Dietary changes during pregnancy and the postpartum period in Singaporean Chinese, Malay and Indian women: the GUSTO birth cohort study

Effects of Parental Predictors on Postpartum Depression

BACKGROUND

Postpartum depression (PPD) is highly prevalent and plagues a significant proportion of parents. Postpartum depression also exerts various negative consequences on infant development and parent-infant relationships. Social support is identified as an important factor influencing many parental predictors, and may affect the development of PPD.

OBJECTIVE

This study aimed to investigate how perceived social support can indirectly influence PPD symptoms in parents at 6 months postpartum by influencing postpartum anxiety, parental satisfaction, and parental self-efficacy (PSE).

METHODS

A secondary analysis of data from a randomized controlled trial was used with a cross-sectional exploratory design. A total of 400 Singaporean parents (200 couples) were included, and structural equation modeling was used to analyze the relationships between PPD and potential predictors.

RESULTS

Findings revealed a less adequate fit between the hypothesized model and the data collected. Social support was found to be a significant predictor of postpartum anxiety, PSE, and parental satisfaction. Postpartum anxiety was a significant predictor of PPD, but PSE and parental satisfaction were not.

CONCLUSION

This study provides an overview of how different parental predictors may be associated with PPD among Asian parents. Postpartum anxiety significantly predicted PPD, but social support had negative effects on postpartum anxiety, parenting satisfaction, and PSE. The findings provide further insight into how parents at risk of PPD can be identified and demonstrated how social support might negatively impact parental outcomes. More qualitative research with Asian parents is needed to further explain these findings and inform the development of future interventions.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

Adherence to the national guidance on foods and drinks to limit or avoid during pregnancy in England: the PEAR Study

OBJECTIVE

The National Health Service (NHS) England website provides guidance on foods/drinks to avoid or limit during pregnancy because of microbiological, toxicological or teratogenic hazards. The aims were to determine adherence and whether demographic characteristics were associated with adherence.

DESIGN

Cross-sectional study.

SETTING

Online survey of postpartum women resident in England during pregnancy.

PARTICIPANTS

Recently, postpartum women resident in England during their pregnancy (n 598; median age 33 (IQR 30-36) years) completed an online questionnaire (April-November 2022). Questions included those on consumption of twenty-one food/drink items that the NHS advises pregnant women to avoid/limit. The study is part of the Pregnancy, the Environment And nutRition (PEAR) Study. Summary statistics were used to determine proportions adhering to the guidance. Adjusted logistic regression was used to model the associations of adherence with demographic characteristics.

RESULTS

Adherence was generally high (>90 % for eight of ten food/drink items to be avoided). However, among pre-pregnancy consumers, several items were not completely avoided, for example, 81 % (128/158) for game meat/gamebirds, 37 % (176/478) for cured meats and 17 % (81/467) for soft cheeses. Greater educational attainment (e.g. caffeinated soft drinks OR 2·25 (95 % CI 1·28, 3·94)), greater maternal age (e.g. oily fish 1·64 (1·05, 2·56)) and lower parity (e.g. caffeinated coffee 0.28 (0.11, 0.69)) were the most usual characteristics associated with adherence.

CONCLUSION

Evidence of concerning levels of non-adherence for some food/drink items suggests a case for more education on some of the guidance, particularly for women with lower educational attainment, greater parity and greater maternal age. Further research on barriers to the implementation of the guidance is needed.

Assessing sugar-sweetened beverage consumption in early pregnancy using a substance abuse framework

Sugar-sweetened beverages (SSB) are previously reported to jeopardize maternal fetal health, most well-known for gestational diabetes, childhood obesity, and cognitive impairment. Although warnings and diet recommendations urge pregnant women to consume less SSB, there is no noticeable difference in their behavior. How and why reproductive women change their SSB consumption patterns were not investigated previously. Our study aims to investigate beverage consumption patterns and how these patterns change in pregnancy in the context of substance use disorder (SUD). We invited all pregnant women visiting the clinic to answer a structured 20-min questionnaire every trimester during the regular antennal visit. At the end of the study, 337 pregnant women aged over 20 participated. A total of 301 responses entered for final analysis, with a response rate of 89.3%. Our finding showed those with high DSM-5-TR scores reduced SSB intake after becoming pregnant, while those with mild or low DSM-5-TR scores increased SSB intake after becoming pregnant. The top 3 factors related to their SSB consumption were "use despite of known health hazard (n = 133)", "increased desire to drink (n = 88)", and "excessive time spent on seeking SSB (n = 85)". The least reported factors were in the domains of social impairment (ranging from n = 3 to n = 26), pharmacologic effects (i.e., tolerance (n = 24) and withdrawal (n = 70). When participants reduced SSB consumption after becoming pregnant, their choice of beverages largely shifted to sugarless beverage but not much plain water. The result provided new insights in deciphering pregnant women's psychomotor factors for SSB intake, which served as useful references for making clinical or even public health recommendations.

Personalization and localization as key expectations of digital health intervention in women pre- to post-pregnancy

Health behaviors before, during and after pregnancy can have lasting effects on maternal and infant health outcomes. Although digital health interventions (DHIs) have potential as a pertinent avenue to deliver mechanisms for a healthy behavior change, its success is reliant on addressing the user needs. Accordingly, the current study aimed to understand DHI needs and expectations of women before, during and after pregnancy to inform and optimize future DHI developments. Forty-four women (13 pre-, 16 during and 15 postpregnancy; age range = 21-40 years) completed a 60-minute, semistructured, qualitative interview exploring participant's experience in their current phase, experience with digital health tools, and their needs and expectations of DHIs. Interviews were audio-recorded, transcribed verbatim and thematically analyzed. From the interviews, two core concepts emerged-personalization and localization of DHI. Between both concepts, five themes and nine subthemes were identified. Themes and subthemes within personalization cover ideas of two-way interactivity, journey organization based on phases and circumstances, and privacy trade-off. Themes and subthemes within localization cover ideas of access to local health-related resources and information, and connecting to local communities through anecdotal stories. Here we report, through understanding user needs and expectations, the key elements for the development and optimization of a successful DHI for women before, during and after pregnancy. To potentially empower downstream DHI implementation and adoption, these insights can serve as a foundation in the initial innovation process for DHI developers and be further built upon through a continued co-design process.

Infant feeding practices and autism spectrum disorder in US children aged 2-5 years: the national survey of children's health (NSCH) 2016-2020

OBJECTIVE

To investigate the relationship between infant feeding practices and autism spectrum disorder (ASD) among children aged 2-5 years in the United States (US).

METHODS

Data from the 2016-2020 National Survey of Children's Health, a nationally representative cross-sectional survey, were utilized for this study. Questionnaires were administered to parents of children aged 2-5 years to gather information on ASD diagnosis, infant feeding practices, and demographic factors (e.g., child sex, ethnic group, and maternal age at birth). Logistic regression with sample weights was employed to assess the association between infant feeding practices and ASD, while controlling for demographic variables. Polynomial regression models were used to examine trends in exclusive breastfeeding and ever breastfeeding rates among children with and without ASD.

RESULTS

A total of 35,050 children aged 2-5 years were analyzed, including 616 diagnosed with ASD, after excluding participants with missing information on breastfeeding and ASD diagnosis. Of these children with ASD, 76.6% (n = 472) had a breastfeeding history, with 67.5% (n = 416) engaged in partial breastfeeding and 9.1% (n = 56) exclusively breastfed. Adjusted odds ratios for each additional month of breastfeeding compared to never being breastfed were 0.98 (95% CI, 0.96-1.01). The adjusted odds ratios for breastfeeding durations of > 0-6 months, > 6-12 months, > 12-24 months, and > 24 months were 0.81 (95% CI, 0.50-1.31), 0.65 (95% CI, 0.36-1.18), 0.81 (95% CI, 0.44-1.49), and 0.48 (95% CI, 0.23-1.01), respectively. Compared to children who were never breastfed, the adjusted odds ratio for children who were ever breastfed was 0.74 (95% CI, 0.47-1.18). Among children with ASD, the proportion of ever breastfeeding declined from 82.0% in 2017 to 64.3% in 2020, while exclusive breastfeeding decreased from 12.0% in 2016 to 4.2% in 2020.

CONCLUSIONS AND RELEVANCE

Although no significant association was found between infant feeding practices and ASD among US children aged 2-5 years, the rates of breastfeeding, particularly exclusive breastfeeding, were suboptimal among children with ASD. This highlights the need for specific policies and practices to promote and support breastfeeding among parents of children with ASD or those at high risk of having a child with ASD.

Dietary intake, physical activity and sedentary behavior and association with BMI during the transition to parenthood: a prospective dyadic study

Introduction

Little is known on how diet, physical activity (PA) and sedentary behavior (SB) changes during pregnancy and after childbirth in primiparous couples. Moreover, it is unclear how potential behavioral changes are associated with changes in BMI. This study examined changes in diet, PA and SB, and their association with changes in BMI in couples transitioning to parenthood.

Methods

Dietary intake (FFQ), PA, SB (both Actigraph GT3X accelerometers) and BMI of women and men were assessed at 12 weeks of gestation, 6 weeks and 6 months postpartum. Data were analyzed using dyadic longitudinal data analyses techniques.

Results

In women, a decrease in fruit intake, an increase in alcohol intake, an increase of light-intensity PA, and a decrease in SB were observed from the beginning of pregnancy up to 6 months postpartum. Decreases in fruit intake between 6 weeks and 6 months postpartum was associated with increases in BMI. Men did not show significant dietary changes, while an increase in light-intensity PA and a decrease in moderate-to-vigorous PA (MVPA) was observed at 6 months postpartum when compared to 12 weeks of gestation. Paternal increases in "avoidance food group" intake were associated with increases in BMI between baseline and 6 weeks postpartum. No associations of changes in BMI and changes in PA and SB were found.

Discussion

Not only mothers but also fathers experienced unfavorable changes in lifestyle during the transition to parenthood, with impact on BMI changes. This highlights the need to monitor unhealthy changes in lifestyle and body weight in both parents when expecting a child and after childbirth.

Clinical trial registration

Clinicaltrials.gov, NCT03454958.

Time in Bed, Sleeping Difficulties, and Nutrition in Pregnant New Zealand Women

We consider the relationship between time in bed (TIB) and sleeping difficulties with demographic variables and nutrient intakes in the second (T2) and third (T3) trimester of pregnancy. Data were acquired from a volunteer sample of New Zealand pregnant women. In T2 and T3, questionnaires were administered, diets were obtained from one 24 h recall and three weighed food records, and physical activity was measured with the use of three 24 h diaries. In total, 370 women had complete information in T2 and 310 in T3. In both trimesters, TIB was associated with welfare or disability status, marital status and age. In T2, TIB was associated with work, childcare, education and pre-pregnancy alcohol consumption. There were fewer significant lifestyle covariates in T3. In both trimesters, TIB declined with increasing dietary intake, especially water, protein, biotin, potassium, magnesium, calcium, phosphorus and manganese. Adjusted for weight of dietary intake and welfare/disability, TIB declined with increasing nutrient density of B vitamins, saturated fats, potassium, fructose and lactose; and TIB increased with carbohydrate, sucrose and vitamin E. Subjective sleeping difficulties increased with the week of gestation, morning sickness severity, anxiety, dairy and saturated fat intake, and they decreased with fruit, vegetable and monounsaturated fat intake. The study highlights the changing influence of covariates throughout the pregnancy and corroborates several published findings on the relationship of diet and sleep.

Associations between Maternal Polychlorinated Dibenzo-p-dioxin and Dibenzofuran Serum Concentrations and Pulse Pressure in Early Pregnancy: A Cross-Sectional Study

Pulse pressure (PP) is the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP), and an independent predictor of cardiovascular risk. Previous research suggests, with different conclusions, that exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) could affect blood pressure (BP). We conducted a cross-sectional study to determine the association of dioxin exposure with PP in early pregnancy. A total of 305 pregnant women in early pregnancy in Yingcheng, China, recruited from May 2018 to February 2021, were included in this study. We measured 17 congeners of PCDD/Fs in maternal serum via high-resolution gas chromatography tandem high-resolution mass spectrometry. A generalized linear regression model was used to analyze the influencing factors of dioxin exposure and their relationships with PP. The levels of total PCDD/Fs (∑PCDD/Fs) ranged from 163.52 pg/g lipid to 1,513,949.52 pg/g lipid, with a mean of 10,474.22 pg/g lipid. The mean toxicity equivalent (TEQ) of total PCDD/Fs (∑TEQ-PCDD/Fs) was 42.03 pg/g lipid. The ratio of tetrachlorinated to octa-chlorinated congeners in maternal serum was enriched with an increasing number of chlorines. Pregnant women with college and above education had higher concentrations of ∑PCDD/Fs than those with education levels of junior high school and below (β = 0.34, 95% CI: 0.01, 0.67). The adjusted model for ∑TEQ-PCDD/Fs was significantly and negatively associated with PP (β = -1.79, 95% CI: -2.91, -0.68). High levels of dioxins were found in this area, and exposure to dioxins may affect the PP of women in early pregnancy, with health risks.

A mixed-methods study on the dietary practices of early postpartum women during the summer rainy season in Belgaum, Karnataka, India

The current mixed-method study uses Food Frequency Questionnaires and 24-hour dietary recalls (n = 41) to assess the food/nutrient intake; and qualitative interviews to identify local perceptions of food among 41 early postpartum women in Belgaum, India. The results show that total energy, protein, and most micronutrient intake were significantly lower than the Recommended Dietary Allowance of India (p < .05 individually); ninety percent of mothers restricted the consumption of some specific fruits, vegetables, and other foods during postpartum due to their perceptions of foods, folk medicines, and health beliefs. Culturally sensitive programs relevant to postpartum diet practices for women should be implemented.

The association between caffeine exposure during pregnancy and risk of gestational hypertension/preeclampsia: A meta-analysis and systematical review

BACKGROUND

The potential effect of caffeine exposure during pregnancy on gestational hypertension (GH)/preeclampsia has attracted attention but remains unclear.

METHODS

A systematic literature search of PubMed, Embase, and Cochrane Library databases was performed until March 2022. Observational studies assessing the association between caffeine exposure during pregnancy and the risk of GH/preeclampsia were included. The study protocol was registered in PROSPERO: CRD42022322387.

RESULTS

Ten studies involving 114 984 pregnant women (2548 diagnosed with GH and 2473 diagnosed with preeclampsia) were included. Comparing caffeine exposure with noncaffeine exposure, no significant association was found between caffeine exposure during pregnancy and the risk of GH (odds ratio [OR] = 0.99, 95% confidence interval [CI]: 0.90-1.08, p = 0.800) and preeclampsia (OR = 1.13, 95% CI: 0.97-1.31, p = 0.114). Subgroup analyses comparing low to moderate doses with no/lowest doses showed that caffeine exposure during pregnancy was not significant associated with GH (OR = 1.00, p = 0.987) or preeclampsia (OR = 1.03, p = 0.648). Besides, subgroup analyses comparing high doses with no/lowest doses showed that caffeine exposure during pregnancy was not significant associated with GH (OR = 1.06, p = 0.623) or preeclampsia (OR = 1.18, p = 0.192).

CONCLUSION

This study found that caffeine exposure during pregnancy was not significantly associated with the risk of GH/preeclampsia.

Low Periconceptional Dietary Intakes among Japanese Women: The Japan Environment and Children's Study (JECS)

Pregnancy is usually associated with dietary imbalances. We aim to assess the changes in Japanese women's diet and nutritional adequacy before and during pregnancy. In the Japan Environment and Children's Study (JECS), we recruited a large cohort of pregnant women (>100,000) from 15 Japanese communities. We assessed their diet before and during pregnancy by a food frequency questionnaire. The before and during pregnancy intakes of energy, macronutrients, and micronutrients were lower than the recommended level for Japanese women by 1% to 49%. The dietary intakes of pregnant women were lower than their intakes before pregnancy, except for milk, dairy products, and calcium. The daily during pregnancy intake of energy, carbohydrate, fat, protein, folic acid, and iron decreased by 85 kcal, 11.6 g, 2.3 g, 2.8 g, 20 μg, and 0.5 mg than the before pregnancy intake. Pregnant women's declined food and nutrients intakes were moderately correlated to their dietary intakes before pregnancy; the correlation coefficient ranged between 0.47 and 0.67. The inter-individual variability was greater than the intra-individual variability of the dietary intakes. Almost half of the pregnant women remained in the same intake quartile for all nutrients and food groups as before pregnancy. Yet, approximately 10% of pregnant women changed their pregnancy intake by ≥50% (≥2 quartiles up or down) compared to before pregnancy. In conclusion, the study identified low periconceptional dietary intakes among Japanese pregnant women. The low dietary intake of essential nutrients, such as folate, requires revising the Japanese national periconceptional dietary and supplementation guidelines.

A descriptive qualitative study exploring the postpartum confinement experiences among first-time mothers from the three major ethnic groups in Singapore

OBJECTIVE

Modern Singaporean mothers still embrace traditional confinement practices after childbirth, which often marks a significant milestone in maternal experiences. However, limited studies have explored in-depth the collective confinement experiences of mothers in Singapore. This study hence aimed to explore the postpartum confinement experiences of first-time mothers from the three major ethnic groups in Singapore, namely Chinese, Malay, and Indian.

DESIGN

A descriptive qualitative study was conducted. Purposive sampling was adopted to recruit participants. Individual semi-structured face-to-face/telephone interviews were used to collect data, which were analysed using thematic analysis.

SETTING AND PARTICIPANTS

Sixteen first-time mothers were recruited from two obstetric clinics in a tertiary hospital in Singapore.

FINDINGS

Five themes emerged: "Specific diets adopted and avoided for different purposes", "Complexity of various traditional confinement practices (TCPs) adopted", "Reasons for adopting TCPs", "Reasons for modifying TCPs", and "Postpartum challenges".

KEY CONCLUSIONS

Our study provided unique insights about Singapore's Chinese, Malay and Indian first-time mothers' postpartum confinement experiences. While confinement practices were still observed, many mothers no longer subscribed to guidelines followed by previous generations and were modifying or forgoing practices they deemed impractical. Mothers faced challenges adapting to new motherhood and often felt restrained or stressed by confinement practices.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should take the lead to educate mothers and their families on harmful traditional confinement practices and their misconceptions. Future studies could explore alternative methods of postpartum check-up to improve first-time mothers' confinement experiences, and focus specifically on lower-income families to explore their unique confinement experiences.

Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

PURPOSE

Few studies have described adherence to dietary patterns over time in women of childbearing age. This study aims to describe, examine the stability and changes in dietary patterns between pregnancy and 6 years post-pregnancy and the sociodemographic and lifestyle factors influencing the adherence over time.

METHODS

During pregnancy and at 6 years post-pregnancy, 24-h recalls and food frequency questionnaires were collected, respectively, from 709 women. Data on sociodemographic and lifestyle factors were collected via questionnaires. Dietary patterns were identified using principal component analysis and stability assessed using Pearson's correlation coefficients (r) and Cohen's weighted kappa (κ). Associations with sociodemographic characteristics were assessed by multiple logistic regression.

RESULTS

The 'Fruits, Vegetables and Legumes' (FVL) and 'Seafood, Noodle, Soup' (SNS) patterns were identified at both time points, with low correlation for the dietary pattern z scores (r 0.2 and 0.3, respectively) and modest agreement in tertile assignment, suggesting poor stability. An 'unhealthy' pattern was only observed at 6 years post-pregnancy. Women who showed increased adherence to FVL pattern had higher educational attainment and exhibited healthy lifestyle behaviours. Women who had gestational diabetes during pregnancy were less likely to decrease adherence to FVL pattern over time. Women who adhered more closely to the 'unhealthy' pattern at 6 years post-pregnancy tended to be younger, of Malay ethnicity, had lower socioeconomic status, were less physically active and had additional pregnancies.

CONCLUSIONS

Dietary habits of women became less healthy during the transition from pregnancy to 6 years post-pregnancy. However, results should be interpreted with caution due to the different dietary assessment tools used at the two time points.

Influence of cultural practices on breast cancer risks, stage at presentation and outcome in a multi-ethnic developing country

Malaysia is a developing country made up of three main ethnicities: Malay, Chinese and Indian. There are significant ethnic differences with regard to the type of daily food and cooking methods, contraception, breast-feeding preferences, confinement period and care, postmenopausal intake and influence of the traditional healer. Breast cancer is the most common cancer among Malaysian women across all three ethnicities. However, the National Cancer Registry and local medical centres have documented ethnic differences in breast cancer risk (Chinese, 40.7 per 100,000; Indian, 38.1 per 100,000; Malay, 31.5 per 100,000), peak age (youngest in the Malays), stage at presentation (largest percentage at advanced stage among the Malays) and survival (poorest survival rate among the Malays). The Malays have several practices that are protective against breast cancer compared with the Chinese. However, the Malays have strong beliefs in the traditional healer, which contribute to the delay in getting treatment, causing a poor outcome and a low survival rate. The highest BRCA1 and 2 genetic mutation incidence is amongst the Chinese, but the Malays have the largest triple-negative breast cancer rates. These factors may also contribute to the statistical breast cancer data.

Consumption of Coffee and Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Observational Studies

Objective: The results from epidemiologic studies on the relationship between intake of coffee and the risk of gestational diabetes mellitus (GDM) remain inconclusive. A meta-analysis was performed to achieve a comprehensive finding regarding the association between intake of coffee and the risk of GDM.

Methods: PubMed, Scopus, ISI Web of Science, and Google Scholar were searched to find articles published up to August 2021. Observational studies that reported risk estimates [risk ratios (RRs), hazard ratios (HRs), and odds ratios (ORs)] for the association of consumption of coffee with the risk of GDM in pregnant women were included. Random effects model was applied to calculate summarized risk estimate and 95% CIs for the highest vs. lowest categories of intake of coffee.

Results: Seven observational studies (three cohort, two case-control, and two cross-sectional studies) with 75,607 participants and 1,625 women with GDM met the inclusion criteria. The meta-analysis of comparing the highest vs. lowest intake of coffee categories showed no significant association between intake of coffee and risk of GDM (summarized risk estimate: 0.89; 95% CI: 0.76, 1.05; I² = 63.4%). Subgroup analysis showed that consumption of coffee had an inverse relationship with GDM in studies conducted in non-Asia countries (summarized risk estimate: 0.75; 95% CI: 0.58, 0.97; I² = 6%).

Conclusion: This study has shown that high consumption of coffee did not decrease the risk of GDM. Furthermore, large-scale cohort studies are required to confirm our findings.

Postpartum dietary and physical activity-related beliefs and behaviors among women with recent gestational diabetes mellitus: a qualitative study from Singapore

BACKGROUND

A woman with a history of GDM has at least seven-fold increased lifetime risk of developing type 2 diabetes mellitus (T2DM), compared to women who have normoglycemic pregnancies. Postpartum lifestyle modification has been shown to reduce postpartum weight retention and prevent the progression to T2DM. The aim of this study was to explore the postpartum dietary and physical activity-related beliefs and behaviors among women in Singapore who had GDM in their most recent pregnancies.

METHODS

Semi-structured in-depth interviews were conducted with 14 women, who were up to four months postpartum and had GDM in their most recent pregnancies. Interview data were analyzed using thematic analysis.

RESULTS

Three themes were identified in the analysis: (1) risk perception and knowledge regarding future diabetes, (2) suboptimal diet and physical activity after delivery and (3) factors influencing the postpartum lifestyle.

CONCLUSIONS

The study findings provided useful information on the postpartum lifestyle beliefs and behaviors among women with a history of GDM. Most participants had low risk perception of future diabetes and their diet and physical activity after delivery were suboptimal due to various influences. These insights can be used to design tailored materials and programs to support women who have had GDM reduce their risk of developing future T2DM.

Urinary bisphenol A and its alternatives among pregnant women: Predictors and risk assessment

BACKGROUND

Exposure to bisphenol A (BPA) has been associated with various adverse health outcomes. Recently, an increasing concern on its alternatives such as bisphenol S (BPS) and bisphenol F (BPF) has been aroused due to the restriction use of BPA. Few studies have identified predictors of exposure to BPA alternatives and assessed their health risks.

OBJECTIVE

The aim of this study was to identify predictors of BPA and its alternatives and to assess their health risks among pregnant women.

METHODS

We detected first morning urinary concentrations of BPA and its alternatives (BPS and BPF) among 1097 pregnant women from an established Chinese cohort. A questionnaire was conducted to obtain demographic characteristics, dietary habits, and lifestyles. We examined the predictors of creatinine-adjusted urinary BPA and its alternatives concentrations using multivariable linear regression. Risk assessment of exposure to BPA and its alternatives was calculated based on the estimated of daily intake (EDI).

RESULTS

Geometric means of creatinine-adjusted urinary BPA, BPF, and BPS were 0.92, 0.12, and 0.08 μg/g creatinine, respectively. Pregnant women from Wuhan had lower concentrations of BPA, BPF, and ∑BPs (sum of BPA, BPF, and BPS) than those from Xiaogan. Intake of fried food was related to higher concentrations of BPA, and intake of pickled food was associated with higher concentrations of BPF and ∑BPs. The maximum EDI values for exposure to BPA, BPF, BPS, and ∑BPs ranged from 5.6428 to 13.3356 nmol/kg body weight/day, which were below the tolerable daily intake (TDI) for BPA defined by the European Food Safety Authority (EFSA) (18 nmol/kg body weight/day). The maximum hazard index (HI) value was 0.7409.

CONCLUSION

Several predictors identified in this study may inform public recommendations to reduce exposure to BPA and its alternatives.

Beverage Intake and the Risk of Gestational Diabetes Mellitus: The SECOST

The contribution and impact of beverage intake to total nutrient and energy intake may be substantial. Given the link between lifestyle, diet, and the risk of pregnancy complications, this study investigated the association between the quantity and types of beverages with gestational diabetes mellitus (GDM) risk. The study included 452 women from the Seremban Cohort Study (SECOST). The mean energy by beverage intake was 273 ± 23.83 kcal/day (pre-pregnancy), 349 ± 69.46 kcal/day (first trimester) and 361 ± 64.24 kcal/day (second trimester). Women significantly increased intake of maternal milks and malted drinks, but significantly reduced the intake of carbonated drinks and other drinks from before until the second trimester of pregnancy. For chocolate drinks, carbonated drinks, and soy milk, women increased intake from pre-conception to the first trimester, but reduced their intake from the first to the second trimester. While higher intake of cultured-milk drinks was associated with an increased risk of GDM, higher fruit juice intake was associated with a lower risk of GDM. However, these associations were only observed for intake prior to pregnancy and during the first trimester. Further research is needed to corroborate these findings and investigate the contributions of different beverages to overall diet quality as well as adverse health outcomes during pregnancy.

Identification and reproducibility of dietary patterns assessed with a FFQ among women planning pregnancy

OBJECTIVE

To identify a posteriori dietary patterns among women planning pregnancy and assess the reproducibility of these patterns in a subsample using two dietary assessment methods.

DESIGN

A semi-quantitative FFQ was administered to women enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes study. Dietary patterns from the FFQ were identified using exploratory factor analysis (EFA). In a subsample of women (n 289), 3-d food diaries (3DFD) were also completed and analysed. Reproducibility of the identified patterns was assessed using confirmatory factor analysis (CFA) in the subsample, and goodness of fit of the CFA models was examined using several fit indices. Subsequently, EFA was conducted in the subsample and dietary patterns of the FFQ and the 3DFD were compared.

SETTING

Singapore.

PARTICIPANTS

1007 women planning pregnancy (18-45 years).

RESULTS

Three dietary patterns were identified from the FFQ: the 'Fish, Poultry/Meat and Noodles' pattern was characterised by higher intakes of fish, poultry/meat and noodles in soup; 'Fast Food and Sweetened Beverages' pattern was characterised by higher intakes of fast food, sweetened beverages and fried snacks; 'Bread, Legumes and Dairy' pattern was characterised by higher intakes of buns/ethnic breads, nuts/legumes and dairy products. The comparative fit indices from the CFA models were 0·79 and 0·34 for the FFQ and 3DFD of the subsample, respectively. In the subsample, three similar patterns were identified in the FFQ while only two for the 3DFD.

CONCLUSIONS

Dietary patterns from the FFQ are reproducible within this cohort, providing a basis for future investigations on diet and health outcomes.

Dietary Cholesterol Intake and Risk of Gestational Diabetes Mellitus: A Meta-Analysis of Observational Studies

This meta-analysis aimed to understand the association between dietary cholesterol intake and the risk of gestational diabetes mellitus (GDM). We systematically searched the PubMed, Web of Science, and EMBASE databases to identify observational studies, published before September 2020, investigating the relationship between dietary cholesterol intake and risk of GDM. After evaluating the heterogeneity among studies, we used fixed- or random-effects models to calculate pooled values of relative risk (RR) and 95% confidence intervals (CIs) in order to estimate the effect of dietary cholesterol on the risk of GDM. We included a total of 9 studies (3 cohort, 4 cross-sectional, and 2 case-control) involving 30123 participants and 3237 cases. The pooled RR of GDM comparing highest versus lowest category of dietary cholesterol intake was 1.49 (95% CI, 1.18-1.88). The dose-response relationship showed that the risk of GDM increased by 32% (RR = 1.32; 95% CI, 1.20-1.45) for every increase of 100 mg per day in dietary cholesterol intake. This meta-analysis indicates that an increase in dietary cholesterol intake is associated with increased risk of GDM. Detailed cohort studies are essential to gain a better understanding of this association. Key teaching pointsStudies on animal models have suggested that a cholesterol-rich diet can promote systemic inflammation and insulin resistance, both of which can contribute to T2DM and GDM.Several epidemiological studies have investigated a potential relationship between dietary cholesterol intake and GDM risk, and the results are controversial.Our meta-analysis indicates that increased dietary cholesterol intake is associated with increased GDM risk.Dose-response analysis showed a linear relationship between dietary cholesterol intake and risk of GDM.

Influence of Dietary Habits and Mediterranean Diet Adherence on Sleep Quality during Pregnancy. The GESTAFIT Project

We examined the association of the dietary habits and the Mediterranean diet (MD) adherence with sleep quality during pregnancy. A food frequency questionnaire and the Mediterranean Food Pattern were employed to assess dietary habits and MD adherence, respectively. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) global score (n = 150; mean age 32.9 ± 4.6 years). A higher consumption of fruits was associated with better sleep quality at the 16th gestational week (g.w.; p < 0.05). A greater olive oil consumption and a higher MD adherence were associated with better sleep quality at the 16th and 34th g.w. (all, p < 0.05). Contrarily, a higher red meat and subproducts consumption was associated with worse sleep quality at the 34th g.w. (p < 0.05). The group with the highest adherence to the MD (Tertile 3) showed better sleep quality than the group with the lowest adherence (Tertile 1) at the 16th and 34th g.w. (both, p < 0.05). A higher adherence to the MD, a greater intake of fruits and olive oil and a lower intake of red meat and subproducts were associated with better sleep quality along the pregnancy course, especially among sedentary women.

Multiple modifiable lifestyle factors and the risk of perinatal depression during pregnancy: Findings from the GUSTO cohort

BACKGROUND

Studies have identified lifestyle risk factors for perinatal depression, but none have examined the cumulative effect of these risk factors in pregnant women.

METHODS

We considered the following six factors during pregnancy: poor diet quality (Healthy eating index for Singapore pregnant women<median), poor sleep quality (global Pittsburgh sleep quality index score > 5), physical inactivity (<600 MET-minutes/week), vitamin D insufficiency (<50 nmol/l), smoking before or during pregnancy, and the perceived need for social support. Probable depression was assessed using the Edinburgh postnatal depression scale during pregnancy (>15) and at three months postpartum (≥13). Prevalence risk ratios were calculated with Poisson regressions while adjusting for potential confounders.

RESULTS

Of 535 pregnant women, 207 (39%) had zero or one risk factor, 146 (27%) had two, 119 (22%) had three, 48 (9%) had four, and 15 (3%) had ≥5 risk factors at 26-28 weeks' gestation. These six lifestyle habits contributed to 32% of the variance in depressive symptoms during pregnancy. The prevalence of being probably depressed was 6.4 (95% CI 2.1, 19.8; p_trend < 0.001) for expecting women who had ≥4 risk factors compared to women who had ≤1 risk factor. No association was observed between the number of risk factors and depressive symptoms at 3 months postpartum (p_trend = 0.746).

CONCLUSION

Pregnant women with ≥4 lifestyle risk factors showed a higher prevalence of depression during pregnancy, while no associations were observed for postpartum depression.

CLINICAL TRIAL REGISTRATION

This cohort is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.

Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations?

The maternal diet influences the long-term health status of both mother and offspring. The current study aimed to compare dietary intakes of pregnant women compared to food and nutrient recommendations in the Australian Guide to Healthy Eating (AGHE) and Nutrient Reference Values (NRVs). Usual dietary intake was assessed in a sample of women in their 3rd trimester of pregnancy attending antenatal outpatient clinics at John Hunter Hospital, Newcastle, New South Wales (NSW). Dietary intake was measured using the Australian Eating Survey, a validated, semi-quantitative 120-item food frequency questionnaire. Daily food group servings and nutrient intakes were compared to AGHE and NRV targets. Of 534 women participating, none met the AGHE recommendations for all food groups. Highest adherence was for fruit serves (38%), and lowest for breads and cereals (0.6%). Only four women met the pregnancy NRVs for folate, iron, calcium, zinc and fibre from food alone. Current dietary intakes of Australian women during pregnancy do not align with national nutrition guidelines. This highlights the importance of routine vitamin and mineral supplementation during pregnancy, as intakes from diet alone may commonly be inadequate. Future revisions of dietary guidelines and pregnancy nutrition recommendations should consider current dietary patterns. Pregnant women currently need more support to optimise food and nutrient intakes.

Tracking of Maternal Diet from Pregnancy to Postpregnancy: A Systematic Review of Observational Studies

We systematically reviewed studies to examine changes in women's diets from pregnancy to the postpregnancy period and sought to understand the characteristics of women making these changes. From a search of 4 databases and up to November 2019, 17 studies met our inclusion criteria. They reported changes in various dietary aspects. Mixed findings were reported for changes in energy and micronutrient intakes. Most studies reported significant decreases in fruit and vegetable consumption, diet quality, and adherence to a healthier dietary pattern during the transition from pregnancy to postpregnancy, whereas increases in discretionary food and fat intakes were observed. Women with lower education level, lower income, and/or who worked full-time tended to have poorer dietary behaviors postpregnancy. Further research, with better aligned dietary measurement time points during pregnancy and postpartum and standardization of dietary assessment tools, is needed for future studies to be comparable. The systematic review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews as CRD42020158033.

Dioxin-like compounds in paired maternal serum and breast milk under long sampling intervals

Serum and breast milk are both important biological samples to evaluate body burden of dioxin-like compounds which include polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs). We collected maternal serum at early pregnancy, and breast milk at 3-8 weeks after delivery from 55 mothers living in Beijing, China, and measured 29 dioxin-like compounds in these samples. The sampling intervals in this study were extended up to 10 months to analyze differences of contents between serum and breast milk under long sampling intervals. The results showed that mean TEq level of PCDD/Fs in serum (9.8 pg TEq g^-1 lipid) was 1.7 times higher than that in milk (4.5 pg TEq g^-1 lipid), while the TEq concentrations of dl-PCBs in serum (1.2 pg TEq g^-1 lipid) was significantly lower than that in milk (2.0 pg TEq g^-1 lipid). There were only two congeners, OCDD (r = 0.32) and PCB105 (r = 0.33), the correlations of which between serum and milk were significant. The differences in distributions of congeners in serum and milk might be influenced by number of chlorine substituents and structures of congeners. In addition, maternal age and BMI were positively and negatively correlated with mass concentrations of dioxin-like compounds in milk and serum respectively. These results suggest that, compared with serum, it is limited to use breast milk to assess long-term exposure for the wider population.

Food, culture, and identity in multicultural societies: Insights from Singapore

The choice of food practices can be influenced by one's identity in many societies, but has mostly been evaluated in light of the maintenance of cultural identity in migrant populations. This study focused on understanding the influence of identity on food practices among individuals in multicultural societies. We conducted 18 focus group discussions (n = 130) among Indian, Chinese and Malay women in Singapore. Focus group transcripts were analysed using Thematic Analysis both inductively and deductively. Deductive analysis was framed within a Social Representations Approach, a social psychological theory that allows a deeper understanding of the contextual aspects of identity. Participants highlighted the central position of food in social events, cultural celebrations, and persistent traditional beliefs about health (such as 'hot-cold balance'). These beliefs extended to the perception of certain traditional foods possessing medicinal properties. Importantly, the consumption of these traditional foods was accepted as necessary for the maintenance of health by the women. We propose that while cultural food practices are integral to identity preservation and identity continuity for Singaporean women from all three racial groups, this is different to other multicultural societies such as Canada where communities preserve their cultural food practices, in part, due to fear of cultural identity loss. In addition, cross-cultural food practices are readily adopted in participants' daily lives for a number of reasons such as the promotion of health, convenience, and variety. At times, this adoption blurred boundaries between different cultural cuisines. Food practices in multicultural societies like Singapore are thus a reflection of everyday multiculturalism, multicultural social policies, and attitudes towards traditional healthful food practices, and these aspects need to be considered in the development of public health policies and interventions.

Influence of sociodemographic, lifestyle and genetic characteristics on maternal DHA and other polyunsaturated fatty acid status in pregnancy: A systematic review

INTRODUCTION

Omega-3 DHA is important for the prevention of preterm birth, however there is limited knowledge of the determinants of omega-3 status during pregnancy. The primary objective of this systematic review was to synthesise data from existing studies assessing relationships between sociodemographic, diet, lifestyle and genetic factors and maternal DHA status.

MATERIALS AND METHODS

The Medline, Embase, Amed, and CINAHL databases were searched for studies reporting measures of maternal omega-3 status and a sociodemographic/lifestyle/genetic characteristic.

RESULTS

Twenty-two studies were included in the final analyses. Higher dietary fish consumption/PUFA intake, higher education level and an older maternal age were associated with higher maternal omega-3 status. Higher alcohol intake, smoking and FADS genotype were each associated with lower maternal omega-3 status.

DISCUSSION

Differences in findings between studies make it difficult to draw clear conclusions about the relationship between these factors and maternal omega-3 DHA status, although socioeconomic status may play a role.

Facilitators and Barriers to Post-partum Diabetes Screening Among Mothers With a History of Gestational Diabetes Mellitus-A Qualitative Study From Singapore

Introduction: Gestational Diabetes Mellitus (GDM) affects one in six births worldwide. Mothers with GDM have an increased risk of developing post-partum Type-2 Diabetes Mellitus (T2DM). However, their uptake of post-partum diabetes screening is suboptimal, including those in Singapore. Literature reports that the patient-doctor relationship, mothers' concerns about diabetes, and family-related practicalities are key factors influencing the uptake of such screening. However, we postulate additional factors related to local society, healthcare system, and policies in influencing post-partum diabetes screening among mothers with GDM. Aim: The qualitative research study aimed to explore the facilitators and barriers to post-partum diabetes screening among mothers with GDM in an Asian community. Methods: In-depth interviews were carried out on mothers with GDM at a public primary care clinic in Singapore. Mothers were recruited from those who brought their child for vaccination appointments and their informed consent was obtained. Both mothers who completed post-partum diabetes screening within 12 weeks after childbirth and those who did not were purposively recruited. The social ecological model (SEM) provides the theoretical framework to identify facilitators and barriers at the individual, interpersonal, organizational, and policy levels. Results: Twenty multi-ethnic Asian mothers with GDM were interviewed. At the individual and interpersonal level, self-perceived risk of developing T2DM, understanding the need for screening and the benefits of early diagnosis, availability of confinement nanny in Chinese family, alternate caregivers, emotional, and peer support facilitated post-partum diabetes screening. Barriers included fear of the diagnosis and its consequences, preference for personal attention and care to child, failure to find trusted caregiver, competing priorities, and unpleasant experiences with the oral glucose tolerance test. At the organizational and public policy level, bundling of scheduled appointments, and standardization of procedure eased screening but uptake was hindered by inconvenient testing locations, variable post-partum care practices and advice in the recommendations for diabetes screening. Conclusion: Based on the SEM, facilitators and barriers towards post-partum diabetes screening exist at multiple levels, with some contextualized to local factors. Interventions to improve its uptake should be multi-pronged, targeting not only at personal but also familial, health system, and policy factors to ensure higher level of success.

Are Asian foods as "fattening" as western-styled fast foods?

In Asia, the consumption of western-styled fast foods is widely perceived as the cause of the rise in obesity and chronic disease. Twenty-five of the most popular local Asian foods were compared for energy, total fat, saturated fat, sodium, and cholesterol with twenty-nine western-styled fast foods. The comparative analysis showed no significant difference in energy (p = 0.150) and total fat (p = 0.346) between the two food categories. These findings suggest that many local Asian foods contribute as much energy and total fat in a single meal as western-styled fast foods. Local Asian foods had greater amounts of sodium (p < 0.001), saturated fat (p = 0.007), and cholesterol (p = 0.009) than western-styled fast foods. The persistent presumption that the consumption of western-styled fast foods is the cause of obesity in Asia needs to be challenged. This observation that local Asian foods are as energy dense as western-styled fast foods, will enable us to redress the necessary strategies to address the Asian diet-health debate.

Dietary Predictors of Phthalate and Bisphenol Exposures in Pregnant Women

Endocrine disrupting chemicals (EDCs) can disrupt fetal developmental processes during pregnancy, leading to long-term adverse outcomes in humans. A major source of exposure to EDCs, such as phthalates and bisphenols, is the food supply, primarily due to contamination from processing and packaging. Therefore, this review aimed to 1) review food-monitoring sources of phthalates and bisphenols, and 2) evaluate methodologies and provide future directions needed to establish EDC-limiting dietary recommendations in pregnancy. Using PubMed, 10 peer-reviewed studies were found on dietary predictors of EDC exposure in pregnancy, and all were selected for review. Use of plastic containers in pregnancy was associated with higher urinary phthalate metabolites, whereas canned food consumption was associated with higher urinary bisphenol A (BPA) concentrations. Foods and dietary patterns associated with healthier food choices (e.g., organic/grown/raised/caught foods, folic acid supplements, vegetarianism) were generally associated with lower urinary phthalate metabolite and BPA concentrations. Despite the many food-monitoring studies reporting high BPA and phthalate concentrations in various foods, the designs of most studies described here were not sufficiently robust to consistently detect associations of specific foods/food groups with phthalates and BPA. Given the limitations of currently available research, future studies should incorporate more valid questionnaires to accurately assess dietary EDC exposure, strive for concurrent diet and exposure assessment, and assess whether geographical and cultural differences modify associations of diet with gestational EDC exposures. Such progress will be critical for developing dietary recommendations that ensure the safety and health of pregnant women.

Dietary intervention strategies for ethnic Chinese women with gestational diabetes mellitus: A systematic review and meta-analysis

Aim

Ethnic Chinese women are one of the populations at high risk of gestational diabetes mellitus (GDM) internationally. This systematic review aimed to determine which dietary intervention strategies were found to be effective in improving glycaemic control and pregnancy outcomes among ethnic Chinese women with GDM.

Methods

The review protocol was registered with PROSPERO (CRD42016043585). Eight English and four Chinese language databases were searched for randomised controlled trials and cohort studies of dietary intervention among ethnic Chinese women with GDM. Review Manager 5.3 and GRADE criteria were used in meta‐analysis and assessment of quality of evidence.

Results

Included studies comprised 3944 women in 29 eligible studies. Compared to standard treatment, low glycaemic index (GI) diets, low glycaemic load (GL) diets and fibre‐enriched diets were associated with a reduction in fasting plasma glucose, 2‐hour plasma glucose and HbA1c, and improved neonatal outcomes. Low GL diets were associated with reduced caesarean section risk.

Conclusions

In ethnic Chinese women with GDM, low GI diets, low GL diets and fibre‐enriched diets were associated with improved glycaemic control and pregnancy outcomes. Given the lack of direct comparison of these three diets, future direct comparison trials are necessary to determine optimal dietary intervention strategies.

Structural Equation Modeling on Effects of Community Empowerment and Supplementary Feeding on Health Status and Nutritional Status of Pregnant Women

Introduction: rates of health problems related to a chronic lack of energy in pregnant women in Indonesia remain prevalence. This study aimed to develop community empowerment and supplementary feeding on health status and nutritional status among pregnant women.Methods: the sample included 189 pregnant women living in the six villages in the Jember District. The research used a cluster random sampling technique. The variables included community empowerment, supplementary feeding, health status, and nutritional status of pregnant women. Data analysis was performed using structural equation modeling (SEM) with parameter data estimation using software (Analysis of Moment Structures (AMOS) version 21).Results: estimations of the direct effects were as follows: community empowerment on health status  (0.224), supplementary feeding on health status (0.169), health status on nutritional status of pregnant women (0.001), community empowerment on nutritional status of pregnant women (2.857), supplementary feeding on nutritional status of pregnant women (-0.537), community empowerment on nutritional status of pregnant women through health status (0.000), supplementary feeding on nutritional status of pregnant women through health status (0.000), community empowerment on health status (0.224), supplementary feeding on health status (0.169).Conclusion: community empowerment remains an important key in improving the engagement of women in maternal health issues. Combined intervention with supplementary feeding based on locality may improve the health outcomes.

Dietary patterns during pregnancy and risk of gestational diabetes: a prospective cohort study in Western China

BACKGROUND

Previous research has demonstrated the association between maternal dietary patterns and gestational diabetes (GDM), but evidence in Asian populations remains limited and inconsistent. This study investigated the association between dietary patterns during early pregnancy and the risk of GDM among pregnant women in Western China.

METHODS

A prospective cohort study was conducted among 1337 pregnant women in Western China. Dietary intakes were assessed at 15-20 weeks of gestation using a validated food frequency questionnaire. GDM was diagnosed by oral glucose tolerance tests at 24-28 weeks of gestation. Exploratory factor analysis was performed to derive dietary patterns, and logistic regression models were used to examine the association between dietary patterns and GDM.

RESULTS

A total of 199 women (14.9%) developed GDM. Three dietary patterns were identified, namely, a plant-based pattern, a meat-based pattern and a high protein-low starch pattern. Notwithstanding a lack of association between dietary patterns and GDM risk in the whole cohort, there was a significant reduction in GDM risk among overweight women (BMI ≥24 kg/m²); the odds ratio being 0.29 (95% confidence interval 0.09 to 0.94) when comparing the highest versus the lowest score of the high protein-low starch pattern.

CONCLUSIONS

There was no significant association between early pregnancy dietary patterns and GDM risk later in pregnancy for women in Western China, but high protein-low starch diet was associated with lower risk for GDM among women who were overweight at pre-pregnancy.

Translation of nutrient recommendations into personalized optimal diets for Chinese urban lactating women by linear programming models

Background

Lactating women need to consume a high-quality diet to replete nutrient stores depleted during pregnancy and to ensure sufficient nutrition for breastfeeding. However, several studies reported suboptimal dietary quality and nutrient intake of lactating mothers in China. The objectives of this study was to apply dietary modeling method to develop individualized optimal diets, which meet the nutrient requirements for lactating women in urban China.

Methods

Data were collected from a sample of 576 lactating women from 0 to 240 days postpartum during the Maternal Infant Nutrition Growth study conducted between 2011 and 2012 in three cities including Beijing, Guangzhou, and Suzhou. Dietary intake data were collected with an interviewer-administered 24-h survey. Linear programming was applied to develop dietary plans that meet recommendations for lactation women in the China Dietary Reference Intakes 2013 and the Chinese Dietary Guideline 2016, while with least deviation from the observed dietary intake.

Results

Through dietary modeling, individual optimal diets were developed for 576 lactating women. The optimal diets met all the food and nutrient intake constraints set in the linear programming models. The large difference between observed and optimized diets suggests that the nutrient needs of lactating mothers in China may only be met after substantial dietary changes. In addition, the analysis showed that it was difficult to meet the recommended intake for six nutrients: vitamin A, vitamin B1, vitamin B6, calcium, selenium, and dietary fiber. Moreover, four clusters in the optimized diets were identified by K-means cluster analysis. The four clusters confirmed that the optimal diets developed by linear programming could characterize the variety in dietary habits by geographical regions and duration of lactation.

Conclusion

Linear programming could help translate nutrient recommendations into personal diet advices for a sample of urban lactating mothers from China. The study showed that dietary modeling is helpful to support healthy eating of lactation women by translating dietary guidelines into personalized meal plans.

Trial registration

The Maternal Infant Nutrition Growth study was registered in ClinicalTrials.gov with identifier NCT01971671. Registration date October 29, 2013.

Oral Health in Pregnant Chinese Women in Singapore: A Call to Go beyond the Traditional Clinical Care

Objective: To examine the correlations among oral health knowledge, attitude, practices and oral disease among pregnant Chinese women in Singapore. Methods: A descriptive correlational study was conducted in pregnant Chinese women in Singapore. A questionnaire was used to collect data of oral health knowledge, attitude and practices. Plaque index scores were used to assess the oral health of subjects. Results: A total of 82 pregnant women participated in the study, out of whom 38% showed adequate oral health knowledge, nearly half of them achieved adequate and oral health attitude and practice scores while 34% had good Plaque index scores. The lower income group had higher experience of self-reported dental problems during pregnancy than those in the higher income group (p = 0.03). There were significant positive correlations between scores of oral health practice, attitude and oral health knowledge levels. The plaque index scores negatively correlated with the oral health practice scores (p = 0.02). Conclusions: Our findings provided evidence that oral health knowledge, attitude and practices among Chinese pregnant women were not optimal which implies the importance of promoting their oral health during pregnancy through the improvement of knowledge and attitudes. This would facilitate formulation and implementation of appropriate oral health promotion policies.

Immigrant women's food choices in pregnancy: perspectives from women of Chinese origin in Canada

OBJECTIVE

Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period.

DESIGN

This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves.

RESULTS

The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors.

CONCLUSION

The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period.

Effect of maternal supplement beverage with and without probiotics during pregnancy and lactation on maternal and infant health: a randomized controlled trial in the Philippines

BACKGROUND

Adequate nutrition is essential during pregnancy and lactation to provide sufficient energy and nutrients to meet the nutritional requirements of the mother, fetus and infant. The primary objective of this study was to assess the effect of a maternal nutritional supplement enriched with probiotics during pregnancy and early lactation on the incidence of infant diarrhea.

METHODS

Healthy, pregnant (24-28 weeks gestation) women were randomized 1:1:1 to receive either no supplement or two servings per day of an oral supplement (140 kcal/serving) providing 7.9 g protein, multivitamin/minerals, and enriched or not with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis, from the third trimester of pregnancy until at least 2 months post-delivery. Incidence of infant diarrhea until 12 months post-delivery was analyzed by Poisson regression. The effect on maternal health, fetal growth, and infant growth and morbidity were also evaluated and analyzed by ANOVA.

RESULTS

A total of 208 mother/infant pairs were included in the analysis. No significant difference in the incidence of infant diarrhea was observed between the three study groups. The mean maternal weight gains at delivery were similar among groups, despite an increase in caloric intake in the supplemented groups. No statistically significant differences between groups were observed in incidence of pregnancy-related or fetal adverse outcomes. Mean weight-, length-, BMI- and head circumference-for-age z-scores were below the WHO median value for all groups. Post-hoc analysis to compare the effect of the combined supplement groups versus the no supplement group on infant growth parameters showed, at 12 months, that the combined supplemented group had gained statistically significant more weight (8.97 vs. 8.61 kg, p = 0.001) and height (74.2 vs. 73.4 cm, p = 0.031), and had a higher weight-for-age z-score (- 0.62 vs. -0.88, p = 0.045) than the no supplement group.

CONCLUSIONS

Maternal nutritional supplement with or without probiotics given during late pregnancy and early lactation was well tolerated and safe. Even though no difference in incidence of infant diarrhea was observed between the three groups, the analysis of the combined supplemented groups showed beneficial effects of maternal supplementation on infant weight and length gains at 12 months.

TRIAL REGISTRATION

ClinicalTrial.gov: NCT01073033 . Registered 17.02.2010.

[Women's dietary habits during pregnancy and breastfeeding in Amoron'i Mania region, Madagascar: a qualitative study]

Introduction

Women's dietary habits are very important due to the specific nutritional requirements for reproduction. This study aimed to describe women's dietary habits during pregnancy and breastfeeding and to identify factors influencing these habits.

Methods

We conducted a qualitative study of pregnant and breastfeeding women living in Amoron'i Mania region, Madagascar. Eight focus groups (6-10 women per group) and 23 individual interviews were carried out to collect data. Thematic analysis was used and focused on the description of women's dietary habits on the basis of dietary behaviours as well as of sociocultural and economic determinants of the described habits.

Results

During pregnancy and breastfeeding, women's dietary habits did not vary considerably except at the very beginning of breastfeeding. They had a little diversified and monotonous diet, poor in fruit and vegetables and poor in proteins. At the very beginning of breastfeeding, during the practice of "mifana " tradition, women had a diet more rich than usual. These dietary habits were influenced by the type of agricultural products in the region and by their availability during the year (self-consumption)as well as by purchasing power (in case of shortage) and tradition.

Conclusion

Mothers' dietary habits appear to be inadequate. This study highlights the importance of improving knowledge of the determinants of mothers' dietary behaviours.

Prospective Associations of Maternal Dietary Patterns and Postpartum Mental Health in a Multi-Ethnic Asian Cohort: The Growing up in Singapore towards Healthy Outcomes (GUSTO) Study

Diet in the first month postpartum, otherwise known as “the confinement diet” in Asia, has unique characteristics that are influenced by traditions, cultures, and beliefs. We aimed to characterize dietary patterns during confinement period in a multi-ethnic Asian cohort and examined their associations with postpartum depression (PPD) and anxiety (PPA). Dietary intakes of 490 women were ascertained in the first month postpartum using 3-day food diaries and dietary patterns were derived by factor analysis. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) at three months’ postpartum; higher scores are indicative of more depressive and anxiety symptoms, respectively. Four dietary patterns were identified: Traditional-Chinese-Confinement diet, Traditional-Indian-Confinement diet, Eat-Out diet and Soup-Vegetables-Fruits diet. The Traditional-Indian-Confinement diet was associated with less PPD symptoms [β (95% CI) −0.62 (−1.16, −0.09) EPDS score per SD increase in diet score] and a non-significant trend with reduced probable PPD (EPDS scores ≥ 13) [OR (95% CI) 0.56 (0.31, 1.01)]. The Soup-Vegetables-Fruits diet was associated with less PPA symptoms [β (95% CI) −1.49 (−2.56, −0.42) STAI-state score]. No associations were observed for other dietary patterns. Independent of ethnicity, adherence to the Traditional-Indian-Confinement diet that is characterized by intake of herbs and legumes, and Soup-Vegetables-Fruits diet high in fruits, vegetables and fish during the postpartum period were associated with less PPD and PPA symptoms, respectively.

Tanzanian Mothers' Cultural Beliefs and Misinformation Regarding the Reasons for Their Cesarean Sections

BACKGROUND

In Tanzania, cesarean section (CS) rates have been steadily increasing, yet little is known about mothers' understanding of the medical rationale for their CSs.

AIM

To identify mothers' cultural understandings of the rationale for their CSs.

METHODS

Design: A qualitative descriptive design was employed.

Setting: A government hospital in the western region in Tanzania.

Participants: A total of 117 mothers were interviewed using convenience sampling post CS.

FINDINGS

Forty percent of the mothers were younger than 18 years, with more than 50% having had five or more live babies. Among multigravida women, 40.2% had had one or more previous CSs.

The emergent themes were lack of dietary knowledge, use of local herbs, delays in coming to hospital, avoiding stressful labor pains and no ability to exercise, and no personal preferences of “push or go for an operation.”

CONCLUSION

Pregnant women in Tanzania need improved health education to make informed choices about childbirth and be involved all processes of antepartum care decision making to achieve optimal birth outcomes.

Dietary Protein Intake, Meat Consumption, and Dairy Consumption in the Year Preceding Pregnancy and During Pregnancy and Their Associations With the Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Southwest China

Background: Gestational diabetes mellitus (GDM) has become a public health problem in China. Objective: To examine the association of dietary protein intake before and during pregnancy with the risk of GDM. Design: Dietary intake before pregnancy and during the first and second trimesters of pregnancy was assessed using food frequency questionnaires in a prospective cohort of pregnant women. To screen GDM, participants underwent an OGTT test during 24-28 weeks of gestation. Cox proportional hazards were used to estimate RRs and 95% CIs for the associations between tertiles of dietary protein and the source of protein intake in different time windows with GDM status. Results: Higher intake of total protein [RR (95% CI): 1.92 (1.10-3.14), p for trend = 0.04] or animal protein [1.67 (1.19-2.93), p for trend = 0.03] in mid-pregnancy was associated with higher risk of GDM. Vegetable protein intake before or during pregnancy was not related to GDM risk (p for trend > 0.05). Moreover, in the mid-pregnancy, participants with higher meat consumption or dairy consumption had a higher risk of GDM. Conclusion: Our study indicated that higher dietary intakes of total protein and animal protein in mid-pregnancy were associated with an increased risk of GDM among pregnant Chinese women.

Identification of Caries Risk Determinants in Toddlers: Results of the GUSTO Birth Cohort Study

The aim of this study was to identify risk determinants leading to early childhood caries (ECC) and visible plaque (VP) in toddlers. Data for mother-child pairs participating in the Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort were collected from pregnancy to toddlerhood. Oral examinations were performed in 543 children during their clinic visit at 24 months to detect ECC and VP. Following logistic regression, ECC and VP were jointly regressed as primary and secondary outcomes, respectively, using the bivariate probit model. The ECC prevalence was 17.8% at 2 years of age, with 7.3% of children having a VP score >1. ECC was associated with nighttime breastfeeding (3 weeks) and biological factors, including Indian ethnicity (lower ECC rate), higher maternal childbearing age and existing health conditions, maternal plasma folate <6 ng/mL, child BMI, and the plaque index, while VP was associated with psychobehavioral factors, including the frequency of dental visits, brushing frequency, lower parental perceived importance of baby teeth, and weaning onto solids. Interestingly, although a higher frequency of dental visits and toothbrushing were associated with lower plaque accumulation, they were associated with increased ECC risk, suggesting that these established caries-risk factors may be a consequence rather than the cause of ECC. In conclusion, Indian toddlers may be less susceptible to ECC, compared to Chinese and Malay toddlers. The study also highlights a problem-driven utilization pattern of dental services (care sought for treatment) in Singapore, in contrast to the prevention-driven approach (care sought to prevent disease) in Western countries.

Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women

BACKGROUND

A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age.

METHODS

Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9-20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model.

RESULTS

The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04).

CONCLUSIONS

We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov database, NCT01001689 . https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1 .

A Comparison of Practices During the Confinement Period among Chinese, Malay, and Indian Mothers in Singapore

BACKGROUND

Confinement (restrictions placed on diet and practices during the month right after delivery) represents a key feature of Asian populations. Few studies, however, have focused specifically on ethnic differences in confinement practices. This study assesses the confinement practices of three ethnic groups in a multi-ethnic Asian population.

METHODS

Participants were part of a prospective birth cohort study that recruited 1,247 pregnant women (57.2% Chinese, 25.5% Malay, and 17.3% Indian) during their first trimester. The 1,220 participants were followed up 3 weeks postpartum at home when questionnaires were administered to ascertain the frequency of adherence to the following confinement practices: showering; confinement-specific meals; going out with or without the baby; choice of caregiver assistance; and the use of massage therapy.

RESULTS

Most participants reported that they followed confinement practices during the first 3 weeks postpartum (Chinese: 96.4%, Malay: 92.4%, Indian: 85.6%). Chinese and Indian mothers tended to eat more special confinement diets than Malay mothers (p < 0.001), and Chinese mothers showered less and were more likely to depend on confinement nannies during this period than mothers from the two other ethnic groups (p < 0.001 for all). Malay mothers tended to make greater use of massage therapy (p < 0.001), whilst Indian mothers tended to have their mothers or mothers-in-law as assistant caregivers (p < 0.001).

CONCLUSION

Most Singapore mothers follow confinement practices, but the three Asian ethnic groups differed in specific confinement practices. Future studies should examine whether ethnic differences persist in later childrearing practices.

Risk of Subsequent Hypertension and Diabetes in Women With Hypertension During Pregnancy and Gestational Diabetes

OBJECTIVE

To assess risks of postpartum hypertension and diabetes mellitus (DM) for women with hypertension during pregnancy (HDP) with and without gestational DM (GDM).

PATIENTS AND METHODS

From insurance data of 15- to 44-year-old women with pregnancy in 2000-2011, we established an HDP/GDM cohort (n=1270), an HDP/non-GDM cohort (n=5077), and a comparison cohort without either disorder (n=12,594), frequency matched by age and year of pregnancy. Postpartum hypertension and DM were assessed before 2012.

RESULTS

The postpartum hypertension incidence increased with age in all cohorts, with overall rates of 13.1, 8.82, and 0.79 per 1000 person-years in the HDP/GDM, HDP/non-GDM, and comparison cohorts, respectively. The adjusted hazard ratios (aHRs) of hypertension were 16.8 (95% CI, 11.8-24.1) for the HDP/GDM cohort and 11.2 (95% CI, 8.19-15.2) for the HDP/non-GDM cohort relative to the comparison cohort. The corresponding incident DM rates were 41.9 and 8.06 vs 2.55 per 1000 person-years in the 3 cohorts, respectively, with aHRs of 16.2 (95% CI, 13.2-19.9) for the HDP/GDM cohort and 3.15 (95% CI, 2.55-3.89) for the HDP/non-GDM cohort relative to the comparison cohort. Incident DM in the HDP/GDM cohort was 44% greater in 15- to 29-year-old women vs 40- to 44-year-old women (49.1 vs 34.2 per 1000 person-years), with aHRs of 39.2 (95% CI, 24.5-62.7) and 5.52 (95% CI, 2.92-10.4), respectively, relative to comparisons of respective age groups.

CONCLUSION

Subsequent hypertension and DM risks are greater in women with HDP/GDM than in women with HDP only compared with women without these complications. Younger women with HDP/GDM should be particularly cautious.