, University of Groningen, Groningen, The Netherlands
| | - Eline M. van der Beek
- Department of Pediatrics, University Medical Centre of Groningen, University of Groningen, Groningen, The Netherlands
- Danone Nutricia Research, Utrecht, The Netherlands
| | - JanJaap H. M. Erwich
- Department of Obstetrics and Gynecology, University Medical Centre of Groningen, University of Groningen, Groningen, The Netherlands
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125
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Sibtain S, Sinha P, Manoharan M, Azeez A. Controversies related to vitamin D deficiency effect on the maternal and feto-placental unit - an update. J OBSTET GYNAECOL 2019; 40:759-766. [PMID: 31790615 DOI: 10.1080/01443615.2019.1669012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vitamin D deficiency (Vit D deficiency) is a global health concern and a common occurrence especially among pregnant women. It has been suggested that Vit D deficiency has implications on both the mother and the foetus. Vitamin D deficiency is the most under-diagnosed nutritional deficiency in the world, affecting the majority of individuals, irrespective of their geography, gender, age or race. Vitamin D deficiency is also linked with several diseases (autoimmune diseases, cancer, cardiovascular, dementia and musculoskeletal diseases). Therefore, appropriate supplementation is required in a deficient population. A diagnosis can be missed as symptoms associated with pregnancy are also seen in vitamin D-deficient women. A timely diagnosis and treatment can be beneficial as these disorders can cause maternal and foetal morbidity. Vitamin D status during pregnancy has been associated with maternal and foetal morbidity, but reported findings are inconsistent.
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Affiliation(s)
| | - Prabha Sinha
- Oman Medical College, National University, College of Medical Science and Technology, Muscat, Oman
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Rodríguez‐González GL, Reyes‐Castro LA, Bautista CJ, Beltrán AA, Ibáñez CA, Vega CC, Lomas‐Soria C, Castro‐Rodríguez DC, Elías‐López AL, Nathanielsz PW, Zambrano E. Maternal obesity accelerates rat offspring metabolic ageing in a sex‐dependent manner. J Physiol 2019; 597:5549-5563. [DOI: 10.1113/jp278232] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Luis A. Reyes‐Castro
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | - Claudia J. Bautista
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | - Azucena A. Beltrán
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | - Carlos A. Ibáñez
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | - Claudia C. Vega
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | - Consuelo Lomas‐Soria
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
- CONACyT‐Cátedras, Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | - Diana C. Castro‐Rodríguez
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
- CONACyT‐Cátedras, Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
| | | | - Peter W. Nathanielsz
- Wyoming Center for Pregnancy and Life Course Health ResearchDepartment of Animal ScienceUniversity Wyoming Laramie WY USA
| | - Elena Zambrano
- Reproductive BiologyInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
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Ługowska K, Kolanowski W. The Nutritional Behaviour of Pregnant Women in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4357. [PMID: 31717286 PMCID: PMC6888330 DOI: 10.3390/ijerph16224357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022]
Abstract
A woman's diet during pregnancy can significantly affect her health, as well as her child's future development and well-being. Unfortunately, many pregnant women do not follow the recommended nutritional guidelines. The reason could be that they have insufficient knowledge about nutritional best practice. Accordingly, the purpose of this study is to investigate the nutritional behaviour of pregnant women in Poland. The research was conducted using a questionnaire to survey a sample of N = 815 pregnant women in first pregnancy. Among the findings were that the subjects ate an excessive amount of sweets, and white bread, and consumed insufficient quantities of fish, milk and fermented milk drinks. Subjects chose white bread more often than wholemeal bread, and fruit rather than vegetables. The study showed that the nutritional behaviour of pregnant women was characterised by many bad practices.
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Affiliation(s)
| | - Wojciech Kolanowski
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce PL-08-110, Poland;
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Reproducibility and relative validity of a newly developed web-based food-frequency questionnaire for assessment of preconception diet. BMC Nutr 2019; 5:47. [PMID: 32153960 PMCID: PMC7050769 DOI: 10.1186/s40795-019-0310-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/24/2019] [Indexed: 12/26/2022] Open
Abstract
Background The importance of diet and nutrition during preconception age is a window of opportunity to promote future parental and transgenerational health. As a sub-study to a large Norwegian study, ‘Diet today – health of tomorrow’, a food-frequency questionnaire (FFQ) was developed to assess diet during the preconception phase in young adults aged 20 – 30 years and in this paper we report the reproducibility and relative validity of this questionnaire. Methods The FFQ was developed from an existing FFQ validated in adolescents. Participants were recruited on social media and at a university. Reproducibility was assessed by comparing the test and retest of the FFQ. Relative validity was assessed by comparing intake measured by the FFQ with a 7-day weighed food record. Energy, nutrients and food intake were used to assess the reproducibility and relative validity of the FFQ. The study applied the Spearman’s rank correlation coefficient, percentage of agreement and Cohen’s Kappa to assess reproducibility and validity. Results There were 32 participants recruited to the study, of which 21 participants completed both the test-retest reproducibility and the relative validation. The test-retest reproducibility had a median correlation coefficient of 0.85 for energy and nutrients, a median Spearman’s rank correlation coefficient of 0.75 and a median Cohen’s Kappa of 0.51 for food groups. The relative validity of the FFQ had a median correlation coefficient of 0.59 for energy and nutrients, a median Spearman’s rank correlation coefficient of 0.54 and a median Cohen’s Kappa of 0.28 for food groups. Conclusion This newly developed FFQ for preconception diet in young adults had a satisfactory test-retest reproducibility and fair relative validity.
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Manta-Vogli PD, Schulpis KH, Dotsikas Y, Loukas YL. The significant role of carnitine and fatty acids during pregnancy, lactation and perinatal period. Nutritional support in specific groups of pregnant women. Clin Nutr 2019; 39:2337-2346. [PMID: 31732292 DOI: 10.1016/j.clnu.2019.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Pregnancy is characterized by a complexity of metabolic processes that may impact fetal health and development. Women's nutrition during pregnancy and lactation is considered important for both mother and infant. This review aims to investigate the significant role of fatty acids and carnitine during pregnancy and lactation in specific groups of pregnant and lactating women. METHODS The literature was reviewed using relevant data bases (e.g. Pubmed, Scopus, Science Direct) and relevant articles were selected to provide information and data for the text and associated Tables. RESULTS Dynamic features especially of plasma carnitine profile during pregnancy and lactation, indicate an extraordinarily active participation of carnitine in the intermediary metabolism both in pregnant woman and in neonate and may also have implications for health and disease later in life. Maternal diets rich in trans and saturated fatty acids can lead to impairments in the metabolism and development of the offspring, whereas the consumption of long chain-polyunsaturated fatty acids during pregnancy plays a beneficial physiologic and metabolic role in the health of offspring. CONCLUSIONS Pregnant women who are underweight, overweight or obese, with gestational diabetes mellitus or diabetes mellitus and those who choose vegan/vegetarian diets or are coming from socially disadvantaged areas, should be nutritionally supported to achieve a higher quality diet during pregnancy and/or lactation.
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Affiliation(s)
- Penelope D Manta-Vogli
- Department of Clinical Nutrition & Dietetics Agia Sofia Children's Hospital, Athens, Greece.
| | | | - Yannis Dotsikas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece.
| | - Yannis L Loukas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece.
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130
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Hanson M, Jacob CM, Hod M, Killeen SL, McAuliffe FM. The FIGO Pregnancy Obesity and Nutrition Initiative (PONI). Int J Gynaecol Obstet 2019; 147:131-133. [PMID: 31571231 DOI: 10.1002/ijgo.12950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 11/12/2022]
Abstract
The activities of the FIGO Pregnancy Obesity and Nutrition Initiative are aimed at reducing all types of malnutrition in women before, during and after pregnancy.
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Affiliation(s)
- Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton, UK
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton, UK
| | - Moshe Hod
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
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131
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Hanson M. The inheritance of cardiovascular disease risk. Acta Paediatr 2019; 108:1747-1756. [PMID: 30964948 DOI: 10.1111/apa.14813] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease (CVD) is foremost among the non-communicable diseases (NCDs) which account for 71% of deaths globally each year. CVD is also prominent among the pre-existing conditions still accounting for nearly 25% of maternal deaths and is linked to gestational diabetes and pre-eclampsia. Markers of CVD risk have been reported even in young children, related to prenatal factors such as mother's diet or body composition. The underlying mechanisms include epigenetic changes which can alter the trajectory of risk across the life course. Preventive interventions need to commence before conception, to reduce transmission of CVD risk by promoting healthy behaviours in prospective parents, as well as in pregnancy, and postpartum through breastfeeding and healthy complementary feeding. Surprisingly, these opportunities are not emphasised in the 2018 United Nations Political Declaration on NCDs. NCDs such as CVD have communicable risk components transmitted across generations by socio-economic as well as biological factors, although the former can also become embodied in the offspring by epigenetic mechanisms. The inheritance of CVD risk, and social inequalities in such risk, thus raises wider questions about responsibility for the health of future generations at societal as well as individual levels.
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Affiliation(s)
- Mark Hanson
- Institute of Developmental Sciences University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton Southampton UK
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Lebrun A, Plante AS, Savard C, Dugas C, Fontaine-Bisson B, Lemieux S, Robitaille J, Morisset AS. Tracking of Dietary Intake and Diet Quality from Late Pregnancy to the Postpartum Period. Nutrients 2019; 11:nu11092080. [PMID: 31484415 PMCID: PMC6769665 DOI: 10.3390/nu11092080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to characterize dietary intake and diet quality from late pregnancy to six months postpartum. Participants (n = 28) completed 2-3 Web-based 24 h recalls at three distinct periods: (1) during the third trimester of pregnancy; (2) three months and (3) six months after delivery. Energy, macro-and micronutrient intakes (from foods and supplements), as well as the Canadian healthy eating index (C-HEI) were derived from the dietary recalls. No significant variation in energy and macronutrient intakes was observed between time points. The proportion of women taking at least one supplement decreased over time (p = 0.003). The total intake of several micronutrients (vitamins A, C, D, group B vitamins, iron, magnesium, zinc, calcium, phosphorus, manganese, and copper) decreased significantly over time (p < 0.05 for all micronutrients). The total C-HEI score and its components did not change, except for the total vegetables and fruit subscore, which decreased over time (8.2 ± 2.0 in the 3rd trimester, 7.1 ± 2.2 at three months postpartum, 6.9 ± 2.4 at 6 months postpartum, p = 0.04). In conclusion, we observed a general stability in diet quality, energy, and macronutrient intakes from the third trimester of pregnancy to six months postpartum. However, several micronutrient intakes decreased over time, mostly due to changes in supplement use.
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Affiliation(s)
- Audrée Lebrun
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada
| | - Anne-Sophie Plante
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada
| | - Claudia Savard
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada
| | - Camille Dugas
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada
| | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | - Simone Lemieux
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada
| | - Anne-Sophie Morisset
- School of Nutrition, Laval University, Québec City, QC G1V 0A6, Canada.
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec City, QC G1V 4G2, Canada.
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada.
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Priani IF, Afiyanti Y, Kurniawati W. Preparing pregnancy through Preconception Education Training. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aagaard-Hansen J, Norris SA, Maindal HT, Hanson M, Fall C. What are the public health implications of the life course perspective? Glob Health Action 2019; 12:1603491. [PMID: 31062667 PMCID: PMC6508051 DOI: 10.1080/16549716.2019.1603491] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
During the past decades innovative research has shown that exposure to harmful events during pregnancy and early infancy ('the first 1000 days') has an impact on health at subsequent stages of the life course and even across generations. Recently it has been shown that even the pre-conception period is of outmost importance, and other scholars have made the case that the 1000 days should be extended to a period of 8000 days post-conception. The present contribution aims to bridge further the gap between research evidence and public health policy by applying a holistic 'full-cycle' perspective. Thus, a conceptual framework is suggested for guiding public health prioritization, including the variables of 'impact on the next generation', 'plasticity' and 'available interventions with documented impact'. This framework could guide decision makers in selecting at which stages of the life course to invest (and not), and furthermore it points to some pertinent research priorities.
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Affiliation(s)
- Jens Aagaard-Hansen
- a Health Promotion , Steno Diabetes Center Copenhagen , Gentofte , Denmark.,b MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Shane A Norris
- b MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Helle Terkildsen Maindal
- a Health Promotion , Steno Diabetes Center Copenhagen , Gentofte , Denmark.,c Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Mark Hanson
- d Institute of Developmental Sciences and NIHR Southampton Biomedical Research Centre , University of Southampton and University Hospital Southampton , Southampton , UK
| | - Caroline Fall
- e MRC Lifecourse Epidemiology Unit, Faculty of Medicine , University of Southampton , Southampton , UK
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Liu J, Song G, Meng T, Zhao G, Guo S. Weight retention at six weeks postpartum and the risk of gestational diabetes mellitus in a second pregnancy. BMC Pregnancy Childbirth 2019; 19:272. [PMID: 31370816 PMCID: PMC6670182 DOI: 10.1186/s12884-019-2423-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common cause of maternal morbidity, and can lead to the development of diabetes later in life. Pre-pregnancy body weight is associated with the change in body mass index (BMI) between a first and second pregnancy. Compared with long-term change in BMI between pregnancies, the most accessible follow-up point to investigate BMI change is 6 weeks after the initial pregnancy. The present study aimed to assess the association between weight retention at 6 weeks postpartum and the risk of GDM in a subsequent pregnancy. METHODS We recruited 6429 singleton pregnancies into this retrospective cohort study. For each pregnancy, we calculated weight retention at 6 weeks postpartum after the first pregnancy, the interpregnancy BMI change between pregnancies, and the gestational weight gain in the second pregnancy. Risk was represented by the odds ratio (OR) and 95% confidence intervals (CIs). We then determined the relationship between postpartum weight retention at 6 weeks after the initial pregnancy, and the interpregnancy change in BMI between pregnancies. Analyses were stratified by BMI during the first pregnancy. RESULTS Compared to women with a stable BMI (- 1 to 1), interpregnancy BMI gains were associated with an increased risk of GDM in the second pregnancy. Risk increased significantly for women with a BMI below and above 25 during the first pregnancy, although the increase was greater in the women with a BMI < 25. The risk of GDM in the second pregnancy was higher in women with inadequate weight gain during the second gestation. The weight retention at 6 weeks postpartum, where there was a gain of > 3 BMI units was significantly more related to weight gain more than when there was 1 BMI unit gain between pregnancies (P < 0.05) and associated with an increased incidence of GDM in the second pregnancy (OR = 2.95, 95% CI: 1.95 ~ 4.45). Women who showed a change in BMI that was > 3 units at 6 weeks postpartum after the first pregnancy showed an increased risk for BMI subsequently (OR = 1.42, 95% CI: 1.08~1.87). CONCLUSIONS Women who gained more than 3 BMI units at 6 weeks postpartum were associated with an increased risk of BMI in a subsequent pregnancy. Six weeks postpartum provides a new early window of opportunity to identify risk factors for a subsequent pregnancy and allows us to implement primary prevention strategies.
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Affiliation(s)
- Jing Liu
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning Province China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tao Meng
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning Province China
| | - Ge Zhao
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning Province China
| | - Songning Guo
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001 Liaoning Province China
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136
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Farabi SS, Hernandez TL. Low-Carbohydrate Diets for Gestational Diabetes. Nutrients 2019; 11:E1737. [PMID: 31357598 PMCID: PMC6723585 DOI: 10.3390/nu11081737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes.
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Affiliation(s)
- Sarah S Farabi
- Goldfarb School of Nursing, Office of Nursing Research, Barnes-Jewish College, St. Louis, MO 63110, USA
- Department of Medicine, Division of Nutritional Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- Department of Research, Innovation, and Professional Practice, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
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137
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Berhe K, Seid O, Gebremariam Y, Berhe A, Etsay N. Risk factors of stunting (chronic undernutrition) of children aged 6 to 24 months in Mekelle City, Tigray Region, North Ethiopia: An unmatched case-control study. PLoS One 2019; 14:e0217736. [PMID: 31181094 PMCID: PMC6557492 DOI: 10.1371/journal.pone.0217736] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/18/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In 2014, 159 million under 5 year-old children were stunted (suffered chronic undernutrition) worldwide. Identifying risk factors for stunting among 6 to 24 month-age children in Mekelle City is important for evidence-based interventions. METHOD Case-Control study design was undertaken in 330 children, from January to February 2016. World Health Organization (WHO) anthropometric software and statistical package for social sciences version 20 were used for analysis. Logistic regression analysis was applied. RESULT The following were identified as risk factors for stunting: mother's lack of formal education (adjusted odds ratio (AOR = 6.4)), mother height less than 150cm (AOR = 4.2), mother with a body mass index less than 18.5 kg/m2 (AOR = 3.8), childbirth weight less than 2.5kg (AOR = 5.3), household with two and above under-five children (AOR = 2.9), a WHO diet diversity score < 4 (AOR = 3.2) and repeated diarrheal episodes (AOR = 5.3). CONCLUSION The factors associated with stunting among children aged 6 to 24 months are no formal education in mother, mother height less than 150cm, low BMI of the mother, low birth weight, low WHO DDS, number of under 5 children in the household and repeated diarrheal episodes. Nutritional interventions should give emphasis to maternal education, maternal nutrition, childbirth weight, family size, diet diversity, and diarrheal diseases.
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Affiliation(s)
| | - Omer Seid
- Department of Nutrition, Mekelle University, Mekelle City, Ethiopia
| | - Yemane Gebremariam
- Department of Health Systems, Mekelle University, Mekelle City, Ethiopia
| | - Almaz Berhe
- Department of Midwifery, Mekelle University, Mekelle City, Ethiopia
| | - Natnael Etsay
- Department of Midwifery, Adigrat University, Adigrat City, Ethiopia
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138
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Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVBD, Guimarães ICB, Corrêa IVDS, Pedrosa KLM, Lopes LM, Nicoloso LHS, Barberato MFA, Zamith MM. Brazilian Fetal Cardiology Guidelines - 2019. Arq Bras Cardiol 2019; 112:600-648. [PMID: 31188968 PMCID: PMC6555576 DOI: 10.5935/abc.20190075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simone R F Fontes Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.,Hospital do Coração (HCor), São Paulo, SP - Brazil
| | - Paulo Zielinsky
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
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139
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Stephenson J, Vogel C, Hall J, Hutchinson J, Mann S, Duncan H, Woods-Townsend K, de Lusignan S, Poston L, Cade J, Godfrey K, Hanson M, Barrett G, Barker M, Conti G, Shannon G, Colbourn T. Preconception health in England: a proposal for annual reporting with core metrics. Lancet 2019; 393:2262-2271. [PMID: 31162084 DOI: 10.1016/s0140-6736(19)30954-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/20/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
Abstract
There is growing interest in preconception health as a crucial period for influencing not only pregnancy outcomes, but also future maternal and child health, and prevention of long-term medical conditions. Successive national and international policy documents emphasise the need to improve preconception health, but resources and action have not followed through with these goals. We argue for a dual intervention strategy at both the public health level (eg, by improving the food environment) and at the individual level (eg, by better identification of those planning a pregnancy who would benefit from support to optimise health before conception) in order to raise awareness of preconception health and to normalise the notion of planning and preparing for pregnancy. Existing strategies that target common risks factors, such as obesity and smoking, should recognise the preconception period as one that offers special opportunity for intervention, based on evidence from life-course epidemiology, developmental (embryo) programming around the time of conception, and maternal motivation. To describe and monitor preconception health in England, we propose an annual report card using metrics from multiple routine data sources. Such a report card should serve to hold governments and other relevant agencies to account for delivering interventions to improve preconception health.
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Affiliation(s)
- Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sue Mann
- Public Health England, London, UK
| | | | - Kathryn Woods-Townsend
- Southampton Education School, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners, London, UK
| | - Lucilla Poston
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas Hospital, London, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Keith Godfrey
- NIHR Southampton Biomedical Research Centre, MRC Lifecourse Epidemiology Unit (University of Southampton), University Hospital Southampton, Southampton, UK
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Gabriella Conti
- Department of Economics and Department of Social Science, University College London, London, UK
| | - Geordan Shannon
- Global Health Epidemiology and Evaluation, UCL Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Global Health Epidemiology and Evaluation, UCL Institute for Global Health, University College London, London, UK
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140
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Abstract
The DOHaD Society has passed its 10th birthday, so it seems an appropriate time to reflect on what has been achieved and the Society's aspirations. At the 10th International Congress in Rotterdam in November 2017, Peter Gluckman (the Society's first President) delivered a plenary lecture entitled 'DOHaD - addressing the science-policy nexus: a reality check'; in opening the Congress, Mark Hanson (second, and outgoing President) not only highlighted the success of the Society but also the challenges it now faces in achieving impact for its work in the global health arena, that is beyond the research agenda; and in assuming the role of third President, Lucilla Poston highlighted the need for the Society to grasp opportunities to change healthcare policy, while persevering with basic research and well-planned intervention studies. In this review we summarize the points made in these three presentations and issue a call to action to the membership to take up the challenge of taking the Society's work to the next level of translating science to policy.
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141
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Griffith RJ, Alsweiler J, Moore AE, Brown S, Middleton P, Shepherd E, Crowther CA. Interventions to prevent women developing gestational diabetes mellitus: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019; 2019:CD012394. [PMCID: PMC6515838 DOI: 10.1002/14651858.cd012394.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This is a protocol for a Cochrane Review (Overview). The objectives are as follows: To summarise the evidence from Cochrane systematic reviews regarding the effects of interventions to prevent women developing gestational diabetes mellitus (GDM).
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Affiliation(s)
- Rebecca J Griffith
- University of AucklandDepartment of Paediatrics: Child and Youth HealthAucklandNew Zealand
| | - Jane Alsweiler
- University of AucklandDepartment of Paediatrics: Child and Youth HealthAucklandNew Zealand
| | - Abigail E Moore
- The University of AucklandLiggins Institute85 Park RoadAucklandNew Zealand1023
| | - Stephen Brown
- Auckland University of TechnologySchool of Interprofessional Health Studies90 Akoranga DriveAucklandNew Zealand0627
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideAustralia5006
| | - Emily Shepherd
- The University of AdelaideRobinson Research Institute, Discipline of Obstetrics and Gynaecology, Adelaide Medical SchoolAdelaideAustralia
| | - Caroline A Crowther
- The University of AucklandLiggins Institute85 Park RoadAucklandNew Zealand1023
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142
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Gernand AD. The upper level: examining the risk of excess micronutrient intake in pregnancy from antenatal supplements. Ann N Y Acad Sci 2019; 1444:22-34. [PMID: 31094004 PMCID: PMC6618111 DOI: 10.1111/nyas.14103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022]
Abstract
Micronutrient deficiencies are prevalent and co-occurring among pregnant women in low- and middle-income countries (LMIC). To prevent and treat deficiencies, antenatal vitamin and mineral supplements are the most common interventions during gestation. With most micronutrients, there can be health risks when intake regularly exceeds a high amount, and an upper threshold value set by the United States and Canada, the World Health Organization, and other groups is commonly called an upper intake level (UL). This review summarizes what is known about risks in pregnancy when ULs are exceeded and assesses the potential risk of exceeding the UL if a pregnant woman is taking a multiple micronutrient supplement. Overall, there is limited information on pregnancy-specific risks from excess intake. When assuming high dietary intake plus the amount in a standard multiple micronutrient supplement (with 30 mg of iron), only niacin and iron would be expected to slightly exceed the UL. Known risks for this level intake for each nutrient are transient and mild.
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Affiliation(s)
- Alison D. Gernand
- Department of Nutritional Sciencesthe Pennsylvania State UniversityUniversity ParkPennsylvania
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143
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The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients 2019; 11:nu11030557. [PMID: 30845641 PMCID: PMC6470702 DOI: 10.3390/nu11030557] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022] Open
Abstract
Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes. Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. A review of the scientific literature in this field was performed, focusing specifically on observational studies in humans, in order to investigate protective effects elicited by maternal diets enriched in plant-derived foods and possible unfavorable outcomes related to micronutrients deficiencies and their impact on fetal development. A design of pregestational nutrition intervention is required in order to avoid maternal undernutrition and consequent impaired fetal growth.
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144
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Good clinical practice advice: Micronutrients in the periconceptional period and pregnancy. Int J Gynaecol Obstet 2019; 144:317-321. [PMID: 30710361 DOI: 10.1002/ijgo.12739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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145
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Good clinical practice advice: Iron deficiency anemia in pregnancy. Int J Gynaecol Obstet 2019; 144:322-324. [PMID: 30710364 DOI: 10.1002/ijgo.12740] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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146
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Prevalence and determinant factors of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital. PLoS One 2019; 14:e0210206. [PMID: 30699140 PMCID: PMC6353093 DOI: 10.1371/journal.pone.0210206] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/18/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction Unintended pregnancy is a pregnancy which is not wanted and/or not planed at the time of conception. It has a major consequence on mothers’ and newborns’ health and its prevalence remains a major health problem in Ethiopia. This study was aimed to assess the prevalence and determinants of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital. Methods An institutional-based cross-sectional study was employed in Addis Zemen hospital from April 01 to May 30, 2018. The sampled 398 pregnant mothers were selected by systematic random sampling. The data were collected using a-pretested structured questionnaire via face to face interview and the collected data were analyzed by using SPSS Version-20. The data were summarized with frequency and cross-tabulation. Both binary and multiple logistic regressions were used in order to identify predictor variables using odds ratio at 95% confidence interval. Results All of 398 mothers answered the questionnaire making the response rate 100%. The prevalence of unintended pregnancy was 26.1% (CI;22.1, 30.4). Women who were multigravid (AOR; 4.7: CI; 2.3, 6.8), women who were multipara (AOR; 2.8: CI; 2.6, 9.7), and women who were from rural (AOR; 2.6: CI; 1.5, 4.6) were more likely experienced unintended pregnancy than their counterparts. Women who were Muslim (AOR; 0.79: CI; 0.6, 0.90) and women who attended secondary education (AOR; 0.58: CI; 0.42, 0.78) were less likely experienced unintended pregnancy. Conclusion and recommendation The prevalence of unintended pregnancy is high in the study area. Educational status, parity, gravity, residence, and religion were the most important predictor variables of unintended pregnancy. Reducing the prevalence of unintended pregnancy especially in the rural area is recommended.
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147
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Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, de Waard M, Brands B, Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. ANNALS OF NUTRITION & METABOLISM 2019; 74:93-106. [PMID: 30673669 PMCID: PMC6397768 DOI: 10.1159/000496471] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease ("developmental or metabolic programming"). METHODS Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. FINDINGS Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. INTERPRETATION We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.
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Affiliation(s)
- Berthold Koletzko
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany,
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lucilla Poston
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Hania Szajewska
- Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland
| | | | - Marita de Waard
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Brigitte Brands
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany
| | - Rosalie M Grivell
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
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148
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Heidari-Beni M. Early Life Nutrition and Non Communicable Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1121:33-40. [PMID: 31392650 DOI: 10.1007/978-3-030-10616-4_4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The origin of some non communicable disease (NCDs) is in early life. Evidence has shown that early life nutrition is associated with the risk of developing chronic non communicable diseases. Pregnancy and infancy are the most critical stages that influence the risks of NCDs in childhood and adult life. Prenatal maternal undernutrition and low birth weight lead to obesity and increase the risk factors of cardiovascular disease and diabetes later in life. Nutrition is one of the easily modifiable environmental factors that may affect outcome of pregnancy, trajectory of growth, and immune system of the fetus and infant. Healthy eating behaviors associate with prevention of weight disorders in pediatric, non communicable diseases, and deficiencies of micronutrient.
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Affiliation(s)
- Motahar Heidari-Beni
- Nutrition Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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149
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Schoenaker DAJM, Vergouwe Y, Soedamah-Muthu SS, Callaway LK, Mishra GD. Preconception risk of gestational diabetes: Development of a prediction model in nulliparous Australian women. Diabetes Res Clin Pract 2018; 146:48-57. [PMID: 30296462 DOI: 10.1016/j.diabres.2018.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022]
Abstract
AIM To develop a prediction model for preconception identification of women at risk of gestational diabetes mellitus (GDM). METHODS Data from a prospective cohort, the Australian Longitudinal Study on Women's Health, were used. Nulliparous women aged 18-23 who reported a pregnancy up to age 37-42 were included. Preconception predictors of GDM during a first pregnancy were selected using logistic regression. Regression coefficients were multiplied by a shrinkage factor estimated with bootstrapping to improve prediction in external populations. RESULTS Among 6504 women, 314 (4.8%) developed GDM during their first pregnancy. The final prediction model included age at menarche, proposed age at future first pregnancy, ethnicity, body mass index, diet, physical activity, polycystic ovary syndrome, and family histories of type 1 or 2 diabetes and GDM. The model showed good discriminative ability with a C-statistic of 0.79 (95% CI 0.76, 0.83) after internal validation. More than half of the women (58%) were classified to be at risk of GDM (>2% predicted risk), with corresponding sensitivity and specificity values of 91% and 43%. CONCLUSIONS Nulliparous women at risk of GDM in a future first pregnancy can be accurately identified based on preconception lifestyle and health-related characteristics. Further studies are needed to test our model in other populations.
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Affiliation(s)
- Danielle A J M Schoenaker
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; Discipline of Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Yvonne Vergouwe
- Department of Public Health, Centre for Medical Decision Sciences, Erasmus MC, Rotterdam, the Netherlands
| | - Sabita S Soedamah-Muthu
- Center of Research on Psychology in Somatic Diseases (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Institute for Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | - Leonie K Callaway
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Gita D Mishra
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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150
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Koletzko B, Cremer M, Flothkötter M, Graf C, Hauner H, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Röbl-Mathieu M, Schiffner U, Vetter K, Weißenborn A, Wöckel A. Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network. Geburtshilfe Frauenheilkd 2018; 78:1262-1282. [PMID: 30655650 PMCID: PMC6294644 DOI: 10.1055/a-0713-1058] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022] Open
Abstract
Diet and exercise before and during pregnancy affect the course of the pregnancy, the child's development and the short- and long-term health of mother and child. The Healthy Start - Young Family Network has updated the recommendations on nutrition in pregnancy that first appeared in 2012 and supplemented them with recommendations on a preconception lifestyle. The recommendations address body weight before conception, weight gain in pregnancy, energy and nutritional requirements and diet (including a vegetarian/vegan diet), the supplements folic acid/folate, iodine, iron and docosahexaenoic acid (DHA), protection against food-borne illnesses, physical activity before and during pregnancy, alcohol, smoking, caffeinated drinks, oral and dental hygiene and the use of medicinal products. Preparation for breast-feeding is recommended already during pregnancy. Vaccination recommendations for women planning a pregnancy are also included. These practical recommendations of the Germany-wide Healthy Start - Young Family Network are intended to assist all professional groups that counsel women and couples wishing to have children and during pregnancy with uniform, scientifically-based and practical information.
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Affiliation(s)
- Berthold Koletzko
- Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, LMU – Ludwig-Maximilians-Universität, München, Germany
- Deutsche Gesellschaft für Kinder- und Jugendheilkunde e. V. (DGKJ), Berlin, Germany
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Monika Cremer
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Maria Flothkötter
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Christine Graf
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Deutsche Sporthochschule Köln, Köln, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Claudia Hellmers
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Hochschule Osnabrück, Osnabrück, Germany
- Deutsche Gesellschaft für Hebammenwissenschaft e. V. (DGHWi), Münster, Germany
| | - Mathilde Kersting
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Forschungsdepartment Kinderernährung, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Krawinkel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Institut für Ernährungswissenschaft, Justus-Liebig-Universität Gießen, Gießen, Germany
- Deutsche Gesellschaft für Ernährung e. V. (DGE), Bonn, Germany
| | - Hildegard Przyrembel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Marianne Röbl-Mathieu
- Mitglied der Ständigen Impfkommission am Robert Koch-Institut (STIKO), Berlin, Germany
| | - Ulrich Schiffner
- Poliklinik für Zahnerhaltung und Präventive Zahnheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Deutsche Gesellschaft für Kinderzahnheilkunde e. V. (DGKiZ), Würzburg, Germany
| | - Klaus Vetter
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Nationale Stillkommission, Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Anke Weißenborn
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Achim Wöckel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Frauenklinik und Poliklinik Universitätsklinikum Würzburg, Würzburg, Germany
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