The importance of nutrition in pregnancy and lactation: lifelong consequences

Recurrent pregnancy loss: risk factors and predictive modeling approaches

PURPOSE

This review aims to identify and analyze the risk factors associated with recurrent pregnancy loss (RPL) and to evaluate the effectiveness of various predictive models in estimating the risk of RPL. The review also explores recent advancements in machine learning algorithms that can enhance the accuracy of these predictive models. The ultimate goal is to provide a comprehensive understanding of how these tools can aid in the personalized management of women experiencing RPL.

MATERIALS AND METHODS

The review synthesizes current literature on RPL, focusing on various risk factors such as chromosomal abnormalities, autoimmune conditions, hormonal imbalances, and structural uterine anomalies. It also analyzes different predictive models for RPL risk assessment, including genetic screening tools, risk scoring systems that integrate multiple clinical parameters, and machine learning algorithms capable of processing complex datasets. The effectiveness and limitations of these models are critically evaluated to provide insights into their clinical application.

RESULTS

Key risk factors for RPL were identified, including chromosomal abnormalities (e.g. translocations and aneuploidies), autoimmune conditions (e.g. antiphospholipid syndrome), hormonal imbalances (e.g. thyroid dysfunction and luteal phase defects), and structural uterine anomalies (e.g. septate or fibroid-affected uteri). Predictive models such as genetic screening tools and risk scoring systems were shown to be effective in estimating RPL risk. Recent advancements in machine learning algorithms demonstrate potential for enhancing predictive accuracy by analyzing complex datasets, which may lead to improved personalized management strategies.

CONCLUSIONS

The integration of risk factors and predictive modeling offers a promising approach to improving outcomes for women affected by RPL. A comprehensive understanding of these factors and models can aid clinicians and researchers in refining risk assessment and developing targeted interventions. The review underscores the need for further research into specific pathways involved in RPL and the potential of novel treatments aimed at mitigating risk.

Strict vegetarian diet and pregnancy outcomes: A systematic review and meta-analysis

Introduction

The increasing adoption of strict vegetarian diets during pregnancy has raised concerns about their effects on maternal and neonatal outcomes. This systematic review and meta-analysis aimed to assess the impact of strict vegetarian diets on key pregnancy outcomes, including neonatal birth weight, small-for-gestational-age (SGA) infants, gestational diabetes mellitus (GDM), hypertensive disorders, and gestational weight gain (GWG).

Methods

A comprehensive literature search across multiple databases yielded eight studies from various countries, involving a total of 72,284 participants. Primary outcomes included neonatal birth weight, SGA, preterm birth, GDM, and maternal hypertensive disorders.

Results

The meta-analysis found that strict vegetarian diets were significantly associated with an increased risk of delivering SGA infants, with a pooled odds ratio (OR) of 2.71 (95 % confidence interval [CI]: 1.24 to 5.95; p = 0.01). Additionally, infants born to strict vegetarian mothers had lower birth weights, with some studies reporting a mean difference of 240g compared to omnivores. For GDM, no significant differences were found between strict vegetarians and omnivores, with a pooled OR of 0.64 (95 % CI: 0.37 to 1.11; p = 0.11). While vegans showed lower gestational weight gain and reduced risk of excessive weight gain, there was considerable heterogeneity in results regarding hypertensive disorders and preterm birth.

Conclusions

Strict vegetarian diets during pregnancy are associated with an increased risk of SGA infants and lower birth weights. To mitigate these risks, specific dietary guidelines emphasizing adequate intake of critical nutrients such as vitamin B12, iron, omega-3 fatty acids, and iodine should be developed. Supplementation and tailored dietary counseling, incorporating fortified foods and plant-based sources like legumes, nuts, seeds, and algae-derived omega-3, are essential to ensure maternal and neonatal health. Further research is necessary to refine these guidelines and explore their impact on diverse populations.

The Association Between Periconceptual Maternal Dietary Patterns and Miscarriage Risk in Women With Recurrent Miscarriages: A Multicentre Cohort Study

OBJECTIVE

To examine the association between periconceptual maternal diet and miscarriage risk among women with recurrent miscarriages.

DESIGN

Prospective multicentre cohort study (Tommy's Net).

SETTING

Three university hospital research centres in the United Kingdom.

POPULATION

1035 women with a baseline history of two or more miscarriages.

METHODS

We analysed baseline dietary data from a 10-item Food Frequency Questionnaire (FFQ). For individual food category analyses, we used multivariable Poisson regression following adjustment for maternal confounders and paternal dietary patterns. For whole diet analyses, ordinal principal component analysis (PCA) was used to identify common dietary patterns. Results were presented as relative risks (RR) with 95% confidence intervals (CI) and accompanying p-values.

MAIN OUTCOME MEASURES

Miscarriage rate, defined as the rate of spontaneous pregnancy loss (< 24 weeks of gestation) relative to the total number of pregnancies (miscarriages and live births).

RESULTS

High consumption of fruit and nuts (almonds and walnuts) was associated with lower miscarriage risk (fruit 226/662 (34.1%) vs. 38/77 (49.4%), RR 0.66, 95% CI 0.51 to 0.85, p = 0.001; nuts 47/152 (30.9%) vs. 220/613 (35.9%), RR 0.73, 95% CI 0.54 to 0.98, p = 0.039). High red meat intake was associated with a possible increase in miscarriage risk (6/12 (50.0%) vs. 165/469 (35.2%), RR 1.86, 95% CI 1.10 to 3.16, p = 0.022). The association with miscarriage risk was unclear for other food groups, including fresh vegetables, white meat, fish, dairy, eggs, soya and chocolate, due to imprecise point estimates. Through PCA, we identified three data-derived dietary patterns. Yet, no distinct relationship emerged between these dietary patterns and miscarriage risk.

CONCLUSIONS

A maternal diet rich in fresh fruits and nuts is associated with a lower miscarriage risk among women with a history of recurrent miscarriage.

TRAIL REGISTRATION

Tommy's Net (ISRCTN17732518) https://www.isrctn.com/ISRCTN17732518. Analysis plan (OSF zp7cs) https://osf.io/zp7cs.

The association between food production, food security, household consumer behaviour and waist-hip ratio amongst women in smallholder farming households in Kilifi County, Kenya

Food insecurity disproportionately affects smallholder farming households and within them women, who bear primary caregiving responsibilities and contend with time and resource constraints that heighten their vulnerability to adverse nutrition-related health outcomes. This study cross-sectionally investigates the association between food production practices, household consumer behaviour, and the experience of food insecurity with women's waist-hip ratio (WHR), a key indicator of abdominal obesity, in a coastal community in Kenya. In total, 394 households were randomly selected from a list of farming households in Kaloleni and Rabai sub-counties of Kilifi. Trained enumerators administered questionnaires to adult female family members who play a pivotal role in household management. Household dietary diversity scores (HDDS) were computed from 16 food groups consumed in the 7 days preceding the survey. Waist-hip measurements focused on these females, representing vulnerable populations. Pathway-based regression models were constructed using STATA version 13 (p < 0.05). Most households practised mixed farming (59.9%) and monocropping (73.2%) and most female respondents were widowed (75.1%) with limited education (73.1% had no formal education) and over 20 years of farming experience. Food insecurity was prevalent, affecting 80.7% of households. Limited dietary diversity was noted with an average HDDS of 9. The most commonly consumed foods were cereals, spices, condiments and beverages, while meat, eggs and fruits were infrequently eaten. An inverse association was observed between HDDS and WHR (standardised regression coefficient = -0.1328; p = 0.026) but while food insecurity was inversely associated with both HDD and WHR, these associations did not reach statistical significance (HDDS-standardised regression coefficient -0.0294; p = 0.592: WHR-standardised regression coefficient -0.0155; p = 0.791). Existing research has primarily addressed the undernutrition and hunger-related impacts of food insecurity. The findings underscore the need to better understand the complex interplay between food insecurity and nutritional health, including markers of adiposity, to effectively promote health.

Vitamin B12 intake during pregnancy linked to child speech development and intelligence quotient

BACKGROUND

Nutrient deficiencies during pregnancy may affect offspring development. We aim to examine the association between prenatal vitamin B12 intake and children's cognitive development.

METHODS

A total of 5151 mother-child pairs from the Czech part of ELSPAC study were included in the analysis. Dietary information was obtained during pregnancy using food frequency questionnaire. Parents reported on their child's speech and language development at 18 months, 3, 5 and 7 years. Intelligence quotient (IQ) was measured at 8 years in subcohort of 854 children.

RESULTS

Children of mothers with higher vitamin B12 intake demonstrated higher scores in language (B = 0.20, 95% CI 0.06, 0.34) and talking and understanding (B = 2.39, 95% CI 0.97, 3.80) in a fully adjusted model at 18 months. Additionally, they were more likely to get maximum points in the intelligibility test at age 3 (OR = 1.05, 95% CI 1.01, 1.09) in unadjusted model, however, not in fully adjusted model. We found a positive effect of higher vitamin B12 intake on verbal IQ (B = 1.08, 95% CI 0.09, 2.08).

CONCLUSIONS

We identified consistent associations between prenatal vitamin B12 intake and children's cognitive development. The results suggest that inadequate vitamin B12 during pregnancy may negatively affect children's cognitive development, particularly in speech and language.

Global levels and variations of breast milk fatty acids and triacylglycerols: A systematic review and meta-analysis

Understanding global temporal and spatial variations in breast milk composition is crucial for developing personalized infant nutrition strategies. This study analyzed 46,673 breast milk samples from 171 studies using a random-effects model to evaluate total fatty acids (TFA), sn-2 fatty acids (sn-2 FA), and triacylglycerols (TAG) across lactation stages, regions, and sample years. Results showed that saturated fatty acids (SFA) increased while unsaturated fatty acids (UFA) decreased with prolonged lactation, with corresponding changes in triacylglycerol profiles. Geographically, Africa had the highest SFA and lowest UFA, Asia had the highest PUFA, and Europe had the highest MUFA. Over time, SFA and SFA-dominant TAGs declined, while UFA and UFA-dominant TAGs rose. These variations reflect shifts in maternal diet, infant nutritional needs, and potential growth outcomes, highlighting the importance of monitoring breast milk lipids to optimize infant nutrition strategies.

Chromium-histidine complex enhances reproductive physiology and development in Drosophila melanogaster by modulating oxidative stress

The interaction of metal ions with biological systems plays a critical role in cellular functions, including oxidative stress regulation and metabolic health. This study aimed to explore the effects of the chromium-histidine complex [Cr(hist)3] on reproductive success, developmental processes, and oxidative stress defence in Drosophila melanogaster. Wild-type D. melanogaster flies were exposed to Cr(hist)3 at concentrations of 5, 10, 15, and 20 µg/ml, and physiological parameters-including fecundity, fertility, developmental timelines, and antioxidant enzyme activity-were measured. Our results indicate that Cr(hist)3 at 15 µg/ml optimally enhanced reproductive health and developmental efficiency. Specifically, fecundity and fertility increased by 15.6% and 15.5%, respectively, and egg-to-adult viability improved by 15.6% compared to controls. Developmental timelines were shortened, with larval and pupal periods reduced by 7.6% and 7.1%. Additionally, Cr(hist)3 treatment led to a significant downregulation of lipid peroxidation (MDA) by 17.54% and upregulation in antioxidant enzymes (catalase, glutathione-S-transferase, and superoxide dismutase), indicating improved cellular defence against oxidative damage. Flies treated with 15 µg/ml Cr(hist)33 also exhibited a 9.7% increase in lifespan. These findings suggest that Cr(hist)3 enhances reproductive success and developmental dynamics through oxidative stress regulation, highlighting its potential for applications in insect health and stress management. This study contributes to the understanding of metal ion interactions in biological systems and their physiological effects.

Effectiveness of a nurse-led family empowerment program to improve the quality of life among pregnant adolescents: A randomized controlled trial

OBJECTIVE

The present study examined the effects of a nurse-led family empowerment program on the quality of life of Palestinian pregnant adolescents.

METHODS

This was a randomized controlled trial with a two-group pre-/post-test design. The sample consisted of 58 pregnant adolescents recruited from six governmental primary health care clinics in Palestine. Participants were randomly allocated in equal numbers to either the control group (n = 29), which received routine care, or the experimental group (n = 29), which received both routine care and the study program. Data collection instruments included a demographic form and the WHO Quality of Life-BREF (WHOQoL-BREF). Data were collected twice: at 32 or 33 weeks' gestation to establish a baseline and at 36 or 37 weeks' gestation post-test. Statistical analyses were performed and included descriptive statistics, chi-square and t-tests.

RESULTS

The study findings indicated a significant increase in the mean quality of life scores of the experimental group in the post-test compared to the pre-test (P < 0.001). Additionally, pregnant adolescents in the experimental group demonstrated significantly higher post-test QoL scores than those in the control group (P < 0.001).

CONCLUSION

The nurse-led family empowerment program emerges as a viable and efficacious alternative intervention for improving the quality of life among Palestinian pregnant adolescents.

CLINICALTRIALS

The study was registered with the NIH U.S. National Library of Medicine ClinicalTrials.gov on 01/09/2021 with the registration code NCT05031130. It can be accessed via this link: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05031130.

Maternal macronutrient intake at pregnancy and offspring growth trajectory through childhood: a prospective analysis in the Growing Up Today Study 2 cohort

BACKGROUND

Childhood obesity has become a public health challenge globally. Existing studies have indicated a potential link between maternal dietary macronutrient compositions and subsequent weight changes in their offspring during early childhood, although few studies have been conducted through early adulthood.

OBJECTIVES

We aimed to investigate the relationship between maternal macronutrient intake before or during pregnancy and offspring body weight from late childhood till early adulthood.

METHODS

We included 5715 children from the Growing Up Today Study 2 (GUTS2) (mean 11.8 y old at baseline in 2004) born to 4731 mothers who participated in the Nurses' Health Study II (NHSII) during 1989-1995. Diet during or before pregnancy was assessed using a validated food frequency questionnaire (FFQ) in 1991 and 1995. Age- and sex-specific body mass index (BMI) were used to define overweight and obesity in childhood and adolescence. Multivariable linear and log-binomial regression models with generalized estimating equations were used to evaluate the associations of interest.

RESULTS

The mean (SD) maternal macronutrient percent energy intake during pregnancy was 19.3% (3.1) for protein, 51.2% (6.6) for carbohydrates, and 30.8% (5.0) for total fat. For diet during pregnancy, after multivariate adjustment for maternal and offspring risk factors, compared with the lowest quartile, the highest quartile of trans fatty acid consumption was associated with a 0.20 unit (95% confidence interval [CI]: 0.00, 0.40) increase in BMI z-score without a significant linear trend (P-trend = 0.06). A positive association with BMI z-score was also observed for total fat intake (β: 0.21; 95% CI: 0.05, 0.36; P-trend = 0.02) when replacing total carbohydrate, and vice versa (β: -0.24; 95% CI: -0.40, -0.08; P-trend = 0.02 for total carbohydrate intake). For diet before pregnancy, none of the macronutrients were associated with offspring BMI z-score or the risk of overweight or obesity.

CONCLUSIONS

Higher fat, especially trans fat intake, during pregnancy was positively associated with higher body weight among offspring. Other macronutrients from various food sources were not associated with the offspring weight. Overall, these data suggest that, apart from trans fatty acids, other macronutrient composition of maternal diet may have minimal impact on offspring body weight in this well-nourished population.

Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission?

With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.

Dietary Energy and Nutrient Intake Among Pregnant Women in Sri Lanka: Findings From the Sri Lanka Mother and Newborn Growth Cohort Study

BACKGROUND

Maternal nutrition during pregnancy is crucial to ensure positive outcomes for both the mother and newborn. Despite its importance, maternal nutritional status remains poor, particularly in low- and middle-income countries, where social, cultural and economic factors play a pivotal role. This study assessed the adequacy of energy and dietary nutrient intake among Sri Lankan pregnant women compared to their dietary reference intakes.

METHODS

This study was part of the Sri Lanka Mother and Newborn Growth study, a nationwide prospective cohort of 2000 pregnant women. We prospectively investigated maternal dietary intake using a validated food frequency questionnaire during the first, second and third trimesters.

RESULTS

We observed an imbalanced macronutrient distribution, with carbohydrates contributing over 67% of total median energy intake, while protein and fat contributed approximately 11% and 17%, respectively. Ethnic and socio-economic disparities in energy and macronutrient intake were notable. The Sinhalese ethnic group showed the highest median percentage of energy consumption derived from carbohydrates at 68.0% (IQR: 64.6%‒71.1%), significantly exceeding the intake of Tamil and Moor groups. Estate residents reported the lowest proportion of energy from protein (10.6%, IQR: 10.1%‒11.3%), which was significantly lower than the intakes of urban and rural residents. Additionally, women in the lowest income group had a lower total energy intake (1871 kcal/day, IQR: 1464-2392) than those in higher income groups, highlighting socio-economic influences on maternal nutrition. Micronutrient deficiencies were pervasive, particularly for vitamin B2 (88.6%-91.0%), folate (99.3%-99.8%), vitamin B12 (97.8%-99.5%), calcium (80.8%-91.4%) and iron (91.1%-96.5%). Sodium intake exceeded recommended levels for over 75% of women across all trimesters.

CONCLUSION

Imbalances in macronutrient intake and widespread micronutrient deficiencies among Sri Lankan pregnant women underscore the urgent need for interventions targeting maternal nutrition. Addressing socio-economic disparities is critical to improving maternal and neonatal health outcomes.

Dietary Micronutrient Intake During Pregnancy Is Suboptimal in a Group of Healthy Scottish Women, Irrespective of Maternal Body Mass Index

Background/Objectives: A balanced nutritious diet is vital during pregnancy for both the mother and the baby. The aims of this longitudinal study were to (1) determine any differences in macro- and micronutrient intakes in a group of UK women during pregnancy (and in the post-partum period) who were overweight or obese (BMI mean (SD) 31.1 (2.9)) at antenatal booking appointment compared with women who were within the ideal BMI range (BMI mean (SD) 22.1 (1.9)) and (2) determine the proportion of women who met the Harmonized Average Requirements (H-AR) during pregnancy. Methods: Forty-two participants attended four clinic visits: three during pregnancy, one in each trimester (V1, V2, and V3), and one 12 weeks post-partum (V4). Dietary intake was assessed by 24 h diet recall and analysed using DietPlan6. Results: There were no differences in energy and macronutrient intakes between overweight/obese and lean women. During pregnancy, the overweight/obese women consumed a mean (SD) of 3238 (941) sodium (mg per day), which was approximately 10% higher compared to 2934 (732) sodium (mg per day) in the lean group (p = 0.015). Dietary and supplemental intakes of the sodium to potassium ratio was 21% higher in overweight/obese women compared to the lean women, p = 0.0031 (mean (SD) of 1.17 (0.35) versus 0.93 (0.28), respectively). Virtually all women did not meet the H-AR for niacin, folate, and vitamin D through dietary intake alone. Conclusions: The 'eat better and not more' message during pregnancy is supported.

An empowerment programme to improve diet quality during pregnancy - the Power 4 a Healthy Pregnancy cluster randomised controlled trial

BACKGROUND

A healthy diet during pregnancy is vital for the well-being of both mothers and babies. However, navigating dietary choices amidst the unique psychological and physiological changes of pregnancy can be challenging. Empowerment, defined as the ability to improve capacities, critically analyse situations, and take actions to improve them, can support pregnant women to make healthier choices. This intervention study assessed the effects of the 'Power 4 a Healthy Pregnancy' (P4HP) programme on diet quality and empowerment.

METHODS

In a nonblinded, two-arm, parallel cluster randomised controlled trial, the P4HP programme was implemented in 16 randomly allocated Dutch midwifery practices, recruiting 342 participants. Participants were assigned to either the intervention (n = 186) or the control group (n = 156). The P4HP programme offered four additional consultations during pregnancy to discuss nutrition with both a midwife and dietitian, using an empowerment approach. The effectiveness of the P4HP programme was evaluated using pre- and post-intervention questionnaires assessing diet quality, empowerment, quality of life, sense of coherence, and self-rated health. The data were analysed using linear mixed models with an intention-to-treat approach.

RESULTS

The P4HP programme was conducted from approximately week 11 to week 34 of pregnancy. The total diet quality score significantly improved during pregnancy in the intervention group compared to the control group (4.28; 95% CI: 7.87 to 0.70; p = 0.019), particularly driven by improvements in the scores for vitamin D, iodine, and fish. Although other components, including fruit, whole-grain foods, nuts, dairy foods, iodine, and fish showed greater average increases in diet quality scores within the intervention group, these differences were not significant. Women across all empowerment levels expressed uncertainty regarding their weight gain during pregnancy.

CONCLUSION

The P4HP programme positively influenced the dietary habits of pregnant women through empowerment. The observed improvement in diet quality underscores the potential of the P4HP programme as an effective intervention during pregnancy. This study lays the foundation for future empowerment-based interventions in maternal health contexts.

TRIAL REGISTRATION

International Clinical Trial Registry Platform NL-OMON23191, date of registration: 19/05/2021.

Patient-Provider Prenatal Nutrition Conversations Using a Human Factors Approach

OBJECTIVE

To examine patient-provider nutrition conversations at initial prenatal visits.

DESIGN

Convergent mixed methods observational study.

SETTING

Two large metropolitan clinics in the midwestern United States.

PARTICIPANTS

Sixteen providers and 20 racially diverse pregnant women.

METHODS

Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, we observed and audio-recorded initial prenatal visits with obstetric providers. Patients completed post-visit surveys and interviews, and providers completed post-visit interviews. Finally, we sent a practice-wide electronic survey to all providers. We completed quantitative data analysis for descriptive statistics of observation and survey results. We completed qualitative thematic analysis of visit and interview transcripts and combined and categorized results into components of the SEIPS 2.0 model.

RESULTS

We identified multiple dynamic and interacting factors relevant to the work system and processes in the SEIPS 2.0 model in patient-provider conversations about nutrition. Although nutrition was covered in all visits, most conversations were provider-centered and covered basic, general recommendations related to a limited number of topics. Few individualized collaborative discussions that addressed contextual factors occurred.

CONCLUSION

Finding ways to incorporate and address contextual factors into patient-centered conversations about nutrition is vital to optimize the dietary habits of women, especially those from vulnerable populations. To do this, multidisciplinary teams that include nurse practitioners, nurses, obstetricians, and registered dietitians who can address the multiple social determinants of health that affect dietary choices are needed.

Influence of Obstructive Sleep Apnea on Oxidative Stress in Pregnancy

Obstructive sleep apnea (OSA) is common during pregnancy and linked to adverse outcomes. While oxidative stress is a proposed pathogenic mechanism, evidence in pregnant populations remains limited. This multicenter, prospective study evaluated oxidative stress through protein carbonyl levels in 171 pregnant women and 86 cord blood samples. Polysomnography (PSG) performed during pregnancy categorized participants with the apnea-hypopnea index (AHI) in OSA, rapid eye movement (REM) OSA, and supine OSA. Protein carbonyl levels were measured by the dinitrophenyl hydrazine (DNPH) method. No significant differences were found in maternal or cord blood protein carbonyl levels between OSA and non-OSA groups, or between REM and supine OSA subgroups. Interestingly, women with shorter apnea-hypopnea (AH) length showed both higher maternal and cord blood protein carbonyl levels and lower nocturnal oxygen saturation. Overall, OSA in pregnancy was not associated with increased oxidative stress as measured by protein carbonyl levels. However, apnea-hypopnea duration and nocturnal hypoxia may influence oxidative stress, pointing to a complex relationship between OSA and oxidative stress during pregnancy, beyond traditional metrics like AHI. Future studies should explore additional biomarkers and diverse molecular pathways that could play a role, with special attention to emerging factors such as apnea-hypopnea length and hypoxic burden to elucidate the interrelationships between OSA and pregnancy more comprehensively.

International expert consensus on micronutrient supplement use during the early life course

BACKGROUND

Growing evidence demonstrates that maternal nutrition is crucial for the health of the mother-to-be, and early life course of the offspring. However, for most micronutrients, guidelines are inconsistent. This Delphi study aimed to investigate the level of expert consensus on maternal nutrition and micronutrient needs during preconception, pregnancy and lactation.

METHODS

We conducted a two-round web-based Delphi survey on various topics including general approaches to diet and supplement use, and existing guidelines. For the periods of preconception, pregnancy and lactation, questions focused on the importance and strength of evidence for supplement use with the following micronutrients for low- and high-risk populations: folic acid, choline, iodine, magnesium, calcium, iron, selenium, docosahexaenoic acid (DHA), and vitamins B1, B2, B6, B12, D and K.

RESULTS

Thirty-five experts participated in the panel, who were healthcare professionals (HCPs), researchers and joint HCP-researchers with expertise in nutrition, gynaecology and/or obstetrics. Panellists reached consensus on the importance of diet and dietary supplement use during pregnancy and agreed on the lack of clarity and consistency in current guidelines, and the need for education in these areas for HCPs, pregnant people and the general population. For general low-risk populations, there was consensus on the importance of supplement use with iron and vitamin D from preconception through lactation, with folic acid and iodine from preconception through the second and third trimesters, respectively, with DHA from the first trimester through lactation and with calcium during lactation. Panellists agreed that the evidence for supplement use with each of these micronutrients during these phases to improve outcomes and/or foetal development is strong, except for vitamin D (preconception), DHA (first trimester), and iron (both periods). There was also consensus that supplement use advice should be tailored for people following vegan/vegetarian diets, restricted diets due to food intolerances, obesity, polycystic ovary syndrome, diabetes mellitus, and previous nutrition-related pregnancy complications.

CONCLUSION

The findings revealed robust consensus on various aspects of maternal nutrition, including the need for education, the lack of consistency in current guidelines on supplement use, the importance of supplement use across specific phases of pregnancy and the at-risk groups requiring tailored approaches.

Nutrition literacy in Vietnamese pregnant women: a cross-sectional study

Inadequate nutrition intake during pregnancy elevates the risk of adverse health outcomes during pregnancy, with potential long-term repercussions for both mother and child, extending to subsequent generations. Current initiatives to improve individual dietary habits emphasize promoting nutrition literacy (NL), which encompasses the ability to access, comprehend, and use basic nutrition information and services necessary for making appropriate nutrition decisions. However, there were limited data on the NL of pregnant women in Vietnam. Therefore, this study aims to explore the NL levels of Vietnamese pregnant women and examine the factors related to their NL. A total of 360 Vietnamese pregnant women participated in the study from May to September 2023. A validated questionnaire (Nutrition Literacy Assessment Instrument for Pregnant Women, NLAI-P), assessing the knowledge, behavior and skill, was applied. A general linear model with univariate linear regression analysis was conducted to identify predictor factors of NL. The findings revealed that 70.3% of participants had inadequate NL. Among the three dimensions, nutrition knowledge was particularly low, with no respondents achieving an adequate level and 94.7% scoring at an inadequate level. High household monthly income, age, normal prepregnancy weight and indoor work were statistically associated with higher NL scores. This study highlights the limited NL among Vietnamese pregnant women. Increasing NL is crucial for supporting their optimal healthy diet, enhancing the health of pregnant women and their offspring and future generations.

Gaining stakeholder perspectives to shape a produce prescription program to improve maternal and birth outcomes: a qualitative study

Introduction

Nutrition during pregnancy significantly impacts maternal and birth outcomes. A key factor contributing to the rise in adverse maternal and birth outcomes is poor nutrition. Produce prescription programs have the potential to address pregnancy-related adverse outcomes such as hypertensive disorders and gestational diabetes, but scientific evidence is limited.

Purpose

To conduct qualitative interviews to gain an in-depth understanding of how, why, and in what context should produce prescriptions be implemented to best meet the needs of pregnant women in a clinical setting.

Methods

We conducted interviews with 11 patients with low incomes and/or experiencing food insecurity and 11 clinic staff from a major metropolitan OB/GYN clinic. Interview questions were designed to understand attitudes toward participating in or helping implement a produce prescription program. We analyzed the data using a deductive qualitative content analysis approach.

Results

Both patients and clinic staff perceived many benefits to this type of program, including easing financial strain, removing barriers to access, and addressing nutrition security during pregnancy. Both groups described a need to consider participants' autonomy in the program design. Patients also perceived some drawbacks to the home delivery aspect, such as limited participation by patients due to unstable housing. Staff expressed some concerns about the staff time needed to implement this type of program.

Conclusion

There was strong support for produce prescription programs for this population; however, results indicate that they may best meet needs if patient autonomy and delivery-related barriers are considered in the design. Designating screening and enrollment tasks for ancillary staff may facilitate implementation in clinics.

A, Guadarrama Gándara CG, Escobar C, Guerrero-Vargas NN. Maternal exposure to dim light at night induces behavioral alterations in the adolescent and adult offspring Wistar rat

Introduction

Access to electric light has exposed living organisms to varying intensities of light throughout the 24 h day. Dim light at night (DLAN) is an inappropriate signal for the biological clock, which is responsible for the circadian organization of physiology. During the gestational period, physiological adaptations occur to ensure a successful pregnancy and optimal fetal development. Environmental maternal conditions, such as disruptions of maternal circadian rhythms, could negatively affect offspring health. We have previously demonstrated that exposure of female Wistar rats to DLAN results in circadian, metabolic, and behavioral alterations. A relevant behavior during adolescence is social play, primarily regulated by the nucleus accumbens (NAc) which is crucial for the proper performance of important behaviors in adulthood. Throughout development, microglia are responsible for the remodeling of diverse brain regions via synaptic pruning. During adolescence, this process occurs within the NAc, where immune-mediated remodeling directly impacts social play behavior.

Methods

This study investigated the effects of maternal exposure to DLAN or a light-dark cycle (LD) before (5 weeks) and during the gestational period (21-23 days) on the metabolism and behavior of offspring in adolescence and adulthood. Body mass was measured every 5 days from postnatal day 1 (PN1) to PN25 and every 10 days from PN40 to PN90; food consumption was monitored weekly from PN40 to PN90. Social play behavior was evaluated at PN40. The quantification and morphology of microglia in the NAc were measured on PN30. An open field test was conducted at PN60, and anhedonia test was assessed at PN90.

Results and discussion

Male and female offspring from mothers exposed to DLAN showed increased body mass gain at PN25. DLAN male offspring had lower food consumption, while DLAN females exhibited increased food consumption. In social play behavior, no differences were found between DLAN and LD female offspring. In contrast, DLAN male offspring exhibited a significant decrease in social play behavior compared to LD animals, which was associated with higher numbers of microglia in the NAc that had more ramified morphology. Importantly, at PN90, DLAN offspring presented increased anxiety-like behaviors. These results demonstrate that DLAN exposure induces intergenerational behavioral alterations that persist until adulthood.

Food Insecurity in Pregnancy, Receipt of Food Assistance, and Perinatal Complications

Importance

Food insecurity is a growing public health concern, but its association with perinatal complications remains unclear.

Objective

To examine whether food insecurity in pregnancy was associated with the risk of perinatal complications and determine whether these potential associations differed by receipt of food assistance.

Design, Setting, and Participants

This cohort study used data from a pregnancy survey conducted between June 22, 2020, and September 9, 2022, at Kaiser Permanente Northern California, an integrated health care system serving a diverse population of 4.6 million. Participants included individuals who delivered singletons. Data were analyzed from December 2023 to June 2024.

Exposure

Food insecurity in pregnancy assessed using the validated 2-item Hunger Vital Sign screener.

Main Outcomes and Measures

Maternal (gestational diabetes, gestational hypertension, preeclampsia, cesarean delivery) and neonatal (preterm birth, neonatal intensive care unit [NICU] admission, small-for-gestational age [SGA], and large-for-gestational age [LGA]) complications extracted from the electronic health records, and a composite adverse perinatal outcome (APO) of maternal and neonatal complications. Modified Poisson regression models were adjusted for covariates and stratified by receipt of food assistance in pregnancy.

Results

Among 19 338 individuals, 2707 (14.0%) reported food insecurity in pregnancy. Individuals with food insecurity in pregnancy had a higher risk of gestational diabetes (adjusted relative risk [aRR], 1.13 [95% CI, 1.01-1.29]), preeclampsia (aRR, 1.28 [95% CI, 1.11-1.49]), preterm birth (aRR, 1.19 [95% CI, 1.02-1.38]), NICU admission (aRR, 1.23 [95% CI, 1.07-1.42]), and APO (aRR, 1.07 [95% CI, 1.02-1.13]) compared with individuals without food insecurity. Among 1471 individuals (7.6%) who received food assistance in pregnancy, associations of food insecurity in pregnancy with perinatal complications were attenuated to the null, except for preeclampsia (aRR, 1.64 [95% CI, 1.06-2.53]). On the contrary, the associations persisted among individuals who did not receive food assistance: gestational diabetes (aRR, 1.20 [95% CI, 1.04-1.37]), preeclampsia (aRR, 1.24 [95% CI, 1.06-1.46]), preterm birth (aRR, 1.23 [95% CI, 1.05-1.46]), NICU admission (aRR, 1.31 [95% CI, 1.12-1.52]), and APO (aRR, 1.12 [95% CI, 1.06-1.18]).

Conclusions and Relevance

In this cohort study, food insecurity in pregnancy was associated with a higher risk of perinatal complications, and these associations were overall attenuated to the null among individuals who received food assistance in pregnancy. These findings support clinical guidelines of screening for food insecurity in pregnancy and provide evidence to expand food assistance programs that may help improve maternal and neonatal outcomes.

Seeking the optimal gestational weight gain according to the pre-pregnancy body mass index: a cross-sectional study from Shanghai, China

OBJECTIVES

Maternal nutritional status is closely related to fetal intrauterine development and an abnormal birth weight increases various disease risks across life stages. To better guide pregnancy weight gain, we aimed to explore the optimal weight gain for pregnant women with different body mass indexes (BMIs).

METHODS

This retrospective cohort study included 68,981 women with singleton live birth between January 2017 and October 2021 in maternity centres in Shanghai, China. The fluctuations of the incidence of small and large for gestational age (small for gestational age (SGA) and LGA, respectively) were recorded at different maternal pre-pregnancy BMI (p-BMI) and different gestational weight gain (GWG) groups to find the lowest point of abnormal fetal weight incidence. The optimal GWG was then determined using a linear regression equation.

RESULT

The lowest risk of LGA/SGA was associated with a maternal p-BMI of 19.46 kg/m2. For pregnant women with maternal p-BMI below 24 kg/m2, we confirmed an optimal GWG linear equation: opt GWG (kg) = -1.94 × p-BMI (kg/m²) + 51, which showed an excellent degree of fit. Women who were overweight and obese could not achieve the lowest risk of LGA/SGA despite controlling their GWG; hence, their BMI should be normalized before pregnancy.

CONCLUSION

By merely using the pre-pregnancy BMI, this study has established the optimal GWG equation, with the goal of achieving the appropriate fetal gestational age. It is a practical measure to ensure desirable pregnancy outcomes and meet the health economics requirements.

Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review

INTRODUCTION

Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling.

METHODS

An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition.

RESULTS

Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines.

DISCUSSION

Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.

15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Maternal Lifestyle Factors Affecting Breast Milk Composition and Infant Health: A Systematic Review

BACKGROUND/OBJECTIVES

Breast milk is a dynamic, personalized nutrition source, influenced by maternal diet, lifestyle, and environmental factors, which shape its composition and impact infant health. This review synthesizes evidence on the associations between maternal lifestyles (e.g., diet, physical activity, smoking), breast milk composition, and child health, offering insights for interventions to optimize breastfeeding benefits.

METHODS

We searched Web of Science, Medline, Embase, and PubMed for studies published up to March 2024 using predefined terms.

RESULTS

Out of 5244 articles, 20 studies met the inclusion criteria. Maternal Body Mass Index and macronutrient intake significantly affected breast milk fatty acid composition, influencing infant growth, cognitive development, and metabolic health. Micronutrient intake, particularly iodine, omega-3 fatty acids, and vitamins, was linked to better neurodevelopment and reduced atopic risks. Maternal diet and supplementation improved breast milk nutrient profiles and infant outcomes, though exposure to toxins like ochratoxin A raised concerns. Smoking was associated with altered milk composition, including lower osteopontin levels, potentially affecting infant immunity and growth.

CONCLUSIONS

This review emphasizes that adequate intake of key nutrients is essential for infant development, highlighting the need for policies that address nutritional deficiencies, promote healthy lifestyles, and reduce socio-economic barriers. These efforts can improve outcomes for both mothers and children, enhancing public health and reducing disparities.

The Effect of Clinical Exercise Training on Plantar Pressure, the Subtalar Joint, and the Gait Cycle in Pregnant Women: Randomized Clinical Trial

Background/Objectives: This study aims to examine the effects of clinical exercise training on foot plantar pressure, the subtalar joint, and the gait cycle during pregnancy. Methods: The study was planned as a randomized, controlled, and single-blind study. Participants' demographic information, obstetric evaluation, physical activity level, fall history, and pain evaluation were recorded. Foot plantar pressure, the subtalar joint, and the gait cycle were measured through pedobarography at Gait Laboratory. The control group was recommended walking. Clinical exercise training was given to the study group 2 days a week for eight weeks. Evaluations were made on day 0 and the day corresponding to the end of week 8. Results: The study was completed with 50 people in the study group (age: 29.7 ± 3.8 years) and 51 in the control group (age: 29.1 ± 6.1 years). As a result of the parametric and non-parametric tests performed before and after the exercise, it was observed that there was a statistically significant difference between the two groups in weight, BMI, pain score, static plantar pressure, dynamic plantar pressure, subtalar joint flexibility, duration of the walking period, and multistep walking speed (p < 0.01). The two groups had a significant difference only in the dominant midfoot plantar pressure (p > 0.05). Conclusions: According to our research, weight control and pain relief are observed in women who engage in clinical exercise in the second trimester of pregnancy; plantar pressure and subtalar joint flexibility are preserved, the walking period does not increase, and the multistep walking speed can be maintained after eight weeks.

Prenatal Origins of Obstructive Airway Disease: Starting on the Wrong Trajectory?

From the results of well-performed population health studies, we now have excellent data demonstrating that deficits in adult lung function may be present early in life, possibly as a result of developmental disorders, incurring a lifelong risk of obstructive airway diseases such as asthma and chronic obstructive pulmonary disease. Suboptimal fetal development results in intrauterine growth restriction and low birth weight at term (an outcome distinct from preterm complications), which are associated with subsequent obstructive disease. Numerous prenatal exposures and disorders compromise fetal development and these are summarized herein. Various physiological, structural, and mechanical abnormalities may result from prenatal disruption, including changes to airway smooth muscle structure-function, goblet cell biology, airway stiffness, geometry of the bronchial tree, lung parenchymal structure and mechanics, respiratory skeletal muscle contraction, and pulmonary inflammation. The literature therefore supports the need for early life intervention to prevent or correct growth defects, which may include simple nutritional or antioxidant therapy. © 2024 American Physiological Society. Compr Physiol 14:5729-5762, 2024.

Exploring Beliefs, Concerns, Prenatal Care Advice, and Sources of Information About Gestational Weight Gain Among Immigrant Central American Pregnant Women in the United States

Gestational weight gain (GWG) is critical for maternal and neonatal health, but excessive GWG can lead to complications such as gestational diabetes, hypertension, and increased obesity risk later in life. Minoritized and immigrant women often face higher risks of excessive GWG. This cross-sectional study assessed Central American women's beliefs and concerns about GWG, the receipt of advice from healthcare providers, and sources of information for healthy weight management during pregnancy. A cross-sectional survey was conducted with 93 pregnant women from El Salvador (31.2%), Guatemala (46.2%), and Honduras (22.6%). Most participants were married (91.4%), and 91.2% had household incomes below $40,000. Self-reported pre-pregnancy weight status varied significantly (p = 0.03), with more Guatemalans self-reporting as overweight (34.9%) compared to Salvadorans (10.3%) and Hondurans (19.1%). Beliefs about GWG varied significantly; 72.1% of Guatemalan women accepted "eating for two", while only 31.0% of Salvadorans did (p = 0.002). More Honduran women (90.5%) received weight gain recommendations from healthcare providers than Salvadorans (62.1%) and Guatemalans (60.5%) (p = 0.04). The Internet and family were common information sources on weight management, highlighting the need for culturally tailored health education. This study underscores critical differences in beliefs and access to prenatal care among pregnant Central American immigrant women, emphasizing the importance of culturally competent health education to support healthy pregnancy outcomes.

Relevance of diet in schizophrenia: a review focusing on prenatal nutritional deficiency, obesity, oxidative stress and inflammation

Background/Objectives

Schizophrenia is a complex mental disorder influenced by genetic and environmental factors, including dietary habits. Oxidative stress and inflammation play a crucial role in the pathophysiology of schizophrenia. Emerging research suggests that diet may affect schizophrenia through different biological mechanisms beyond oxidative stress and inflammation. In particular, epigenetic changes may alter the expression of genes related to neurodevelopment and neurotransmitter systems, while neuroplasticity plays a crucial role in brain adaptation and resilience to psychiatric disorders.

Methods

The literature search included the main available databases (Science Direct, PubMed and Google Scholar), considering the English language, and our screening was performed based on several words such as "schizophrenia", "diet", "nutrients", "obesity", "oxidative stress", "inflammation", "antioxidants" and "prenatal nutritional deficiency". The review focused specifically on studies examining the relevance of diet in schizophrenia, as well as prenatal nutritional deficiency, obesity, oxidative stress, and inflammation associated with this disorder.

Results

Following a review of the literature, it was found that nutritional deficiencies, including lack of omega-3 fatty acids, vitamins D, and B, during the prenatal and postnatal periods can have a negative impact on neurodevelopment and increase the risk of schizophrenia. Patients with schizophrenia have imbalances in antioxidant enzymes, such as glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), and reduced levels of antioxidants (vitamin E, vitamin C). These biochemical changes lead to an increase in markers of oxidative stress, including malondialdehyde (MDA). In addition, cytokine-mediated inflammation, microglial activation, and intestinal dysbiosis are associated with the onset of schizophrenia and the severity of schizophrenia symptoms. Currently, there is no universally accepted dietary regimen for control. However, various diets and nutritional methods are being researched and applied to alleviate the symptoms of schizophrenia and improve the overall health of patients, including the Mediterranean diet, the ketogenic diet, the gluten-free diet, and the DASH (Dietary Approaches to Stop Hypertension) diet.

Conclusion

A healthy diet, rich in anti-inflammatory nutrients and antioxidants, may help manage schizophrenia by reducing oxidative stress, preventing complications, and improving quality of life. Omega-3 fatty acids, vitamin D, and B vitamins are particularly important for brain development and function. In this review, we aim to analyze the literature on the influence of diet on schizophrenia, focusing on the role of prenatal nutritional deficiencies, obesity, oxidative stress, and inflammation.

The Impact of Parental Preconception Nutrition, Body Weight, and Exercise Habits on Offspring Health Outcomes: A Narrative Review

An increasing number of studies highlight the critical role of both maternal and paternal nutrition and body weight before conception in shaping offspring health. Traditionally, research has focused on maternal factors, particularly in utero exposures, as key determinants of chronic disease development. However, emerging evidence underscores the significant influence of paternal preconception health on offspring metabolic outcomes. While maternal health remains vital, with preconception nutrition playing a pivotal role in fetal development, paternal obesity and poor nutrition are linked to increased risks of metabolic disorders, including type 2 diabetes and cardiovascular disease in children. This narrative review aims to synthesize recent findings on the effects of both maternal and paternal preconception health, emphasizing the need for integrated early interventions. The literature search utilized PubMed, UNF One Search, and Google Scholar, focusing on RCTs; cohort, retrospective, and animal studies; and systematic reviews, excluding non-English and non-peer-reviewed articles. The findings of this review indicate that paternal effects are mediated by epigenetic changes in sperm, such as DNA methylation and non-coding RNA, which influence gene expression in offspring. Nutrient imbalances during preconception in both parents can lead to low birth weight and increased metabolic disease risk, while deficiencies in folic acid, iron, iodine, and vitamin D are linked to developmental disorders. Additionally, maternal obesity elevates the risk of chronic diseases in children. Future research should prioritize human studies to explore the influence of parental nutrition, body weight, and lifestyle on offspring health, ensuring findings are applicable across diverse populations. By addressing both maternal and paternal factors, healthcare providers can better reduce the prevalence of metabolic syndrome and its associated risks in future generations.

Maternal Supplementation with Lacticaseibacillus rhamnosus GG Improves Glucose Tolerance and Modulates the Intestinal Microbiota of Offspring

INTRODUCTION

Consuming hypercaloric diets during pregnancy induces metabolic, immune, and maternal intestinal dysbiosis disorders. These conditions are transferred to the offspring through the placenta and breastfeeding, increasing susceptibility to metabolic diseases. We investigated the effect of L. rhamnosus GG supplementation on offspring maternally programmed with a hypercaloric diet.

METHODS

Our study involved sixteen female Wistar rats aged ten weeks, which were divided into four groups based on their diets: control (Ctrl), cafeteria (CAF), control + probiotic (PRO), and cafeteria + probiotic (CPRO). The control + probiotic and cafeteria + probiotic groups received a daily oral administration of 250 μL of L. rhamnosus GG cell suspension (equivalent to 109 UFC) for nine weeks. The body weight of the animals was recorded weekly, and their food intake was monitored every 24 h. An oral glucose tolerance test was conducted on the offspring at seven weeks of age. At the ninth week of age, animals were euthanized, and blood, tissues, and organs were collected.

RESULTS

Maternal supplementation with L. rhamnosus GG decreased food intake and the average birth weight, improved glucose sensitivity, and lowered the levels of LDL, cholesterol, triglycerides, and mesenteric adipose tissue in offspring compared with the control and cafeteria groups.

CONCLUSIONS

Our findings indicate that supplementing with LGG during maternal programming could protect offspring from metabolic disruptions caused by a hypercaloric maternal diet.

Exploring basal metabolic rate and dietary adequacy in twin pregnancies: the VENERE study

BACKGROUND

Twin pregnancies present unique challenges in maternal healthcare. However, current guidelines primarily address singleton pregnancies, resulting in a knowledge gap regarding their specific metabolic and dietary needs. This study aimed to follow women with twin pregnancies through all three trimesters, assessing basal metabolic rate (BMR), dietary intake, and diet quality.

METHODS

A two-year prospective observational study was conducted at AOU Careggi Hospital, Florence, Italy, involving 35 twin-pregnant women, with 32 completing the study. Participants underwent calorimetric, anthropometric, and dietary assessments during the first (8-13 weeks), second (14-27 weeks), and third trimesters (28-34 weeks). BMR was measured using indirect calorimetry and compared with predictive equations. Dietary intake was evaluated using 7-day food diaries and the Medi-Lite adherence score.

RESULTS

Indirect calorimetry revealed an increase in BMR by 16%, rising from 1479 ± 196 kcal in the first trimester to 1733 ± 224 kcal in the third trimester. Hronek's equation, previously validated for singleton pregnancies, was identified as the most accurate predictive tool for estimating BMR. Dietary analysis revealed that mean daily energy intake increased from 1660 ± 244 kcal in the first trimester to 1889 ± 262 kcal in the third trimester, consistently below recommendations, with insufficient macro- and micronutrient consumption. Poor diet quality was characterized by low intake of fruits, vegetables, legumes, and fresh fish, and high consumption of processed meats, cheese, and sugar-sweetened beverages. Adherence to the Mediterranean diet was moderate across all three trimesters.

CONCLUSIONS

This study highlights the increased energy demands and nutritional inadequacies in twin pregnancies, underscoring the need for tailored dietary guidelines and interventions.

Nutritional requirements in pregnancy and lactation

Optimal nutrition during pregnancy and lactation is vital for the health of the mother and fetus. Nutritional needs should begin in the preconception period, as the fetus depends on the placenta for essential nutrients required for growth and development. A balanced diet rich in nutrient-dense foods-such as whole grains, vegetables, fruits, dairy, legumes, fish, and lean meats-is essential to meet caloric needs during pregnancy. Assessment of maternal health, including dietary history and micronutrient status, is critical to identify potential risks and ensure adequate nutrition. The increased need for micronutrients must be met to prevent complications and fetal growth. Exclusive breastfeeding is recommended for the first six months, and continued breastfeeding is recommended throughout the first year and beyond. During pregnancy and lactation, calorie intake should be increased by focusing on protein and healthy fats. The composition of breast milk is adapted during the breastfeeding period, so that it can provide the necessary nutrients for the growth of the infant. Personalized nutrition plans, developed in consultation with health care professionals, are critical to optimizing maternal and infant health outcomes. This manuscript supports the importance of comprehensive nutritional strategies during pregnancy and lactation to reduce risks and support healthy growth and development of mother and child.

Obesity prevention across the lifespan: assessing the efficacy of intervention studies and discussing future challenges

INTRODUCTION

Obesity is intricately linked with metabolic conditions that disrupt hormones and metabolism, often resulting in weight-related challenges. Given the heightened mortality rates associated with cardiovascular and metabolic disorders linked to obesity, there is a pressing call to mobilize medical professionals, researchers, and policymakers towards advocating for healthy lifestyles and preventing obesity. Traditionally, obesity prevention and treatment have been viewed as separate endeavors, with prevention primarily falling under public health initiatives and treatment within the purview of clinicians. However, this division has led to significant healthcare costs without a substantial reduction in obesity rates.

EVIDENCE ACQUISITION

Our search encompassed published articles focused on prevention, excluding any mention of "treatment". Data was gathered from diverse sources including academic databases, government health agency websites like the CDC, research organizations, clinical trials registries, and public health campaigns.

EVIDENCE SYNTHESIS

Due to the diverse range of interventions (encompassing dietary modifications, physical activity promotion, policy initiatives, education, and community-based programs, either independently or in combination), and the variability in study design and population demographics, we conducted a narrative review to systematically present and critically analyze evidence on preventing overweight and obesity across different age groups.

CONCLUSIONS

Effectively addressing obesity prevention necessitates a comprehensive, multidisciplinary approach that establishes an environment where healthier choices are accessible and viable for all. This requires collaborative efforts between individuals, communities, healthcare providers, policymakers, and industries to institute enduring change. Furthermore, there remains a critical need for national and international guidelines tailored to age-related risk factors, paving the way for innovative precision medicine approaches centered on salutogenesis rather than pathogenesis.

Obstetric healthcare experiences and information needs of Dutch women in relation to their vegan diet during pregnancy

Objectives

The prevalence of a vegan (strict plant-based) diet is increasing. Adequate access to nutritional information for pregnant women on a vegan diet is vital, as optimal maternal nutrition is important in order to prevent maternal and fetal complications. This study evaluated the obstetric healthcare experiences and information needs of pregnant women following a vegan diet in the Netherlands.

Methods

An online survey examined women's experiences with obstetric healthcare in relation to their vegan diet during pregnancy. In total, 195 women, all of whom followed a vegan diet during their pregnancy and gave birth between January 2018 and April 2020, completed an online survey about their experiences. Descriptive statistics were used to present the data.

Results

In total, 36.5% of participants reported that an obstetric healthcare provider had inquired about their diet in general during the first prenatal consultation, and an additional 43.1% of participants proactively informed their healthcare provider about their diet. Only 19.0% of all participants received specific information about their vegan diet during pregnancy, and 25.2% reported having had extra checks, mostly blood tests, during their pregnancy. Of all participants, 35.9% would have preferred to receive additional information regarding their diet.

Conclusions

Our data shows that only a minority of pregnant women following a vegan diet received information and recommendations about their diet from their healthcare providers. It is our recommendation that healthcare providers inquire about pregnant women's diets, and refer those following a vegan diet to reliable sources of dietary information or to a specialized dietitian.

Assessment of Pregnant Women's Satisfaction With the Model of Care Initiative: Antenatal Care Services at Primary Health Care Centers in the Qassim Health Cluster, Saudi Arabia

BACKGROUND

 Patient satisfaction is a critical indicator of healthcare quality, including high-quality antenatal care (ANC), and it directly impacts care continuity and health outcomes. This study assessed the satisfaction levels of pregnant women with ANC services provided at primary healthcare centers (PHCs) within the Qassim Health Cluster, Saudi Arabia.

METHODS

 A cross-sectional survey was conducted among 646 pregnant women attending ANC services in the Qassim region. Participants completed a validated questionnaire assessing demographic characteristics, healthcare interactions, and satisfaction levels across various ANC service aspects, including waiting times, healthcare provider communication, and healthcare service quality. Statistical analyses, including Pearson's chi-squared tests, Fisher's exact tests, and regression analyses, were performed to identify predictors of satisfaction.

RESULTS

 The majority of participants (N=366, 90.6%) reported successfully booking their appointments, and 368 (91.1%) faced no challenges during the process. While 393 (97.3%) and 398 (98.5%) reported receiving weight and blood pressure measurements, respectively, only 312 (77.2%) were advised on diet, and 298 (73.8%) received explanations about alarming symptoms. Communication gaps were noted, with 71% (N=287) of participants indicating that physicians did not introduce themselves, and 307 (76%) reported that physicians did not disclose their specialties. Satisfaction levels were highest for maintaining privacy (273 (67.6%) highly satisfied) and healthcare staff attitudes (247 (61.1%) highly satisfied), with an overall satisfaction mean score of 4.31±0.869. Regression analyses identified healthcare service levels and years of marriage as significant predictors of satisfaction (p<0.05).

CONCLUSION

 While overall satisfaction with ANC services was high, areas such as physician communication and health education require improvement. Interventions focusing on enhancing patient-provider interactions, providing comprehensive health education, and optimizing service delivery could further improve satisfaction.

INSIGHT-2: mechanistic studies into pregnancy complications and their impact on maternal and child health-study protocol

BACKGROUND

Pregnancy and early childhood cohorts provide a framework for investigating the complex interplay between early-life exposures and health outcomes, thereby informing prevention strategies and interventions to improve maternal and child health. In this paper, we outline the objectives, methodologies and expected contributions of INSIGHT-2, a comprehensive cohort study dedicated to advancing our understanding of pregnancy and pregnancy complications towards improving the health and well-being of mothers and their offspring.

METHODS

Over the course of 5 years, the study aims to establish a diverse cohort of 1700 pregnant women and to follow up their children up to 2 years of age. Recruitment targets participants with healthy pregnancies, preexisting conditions, and/or risk factors for pregnancy complications or later child health problems. Clinical and lifestyle data and a range of biological samples will be collected, providing a comprehensive resource for biomarker investigations and cross-sectional analyses. It is anticipated that the cohort will continue beyond this initial 5-year plan.

DISCUSSION

By gathering a wide range of biological samples and using diverse analytical techniques, this study supports broad participation, potential replication and collaboration across various sites. The extensive collection of longitudinal data and samples not only facilitates current investigations but also establishes a biobank for future research. The exploration of pre-pregnancy and pregnancy factors that may contribute to disease processes and impact fetal well-being and future health will provide a comprehensive picture of disease mechanisms in both mothers and children, facilitating the identification of biomarkers for the prediction, diagnosis, and management of pregnancy complications. Additionally, our diverse population allows for the capture of various pregnancy complications and outcomes, enhancing external validity and addressing health disparities. This comprehensive design ultimately aims to improve maternal and child health outcomes by providing a valuable longitudinal study of the relationships among the in utero environment, pregnancy management, and long-term maternal and child health, ensuring that findings are relevant and beneficial to a broader population.

Energy, Macronutrients and Micronutrients Intake Among Pregnant Women in Lebanon: Findings from the Updated Lebanese National Food Consumption Survey (LEBANON-FCS)

BACKGROUND

Pregnancy is a crucial period for maternal and fetal health, and in Lebanon, where cultural and economic factors influence dietary practices, there is an urgent need to evaluate the food consumption patterns and diet quality of pregnant women.

AIM

To evaluate the food consumption patterns, energy intake, as well as macro- and micro-nutrient intake among a nationally representative sample of Lebanese pregnant women aged 18-49 years old.

METHODS

A cross-sectional study was carried out from March to October 2023, involving 500 pregnant women from all eight Lebanese governorates. Sociodemographic and medical information was gathered, food consumption was evaluated using a validated Food Frequency Questionnaire (FFQ) and three 24-h recall, and anthropometric measurements were recorded.

RESULTS

The current population did not meet the USDA healthy pattern recommendations for whole grain, seafood, dairy, nuts, seeds and soy products consumption but exceeded the guidelines for vegetables, meats, poultry, eggs, oils, and refined grains. According to Mediterranean diet guidelines, the sample fell short in recommended intakes for fruits, olives/nuts/seeds, eggs, and olive oil, while surpassing the recommended levels for potatoes, legumes, pulses, sweets, red meat, processed meat, and fish and seafood. None of the participants met the energy requirements for their trimester and age group. In terms of macronutrient intake, the requirements for protein, unsaturated fats, and fiber were not met, while intakes of fats and sugars were exceeded. Regarding micronutrients, the recommended levels were not fully achieved, with particularly low intakes of vitamin D and iodine, as well as inadequate adherence to recommendations for iron, calcium, vitamin A, vitamin E, zinc, and choline. Additionally, a third of the participants did not meet the recommended intakes for folate and vitamin B12.

CONCLUSIONS

The findings reveal significant dietary inadequacies among the current population, with participants failing to meet essential recommendations for whole grains and key food groups, alongside insufficient energy intake for their trimesters and age groups. Critical micronutrient deficiencies, particularly in vitamin D, iodine, and B vitamins, highlight the urgent need for targeted nutritional interventions and public health initiatives to improve dietary practices among pregnant women in Lebanon.

Association between maternal dietary diversity during pregnancy and birth outcomes: evidence from a systematic review and meta-analysis

BACKGROUND

Maternal nutrition is a key factor influencing birth and offspring health outcomes in later life. Dietary diversity (DD) is a proxy for the macro/micronutrient adequacy of an individual's diet. There is inadequate comprehensive evidence regarding maternal nutrition during pregnancy, measured through DD and birth outcomes. This study aimed to provide extensive evidence on maternal DD during pregnancy and birth outcomes.

METHODS

A comprehensive search was performed using PubMed, HINARI, and Google Scholar databases up to January 17, 2024. Studies conducted among pregnant mothers and measuring maternal DD with an evaluation of birth outcomes (low birth weight, small for gestational age, preterm birth), in the global context without design restriction were included. The Newcastle Ottawa Scale and the Cochrane Risk of Bias tool were used to assess the risk of bias. The results are summarized in a table, and odds ratios were pooled where possible. Between-study heterogeneity was evaluated using I2 statistics. Potential publication bias was assessed using a funnel plot and Egger's regression test. To explore the robustness, a leave-one-out sensitivity analysis was conducted.

RESULTS

Thirty-three studies were used to synthesize narrative evidence (low birth weight: 31, preterm birth: 9, and small for gestational age: 4). In contrast, 24 records for low birth weight, eight for preterm birth, and four for small for gestational age were used to pool the results quantitatively. Of the 31 studies, 17 reported a positive association between maternal DD and infant birth weight, 13 studies reported a neutral association (not statistically significant), and one study reported a negative association. Overall, inadequate DD increased the risk of low birth weight OR = 1.71, 95% CI; (1.24-2.18), with I2 of 68.7%. No significant association was observed between maternal DD and preterm birth. Inadequate DD was significantly associated with small for gestational age (OR = 1.32, 95% CI; 1.15-1.49, and I2 = 0.0%).

CONCLUSION

Inadequate maternal DD is associated with an increased risk of low birth weight and small for gestational age but not preterm birth, underscoring the importance of promoting adequate DD during pregnancy. To address these issues, it is essential to implement and expand nutritional programs targeted at pregnant women, especially in low-resource settings, to ensure they receive diverse and adequate diets. Further research is needed to address the current limitations and to explore the long-term implications of maternal nutrition on child health. The study was prospectively registered on PROSPERO (registration number CRD42024513197). No funding was received for this study.

Content-Related Quality Control of Water- and Fat-Soluble Vitamins in Fortified Non-Alcoholic Beverages

BACKGROUND/OBJECTIVES

Vitamin-fortified non-alcoholic beverages (VFNABs) are rising in popularity and availability. However, owing to their regulation as foods, there are also growing quality and safety concerns. Therefore, we aimed to provide an overview of the content-related quality of VFNABs on the Slovenian market.

METHODS

Vitamin contents in 50 VFNABs (29 waters, 5 juices, 12 energy drinks, and 4 instant drinks) were determined using validated methods based on liquid chromatography.

RESULTS

The results revealed several quality issues, which were determined in all four VFNAB types. These included an indication of at least one vitamin, present in a lower-than-significant amount, on the nutrition declaration in 64% of the tested VFNABs and vitamin contents outside the tolerance interval (65-150% of the label claim) in almost half of the cases (48.4%, n = 244). Since the disclosed quality issues are not only a reason for the misleading of consumers but may also pose safety risks for both individuals and public health, we further performed an overall assessment of the VFNABs as vitamin sources. The results revealed that the tested VFNABs not only fully cover but in several cases considerably exceed daily vitamin needs (up to 616% of the reference values), an effect which is further accentuated in children.

CONCLUSIONS

The performed content-related quality control study undoubtedly highlight the need for stricter quality control and regulation and can be utilized as a foundation and recommendation for the manufacturers in terms of committing to and pursuing the production of VFNABs.

Influence of Nutrition on Growth and Development of Metabolic Syndrome in Children

Obesity is currently an increasing public health burden due to its related metabolic and cardiovascular complications. In Western countries, a significant number of people are overweight or obese, and this trend is, unfortunately, becoming increasingly common even among the pediatric population. In this narrative review, we analyzed the role of nutrition during growth and its impact on the risk of developing metabolic syndrome and cardiovascular complications later in life. An impactful role in determining the phenotypic characteristics of the offspring is the parental diet carried out before conception. During intrauterine growth, the main risk factors are represented by an unbalanced maternal diet, excessive gestational weight gain, and impaired glycemic status. Breastfeeding, on the other hand, has many beneficial effects, but at the same time the quality of breast milk may be modified if maternal overweight or obesity subsists. Complementary feeding is likewise pivotal because an early introduction before 4 months of age and a high protein intake contribute to weight gain later. Knowledge of these mechanisms may allow early modification of risk factors by implementing targeted preventive strategies.

Maternal supplementation of egg yolk modulates brain functional organization and functional outcomes of offspring

Maternal nutrition during the perinatal stage is critical to offspring brain development. Egg yolks are a balanced and nutrient-dense food that is rich in bioactive components crucial to optimal neurodevelopment early in life. Egg consumption is often recommended to pregnant women to enhance both maternal and fetal health. We hypothesized that maternal intake of egg yolk from late gestation and throughout lactation would enhance functional organization and cognitive developmental outcomes in offspring using a pig model. Sows were fed a control diet (n = 6) or a diet containing egg yolks (n = 5, 350 mg egg yolk powder/kg BW/day, equivalent to ∼3 eggs/day for humans) from late gestation through lactation. At weaning, piglet offspring (n = 2/sow, total n = 22) underwent structural magnetic resonance imaging (MRI) and resting-state-functional MRI. Piglets underwent novel object recognition testing to assess hippocampal-dependent learning and memory. Functional MRI results demonstrated that egg yolk significantly increased functional activation in the executive network (p = 0.0343) and cerebellar network (p = 0.0253) in piglets when compared to control. Diffusion tensor imaging analysis showed that perinatal intake of egg yolks significantly increased white matter fiber length in the hippocampus (p = 0.0363) and cerebellum (p = 0.0287) in piglet offspring compared to control piglets. Furthermore, piglets from egg yolk-fed sows spent significantly more proportional frequency exploring the novel object than the familiar object in novel object recognition testing (p = 0.0370). The findings from this study support egg yolk-altered activation of specific brain networks may be associated with functional cognitive outcomes in weaning piglets.

Biochemical properties of sheep colostrum and its potential benefits for lamb survival: a review

Colostrum is the initial secretion of the mammary glands following parturition, which offers main food, protection, and biological active substances for the new born. The most threatening episode of neonate's life is the initial two weeks after birth. This period is associated with high neonatal mortality and morbidity. These worthwhile losses lead to a poor prolificacy rate, low profitability, and ultimately poor performance in animal production. Hence, both diseases and mortality cause valuable losses in terms of production and economic losses. The survival of neonate is correlated with their immune status and passive immune transfer (PIT). Colostrum provides the primary source of nutrition and immunity (PIT) that protects neonates against infections. It must be given as soon as possible after birth since its immunoglobulins are absorbed within the first 16-27 hours after birth, ideally within 2-4 hours. As a result, immunoglobulin (PIT) is the most important component of distressing infectious immunity, and a passable concentration of immunoglobulin in the blood of newborn lambs is linked to their health and survival rate. In this review, we summarized the importance of colostrum in early life and its association with neonatal lamb's survival, profitability and productivity of sheep farming.

Socioeconomic adversity, maternal nutrition, and the prenatal programming of offspring cognition and language at two years of age through maternal inflammation

Increasing rates of child neurodevelopmental vulnerability are a significant public health challenge. The adverse effect of socioeconomic adversity on offspring cognition may be mediated through elevated prenatal maternal systemic inflammation, but the role of modifiable antecedents such as maternal nutrition has not yet been clarified. This study aimed to examine (1) whether prenatal factors, with an emphasis on maternal nutrition, were associated with prenatal maternal systemic inflammation at 28 weeks' gestation, including the metabolomic marker glycoprotein acetyls (GlycA); (2) the extent to which the association between prenatal maternal nutrition and child cognition and language at age two years was mediated by elevated maternal inflammation in pregnancy; (3) the extent to which the associations between prenatal socioeconomic adversity and child neurodevelopment were mediated through prenatal maternal nutrition and GlycA levels. We used a prospective population-derived pre-birth longitudinal cohort study, the Barwon Infant Study (Barwon region of Victoria, Australia), where 1074 mother-child pairs were recruited by 28 weeks' gestation using an unselected sampling frame. Exposures included prenatal factors such as maternal diet measured by a validated food frequency questionnaire at 28 weeks' gestation and dietary patterns determined by principal component analysis. The main outcome measures were maternal inflammatory biomarkers (GlycA and hsCRP levels) at 28 weeks' gestation, and offspring Bayley-III cognition and language scores at age two years. Results showed that the 'modern wholefoods' and 'processed' maternal dietary patterns were independently associated with reduced and elevated maternal inflammation respectively (GlycA or hsCRP p < 0.001), and also with higher and reduced offspring Bayley-III scores respectively (cognition p ≤ 0.004, language p ≤ 0.009). Associations between dietary patterns and offspring cognition and language were partially mediated by higher maternal GlycA (indirect effect: cognition p ≤ 0.036, language p ≤ 0.05), but were less evident for hsCRP. The maternal dietary patterns mediated 22 % of the association between socioeconomic adversity (lower maternal education and/or lower household income vs otherwise) and poorer offspring cognition (indirect effect p = 0.001). Variation in prenatal GlycA levels that were independent of these dietary measures appeared less important. In conclusion, modifiable prenatal maternal dietary patterns were associated with adverse child neurocognitive outcomes through their effect on maternal inflammation (GlycA). Maternal diet may partially explain the association between socioeconomic adversity and child neurocognitive vulnerability. Maternal diet-by-inflammation pathways are an attractive target for future intervention studies.

[Analysis of the relationship between neonatal birth weight and meconium metabolites based on birth cohort metabolomics]

Neonatal birth weight is a crucial indicator of intrauterine growth and development with important implications for child development and adult health. The birth weight of a newborn is closely linked to the nutrition and health of the mother during pregnancy as well as genetic factors. Therefore, assessing the metabolic status of the fetus in utero is greatly significant for understanding the mechanisms responsible for abnormal birth weight. While previous studies often analyzed the impact of maternal metabolism on fetal development using umbilical cord blood from pregnant women, such blood may not accurately reflect the actual intrauterine environment owing to the barrier function of the placenta; moreover, obtaining biological samples during the fetal period is challenging. Meconium, the first feces excreted by a newborn, provides ideal biological material for studying maternal and infant health. Metabolomics can reveal metabolic changes in living organisms by analyzing small molecules in biological samples; hence studying meconium samples using metabolomics technology is expected to reveal fetal metabolic changes during pregnancy, thereby providing new insights into fetal nutritional intake, growth, and development, as well as metabolic pathways related to birth weight. To gain a deeper understanding of the metabolic changes associated with birth weight, this study collected metabolomic data from the meconium of 484 newborns in the established Xiaogan birth cohort using an untargeted metabolomics technique based on liquid chromatography-high resolution mass spectrometry (LC-HRMS) and analyzed the association between meconium metabolites and birth weight. This cohort exhibited incidence rates of low birth weight (<2500 g) and macrosomia (>4000 g) of 3.3% and 7.2%, respectively, which were roughly equivalent to the national average. Orthogonal partial least squares discriminant analysis revealed significant differences between the meconium metabolomes of the low birth weight and macrosomic groups when compared to the normal weight group. We discovered significant distinctions between the differential metabolites of newborns of low birth weight and those of normal weight, as well as between macrosomic and normal weight newborns that point to disparate biological pathways. Newborns with low birth weight exhibited significantly lower levels of critical amino acids, such as glutamate and proline, compared to the normal weight group, which may be associated with placental dysfunction and maternal nutritional deficiencies. Conversely, the meconium of macrosomic newborns contained significantly elevated levels of hormone metabolites such as estrone that reflected the pathophysiological state associated with maternal metabolic diseases or excessive placental hormone levels. Our study suggests that the metabolomic profile of the meconium reflects the metabolic pathways and regulatory mechanisms at play during fetal growth and development, and offers potential metabolic biomarkers and directions for future in-depth research into diseases related to fetal development. However, this study was based solely on the Xiaogan birth cohort, which was limited to specific regions and populations. A multicenter, multiethnic, and multiregional study is expected to help validate the universality of our research findings.

A maternal low-protein diet results in sex-specific differences in synaptophysin expression and milk fatty acid profiles in neonatal rats

The developmental origins of health and disease hypothesis have highlighted the link between early life environment and long-term health outcomes in offspring. For example, maternal protein restriction during pregnancy and lactation can result in adverse metabolic and cognitive outcomes in offspring postnatal. Hence, in the present study, we assess whether an isocaloric low-protein diet (ILPD) affects the fatty acid profile in breast milk, the hippocampal synaptophysin (Syn) ratio, and the oxidative stress markers in the neonatal stage of male and female offspring. The aim of this work was to assess the effect of an ILPD on the fatty acid profile in breast milk, quantified the hippocampal synaptophysin (Syn) ratio and oxidative stress markers in neonatal stage of male and female offspring. Female Wistar rats were fed with either a control diet or an ILPD during gestation to day 10 of lactation. Oxidative stress markers were assessed in serum and liver. All quantifications were done at postnatal day 10. The results showed: ILPD led to decreases of 38.5% and 17.4% in breast milk volume and polyunsaturated fatty acids content. Significant decreases of hippocampal Syn ratio in male offspring (decreases of 98% in hippocampal CA1 pyramidal and CA1 oriens, 83%, stratum pyramidal in CA3, 80%, stratum lucidum in CA3, and 81% stratum oriens in CA3). Male offspring showed an increase in pro-oxidant status in serum and liver. Thus, the data suggest that male offspring are more vulnerable than females to an ILPD during gestation and lactation.

Exploring risk factors for undernutrition in children aged under five years in Yemen

BACKGROUND

Undernutrition is a global health concern, particularly in low-income countries, and can manifest as wasting, stunting and/or underweight. In Yemen, the recent armed conflict is likely to have significantly increased the incidence of undernutrition in young children, particularly those living in communities that were already experiencing socioeconomic and health disparities.

AIM

To explore the risk factors associated with wasting, stunting and underweight in children aged between six months and five years living in one district of Yemen.

METHOD

A cross-sectional study was conducted using a two-part questionnaire to collect anthropometric measurements and sociodemographic characteristics of children enrolled on an outpatient programme for undernourished children at three healthcare facilities in the Jiblah district, and of their families and households.

RESULTS

Of the 120 children included in the study, 58 (48%) had wasting, 27 (23%) had stunting and 35 (29%) were underweight. Risk factors for undernutrition included being under the age of three years, being a girl, having had a low birthweight, having siblings under the age of five years, having a mother who is a housewife, living in a household relying on unimproved sources of drinking water, living in a rural area, and living in a low-income household.

CONCLUSION

The nutritional status of children in Yemen is under continuing threat. The identification of risk factors for undernutrition may increase awareness of the issue and influence the policy decisions of the international community.

Infant and early childhood physical health assessments in the HEALthy Brain and Child Development (HBCD) Study

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child's routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.