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Fu JY, Wang CA, Mead EC, Phung J, Makrides M, Pennell CE. The role of omega-3 polyunsaturated fatty acids in the prevention of preterm birth. Med J Aust 2024; 220:502-504. [PMID: 38714366 DOI: 10.5694/mja2.52301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/21/2023] [Indexed: 05/09/2024]
Affiliation(s)
| | - Carol A Wang
- University of Newcastle, Newcastle, NSW
- Mothers and Babies Research Program, Hunter Medical Research Institute, Newcastle, NSW
| | - Elyse C Mead
- University of Newcastle, Newcastle, NSW
- Hunter New England Local Health District, NSW Health, Newcastle, NSW
| | - Jason Phung
- University of Newcastle, Newcastle, NSW
- Mothers and Babies Research Program, Hunter Medical Research Institute, Newcastle, NSW
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, SA
| | - Craig E Pennell
- University of Newcastle, Newcastle, NSW
- Mothers and Babies Research Program, Hunter Medical Research Institute, Newcastle, NSW
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Aristizabal-Henao JJ, Biltoft-Jensen AP, Christensen T, Stark KD. Lipidomic and Fatty Acid Biomarkers in Whole Blood Can Predict the Dietary Intake of Eicosapentaenoic and Docosahexaenoic Acids in a Danish Population. J Nutr 2024:S0022-3166(24)00269-4. [PMID: 38710305 DOI: 10.1016/j.tjnut.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been associated with health benefits. Blood levels of these fatty acids, measured by gas chromatography (GC), are associated with their dietary intake, but the relationships with lipidomic measurements are not well defined. OBJECTIVES This study aimed to determine the lipidomic biomarkers in whole blood that predict intakes of EPA + DHA and examine the relationship between lipidomic and GC-based n-3 polyunsaturated fatty acid (n-3 PUFA) biomarkers. METHODS Lipidomic and fatty acid analyses were completed on 120 whole blood samples collected from Danish participants. Dietary intakes were completed using a web-based 7-d food diary. Stepwise multiple linear regression was used to identify the fatty acid and lipidomic variables that predict intakes of EPA + DHA and to determine lipidomic species that predict commonly used fatty acid biomarkers. RESULTS Stepwise regression selected lipidomic variables with an R2 = 0.52 for predicting EPA + DHA intake compared to R2 = 0.40 for the selected fatty acid GC-based variables. More predictive models were generated when the lipidomic variables were selected for females only (R2 = 0.62, n = 68) and males only (R2 = 0.72, n = 52). Phosphatidylethanolamine plasmalogen species containing EPA or DHA tended to be the most predictive lipidomic variables. Stepwise regression also indicated that selected lipidomic variables can predict commonly used fatty acid GC-based n-3 PUFA biomarkers as the R2 values ranged from 0.84 to 0.91. CONCLUSIONS Both fatty acid and lipidomic data can be used to predict EPA + DHA intakes, and fatty acid GC-based biomarkers can be emulated by lipidomic species. Lipidomic-based biomarkers appear to be influenced by sex differences, probably in n-3 PUFA and lipoprotein metabolism. These results improve our ability to understand the relationship between novel lipidomic data and GC fatty acid data and will increase our ability to apply lipidomic methods to fatty acid and lipid nutritional research.
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Affiliation(s)
- Juan J Aristizabal-Henao
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada; Platforms and Translational Sciences, BPGbio Inc., Framingham, MA, United States
| | | | - Tue Christensen
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ken D Stark
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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Zielinsky P, Alves DR, Foresti JDÁ, Guimarães DB, Zucatti KP, Vian I. Maternal supplementation with docosahexaenoic acid does not cause constriction of fetal ductus arteriosus: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:586-591. [PMID: 38214544 DOI: 10.1002/uog.27584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Docosahexaenoic acid (DHA) is recommended routinely in pregnancy to promote fetal development. DHA has anti-inflammatory activity, but its effects on the fetal heart and circulation are unknown. This study aimed to investigate whether maternal DHA supplementation in the third trimester affects maternal prostaglandin levels and fetal ductus arteriosus flow dynamics. METHODS This was a double-blind randomized controlled trial with parallel groups conducted between 2018 and 2021. Pregnant women aged over 18 years with a normal fetus at 27-28 weeks' gestation showing no cardiac/extracardiac anomalies or ductal constriction were eligible for the trial. Women consuming substances with a known inhibitory effect on prostaglandin metabolism, such as non-steroidal anti-inflammatory drugs and polyphenol-rich foods, were excluded. The intervention group received oral supplementation of omega-3 with 450 mg/day of DHA for 8 weeks and the placebo group received capsules of soy lecithin for 8 weeks. Anthropometric measurements, assessment of polyphenol and omega-3 consumption, fetal morphological ultrasound examination, fetal Doppler echocardiographic examination and blood sample collection were performed at the start of the study and the latter two were repeated at follow-up. Prostaglandin E2 (PGE2) level and echocardiographic parameters were compared between the intervention and placebo groups and between baseline and follow-up. RESULTS A total of 24 participants were included in each group. After 8 weeks, there were no significant differences between the intervention and placebo groups in maternal serum PGE2 level or Doppler echocardiographic parameters of ductal flow. No case of ductus arteriosus constriction was observed. The expected intragroup changes in cardiac morphology, as a result of advancing gestation, were present. CONCLUSIONS Maternal DHA supplementation in the third trimester at a clinically recommended dose did not result in inhibition of PGE2 or constriction of the ductus arteriosus. These findings should be confirmed in postmarket surveillance studies with larger patient numbers in order to test the full safety profile of DHA and provide robust clinical reassurance. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
- Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - D R Alves
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - J D Á Foresti
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - D B Guimarães
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - K P Zucatti
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - I Vian
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
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DeFranco EA, Valentine CJ, Carlson SE, Sands SA, Gajewski BJ. Racial disparity in efficacy of docosahexaenoic acid supplementation for prevention of preterm birth: secondary analysis from a randomized, double-blind trial. Am J Obstet Gynecol MFM 2024; 6:101358. [PMID: 38552960 PMCID: PMC11102282 DOI: 10.1016/j.ajogmf.2024.101358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Emily A DeFranco
- Department of Obstetrics and Gynecology, University of Kentucky, 800 Rose St., C373, Lexington, KY 40536.
| | | | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, MO
| | - Scott A Sands
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, MO
| | - Byron J Gajewski
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO
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Marsubrin PMT, Ibrahim NAA, Dilmy MAF, Ariani Y, Wiweko B, Irwinda R, Harzif AK, Hegar B, Basrowi RW. Determinants of prematurity in urban Indonesia: a meta-analysis. J Perinat Med 2024; 52:270-282. [PMID: 38146621 DOI: 10.1515/jpm-2023-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/26/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Indonesia is the fifth country with the highest number of preterm births worldwide. More than a third of neonatal deaths in Indonesia were attributed to preterm birth. Residential areas affected the occurrence of preterm birth due to differing socioeconomic and environmental conditions. Many studies have investigated the determinants of prematurity in Indonesia, however, most of them were performed in rural areas. This study is the first meta-analysis describing the determinants of preterm birth in urban Indonesia, which aimed to become the foundation upon implementing the most suitable preventative measure and policy to reduce the rate of preterm birth. METHODS We collected all published papers investigating the determinants of preterm birth in urban Indonesia from PubMed MEDLINE and EMBASE, using keywords developed from the following key concepts: "preterm birth", "determinants", "risk factors", "Indonesia" and the risk factors, such as "high-risk pregnancy", "anemia", "pre-eclampsia", and "infections". Exclusion criteria were multicenter studies that did not perform a specific analysis on the Indonesian population or did not separate urban and rural populations in their analysis, and articles not available in English or Indonesian. The Newcastle Ottawa Scale was used to assess the risk of bias. This systematic review was registered in PROSPERO. RESULTS Sixteen articles were included in the analysis and classified into five categories: genetic factors, nutrition, smoking, pregnancy characteristics or complications, and disease-related characteristics. CONCLUSIONS Our meta-analysis revealed adolescent pregnancy, smoking, eclampsia, bacterial vaginosis, LC-PUFA, placental vitamin D, and several minerals as the significant determinants of preterm birth in urban Indonesia.
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Affiliation(s)
| | | | - Mohammad Adya Firmansha Dilmy
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yulia Ariani
- Faculty of Medicine, Indonesian Medical Education and Research Institute, Universitas Indonesia, Jakarta, Indonesia
| | - Budi Wiweko
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rima Irwinda
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Achmad Kemal Harzif
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Badriul Hegar
- Faculty of Medicine, Indonesian Medical Education and Research Institute, Universitas Indonesia, Jakarta, Indonesia
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Dicklin MR, Anthony JC, Winters BL, Maki KC. ω-3 Polyunsaturated Fatty Acid Status Testing in Humans: A Narrative Review of Commercially Available Options. J Nutr 2024:S0022-3166(24)00164-0. [PMID: 38522783 DOI: 10.1016/j.tjnut.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
There is an increasing body of evidence supporting a link between low intakes of ω-3 long-chain polyunsaturated fatty acids (LCPUFA) and numerous diseases and health conditions. However, few people are achieving the levels of fish/seafood or eicosapentaenoic acid and docosahexaenoic acid intake recommended in national and international guidelines. Knowledge of a person's ω-3 LCPUFA status will benefit the interpretation of research results and could be expected to lead to an increased effort to increase intake. Dietary intake survey methods are often used as a surrogate for measuring ω-3 PUFA tissue status and its impact on health and functional outcomes. However, because individuals vary widely in their ability to digest and absorb ω-3 PUFA, analytical testing of biological samples is desirable to accurately evaluate ω-3 PUFA status. Adipose tissue is the reference biospecimen for measuring tissue fatty acids, but less-invasive methods, such as measurements in whole blood or its components (e.g., plasma, serum, red blood cell membranes) or breast milk are often used. Numerous commercial laboratories provide fatty acid testing of blood and breast milk samples by different methods and present their results in a variety of reports such as a full fatty acid profile, ω-3 and ω-6 fatty acid profiles, fatty acid ratios, as well as the Omega-3 Index, the Holman Omega-3 Test, OmegaScore, and OmegaCheck, among others. This narrative review provides information about the different ways to measure ω-3 LCPUFA status (including both dietary assessments and selected commercially available analytical tests of blood and breast milk samples) and discusses evidence linking increased ω-3 LCPUFA intake or status to improved health, focusing on cardiovascular, neurological, pregnancy, and eye health, in support of recommendations to increase ω-3 LCPUFA intake and testing.
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Affiliation(s)
| | | | | | - Kevin C Maki
- Midwest Biomedical Research, Addison, IL, United States; Indiana University School of Public Health, Bloomington, IN, United States.
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Oken E, Musci RJ, Westlake M, Gachigi K, Aschner JL, Barnes KL, Bastain TM, Buss C, Camargo CA, Cordero JF, Dabelea D, Dunlop AL, Ghassabian A, Hipwell AE, Hockett CW, Karagas MR, Lugo-Candelas C, Margolis AE, O’Connor TG, Shuster CL, Straughen JK, Lyall K. Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO programme. Public Health Nutr 2024; 27:e94. [PMID: 38410088 PMCID: PMC10993063 DOI: 10.1017/s136898002400051x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake. DESIGN Pooled pregnancy cohort studies. SETTING Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020. PARTICIPANTS A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use. RESULTS Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1-2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35-40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never). CONCLUSIONS One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease research across the Lifecourse, Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, 401 Park Drive, Suite 401 East, Boston,
MA, USA
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD,
USA
| | | | - Kennedy Gachigi
- Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Judy L Aschner
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital,
Hackensack Meridian School of Medicine, Nutley,
NJ, USA
- Albert Einstein College of Medicine, Bronx,
NY, USA
| | | | - Theresa M Bastain
- Department of Population and Public Health Sciences,
University of Southern California, Los Angeles,
CA, USA
| | - Claudia Buss
- Department of Medical Psychology, Charité University of
Medicine Berlin, Berlin, Germany
- Development, Health, Disease Research Program, University of
California Irvine, Irvine, CA,
USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA,
USA
| | - Jose F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, GA,
USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Anne L Dunlop
- Department of Gynecology & Obstetrics, Emory University
School of Medicine, Atlanta, GA,
USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman
School of Medicine, New York, NY,
USA
| | - Alison E Hipwell
- Department of Psychiatry, University of
Pittsburgh, Pittsburgh, PA,
USA
| | | | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at
Dartmouth, Lebanon, NH, USA
| | | | - Amy E Margolis
- Columbia University Irving Medical center, New York,
NY, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and
Gynecology, University of Rochester, Rochester,
NY, USA
| | - Coral L Shuster
- Brown Center for the Study of Children at Risk, Women and
Infants Hospital, Providence, RI,
USA
| | - Jennifer K Straughen
- Department of Public Health Sciences, Henry Ford Health
System, Detroit, MI, USA
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Cetin I, Carlson SE, Burden C, da Fonseca EB, di Renzo GC, Hadjipanayis A, Harris WS, Kumar KR, Olsen SF, Mader S, McAuliffe FM, Muhlhausler B, Oken E, Poon LC, Poston L, Ramakrishnan U, Roehr CC, Savona-Ventura C, Smuts CM, Sotiriadis A, Su KP, Tribe RM, Vannice G, Koletzko B. Omega-3 fatty acid supply in pregnancy for risk reduction of preterm and early preterm birth. Am J Obstet Gynecol MFM 2024; 6:101251. [PMID: 38070679 DOI: 10.1016/j.ajogmf.2023.101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
This clinical practice guideline on the supply of the omega-3 docosahexaenoic acid and eicosapentaenoic acid in pregnant women for risk reduction of preterm birth and early preterm birth was developed with support from several medical-scientific organizations, and is based on a review of the available strong evidence from randomized clinical trials and a formal consensus process. We concluded the following. Women of childbearing age should obtain a supply of at least 250 mg/d of docosahexaenoic+eicosapentaenoic acid from diet or supplements, and in pregnancy an additional intake of ≥100 to 200 mg/d of docosahexaenoic acid. Pregnant women with a low docosahexaenoic acid intake and/or low docosahexaenoic acid blood levels have an increased risk of preterm birth and early preterm birth. Thus, they should receive a supply of approximately 600 to 1000 mg/d of docosahexaenoic+eicosapentaenoic acid, or docosahexaenoic acid alone, given that this dosage showed significant reduction of preterm birth and early preterm birth in randomized controlled trials. This additional supply should preferably begin in the second trimester of pregnancy (not later than approximately 20 weeks' gestation) and continue until approximately 37 weeks' gestation or until childbirth if before 37 weeks' gestation. Identification of women with inadequate omega-3 supply is achievable by a set of standardized questions on intake. Docosahexaenoic acid measurement from blood is another option to identify women with low status, but further standardization of laboratory methods and appropriate cutoff values is needed. Information on how to achieve an appropriate intake of docosahexaenoic acid or docosahexaenoic+eicosapentaenoic acid for women of childbearing age and pregnant women should be provided to women and their partners.
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Affiliation(s)
- Irene Cetin
- Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy (Dr Cetin)
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS (Dr Carlson)
| | - Christy Burden
- Academic Women's Health Unit, Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, United Kingdom (Dr Burden)
| | - Eduardo B da Fonseca
- Department of Obstetrics and Gynaecology, Federal University of Paraíba, João Pessoa, Brazil (Dr da Fonseca)
| | - Gian Carlo di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy (Dr di Renzo); PREIS School, Florence, Italy (Dr di Renzo)
| | - Adamos Hadjipanayis
- School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Hadjipanayis); European Academy of Paediatrics, Brussels, Belgium (Dr Hadjipanayis)
| | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD (Dr Harris); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD (Dr Harris)
| | - Kishore R Kumar
- Cloudnine Hospitals, Bangalore, India (Dr Kumar); University of Notre Dame Australia, Perth, Australia (Dr Kumar)
| | - Sjurdur Frodi Olsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (Dr Olsen); Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Dr Olsen); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (Dr Olsen)
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany (Ms Mader)
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland (Dr McAuliffe)
| | - Beverly Muhlhausler
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia (Dr Muhlhausler); School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia (Dr Muhlhausler); South Australian Health and Medical Research Institute, Adelaide, Australia (Dr Muhlhausler)
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (Dr Oken)
| | - Liona C Poon
- Maternal Medicine, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China (Dr Poon); Department of Women and Children's Health, King's College London, London, United Kingdom (Dr Poon)
| | - Lucilla Poston
- School of Life Course and Population Sciences, King's College London, London, United Kingdom (Dr Poston); International Society for Developmental Origins of Health and Disease (Dr Poston)
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA (Dr Ramakrishnan); Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA (Dr Ramakrishnan)
| | - Charles C Roehr
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (Dr Roehr); Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom (Dr Roehr); Newborn Care, Women and Children's Division, Southmead Hospital, Bristol, United Kingdom (Dr Roehr); European Society for Paediatric Research, Satigny, Switzerland (Dr Roehr)
| | - Charles Savona-Ventura
- Department of Obstetrics & Gynaecology, Mater Dei Hospital, University of Malta Medical School, Msida, Malta (Dr Savona-Ventura); Centre for Traditional Chinese Medicine & Culture, University of Malta, Msida, Malta (Dr Savona-Ventura)
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa (Dr Smuts)
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece (Dr Sotiriadis)
| | - Kuan-Pin Su
- Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan (Dr Su); An-Nan Hospital, China Medical University, Tainan, Taiwan (Dr Su); College of Medicine, China Medical University, Taichung, Taiwan (Dr Su)
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, London, United Kingdom (Dr Tribe)
| | | | - Berthold Koletzko
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich Hospital, Munich, Germany (Dr Koletzko); Child Health Foundation (Stiftung Kindergesundheit), Munich, Germany (Dr Koletzko); European Academy of Paediatrics, Brussels, Belgium (Dr Koletzko).
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Cáceres A, Cruz SM, de León C, Méndez R. Yield and Chemical Characteristics of Salvia hispanica L. (Chia) Oil from Native Seeds from Four Provenances of Guatemala. Comb Chem High Throughput Screen 2024; 27:555-561. [PMID: 37183473 DOI: 10.2174/1386207326666230512124457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Chia (Salvia hispanica L.) is a plant from the Lamiaceae family that has been used as ancestral food, medicine, and oil, with culinary, artistic, and religious purposes by most of the Mesoamerican civilizations. Native from Mesoamerica, introduced into South America, Australia, and Europe, it is presently consumed as a nutritional and functional food. OBJECTIVE This research aims to characterize ancient native cultivars from four provenances in Guatemala to recommend their direct consumption by the population as well as to establish its trade. METHODS Seed samples were collected in four places where they have been cultivated for several generations. The oil was obtained by expression and analyzed chemically by gas chromatography following standard qualitative and quantitative methods. RESULTS Variations in oil yield and some of the characteristic parameters of the phytochemical analysis were obtained. In general, the profile was similar to most of the reported data in the literature, with the saturated fatty acids (8.54-9.25%) relatively lower than the references (7.95-11.45%) but a higher concentration of unsaturated fatty oils, particularly of omega-3 (64.68-68.62%). CONCLUSION The oil from native cultivars contains high quantities of omega-3, which might help pregnant women during gestation and to control other conditions such as metabolic syndrome, particularly in low- and middle-income populations where these seeds are consumed regularly. The suggestion is made to encourage the cultivation and use of these ancestral seeds with the possibility of commercialization abroad with an appellation of origin label.
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Affiliation(s)
- Armando Cáceres
- Laboratorio de Investigación de Productos Naturales (Lipronat), Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos, Cdad. de Guatemala, 01002, Guatemala
- Laboratorio de Productos Naturales Farmaya, Guatemala
| | - Sully M Cruz
- Laboratorio de Investigación de Productos Naturales (Lipronat), Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos, Cdad. de Guatemala, 01002, Guatemala
| | - Claudia de León
- Instituto de Investigaciones Químicas, Biológicas, Biomédicas y Biofísicas, Universidad Mariano Gálvez, Cdad. de Guatemala, Guatemala
| | - Rebeca Méndez
- Instituto de Investigaciones Químicas, Biológicas, Biomédicas y Biofísicas, Universidad Mariano Gálvez, Cdad. de Guatemala, Guatemala
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Wakabayashi N, Haruna M, Yonezawa K, Sasagawa E, Usui Y, Ohori R, Aoyama S, Sasaki S, Nagamatsu T. Association of serum docosahexaenoic acid and eicosapentaenoic acid levels with dietary intakes and supplement use during pregnancy: a prospective observational study. J Nutr Sci 2023; 12:e125. [PMID: 38155803 PMCID: PMC10753464 DOI: 10.1017/jns.2023.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/29/2023] [Accepted: 10/27/2023] [Indexed: 12/30/2023] Open
Abstract
This study aimed to determine the association of serum docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) levels with dietary intakes and supplement use during pregnancy. This prospective observational study was conducted at a university hospital in Tokyo, Japan. Participants in their second and third trimesters were given a self-administered questionnaire assessing the frequency of DHA and EPA supplement use in the past month and a brief-type self-administered diet history questionnaire. Non-fasting serum DHA and EPA levels were analysed using gas chromatography. Differences in biomarkers by frequency of supplement use were determined using multiple comparison analyses, and Spearman's correlation coefficient was used to determine biomarkers and DHA and EPA intakes by food group. Of the 116 participants, 11 (9⋅5 %) in the second trimester and 18 (15⋅5 %) in the third trimester regularly used supplements (≥5 times per week). Regular users had higher serum DHA and EPA levels than never users in the second and third trimesters. Dietary DHA and EPA intake from fish and shellfish was positively correlated with serum DHA and EPA in the second and third trimesters. Supplement use ≥5 times per week and fish and shellfish intake were associated with high serum DHA and EPA levels.
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Affiliation(s)
- Nana Wakabayashi
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Haruna
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emi Sasagawa
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Usui
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Riko Ohori
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Aoyama
- Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Facility of Medicine, The University of Tokyo, Tokyo, Japan
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Bisgaard H, Mikkelsen M, Rasmussen MA, Sevelsted A, Schoos AMM, Brustad N, Eliasen AU, Thorsen J, Chawes B, Gürdeniz G, Morin A, Stark K, Stokholm J, Ober C, Pedersen CET, Bønnelykke K. Atopic and non-atopic effects of fish oil supplementation during pregnancy. Thorax 2023; 78:1168-1174. [PMID: 37696621 PMCID: PMC10777305 DOI: 10.1136/thorax-2022-219725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/15/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND We recently conducted a double-blinded randomised controlled trial showing that fish-oil supplementation during pregnancy reduced the risk of persistent wheeze or asthma in the child by 30%. Here, we explore the mechanisms of the intervention. METHODS 736 pregnant women were given either placebo or n-3 long-chain polyunsaturated fatty acids (LCPUFAs) in the third trimester in a randomised controlled trial. Deep clinical follow-up of the 695 children in the trial was done at 12 visits until age 6 years, including assessment of genotype at the fatty acid desaturase (FADS) locus, plasma fatty acids, airway DNA methylation, gene expression, microbiome and metabolomics. RESULTS Supplementation with n-3 LCPUFA reduced the overall risk of non-atopic asthma by 73% at age 6 (relative risk (RR) 0.27 (95% CI 0.06 to 0.85), p=0.042). In contrast, there was no overall effect on asthma with atopic traits (RR 1.42 (95% CI 0.63 to 3.38), p=0.40), but this was significantly modified by maternal FADS genotype and LCPUFA blood levels (interaction p<0.05), and supplementation did reduce the risk of atopic asthma in the subgroup of mothers with FADS risk variants and/or low blood levels of n-3 LCPUFA before the intervention (RR 0.31 (95% CI 0.11 to 0.75), p=0.016). Furthermore, n-3 LCPUFA significantly reduced the number of infections (croup, gastroenteritis, tonsillitis, otitis media and pneumonia) by 16% (incidence rate ratio 0.84 (95% CI 0.74 to 0.96), p=0.009). CONCLUSIONS n-3 LCPUFA supplementation in pregnancy showed protective effects on non-atopic asthma and infections. Protective effects on atopic asthma depended on maternal FADS genotype and n-3 LCPUFA levels. This indicates that the fatty acid pathway is involved in multiple mechanisms affecting the risk of asthma subtypes and infections. TRIAL REGISTRATION NUMBER NCT00798226.
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Affiliation(s)
- Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Marianne Mikkelsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Morten Arendt Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
- Department of Food Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sevelsted
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Ann-Marie Malby Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
- Department of Pediatrics, Slagelse Sygehus, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicklas Brustad
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Anders U Eliasen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gözde Gürdeniz
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Andreanne Morin
- Department of Human Genetics, University of Chicago, Chicago, Illinois, USA
| | - Ken Stark
- Department of Kinesiology and Human Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
- Department of Pediatrics, Slagelse Sygehus, Slagelse, Denmark
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Illinois, USA
| | - Casper Emil Tingskov Pedersen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Sullivan TR, Yelland LN, Gibson RA, Thakkar SK, Huang F, Best KP, Devaraj S, Zolezzi IS, Makrides M. Predictors of compliance with higher dose omega-3 fatty acid supplementation during pregnancy and implications for the risk of prematurity: exploratory analysis of the ORIP randomised trial. BMJ Open 2023; 13:e076507. [PMID: 37739459 PMCID: PMC10533701 DOI: 10.1136/bmjopen-2023-076507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Intention-to-treat analyses of the Omega-3 to Reduce the Incidence of Prematurity (ORIP) trial found that omega-3 (n-3) fatty acid supplementation reduces the risk of prematurity in the subgroup of women with a singleton pregnancy and low n-3 status early in pregnancy, but not overall. However, results may have been influenced by less-than-optimal compliance. OBJECTIVES To identify predictors of compliance with n-3 supplementation and determine treatment effects among compliers. DESIGN Exploratory analyses of a multicentre-blinded randomised trial. SETTING 6 tertiary care centres in Australia. PARTICIPANTS 5328 singleton pregnancies. INTERVENTIONS Daily capsules containing 900 mg n-3 long-chain polyunsaturated fatty acids or vegetable oil, consumed from before 20 weeks gestation until 34 weeks gestation. OUTCOME MEASURES Early preterm (<34 weeks gestation) and preterm birth (<37 weeks gestation). Women were considered compliant if they reported missing less than a third of their allocated capsules in the previous week during a mid-pregnancy appointment. RESULTS Among 2654 singleton pregnancies in the n-3 intervention group, 1727 (65%) were deemed compliant with supplementation. Maternal characteristics associated with compliance included age, years of full-time education, consuming alcohol but not smoking in the 3 months leading up to pregnancy, fewer previous births and taking dietary supplements at enrolment. Based on complier average causal effects, n-3 supplementation reduced the risk of preterm birth in compliers (relative risk=0.76; 95% CI 0.60 to 0.97), but not early preterm birth (relative risk=0.80; 95% CI 0.44 to 1.46). Consistent with intention-to-treat analyses, the lack of an overall effect on early preterm birth in compliers appeared to be due to beneficial effects in women with low n-3 status at enrolment but not women with replete status. CONCLUSIONS Results in compliers were similar to those from intention-to-treat analyses, suggesting that non-compliance was not a major factor in explaining outcomes from the ORIP trial. TRIAL REGISTRATION NUMBER ACTRN12613001142729.
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Affiliation(s)
- Thomas R Sullivan
- SAHMRI Women & Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa N Yelland
- SAHMRI Women & Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women & Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sagar K Thakkar
- Nestlé Product Technology Center-Nutrition, Societe des Produits Nestle SA, Vevey, Vaud, Switzerland
| | - Fang Huang
- Nestlé Research, Societe des Produits Nestle SA, Beijing, China
| | - Karen P Best
- SAHMRI Women & Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Irma Silva Zolezzi
- Nestlé Product Technology Center-Nutrition, Societe des Produits Nestle SA, Vevey, Vaud, Switzerland
| | - Maria Makrides
- SAHMRI Women & Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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13
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Jiang Y, Chen Y, Wei L, Zhang H, Zhang J, Zhou X, Zhu S, Du Y, Su R, Fang C, Ding W, Feng L. DHA supplementation and pregnancy complications. J Transl Med 2023; 21:394. [PMID: 37330569 PMCID: PMC10276458 DOI: 10.1186/s12967-023-04239-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023] Open
Abstract
Docosahexaenoic acid (DHA) supplementation is recommended for women during pregnancy because of its neurological, visual, and cognitive effects. Previous studies have suggested that DHA supplementation during pregnancy may prevent and treat certain pregnancy complications. However, there are contradictions in the current related studies, and the specific mechanism by which DHA acts remains unclear. This review summarizes the research on the relationship between DHA intake during pregnancy and preeclampsia, gestational diabetes mellitus, preterm birth, intrauterine growth restriction, and postpartum depression. Furthermore, we explore the impact of DHA intake during pregnancy on the prediction, prevention, and treatment of pregnancy complications as well as its impact on offspring neurodevelopment. Our results suggest that there is limited and controversial evidence for the protective effect of DHA intake on pregnancy complications, with the exception of preterm birth and gestational diabetes mellitus. However, additional DHA supplementation may improve long-term neurodevelopmental outcomes in the offspring of women with pregnancy complications.
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Affiliation(s)
- Yi Jiang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yuting Chen
- Department of Obstetrics and Gynecology Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lijie Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Huiting Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Jingyi Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Xuan Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Shenglan Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yuanyuan Du
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Rui Su
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Chenyun Fang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Wencheng Ding
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China.
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14
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Fu JY, Wang CA, Liu G, Mead E, Phung J, Makrides M, Pennell CE. Development and internal validation of a non-invasive clinical tool to predict sufficient omega-3 levels in early pregnancy. BMC Pregnancy Childbirth 2023; 23:442. [PMID: 37316786 DOI: 10.1186/s12884-023-05687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/07/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Complications from preterm birth (PTB) are the leading cause of death and disability in those under five years. Whilst the role of omega-3 (n-3) supplementation in reducing PTB is well-established, growing evidence suggests supplementation use in those replete may increase the risk of early PTB. AIM To develop a non-invasive tool to identify individuals with total n-3 serum levels above 4.3% of total fatty acids in early pregnancy. METHODS We conducted a prospective observational study recruiting 331 participants from three clinical sites in Newcastle, Australia. Eligible participants (n = 307) had a singleton pregnancy between 8 and 20 weeks' gestation at recruitment. Data on factors associated with n-3 serum levels were collected using an electronic questionnaire; these included estimated intake of n-3 (including food type, portion size, frequency of consumption), n-3 supplementation, and sociodemographic factors. The optimal cut-point of estimated n-3 intake that predicted mothers with total serum n-3 levels likely above 4.3% was developed using multivariate logistic regression, adjusting for maternal age, body mass index, socioeconomic status, and n-3 supplementation use. Total serum n-3 levels above 4.3% was selected as previous research has demonstrated that mothers with these levels are at increased risk of early PTB if they take additional n-3 supplementation during pregnancy. Models were evaluated using various performance metrics including sensitivity, specificity, area under receiver operator characteristic (AUROC) curve, true positive rate (TPR) at 10% false positive rate (FPR), Youden Index, Closest to (0,1) Criteria, Concordance Probability, and Index of Union. Internal validation was performed using 1000-bootstraps to generate 95% confidence intervals for performance metrics generated. RESULTS Of 307 eligible participants included for analysis, 58.6% had total n-3 serum levels above 4.3%. The optimal model had a moderate discriminative ability (AUROC 0.744, 95% CI 0.742-0.746) with 84.7% sensitivity, 54.7% specificity and 37.6% TPR at 10% FPR. CONCLUSIONS Our non-invasive tool was a moderate predictor of pregnant women with total serum n-3 levels above 4.3%; however, its performance is not yet adequate for clinical use. TRIAL REGISTRATION This trial was approved by the Hunter New England Human Research Ethics Committee of the Hunter New England Local Health District (Reference 2020/ETH00498 on 07/05/2020 and 2020/ETH02881 on 08/12/2020).
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Affiliation(s)
- Joanna Yx Fu
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2300, Australia
| | - Carol A Wang
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2300, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Ge Liu
- South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia
| | - Elyse Mead
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2300, Australia
| | - Jason Phung
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2300, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia
| | - Craig E Pennell
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2300, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
- John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia.
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15
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Hunter PJ, Awoyemi T, Ayede AI, Chico RM, David AL, Dewey KG, Duggan CP, Gravett M, Prendergast AJ, Ramakrishnan U, Ashorn P, Klein N. Biological and pathological mechanisms leading to the birth of a small vulnerable newborn. Lancet 2023; 401:1720-1732. [PMID: 37167990 DOI: 10.1016/s0140-6736(23)00573-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 05/13/2023]
Abstract
The pathway to a thriving newborn begins before conception and continues in utero with a healthy placenta and the right balance of nutrients and growth factors that are timed and sequenced alongside hormonal suppression of labour until a mature infant is ready for birth. Optimal nutrition that includes adequate quantities of quality protein, energy, essential fats, and an extensive range of vitamins and minerals not only supports fetal growth but could also prevent preterm birth by supporting the immune system and alleviating oxidative stress. Infection, illness, undernourishment, and harmful environmental exposures can alter this trajectory leading to an infant who is too small due to either poor growth during pregnancy or preterm birth. Systemic inflammation suppresses fetal growth by interfering with growth hormone and its regulation of insulin-like growth factors. Evidence supports the prevention and treatment of several maternal infections during pregnancy to improve newborn health. However, microbes, such as Ureaplasma species, which are able to ascend the cervix and cause membrane rupture and chorioamnionitis, require new strategies for detection and treatment. The surge in fetal cortisol late in pregnancy is essential to parturition at the right time, but acute or chronically high maternal cortisol levels caused by psychological or physical stress could also trigger labour onset prematurely. In every pathway to the small vulnerable newborn, there is a possibility to modify the course of pregnancy by supporting improved nutrition, protection against infection, holistic maternal wellness, and healthy environments.
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Affiliation(s)
- Patricia J Hunter
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | | | - Adejumoke I Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna L David
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Kathryn G Dewey
- Department of Nutrition, University of California at Davis, Davis, CA, USA
| | - Christopher P Duggan
- Department of Nutrition and Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Center for Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Gravett
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal & Child Health Research, Harare, Zimbabwe
| | | | - Per Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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16
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Yelland LN, Sullivan TR, Gibson RA, Simmonds LA, Thakkar SK, Huang F, Devaraj S, Best KP, Zolezzi IS, Makrides M. Identifying women who may benefit from higher dose omega-3 supplementation during pregnancy to reduce their risk of prematurity: exploratory analyses from the ORIP trial. BMJ Open 2023; 13:e070220. [PMID: 37068907 PMCID: PMC10111924 DOI: 10.1136/bmjopen-2022-070220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES The risk factors for prematurity are multifactorial and include low omega-3 status. Omega-3 supplementation in pregnancy has been found to reduce prematurity risk, particularly among women with low omega-3 levels. This study aimed to identify maternal characteristics that predict whether women with a singleton pregnancy will benefit from omega-3 supplementation to reduce their risk of prematurity. DESIGN Exploratory analyses of a multicentre, double-blind randomised trial. SETTING 6 tertiary care centres in four states in Australia. PARTICIPANTS 5328 singleton pregnancies in 5305 women recruited before 20 weeks of gestation. INTERVENTIONS Fish oil capsules containing 900 mg omega-3 long-chain polyunsaturated fatty acids per day versus vegetable oil capsules consumed from enrolment until 34 weeks' gestation. OUTCOME MEASURES Early preterm birth (EPTB, <34 weeks' gestation) and preterm birth (PTB, <37 weeks' gestation) analysed using logistic regression models with interactions between treatment group and a range of maternal biological, clinical and demographic characteristics. RESULTS Omega-3 supplementation reduced the odds of EPTB for women with low total omega-3 status in early pregnancy (OR=0.30, 95% CI 0.10-0.93). No additional maternal characteristics influenced whether omega-3 supplementation reduced the odds of EPTB. For PTB, women were more likely to benefit from omega-3 supplementation if they were multiparous (OR=0.65, 95% CI 0.49-0.87) or avoided alcohol in the lead up to pregnancy (OR=0.62, 95% CI 0.45-0.86). CONCLUSIONS Our results support previous findings that women with low total omega-3 levels in early pregnancy are most likely to benefit from taking omega-3 supplements to reduce their risk of EPTB. Understanding how other maternal characteristics influence the effectiveness of omega-3 supplementation on reducing PTB requires further investigation. TRIAL REGISTRATION NUMBER ACTRN12613001142729.
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Affiliation(s)
- Lisa N Yelland
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucy A Simmonds
- College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
| | - Sagar K Thakkar
- Scientific Affairs, Nestlé Product Technology Center-Nutrition, Société des Produits Nestlé S.A, Vevey, Switzerland
| | - Fang Huang
- Nestlé Research, Société des Produits Nestlé S.A, Beijing, China
| | | | - Karen P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Irma Silva Zolezzi
- Nestlé Product Technology Center-Nutrition, Société des Produits Nestlé S.A, Vevey, Switzerland
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Weiner CP, Zhou H, Cuckle H, Syngelaki A, Nicolaides KH, Weiss ML, Dong Y. Maternal Plasma RNA in First Trimester Nullipara for the Prediction of Spontaneous Preterm Birth ≤ 32 Weeks: Validation Study. Biomedicines 2023; 11:biomedicines11041149. [PMID: 37189767 DOI: 10.3390/biomedicines11041149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
The first-trimester prediction of spontaneous preterm birth (sPTB) has been elusive, and current screening is heavily dependent on obstetric history. However, nullipara lack a relevant history and are at higher risk for spontaneous (s)PTB ≤ 32 weeks compared to multipara. No available objective first-trimester screening test has proven a fair predictor of sPTB ≤ 32 weeks. We questioned whether a panel of maternal plasma cell-free (PCF) RNAs (PSME2, NAMPT, APOA1, APOA4, and Hsa-Let-7g) previously validated at 16-20 weeks for the prediction of sPTB ≤ 32 weeks might be useful in first-trimester nullipara. Sixty (60) nulliparous women (40 with sPTB ≤ 32 weeks) who were free of comorbidities were randomly selected from the King's College Fetal Medicine Research Institute biobank. Total PCF RNA was extracted and the expression of panel RNAs was quantitated by qRT-PCR. The analysis employed, primarily, multiple regression with the main outcome being the prediction of subsequent sPTB ≤ 32 weeks. The test performance was judged by the area under the curve (AUC) using a single threshold cut point with observed detection rates (DRs) at three fixed false positive rates (FPR). The mean gestation was 12.9 ± 0.5 weeks (range 12.0-14.1 weeks). Two RNAs were differentially expressed in women destined for sPTB ≤ 32 weeks: APOA1 (p < 0.001) and PSME2 (p = 0.05). APOA1 testing at 11-14 weeks predicted sPTB ≤ 32 weeks with fair to good accuracy. The best predictive model generated an AUC of 0.79 (95% CI 0.66-0.91) with observed DRs of 41%, 61%, and 79% for FPRs of 10%, 20%, and 30%, including crown-rump length, maternal weight, race, tobacco use, and age.
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Affiliation(s)
- Carl P Weiner
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Rosetta Signaling Laboratory LLC, Phoenix, AZ 85018, USA
| | - Helen Zhou
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
| | - Argyro Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London SE5 9RS, UK
| | - Kypros H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London SE5 9RS, UK
| | - Mark L Weiss
- Departments of Anatomy and Physiology & Midwest Institute of Comparative Stem Cell Biology, Kansas State University, Manhattan, KS 66503, USA
| | - Yafeng Dong
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Rosetta Signaling Laboratory LLC, Phoenix, AZ 85018, USA
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18
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Grohmann RM, Marçal VMG, Corazza IC, Peixoto AB, Júnior EA, Nardozza LMM. Maternal Blood Fatty Acid Levels in Fetal Growth Restriction. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:127-133. [PMID: 37105196 PMCID: PMC10139773 DOI: 10.1055/s-0043-1768455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To assess the maternal blood levels of fatty acids (FAs) in pregnancies with fetal growth restriction (FGR). METHODS This prospective cross-sectional study included pregnant women with gestational age between 26 and 37 + 6 weeks with FGR and appropriate for gestational age (AGA) fetuses. The levels of saturated, trans, monounsaturated, and polyunsaturated FAs were measured using centrifugation and liquid chromatography. The Student's t-test, Mann-Whitney test, and general linear model, with gestational age and maternal weight as covariants, were used to compare FA levels and the FGR and AGA groups. The Chi-square was used to evaluate the association between groups and studied variables. RESULTS Maternal blood sample was collected from 64 pregnant women, being 24 FGR and 40 AGA. A weak positive correlation was found between the palmitoleic acid level and maternal weight (r = 0.285, p = 0.036). A weak negative correlation was found between the gamma-linoleic acid level and gestational age (r = - 0.277, p = 0.026). The median of the elaidic acid level (2.3 vs. 4.7 ng/ml, p = 0.045) and gamma-linoleic acid (6.3 vs. 6.6 ng/ml, p = 0.024) was significantly lower in the FGR than the AGA group. The palmitoleic acid level was significantly higher in the FGR than AGA group (50.5 vs. 47.6 ng/ml, p = 0.033). CONCLUSION Pregnant women with FGR had lower elaidic acid and gamma-linoleic acid levels and higher palmitoleic acid levels than AGA fetuses.
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Affiliation(s)
- Raquel Margiotte Grohmann
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
| | - Vivian Macedo Gomes Marçal
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Obstetrics and Gynecology, Medical Science College of Santos, Santos, SP, Brazil
| | - Isabela César Corazza
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba, Uberaba, MG, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo, São Paulo, SP, Brazil
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19
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Carlson SE, Gajewski BJ, Valentine CJ, Sands SA, Brown AR, Kerling EH, Crawford SA, Buhimschi CS, Weiner CP, Cackovic M, DeFranco EA, Mudaranthakam DP, Rogers LK. Early and late preterm birth rates in participants adherent to randomly assigned high dose docosahexaenoic acid (DHA) supplementation in pregnancy. Clin Nutr 2023; 42:235-243. [PMID: 36680919 PMCID: PMC10546372 DOI: 10.1016/j.clnu.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Intention-to-treat analyses do not address adherence. Per protocol analyses treat nonadherence as a protocol deviation and assess if the intervention is effective if followed. OBJECTIVE To determine the rate of early preterm birth (EPTB, <34 weeks gestation) and preterm birth (PTB, <37 weeks gestation) in participants who adhered to a randomly assigned docosahexaenoic acid (DHA) dose of 1000 mg/day. STUDY DESIGN Eleven hundred women with a singleton pregnancy were enrolled before 20-weeks' gestation, provided a capsule with 200 mg/day DHA and randomly assigned to two additional capsules containing a placebo or 800 mg of DHA. In the Bayesian Adaptive Design, new randomization schedules were determined at prespecified intervals. In each randomization, the group with the most EPTB was assigned fewer participants than the other group. Adherence was defined a priori as a postpartum red blood cell phospholipid DHA (RBC-PL-DHA) ≥5.5%.and post hoc as ≥8.0% RBC-PL-DHA, the latter after examination of postpartum RBC-PL-DHA. Bayesian mixture models were fitted for gestational age and dichotomized for EPTB and PTB as a function of baseline RBC-PL-DHA and dose-adherence. Bayesian hierarchical models were also fitted for EPTB by dose adherence and quartiles of baseline RBC-PL-DHA. RESULTS Adherence to the high dose using both RBC-PL-DHA cut points resulted in less EPTB compared to 200 mg [Bayesian posterior probability (pp) = 0.93 and 0.92, respectively]. For participants in the two lowest quartiles of baseline DHA status, adherence to the higher dose resulted in lower EPTB (≥5.5% RBC-PL-DHA, quartiles 1 and 2, pp = 0.95 and 0.96; ≥8% RBC-PL-DHA, quartiles 1 and 2, pp = 0.94 and 0.95). Using the Bayesian model, EPTB was reduced by 65%, from 3.45% to 1.2%, using both cut points. Adherence also reduced PTB before 35, 36 and 37 weeks using both cut points (pp ≥ 0.95). In general, performance of the nonadherent subgroup mirrored that of participants assigned to 200 mg. CONCLUSION Adherence to high dose DHA reduced EPTB and PTB. The largest effect of adherence on reducing EPTB was observed in women with low baseline DHA levels. CLINICALTRIALS gov (NCT02626299).
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Affiliation(s)
- S E Carlson
- University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA.
| | - B J Gajewski
- University of Kansas Medical Center, Department of Biostatistics & Data Science, Kansas City, KS, USA
| | - C J Valentine
- University of Arizona, Department of Pediatrics, Tucson, AZ, USA
| | - S A Sands
- University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA
| | - A R Brown
- University of Kansas Medical Center, Department of Biostatistics & Data Science, Kansas City, KS, USA
| | - E H Kerling
- University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA
| | - S A Crawford
- University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA
| | - C S Buhimschi
- University of Illinois, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - C P Weiner
- Creighton University Medical School, Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Phoenix, AZ, USA
| | - M Cackovic
- Ohio State University, Department of Obstetrics and Gynecology, Columbus, OH, USA
| | - E A DeFranco
- University of Cincinnati, Department of Obstetrics and Gynecology, Cincinnati, OH, USA
| | | | - L K Rogers
- Nationwide Children's Hospital, Columbus, OH, USA
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20
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Christifano DN, Crawford SA, Lee G, Brown AR, Camargo JT, Kerling EH, Gajewski BJ, Valentine CJ, Gustafson KM, DeFranco EA, Carlson SE. Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation. Clin Nutr ESPEN 2023; 53:93-99. [PMID: 36657936 PMCID: PMC9852746 DOI: 10.1016/j.clnesp.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two randomized trials found women with low blood docosahexaenoic acid (DHA; an omega 3 fatty acid) had fewer early preterm births (<34 weeks gestation) if they were assigned to high dose DHA supplementation, however, there is currently no capacity for clinicians who care for pregnancies to obtain a blood assessment of DHA. Determining a way to identify women with low DHA intake whose risk could be lowered by high dose DHA supplementation is desired. OBJECTIVE To determine if assessing DHA intake can identify pregnancies that benefit from high dose DHA supplementation. STUDY DESIGN This secondary analysis used birth data from 1310 pregnant women who completed a 7-question food frequency questionnaire (DHA-FFQ) at 16.8 ± 2.5 weeks gestation that is validated to assess DHA status. They were then randomly assigned to a standard (200 mg/day) or high dose (800 or 1000 mg/day) DHA supplement for the remainder of pregnancy. Bayesian logistic regressions were fitted for early preterm birth and preterm birth as a function of DHA intake and assigned DHA dose. RESULTS Participants who consumed less than 150 mg/day DHA prior to 20 weeks' gestation (n = 810/1310, 58.1%) had a lower Bayesian posterior probability (pp) of early preterm birth if they were assigned to high dose DHA supplementation (1.4% vs 3.9%, pp = 0.99). The effect on preterm birth (<37 weeks) was also significant (11.3% vs 14.8%, pp = 0.97). CONCLUSION The DHA-FFQ can identify pregnancies that will benefit most from high dose DHA supplementation and reduce the risk of preterm birth. The DHA-FFQ is low burden to providers and patients and could be easily implemented in obstetrical practice.
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Affiliation(s)
- D N Christifano
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA; The University of Kansas Medical Center, Hoglund Biomedical Imaging Center, Kansas City, KS, USA
| | - S A Crawford
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA
| | - G Lee
- The University of Kansas Medical Center, Department of Obstetrics and Gynecology, Kansas City, KS, USA
| | - A R Brown
- The University of Kansas Medical Center, Department of Biostatistics & Data Science, Kansas City, KS, USA
| | - J T Camargo
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA; The University of Kansas Medical Center, Department of Urology, Kansas City, KS, USA
| | - E H Kerling
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA
| | - B J Gajewski
- The University of Kansas Medical Center, Department of Biostatistics & Data Science, Kansas City, KS, USA
| | - C J Valentine
- Banner University Medical Center, The University of Arizona, Department of Pediatrics, Tucson, AZ, USA
| | - K M Gustafson
- The University of Kansas Medical Center, Hoglund Biomedical Imaging Center, Kansas City, KS, USA; The University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
| | - E A DeFranco
- The University of Cincinnati, Department of Obstetrics and Gynecology, Cincinnati, OH, USA
| | - S E Carlson
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA.
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21
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Gajewski BJ, Carlson SE, Brown AR, Mudaranthakam DP, Kerling EH, Valentine CJ. The value of a two-armed Bayesian response adaptive randomization trial. J Biopharm Stat 2023; 33:43-52. [PMID: 36411742 PMCID: PMC9812849 DOI: 10.1080/10543406.2022.2148161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/12/2022] [Indexed: 11/23/2022]
Abstract
We investigate the value of a two-armed Bayesian response adaptive randomization (RAR) design to investigate early preterm birth rates of high versus low dose of docosahexaenoic acid during pregnancy. Unexpectedly, the COVID-19 pandemic forced recruitment to pause at 1100 participants rather than the planned 1355. The difference in power between number of participants at the pause and planned was 87% and 90% respectively. We decided to stop the study. This paper describes how the RAR was used to execute the study. The value of RAR in two-armed studies is quite high and their use in the future is promising.
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Affiliation(s)
- Byron J Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alexandra R Brown
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth H Kerling
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
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22
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Best KP, Gibson RA, Makrides M. ISSFAL statement number 7 - Omega-3 fatty acids during pregnancy to reduce preterm birth. Prostaglandins Leukot Essent Fatty Acids 2022; 186:102495. [PMID: 36228573 DOI: 10.1016/j.plefa.2022.102495] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/29/2022]
Abstract
Globally, preterm birth is the leading cause of death in children under the age of 5 years and survivors may suffer life-long consequences. Following many years of investigation, there is strong evidence that a proportion of preterm births can be prevented by increasing maternal dietary omega-3 long chain polyunsaturated fatty acid (LCPUFA) intake during pregnancy. This Statement provides a synthesis of contemporary evidence on the role of omega-3 LCPUFA on prevention of preterm birth and is designed to provide fatty acid-specific knowledge and guidance for medical practitioners, midwives, health services, professional bodies and policy makers to consider for their contextual situations. The evidence synthesis, which underpins this statement, is based on the 2018 Cochrane systematic review with supplemental evidence from RCTs completed since that time as well as other systematic reviews. Heterogeneity between studies was explored to understand how the effect of omega-3 supplementation may vary in different population groups and by dose and type of omega-3 supplementation. Most trials were conducted in upper-middle or high-income countries and the evidence are most applicable in those settings. The evidence synthesis confirmed that omega-3 LCPUFA, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have an important role to play in determining gestational length in singleton pregnancies. Adequate intake of omega-3 LCPUFA in early pregnancy, consistent with existing nutritional guidelines, is associated with a lower risk of preterm and early preterm births for women with singleton pregnancies. Therefore, women with adequate omega-3 intakes in early pregnancy should maintain these intakes. Women who are low in omega-3 fatty acids will benefit most from omega-3 LCPUFA supplementation to reduce their risk of early birth. In such cases supplementation with a total of about 1000 mg of DHA plus EPA is effective at reducing risk of early birth, preferably with supplementation commencing before 20 weeks' gestation.
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Affiliation(s)
- K P Best
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA Australia; School of Medicine, University of Adelaide, North Terrace, Adelaide SA Australia
| | - R A Gibson
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA Australia; School of Agriculture, Food and Wine, University of Adelaide, North Terrace, Adelaide SA Australia
| | - M Makrides
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA Australia; School of Medicine, University of Adelaide, North Terrace, Adelaide SA Australia.
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23
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Nannan M, Xiaoping L, Ying J. Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies. Front Med (Lausanne) 2022; 9:963956. [PMID: 36388896 PMCID: PMC9640773 DOI: 10.3389/fmed.2022.963956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 10/28/2023] Open
Abstract
Periodontal disease is an inflammatory and destructive disease of tissues supporting the tooth. A large number of studies have confirmed that periodontal pathogens and their metabolites can lead to adverse pregnancy outcomes in direct or indirect ways. Adverse pregnancy outcomes, such as preterm birth, low birth weight, and pre-eclampsia, have a serious impact on human reproductive health. In recent years, although the level of global medical technology has gradually improved, the incidence of adverse pregnancy outcomes has not declined and is still a global public health problem. The purpose of this review is to summarize the current data on periodontal disease in pregnancy and adverse pregnancy outcomes, including the association between periodontal disease and adverse pregnancy outcomes, the pathogenic mechanism related to this association, the efficacy of different nutrition supplements for both periodontal disease and adverse pregnancy outcomes and the effect of providing periodontal treatment on the occurrence of adverse pregnancy outcomes, to provide guidance for the prevention and treatment of adverse pregnancy outcomes in clinical practice.
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Affiliation(s)
| | | | - Jin Ying
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China
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24
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Luo M, Guo J, Lu W, Fang X, Zhang R, Tang M, Luo Q, Liang W, Yu X, Hu C. The mediating role of maternal metabolites between lipids and adverse pregnancy outcomes of gestational diabetes mellitus. Front Med (Lausanne) 2022; 9:925602. [PMID: 36035400 PMCID: PMC9400014 DOI: 10.3389/fmed.2022.925602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, and the demographics of pregnant women have changed in recent decades. GDM is a metabolic disease with short- and long-term adverse effects on both pregnant women and newborns. The metabolic changes and corresponding risk factors should be of great significance in understanding the pathological mechanism of GDM and reducing the incidence of adverse pregnancy outcomes in patients with GDM. The well-known GDM-associated lipids used in clinical tests, such as triglyceride (TG), are thought to play a major role in metabolic changes during GDM, which have a potential causal relationship with abnormal pregnancy outcomes of GDM. Therefore, this study analyzed the relationship between clinical lipid indicators, metabolic profiles, and abnormal pregnancy outcomes in GDM through mediation analysis. By constructing a metabolic atlas of 399 samples from GDM patients in different trimesters, we efficiently detected the key metabolites of adverse pregnancy outcomes and their mediating roles in bridging abnormal lipids and adverse pregnancy outcomes in patients with GDM. Our study confirmed that TG and total cholesterol were independent risk factors for adverse pregnancy outcomes in patients with GDM. Several key metabolites as mediators (e.g., gamma-linolenic acid, heptadecanoic acid, oleic acid, palmitic acid, and palmitoleic acid) have been identified as potential biomarkers for adverse pregnancy outcomes in patients with GDM. These metabolites mainly participate in the biosynthesis of unsaturated fatty acids, which may shed new light on the pathology of GDM and provide insights for further exploration of the molecular mechanisms underlying adverse pregnancy outcomes.
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Affiliation(s)
- Mingjuan Luo
- Department of Endocrinology and Metabolism, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, Fengxian Central Hospital Affiliated to the Southern Medical University, Shanghai, China
| | - Jingyi Guo
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wenqian Lu
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, Fengxian Central Hospital Affiliated to the Southern Medical University, Shanghai, China
| | - Xiangnan Fang
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, Fengxian Central Hospital Affiliated to the Southern Medical University, Shanghai, China
- Department of Endocrinology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Rong Zhang
- Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Mengyang Tang
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Endocrinology and Metabolism, Fengxian Central Hospital Affiliated to the Southern Medical University, Shanghai, China
| | - Qiong Luo
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wei Liang
- Department of Endocrinology and Metabolism, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiangtian Yu
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Correspondence: Xiangtian Yu
| | - Cheng Hu
- Department of Endocrinology and Metabolism, Fengxian Central Hospital Affiliated to the Southern Medical University, Shanghai, China
- Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Cheng Hu
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25
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Dunleavy JEM, Dinh DT, Filby CE, Green E, Hofstee P, Pini T, Rivers N, Skerrett-Byrne DA, Wijayarathna R, Winstanley YE, Zhou W, Richani D. Reproductive biology research down under: highlights from the Australian and New Zealand Annual Meeting of the Society for Reproductive Biology, 2021. Reprod Fertil Dev 2022; 34:855-866. [PMID: 35836362 DOI: 10.1071/rd22115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Against the backdrop of a global pandemic, the Society for Reproductive Biology (SRB) 2021 meeting reunited the Australian and New Zealand reproductive research community for the first time since 2019 and was the first virtual SRB meeting. Despite the recent global research disruptions, the conference revealed significant advancements in reproductive research, the importance of which span human health, agriculture, and conservation. A core theme was novel technologies, including the use of medical microrobots for therapeutic and sperm delivery, diagnostic hyperspectral imaging, and hydrogel condoms with potential beyond contraception. The importance of challenging the contraceptive status quo was further highlighted with innovations in gene therapies, non-hormonal female contraceptives, epigenetic semen analysis, and in applying evolutionary theory to suppress pest population reproduction. How best to support pregnancies, particularly in the context of global trends of increasing maternal age, was also discussed, with several promising therapies for improved outcomes in assisted reproductive technology, pre-eclampsia, and pre-term birth prevention. The unique insights gained via non-model species was another key focus and presented research emphasised the importance of studying diverse systems to understand fundamental aspects of reproductive biology and evolution. Finally, the meeting highlighted how to effectively translate reproductive research into policy and industry practice.
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Affiliation(s)
- Jessica E M Dunleavy
- School of BioSciences, Faculty of Science, The University of Melbourne, Parkville, Vic. 3010, Australia
| | - Doan Thao Dinh
- Robinson Research Institute, School of Biomedicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Caitlin E Filby
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Vic. 3168, Australia; and Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Vic. 3168, Australia
| | - Ella Green
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Pierre Hofstee
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Taylor Pini
- School of Veterinary Science, The University of Queensland, Gatton, Qld 4343, Australia
| | - Nicola Rivers
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Vic. 3168, Australia
| | - David A Skerrett-Byrne
- School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia; and Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia
| | - Rukmali Wijayarathna
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Vic. 3168, Australia; and Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Vic. 3800, Australia
| | - Yasmyn E Winstanley
- Robinson Research Institute, School of Biomedicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Wei Zhou
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3010, Australia; and Gynaecology Research Centre, Royal Women's Hospital, Parkville, Vic. 3052, Australia
| | - Dulama Richani
- Fertility & Research Centre, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia
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26
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Gibson RA, Makrides M, Sullivan T, Yelland LN, Best KP. Response to Jackson and Harris, 2022;179:102417. Prostaglandins Leukot Essent Fatty Acids 2022; 182:102454. [PMID: 35688084 DOI: 10.1016/j.plefa.2022.102454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 12/29/2022]
Affiliation(s)
- R A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Women's and Children's Hospital, Level 7, 72 King William Road, North Terrace, Adelaide, SA 5006, Australia; School of Agriculture, Food and Wine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - M Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Women's and Children's Hospital, Level 7, 72 King William Road, North Terrace, Adelaide, SA 5006, Australia; School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia.
| | - T Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Women's and Children's Hospital, Level 7, 72 King William Road, North Terrace, Adelaide, SA 5006, Australia; School of Public Health, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - L N Yelland
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Women's and Children's Hospital, Level 7, 72 King William Road, North Terrace, Adelaide, SA 5006, Australia; School of Public Health, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - K P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Women's and Children's Hospital, Level 7, 72 King William Road, North Terrace, Adelaide, SA 5006, Australia; School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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Jackson KH, Harris WS. Harmonizing blood DHA levels in pregnancy studies: An interlaboratory investigation. Prostaglandins Leukot Essent Fatty Acids 2022; 179:102417. [PMID: 35390621 DOI: 10.1016/j.plefa.2022.102417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022]
Abstract
Recent trials in pregnant women on the effects of supplemental DHA on early preterm birth (ePTB) risk have shown that there is a maternal blood docosahexaenoic acid (DHA) level below which risk for ePTB was increased and supplemental DHA was effective at reducing risk. However, DHA levels were expressed in different terms across these trials making cross study comparisons impossible. The purposes of this study were 1) to report interlaboratory conversion factors from study-specific metrics to a common metric, red blood cell (RBC) DHA measured by OmegaQuant Analytics (OQA), and 2) to translate reported pre- and post-treatment DHA levels from these trials into a RBC DHA for comparison. Data from five published and one unpublished study are included. Across these studies, the effects on RBC DHA levels after supplementation with 0, 200, 600, 800 and 1000 mg of DHA were (as a% change from baseline): 0 mg, no change; 200 mg, 15-20% increase; 600 mg, 55-60% increase; 800 mg, 13-65% increase; and 1000 mg, 51% increase. Standardization of fatty acid analysis and reporting and a target omega-3 or DHA level for identifying those for which higher dose DHA supplementation is indicated to prevent ePTB are needed for clinical use.
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Affiliation(s)
- Kristina Harris Jackson
- OmegaQuant Analytics, LLC, the Fatty Acid Research Institute; and Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, 57105 United States of America.
| | - William S Harris
- OmegaQuant Analytics, LLC, the Fatty Acid Research Institute; and Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, 57105 United States of America
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Abstract
The link between oral health and adverse pregnancy outcomes has been suggested by numerous epidemiological studies. More recent studies indicate the relationship between severity of periodontal disease and adverse pregnancy outcomes. Two virulence mechanisms are proposed: direct invasion of oral microorganisms or their components into the fetal-placenta unit and inflammatory mediators produced in the oral cavity affecting the fetal-placenta unit. While interventional periodontal therapy still yielded contradictory results, animal studies suggest that maternal supplementation of omega-3 fatty acids protects the fetus by suppressing inflammation as well as bacteria proliferation in the placenta. This article reviews the recent epidemiological, mechanistic, interventional, and therapeutic studies of oral health and adverse pregnancy outcomes.
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Affiliation(s)
- Biyang Xu
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Yiping W Han
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Microbiology & Immunology, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York, USA.,Department of Obstetrics & Gynecology, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, New York, USA
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Liu G, Makrides M, Coates P, Lam K, Ranieri E, Mas E, Gibson RA. A rapid method for the screening of fatty acids in lipids in plasma or serum without prior extraction. Prostaglandins Leukot Essent Fatty Acids 2022; 178:102416. [PMID: 35325692 DOI: 10.1016/j.plefa.2022.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/20/2022]
Abstract
Serum or plasma are the commonly used blood fractions to determine the relationship between dietary and circulating fatty acids in health and disease. Most methods available for the measurement of fatty acids in serum or plasma (referred to as serum henceforth) require prior extraction with organic solvents. We have determined that it is possible to directly convert the lipids in aqueous biological samples to fatty acid methyl esters (FAME) without prior extraction, providing that the ratio of serum to transmethylation solvent does not exceed 10%. Our in-vial transmethylation system uses 50uL serum pipetted into 2 mL screw top GC vials containing 1 mL of 1% H2SO4 in methanol at 50 °C and subsequent FAME extracted in the same vial into 300uL heptane. The system yields both compositional and quantitative analysis of the fatty acids of serum identical to conventional standard methods. Evaluation of our new serum assay confirms significant correlations between the fatty acid measures and those obtained from conventional standard assay for all fatty acids (r > 0.99, P<0.0001), including the n-6 (r = 0.998, P<0.0001) and n-3 long chain polyunsaturated fatty acids (r = 0.993, P<0.0001). There were high levels of agreement between methods on Bland -Altman analysis, indicating the interchangeability of the methods. These results establish our new method as reliable for the assessment of fatty acid composition of small volumes of serum useful for high throughput situations that limits the volume of organic solvents and technical input.
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Affiliation(s)
- Ge Liu
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000, Australia; School of Medicine, The University of Adelaide, North Terrace, Adelaide SA 5000, Australia
| | | | - Khoa Lam
- SA Pathology, Frome Rd., Adelaide SA 5000, Australia
| | - Enzo Ranieri
- SA Pathology, Frome Rd., Adelaide SA 5000, Australia
| | - Emilie Mas
- SA Pathology, Frome Rd., Adelaide SA 5000, Australia
| | - Robert A Gibson
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000, Australia; School of Agriculture, Food and Wine, The University of Adelaide, North Terrace, Adelaide SA 5000, Australia.
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Simmonds LA, Middleton PF, Makrides M. Recent advances in policy and practice translation of the evidence for additional omega-3 fatty acids and prematurity. Curr Opin Clin Nutr Metab Care 2022; 25:81-85. [PMID: 34937851 DOI: 10.1097/mco.0000000000000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This is a review of the most up-to-date research on the effectiveness of omega-3 fatty acids for reducing the risk of prematurity in well nourished women with access to high-quality obstetric care. It will provide an overview of the translation of the evidence on omega-3 screening into policy, and the latest research on how to implement the policy into practice. RECENT FINDINGS Findings of the included clinical studies support that omega-3 supplementation for women with a singleton pregnancy who have a low omega-3 status reduces the risk of early preterm birth. SUMMARY There is evidence that screening and providing appropriate advice to women with a singleton pregnancy who have a low omega-3 status can reduce their risk of early preterm birth, and avoiding supplementation for women who are replete will avoid unnecessary supplementation and potential harm.
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Affiliation(s)
- Lucy A Simmonds
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids
| | - Philippa F Middleton
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids
- School of Medicine, the University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids
- School of Medicine, the University of Adelaide, North Terrace, Adelaide, South Australia, Australia
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De Cosmi V, Mazzocchi A, Agostoni C, Visioli F. Fructooligosaccharides: From Breast Milk Components to Potential Supplements. A Systematic Review. Adv Nutr 2022; 13:318-327. [PMID: 34555852 PMCID: PMC8803487 DOI: 10.1093/advances/nmab102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
Breast milk is the optimal food choice for infant growth and development. Among breast milk components, fructooligosaccharides (FOSs) are being actively studied because of their role in microbiota development. In particular, 2'-fucosyllactose is being proposed as a potential supplement/nutraceutical or component of infant formula. In this systematic review, we critically summarize the available information on FOSs and we discuss their future use in infant nutrition. We searched the main electronic databases (PubMed, Embase, and Scopus), with a final check in May 2021. Search terms were inserted individually and using the Boolean tools AND and OR. Relevant articles were identified using the following words: ("fructooligosaccharides" OR "FOS") AND ("human milk" OR "breast milk" OR "donor milk" OR "bank milk"). The search retrieved 1814 articles. After removal of duplicates, we screened 1591 articles based on title, abstract, and exclusive use of the English language. We included articles describing the concentration of FOSs in human milk and assessed the relevant ones. We excluded reviews, studies on animals, and studies exclusively carried out on adults. Also, we excluded studies that have not reported evidence either on FOSs or on galactooligosaccharides from human milk. The resulting publications were reviewed, and 10 studies were included in the systematic review. We conclude that human milk FOSs are, indeed, crucial to infant gut development and their addition to infant formula is safe, well-tolerated, and might provide immune benefits to newborns. However, we would like to underscore the scantiness of human data and the need to avoid the immediate translation of infant research to the commercialization of supplements marketed to adults.
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Affiliation(s)
- Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Mazzocchi
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Christifano DN, Crawford SA, Lee G, Gajewski BJ, Carlson SE. Utility of a 7- question online screener for DHA intake. Prostaglandins Leukot Essent Fatty Acids 2022; 177:102399. [PMID: 35063885 PMCID: PMC8825685 DOI: 10.1016/j.plefa.2022.102399] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
The secondary analyses of two large, recently completed randomized clinical trials of DHA supplementation in pregnancy found that women with a low baseline DHA status benefited from randomization to a higher dose (800 vs 0 and 1000 vs 200 mg/day DHA). To obtain DHA status, it is necessary to obtain a blood sample and conduct an analysis using gas chromatography (GC) or GC-mass spectrometry (GCMS), both barriers to clinics where pregnant women receive advice on nutrition. Participants consuming less than 150 mg/day of DHA at baseline in our recent trial had a lower risk of early preterm birth and preterm birth when assigned to 1000 vs 200 m/day DHA. DHA intake was determined using a 7-question food frequency questionnaire administered by a trained nutritionist. Because the need for trained personnel to administer the questionnaire would be a barrier to implementing this finding in clinical management of pregnancy, the goal of this study was to determine if an online version of the questionnaire could be validly completed without assistance.
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Affiliation(s)
- D N Christifano
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA; The University of Kansas Medical Center, Hoglund Biomedical Imaging Center, Kansas City, KS, USA
| | - S A Crawford
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA
| | - G Lee
- The University of Kansas Medical Center, Department of Obstetrics and Gynecology, Kansas City, KS, USA
| | - B J Gajewski
- The University of Kansas Medical Center, Department of Biostatistics & Data Science, Kansas City, KS, USA
| | - S E Carlson
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS, USA.
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Seravalli V, Strambi N, D’Arienzo A, Magni F, Bernardi L, Morucchio A, Di Tommaso M. Patient’s experience with the Arabin cervical pessary during pregnancy: A questionnaire survey. PLoS One 2022; 17:e0261830. [PMID: 35020768 PMCID: PMC8754293 DOI: 10.1371/journal.pone.0261830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction
The cervical pessary is used in women with precocious cervical ripening to prevent preterm birth. Up to now however, there have been no systematic studies on compliance and tolerance, which vary among different study cohorts.
Material and methods
A questionnaire was administered to 166 women treated with the Arabin cervical pessary in one center. Data were analysed about the patient’s experience before insertion (adequacy of information received), during treatment (follow-up, impact on daily life, perceived discomfort, side effects) and at the time of removal (pain, if the patient’s expectations had been met regarding the treatment).
Results
Information received before the insertion of the Arabin cervical pessary was considered adequate in 163/166 (98.2%) women. An increase in vaginal discharge was experienced by 70/166 (42.2%) women. Discomfort or other side effects were reported in 13.8% and 16.3% of cases, respectively. Overall, 77% of women reported an improved quality of life and 94% considered the follow-up during pregnancy adequate. Removal was moderately painful for 58/166 (35%) of women. Patient’s expectations regarding the treatment were exceeded in the majority of cases (75.3%). In a final step, we compared our results to previous studies regarding the use of the pessary in singleton and twin pregnancies.
Conclusion
Although some trials report high rates of non-compliant patients, this could not be confirmed by our study. In contrast, most women reported having a positive experience and that they were motivated to continue the treatment when they were continuously followed by experienced clinicians.
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Affiliation(s)
- Viola Seravalli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Noemi Strambi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Francesco Magni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Ludovico Bernardi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Anna Morucchio
- Department of Health Sciences, University of Florence, Florence, Italy
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Simmonds LA, Yelland LN, Best KP, Liu G, Gibson RA, Makrides M. Translating n-3 polyunsaturated fatty acid status from whole blood to plasma and red blood cells during pregnancy: Translating n-3 status across blood fractions in pregnancy. Prostaglandins Leukot Essent Fatty Acids 2022; 176:102367. [PMID: 34864617 DOI: 10.1016/j.plefa.2021.102367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/04/2023]
Abstract
Women with low n-3 (omega-3) status in pregnancy can reduce their risk of early preterm birth (<34 weeks' gestation) through n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation. As investigators measure fatty acid status in different blood fractions, equations are needed to compare results across studies. Similarly, derived cut-points for defining low and replete n-3 status are needed to assist clinical interpretation during early pregnancy. Our aims were to develop equations to convert the percentage of total n-3 fatty acids, EPA+DHA and DHA between whole blood, plasma and red blood cells (RBC), and to derive cut-points for defining low and replete total n-3 fatty acid status in plasma and RBC from those already established in whole blood. Using blood samples from 457 pregnant women in a multicentre randomised controlled trial, equations for these interconversions were developed using simple linear regression models. Measures of n-3 fatty acid status in whole blood and plasma were strongly related (R2 > 0.85), while more moderate relationships were observed between measures in whole blood and RBC (R2 0.55 - 0.71), or plasma and RBC (R2 0.55 - 0.63). Using the conversion equations, established cut-points for low and replete n-3 status in whole blood (<4.2% and >4.9% of total fatty acids) converted to <3.7% and >4.3% of plasma total fatty acids, and to <7.3% and >8.1% of RBC total fatty acids. Agreement to define low and replete n-3 status was better between whole blood and plasma, rather than between whole blood and RBC. Our data also show that total n-3 fatty acids in plasma and serum are interchangeable. We conclude that either whole blood or plasma total n-3 fatty acids can be used to define low status in pregnancy and identify women who will most benefit from n-3 LCPUFA supplementation to reduce their risk of early birth. Further research is needed to determine the clinical utility of other fatty acid measures in various blood lipid fractions.
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Affiliation(s)
- Lucy A Simmonds
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000 (LAS, LNY, KPB, GL, RAG, MM); School of Medicine (LAS, KPB, MM), School of Public Health (LNY), and the School of Agriculture, Food and Wine (RAG), The University of Adelaide, North Terrace, Adelaide SA 5000, Australia.
| | - Lisa N Yelland
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000 (LAS, LNY, KPB, GL, RAG, MM); School of Medicine (LAS, KPB, MM), School of Public Health (LNY), and the School of Agriculture, Food and Wine (RAG), The University of Adelaide, North Terrace, Adelaide SA 5000, Australia
| | - Karen P Best
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000 (LAS, LNY, KPB, GL, RAG, MM); School of Medicine (LAS, KPB, MM), School of Public Health (LNY), and the School of Agriculture, Food and Wine (RAG), The University of Adelaide, North Terrace, Adelaide SA 5000, Australia
| | - Ge Liu
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000 (LAS, LNY, KPB, GL, RAG, MM); School of Medicine (LAS, KPB, MM), School of Public Health (LNY), and the School of Agriculture, Food and Wine (RAG), The University of Adelaide, North Terrace, Adelaide SA 5000, Australia
| | - Robert A Gibson
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000 (LAS, LNY, KPB, GL, RAG, MM); School of Medicine (LAS, KPB, MM), School of Public Health (LNY), and the School of Agriculture, Food and Wine (RAG), The University of Adelaide, North Terrace, Adelaide SA 5000, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA 5000 (LAS, LNY, KPB, GL, RAG, MM); School of Medicine (LAS, KPB, MM), School of Public Health (LNY), and the School of Agriculture, Food and Wine (RAG), The University of Adelaide, North Terrace, Adelaide SA 5000, Australia.
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Prenatal docosahexaenoic acid effect on maternal-infant DHA-equilibrium and fetal neurodevelopment: a randomized clinical trial. Pediatr Res 2022; 92:255-264. [PMID: 34552200 PMCID: PMC8456398 DOI: 10.1038/s41390-021-01742-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/03/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Maternal-infant equilibrium occurs when cord blood docosahexaenoic acid (DHA) is less than or equal to maternal DHA at delivery. Equilibrium may be an indicator of sufficient DHA for optimal fetal and infant neurodevelopment. The purpose of this study was to test the effect of maternal DHA supplementation on equilibrium status and fetal neurodevelopment. METHODS Women enrolled between 12 and 20 weeks gestation and were randomized to 200 or 800 mg DHA/day until delivery. Maternal red blood cell (RBC) phospholipids were measured at enrollment, 32 weeks, delivery, and in cord blood at delivery. Fetal neurodevelopment was measured at 32 and 36 weeks gestation. Intent-to-treat analyses were conducted to test differences in equilibrium status by group. Fetal outcomes were assessed by equilibrium status and group. RESULTS Three hundred women enrolled and 262 maternal-infant dyads provided blood samples at delivery. No maternal-infant dyads with maternal RBC-DHA ≤ 6.96% at delivery achieved equilibrium. The incidence of equilibrium was significantly higher in the 800 mg group. There was no effect of maternal group or equilibrium status on fetal neurodevelopment. CONCLUSION The significance of maternal-infant DHA equilibrium remains unknown. Ongoing research will test the effect of treatment group, equilibrium, and nutrient status on infant behavior and brain function. IMPACT Pregnant women who received a higher dose of docosahexaenoic acid (DHA) were more likely to achieve maternal-infant DHA equilibrium at delivery. Equilibrium status had no effect on fetal neurodevelopment in this sample. While DHA is crucial for early life neurodevelopment, the significance of achieving maternal-infant equilibrium above the lower threshold is uncertain. There is a lower threshold of maternal DHA status where maternal-infant DHA equilibrium never occurs. The lack of equilibrium associated with low maternal DHA status may indicate insufficient maternal status for optimal placental transfer.
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Davies SJ, Roderick E, Brudenell‐Bruce T, Bavington CD, Hartnett F, Hyland J, Valente CDS, Wan AHL. Delivering a Nutritionally Enhanced Tilapia Fillet Using a Pre‐Harvest Phase Omega‐3 Thraustochytrids Protist Enriched Diet. EUR J LIPID SCI TECH 2021. [DOI: 10.1002/ejlt.202100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Simon J. Davies
- Department of Veterinary Health and Animal Sciences Harper Adams University Newport Shropshire TF10 8NB UK
- Aquaculture and Nutrition Research Unit (ANRU) Carna Research Station Ryan Institute National University of Ireland Galway Galway city Ireland
| | - Eric Roderick
- Fishgen Ltd Pantyrynn Farm, Llannon, Lanelli Carmarthenshire Wales SA14 8JU UK
| | | | | | - Finnian Hartnett
- Aquaculture and Nutrition Research Unit (ANRU) Carna Research Station Ryan Institute National University of Ireland Galway Galway city Ireland
| | - John Hyland
- Aquaculture and Nutrition Research Unit (ANRU) Carna Research Station Ryan Institute National University of Ireland Galway Galway city Ireland
| | - Cecília de Souza Valente
- Aquaculture and Nutrition Research Unit (ANRU) Carna Research Station Ryan Institute National University of Ireland Galway Galway city Ireland
| | - Alex H. L. Wan
- Aquaculture and Nutrition Research Unit (ANRU) Carna Research Station Ryan Institute National University of Ireland Galway Galway city Ireland
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Affiliation(s)
| | - John Colombo
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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38
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Care AG, Gupta JK, Goodfellow L, Zhang G, Monangi N, Belling E, Landero J, Chappell J, Sharp A, Alfirevic A, Müller-Myhsok B, Muglia LJ, Alfirevic Z. Maternal selenium levels and whole genome screen in recurrent spontaneous preterm birth population: A nested case control study. Eur J Obstet Gynecol Reprod Biol 2021; 265:203-211. [PMID: 34534736 DOI: 10.1016/j.ejogrb.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To establish if low maternal selenium (Se) was associated with sPTB in women with recurrent sPTB and identify genetic link with maternal Se levels. DESIGN Nested case-control study. SETTING Tertiary Maternity Hospital. POPULATION Plasma and whole blood from pregnant women with history of early sPTB/PPROM < 34+0 and European ancestry were obtained at 20 weeks (range 15-24 weeks). 'Cases' were recurrent PTB/PPROM < 34+0 weeks and term (≥37+0) deliveries were classified as 'high-risk controls.' Women with previous term births and index birth ≥ 39 weeks were 'low-risk controls'. METHODS Maternal plasma Se measured by ICP-MS was used as a continuous phenotype in a GWAS analysis. Se was added to a logistic regression model using PTB predictor variables. MAIN OUTCOME MEASURES Maternal Se concentration, recurrent early sPTB/PPROM. RESULTS 53/177 high-risk women had a recurrent sPTB/PPROM < 34+0weeks and were 2.7 times more likely to have a Se level < 83.3 ppm at 20weeks of pregnancy compared with low-risk term controls (n = 179), (RR 2.7, 95%CI 1.5-4.8; p = .001). One SNP from a non-coding region (FOXN3 intron variant, rs55793422) reached genome-wide significance level (p = 3.73E-08). Targeted analysis of Se gene variant did not show difference between preterm and term births. (χ2 test, OR = 0.95; 95%CI = 0.59-1.56; p = 0.82). When Se levels were added to a clinical prediction model, only an additional 5% of cases (n = 3) and 0.6% (n = 1) of controls were correctly identified. CONCLUSIONS Low plasma Se is associated with sPTB risk but is not sufficiently predictive at individual patient level. We did not find a genetic association between maternal Se levels and Se-related genes.
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Affiliation(s)
- Angharad G Care
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom.
| | - Juhi K Gupta
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom; Wolfson Centre for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Laura Goodfellow
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Ge Zhang
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nagendra Monangi
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Elizabeth Belling
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Julio Landero
- Department of Chemistry, University of Cincinnati, Cincinnati, OH, United States
| | - Joanne Chappell
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Andrew Sharp
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Ana Alfirevic
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom; Wolfson Centre for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Bertram Müller-Myhsok
- Waterhouse Building, University of Liverpool, Liverpool, United Kingdom; Max Plank Institute of Psychiatry, Munich, Germany
| | - Louis J Muglia
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Zarko Alfirevic
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
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Gould JF, Anderson PJ, Yelland LN, Gibson RA, Makrides M. The Influence of Prenatal DHA Supplementation on Individual Domains of Behavioral Functioning in School-Aged Children: Follow-Up of a Randomized Controlled Trial. Nutrients 2021; 13:nu13092996. [PMID: 34578873 PMCID: PMC8472059 DOI: 10.3390/nu13092996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Docosahexaenoic acid (DHA) accumulates in the fetal brain during pregnancy and is thought to have a role in supporting neurodevelopment. We conducted a multicenter, double-blind, randomized controlled trial in women with a singleton pregnancy who were <21 weeks’ gestation at trial entry. Women were provided with 800 mg DHA/day or a placebo supplement from trial entry until birth. When children reached seven years of age, we invited parents to complete the Strengths and Difficulties Questionnaire (SDQ), the Behavior Rating Inventory of Executive Function (BRIEF), and the Conners 3rd Edition Attention-Deficit Hyperactivity Disorder (ADHD) Index to assess child behavior and behavioral manifestations of executive dysfunction. There were 543 parent–child pairs (85% of those eligible) that participated in the follow-up. Scores were worse in the DHA group than the placebo group for the BRIEF Global Executive, Behavioral Regulation and Metacognition Indexes, and the Shift, Inhibit, Monitor, Working Memory, and Organization of Materials scales, as well as for the Conners 3 ADHD index, and the SDQ Total Difficulties score, Hyperactivity/Inattention score, and Peer Relationship Problems score. In this healthy, largely term-born sample of children, prenatal DHA supplementation conferred no advantage to childhood behavior, and instead appeared to have an adverse effect on behavioral functioning, as assessed by standardized parental report scales.
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Affiliation(s)
- Jacqueline F. Gould
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia
- Correspondence: ; Tel.: +618-128-4423
| | - Peter J. Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne 3800, Australia;
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Lisa N. Yelland
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia
| | - Robert A. Gibson
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- School of Agriculture, Food and Wine, Waite Campus, University of Adelaide, Adelaide 5000, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia; (L.N.Y.); (R.A.G.); (M.M.)
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia
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Irwinda R, Hiksas R, Siregar AA, Saroyo YB, Wibowo N. Long-chain polyunsaturated fatty acid (LC-PUFA) status in severe preeclampsia and preterm birth: a cross sectional study. Sci Rep 2021; 11:14701. [PMID: 34282168 PMCID: PMC8289913 DOI: 10.1038/s41598-021-93846-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/29/2021] [Indexed: 02/06/2023] Open
Abstract
Long-Chain Polyunsaturated Fatty Acid (LCPUFA) is essential throughout pregnancy, since deficiency of LPUFA may linked to obstetrical complications. This study aimed to investigate LCPUFA status in severe preeclampsia and preterm birth. A cross sectional study was conducted in 104 pregnant women, which divided into normal pregnancy, severe preeclampsia and preterm birth groups. Serum percentage and concentration of total LCPUFA, omega-3, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), omega-6, linoleic acid (LA), and arachidonic acid (AA) were measured using gas chromatography/mass spectrometry. Receiver operating characteristic (ROC), bivariate and multivariate analysis were performed. Severe preeclampsia showed the highest concentration of total PUFA and the lowest DHA percentage, with significantly higher Omega-6/Omega-3 ratio (p = 0.004) and lower omega-3 index (p < 0.002) compared to control. Preterm birth showed the least omega-3 concentrations, with significantly low omega-6 derivates (LA (p = 0.014) and AA (p = 0.025)) compared to control. LCPUFA parameters have shown to increase the risk in both conditions, particularly ALA ≤ 53 µmol/L in preeclampsia with OR 5.44, 95%CI 1.16-25.42 and preterm birth with OR 4.68, 95%CI 1.52-14.38. These findings suggest that severe preeclampsia and preterm birth have an imbalance in LCPUFA status.
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Affiliation(s)
- Rima Irwinda
- Maternal Fetal Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Rabbania Hiksas
- Faculty of Medicine, Universitas Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yudianto Budi Saroyo
- Maternal Fetal Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, Indonesia
| | - Noroyono Wibowo
- Maternal Fetal Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, Indonesia
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Carlson SE, Gajewski BJ, Valentine CJ, Kerling EH, Weiner CP, Cackovic M, Buhimschi CS, Rogers LK, Sands SA, Brown AR, Mudaranthakam DP, Crawford SA, DeFranco EA. Higher dose docosahexaenoic acid supplementation during pregnancy and early preterm birth: A randomised, double-blind, adaptive-design superiority trial. EClinicalMedicine 2021; 36:100905. [PMID: 34308309 PMCID: PMC8257993 DOI: 10.1016/j.eclinm.2021.100905] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Several meta analyses have concluded n-3 fatty acids, including docosahexaenoic acid (DHA), reduce early preterm birth (EPB, < 34 weeks), however, the amount of DHA required is unclear. We hypothesized that 1000 mg DHA per day would be superior to 200 mg, the amount in most prenatal supplements. METHODS This randomised, multicentre, double-blind, adaptive-design, superiority trial was conducted in three USA medical centres. Women with singleton pregnancies and 12 to 20 weeks gestation were eligible. randomization was generated in SAS® by site in blocks of 4. The planned adaptive design periodically generated allocation ratios favoring the better performing dose. Managing study personnel were blind to treatment until 30 days after the last birth. The primary outcome was EPB by dose and by enrolment DHA status (low/high). Bayesian posterior probabilities (pp) were determined for planned efficacy and safety outcomes using intention-to-treat. The study is registered with ClinicalTrials.gov (NCT02626299) and closed to enrolment. FINDINGS Eleven hundred participants (1000 mg, n = 576; 200 mg, n = 524) were enrolled between June 8, 2016 and March 13, 2020 with the last birth September 5, 2020. 1032 (n = 540 and n = 492) were included in the primary analyses. The higher dose had a lower EPB rate [1.7% (9/540) vs 2.4% (12/492), pp=0.81] especially if participants had low DHA status at enrolment [2.0% (5/249) vs 4.1%, (9/219), pp=0.93]. Participants with high enrolment DHA status did not realize a dose effect [1000 mg: 1.4% (4/289); 200 mg: 1.1% (3/271), pp = 0.57]. The higher dose was associated with fewer serious adverse events (maternal: chorioamnionitis, premature rupture of membranes and pyelonephritis; neonatal: feeding, genitourinary and neurologic problems, all pp>0.90). INTERPRETATION Clinicians could consider prescribing 1000 mg DHA daily during pregnancy to reduce EPB in women with low DHA status if they are able to screen for DHA. FUNDING The National Institutes of Health Child Health and Human Development (NICHD) funded the study. Life's DHA™-S oil, DSM Nutritional Products LLC, Switzerland provided all capsules.
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Affiliation(s)
- Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States
| | - Byron J Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Christina J Valentine
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, United States
| | - Elizabeth H Kerling
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States
| | - Carl P Weiner
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Michael Cackovic
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, United States
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Chicago, IL, United States
| | | | - Scott A Sands
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States
| | - Alexandra R Brown
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah A Crawford
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States
| | - Emily A DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, United States
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Goodfellow L, Care A, Harrold J, Sharp A, Ivandic J, Poljak B, Roberts D, Alfirevic A, Müller-Myhsok B, Gibson R, Makrides M, Alfirevic Z. Plasma long-chain omega-3 fatty acid status and risk of recurrent early spontaneous preterm birth: a prospective observational study. Acta Obstet Gynecol Scand 2021; 100:1401-1411. [PMID: 33742474 DOI: 10.1111/aogs.14147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A 2018 Cochrane review found that omega-3 supplementation in pregnancy was associated with a risk reduction of early preterm birth of 0.58; prompting calls for universal supplementation. Recent analysis suggests the benefit may be confined to women with a low baseline omega-3 fatty acid status. However, the contemporary omega-3 fatty acid status of pregnant women in the UK is largely unknown. This is particularly pertinent for women with a previous preterm birth, in whom a small relative risk reduction would have a larger reduction of absolute risk. This study aimed to assess the omega-3 fatty acid status of a UK pregnant population and determine the association between the long-chain omega-3 fatty acids and recurrent spontaneous early preterm birth. MATERIAL AND METHODS A total of 283 high-risk women with previous early preterm birth were recruited to the prospective observational study in Liverpool, UK. Additionally, 96 pregnant women with previous term births and birth ≥39+0 weeks in the index pregnancy provided a low-risk population sample. Within the high-risk group we assessed the odds ratio of recurrent early preterm birth compared with birth at ≥37+0 weeks of gestation according to plasma eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA) at 15-22 weeks of gestation. RESULTS Our participants had low EPA+DHA; 62% (143/229) of women with previous preterm birth and 69% (68/96) of the population sample had levels within the lowest two quintiles of a previously published pregnancy cohort. We found no association between long-chain omega-3 status and recurrent early preterm birth (n = 51). The crude odds ratio of a recurrent event was 0.91 (95% CI 0.38-2.15, p = 0.83) for women in the lowest, compared with the highest three quintiles of EPA+DHA. CONCLUSIONS In the majority of our participants, levels of long-chain omega-3 were low; within the range that may benefit from supplementation. However, levels showed no association with risk of recurrent early spontaneous preterm birth. This could be because our population levels were too low to show benefit in being omega-3 "replete"; or else omega-3 levels may be of lesser importance in recurrent early preterm birth.
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Affiliation(s)
- Laura Goodfellow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
| | - Angharad Care
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
| | - Jane Harrold
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
| | | | | | | | - Ana Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, KE, UK
| | - Bertram Müller-Myhsok
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Robert Gibson
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
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Meyer BJ, Sparkes C, Sinclair AJ, Gibson RA, Else PL. Fingertip Whole Blood as an Indicator of Omega-3 Long-Chain Polyunsaturated Fatty Acid Changes during Dose-Response Supplementation in Women: Comparison with Plasma and Erythrocyte Fatty Acids. Nutrients 2021; 13:nu13051419. [PMID: 33922507 PMCID: PMC8147031 DOI: 10.3390/nu13051419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022] Open
Abstract
The sensitivity of fingertip whole blood to reflect habitual dietary and dose-dependent supplemental omega-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) intake in premenopausal women was compared to that of venous erythrocytes and plasma fatty acids. Samples were obtained from women in a randomised, double-blind, placebo-controlled trial in which premenopausal women (n = 53) were supplemented with DHA-rich tuna oil capsules and/or placebo (Sunola oil) capsules (6 capsules per day) for 8 weeks to achieve doses of either 0, 0.35, 0.7 or 1.05 g/day n-3 LCPUFA. All blood biomarkers were very similar in their ability to reflect dietary n-3 LCPUFA intake (r = 0.38–0.46 for EPA and DHA intake), and in their dose-dependent increases in n-3 LCPUFA levels after supplementation (R2 = 0.41–0.51 for dose effect on biomarker EPA and DHA levels (mol %)). Fingertip whole blood is an effective alternative to erythrocytes and plasma as a biomarker n-3 LCPUFA intake in premenopausal women.
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Affiliation(s)
- Barbara J. Meyer
- School of Medicine, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia; (C.S.); (P.L.E.)
- Illawarra Medical Research Institute, Wollongong, NSW 2522, Australia
- Correspondence: ; Tel.: +61-2-4221-3459
| | - Cassandra Sparkes
- School of Medicine, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia; (C.S.); (P.L.E.)
- Illawarra Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Andrew J. Sinclair
- Faculty of Health, Deakin University, Geelong, VIC 3220, Australia;
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia
| | - Robert A. Gibson
- Faculty of Sciences, School of Agriculture, Food and Wine, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Paul L. Else
- School of Medicine, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia; (C.S.); (P.L.E.)
- Illawarra Medical Research Institute, Wollongong, NSW 2522, Australia
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Svenvik M, Raffetseder J, Brudin L, Lindberg R, Blomberg M, Axelsson D, Jenmalm MC, Ernerudh J, Nording ML. Plasma oxylipin levels associated with preterm birth in preterm labor ✰. Prostaglandins Leukot Essent Fatty Acids 2021; 166:102251. [PMID: 33626402 DOI: 10.1016/j.plefa.2021.102251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Preterm labor is a common clinical problem in obstetrics. Since the majority of women with preterm labor eventually deliver at full term, biomarkers are needed to more accurately predict who will deliver preterm. Oxylipins, given their importance in inflammation regulation, are highly interesting in this respect since labor is an inflammatory process. METHODS Eighty women with preterm labor before 34 weeks of gestation were enrolled in a prospective observational multi-center cohort study. Oxylipin levels of 67 analytes in plasma samples were analyzed by liquid chromatography coupled to tandem mass spectrometry. RESULTS Twenty-one (26%) of the women delivered before 34 weeks of gestation, and of those women, fourteen delivered within 48 h of admission. Logistic multivariate regression showed that lower levels of 9,10-DiHODE were associated with delivery before 34 weeks of gestation (aOR 0.12 (0.024-0.62)) and within 48 h ((aOR 0.13 (0.019-0.93)). Furthermore, higher levels of 11,12-DiHETrE were associated with delivery before 34 weeks of gestation ((aOR 6.19 (1.17-32.7)) and higher levels of 8-HETE were associated with delivery within 48 h ((aOR 5.01 (1.13-22.14)). CONCLUSIONS The oxylipin 9,10-DiHODE may be protective in preterm labor, both for delivery after 34 weeks of gestation and for delivery later than 48 h of admission, whereas 11,12-DiHETrE and 8-HETE display the opposite effect. Larger studies are needed to validate these mediators as biomarkers for prediction of preterm birth following preterm labor.
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Affiliation(s)
- M Svenvik
- Department of Obstetrics and Gynecology, Region Kalmar County, Kalmar, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - J Raffetseder
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - L Brudin
- Department of Clinical Physiology, Region Kalmar County, Kalmar, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - R Lindberg
- Department of Chemistry, Umeå University, Umeå, Sweden
| | - M Blomberg
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - D Axelsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden
| | - M C Jenmalm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - J Ernerudh
- Department of Clinical Immunology and Transfusion Medicine, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - M L Nording
- Department of Chemistry, Umeå University, Umeå, Sweden
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Monthé-Drèze C, Sen S, Hauguel-de Mouzon S, Catalano PM. Effect of Omega-3 Supplementation in Pregnant Women with Obesity on Newborn Body Composition, Growth and Length of Gestation: A Randomized Controlled Pilot Study. Nutrients 2021; 13:nu13020578. [PMID: 33572368 PMCID: PMC7916127 DOI: 10.3390/nu13020578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
Maternal obesity, a state of chronic low-grade metabolic inflammation, is a growing health burden associated with offspring adiposity, abnormal fetal growth and prematurity, which are all linked to adverse offspring cardiometabolic health. Higher intake of anti-inflammatory omega-3 (n-3) polyunsaturated fatty acids (PUFA) in pregnancy has been associated with lower adiposity, higher birthweight and longer gestation. However, the effects of n-3 supplementation specifically in pregnant women with overweight and obesity (OWOB) have not been explored. We conducted a pilot double-blind randomized controlled trial of 72 pregnant women with first trimester body mass index (BMI) ≥ 25 kg/m2 to explore preliminary efficacy of n-3 supplementation. Participants were randomized to daily DHA plus EPA (2 g/d) or placebo (wheat germ oil) from 10-16 weeks gestation to delivery. Neonatal body composition, fetal growth and length of gestation were assessed. For the 48 dyads with outcome data, median (IQR) maternal BMI was 30.2 (28.2, 35.4) kg/m2. In sex-adjusted analyses, n-3 supplementation was associated with higher neonatal fat-free mass (β: 218 g; 95% CI 49, 387) but not with % body fat or fat mass. Birthweight for gestational age z-score (-0.17 ± 0.67 vs. -0.61 ± 0.61 SD unit, p = 0.02) was higher, and gestation longer (40 (38.5, 40.1) vs. 39 (38, 39.4) weeks, p = 0.02), in the treatment vs. placebo group. Supplementation with n-3 PUFA in women with OWOB led to higher lean mass accrual at birth as well as improved fetal growth and longer gestation. Larger well-powered trials of n-3 PUFA supplementation specifically in pregnant women with OWOB should be conducted to confirm these findings and explore the long-term impact on offspring obesity and cardiometabolic health.
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Affiliation(s)
- Carmen Monthé-Drèze
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- School of Medicine, Harvard University, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-525-4139
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- School of Medicine, Harvard University, Boston, MA 02115, USA
| | | | - Patrick M. Catalano
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA;
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The Influence of Omega-3 Long-Chain Polyunsaturated Fatty Acid, Docosahexaenoic Acid, on Child Behavioral Functioning: A Review of Randomized Controlled Trials of DHA Supplementation in Pregnancy, the Neonatal Period and Infancy. Nutrients 2021; 13:nu13020415. [PMID: 33525526 PMCID: PMC7911027 DOI: 10.3390/nu13020415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
This is a review of randomized controlled trials using docosahexaenoic acid (DHA) interventions in the first 1000 days of life with assessments of behavioral functioning in childhood. Electronic databases were searched for trials with a DHA intervention (compared with a placebo group that received no or less DHA) at any time to either women or infants during the first 1000 days, with a subsequent assessment of child behavior. There were 25 trials involving 10,320 mother–child pairs, and 71 assessments of behavior in 6867 of the children (66.5% of those originally enrolled). From the 71 assessments administered, there were 401 comparisons between a DHA group and a control group, with most reporting a null effect. There were no findings of a positive effect of DHA, and 23 instances where the DHA group had worse scores compared with the control group. There was limited evidence that DHA supplementation had any effect on behavioral development, although two of the largest trials with behavioral measures detected adverse effects. Future trials, and future follow-ups of existing trials, should make an effort to evaluate the effect of DHA intervention on behavioral functioning.
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47
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Goodfellow L, Care A, Alfirevic Z. Controversies in the prevention of spontaneous preterm birth in asymptomatic women: an evidence summary and expert opinion. BJOG 2020; 128:177-194. [PMID: 32981206 DOI: 10.1111/1471-0528.16544] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/11/2023]
Abstract
Preterm birth prevention is multifaceted and produces many nuanced questions. This review addresses six important clinical questions about preterm birth prevention as voted for by members of the UK Preterm Clinical Network. The questions cover the following areas: preterm birth prevention in 'low-risk' populations; screening for asymptomatic genital tract infection in women at high risk of preterm birth; cervical length screening with cerclage or vaginal pessary in situ; cervical shortening whilst using progesterone; use of vaginal progesterone in combination with cervical cerclage; and optimal advice about intercourse for women at high risk of preterm birth.
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Affiliation(s)
- Laura Goodfellow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Angharad Care
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
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48
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Best KP, Gibson RA, Yelland LN, Leemaqz S, Gomersall J, Liu G, Makrides M. Effect of omega-3 lcpufa supplementation on maternal fatty acid and oxylipin concentrations during pregnancy. Prostaglandins Leukot Essent Fatty Acids 2020; 162:102181. [PMID: 33038832 DOI: 10.1016/j.plefa.2020.102181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Omega-3 long chain polyunsaturated fatty acids (LCPUFA) have been associated with a reduction in risk for preterm birth. However, there is limited understanding of how fatty acids and their bioactive derivatives (oxylipins) change over the course of pregnancy. Here we document the changes in concentration of fatty acids and oxylipins during pregnancy and how fatty acid status and oxylipin concentrations are affected by supplementation with omega-3 LCPUFA. We also investigate the degree to which fatty acid and oxylipin changes across pregnancy are influenced by baseline omega-3 status. MATERIALS AND METHODS We profiled the fatty acids in all lipids in dried blood spots (total blood fatty acids) by gas chromatography and free (unesterified) fatty acids and their associated oxylipins in separate dried blood spot samples by LC-MS-MS collected from a random sample of 1263 women with a singleton pregnancy who participated in the ORIP (Omega-3 fats to Reduce the Incidence of Prematurity) trial. ORIP is a double-blind, randomized controlled trial involving 5544 participants and designed to determine the effect of supplementing the diets of pregnant women with omega-3 LCPUFA on the incidence of early preterm birth. Maternal whole blood finger prick samples were collected at baseline (~14 weeks gestation) and at completion of the study intervention period (34 weeks gestation). RESULTS The concentration of most total and free polyunsaturated fatty acids and their associated oxylipins declined over the course of pregnancy. Omega-3 LCPUFA supplementation increased total DHA and 7-HDHA and mitigated the decline in free DHA, 4-HDHA and 14-HDHA. The intervention had minimal or no effect on free EPA, LA, AA and their associated oxylipins. Omega-3 LCPUFA supplementation in women with higher omega-3 status at baseline was associated with a significant increase in 7-HDHA and 4-HDHA between the treatment and control whereas there were no differences between groups in 7-HDHA and 4-HDHA in women with intermediate or lower baseline omega-3 status. CONCLUSION Our data suggest a differential response with or without omega-3 supplementation for DHA and DHA-derived oxylipins, which may have an important role to play in modulating pregnancy duration. Further work is needed to understand their role, which may allow us to better tailor omega-3 supplementation for preterm birth prevention.
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Affiliation(s)
- K P Best
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA; School of Medicine, University of Adelaide, North Terrace, Adelaide SA.
| | - R A Gibson
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA; School of Agriculture, Food and Wine, University of Adelaide, North Terrace, Adelaide SA
| | - L N Yelland
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA; School of Public Health, University of Adelaide, North Terrace, Adelaide SA
| | - S Leemaqz
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA
| | - J Gomersall
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA; School of Public Health, University of Adelaide, North Terrace, Adelaide SA
| | - G Liu
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA
| | - M Makrides
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, North Terrace, Adelaide SA; School of Medicine, University of Adelaide, North Terrace, Adelaide SA
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Phung AS, Bannenberg G, Vigor C, Reversat G, Oger C, Roumain M, Galano JM, Durand T, Muccioli GG, Ismail A, Wang SC. Chemical Compositional Changes in Over-Oxidized Fish Oils. Foods 2020; 9:foods9101501. [PMID: 33092165 PMCID: PMC7590219 DOI: 10.3390/foods9101501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
A recent study has reported that the administration during gestation of a highly rancid hoki liver oil, obtained by oxidation through sustained exposure to oxygen gas and incident light for 30 days, causes newborn mortality in rats. This effect was attributed to lipid hydroperoxides formed in the omega-3 long-chain polyunsaturated fatty acid-rich oil, while other chemical changes in the damaged oil were overlooked. In the present study, the oxidation condition employed to damage the hoki liver oil was replicated, and the extreme rancidity was confirmed. A detailed analysis of temporal chemical changes resulting from the sustained oxidative challenge involved measures of eicosapentaenoic acid/docosahexaenoic acid (EPA/DHA) omega-3 oil oxidative quality (peroxide value, para-anisidine value, total oxidation number, acid value, oligomers, antioxidant content, and induction time) as well as changes in fatty acid content, volatiles, isoprostanoids, and oxysterols. The chemical description was extended to refined anchovy oil, which is a more representative ingredient oil used in omega-3 finished products. The present study also analyzed the effects of a different oxidation method involving thermal exposure in the dark in contact with air, which is an oxidation condition that is more relevant to retail products. The two oils had different susceptibility to the oxidation conditions, resulting in distinct chemical oxidation signatures that were determined primarily by antioxidant protection as well as specific methodological aspects of the applied oxidative conditions. Unique isoprostanoids and oxysterols were formed in the over-oxidized fish oils, which are discussed in light of their potential biological activities.
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Affiliation(s)
- Austin S. Phung
- Department of Chemistry, University of California, Davis, CA 95616, USA;
| | - Gerard Bannenberg
- Global Organization for EPA and DHA Omega-3s (GOED), Salt Lake City, UT 84105, USA;
- Correspondence: (G.B.); (S.C.W.)
| | - Claire Vigor
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, Université de Montpellier, ENSCM, 34093 Montpellier, France; (C.V.); (G.R.); (C.O.); (J.-M.G.); (T.D.)
| | - Guillaume Reversat
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, Université de Montpellier, ENSCM, 34093 Montpellier, France; (C.V.); (G.R.); (C.O.); (J.-M.G.); (T.D.)
| | - Camille Oger
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, Université de Montpellier, ENSCM, 34093 Montpellier, France; (C.V.); (G.R.); (C.O.); (J.-M.G.); (T.D.)
| | - Martin Roumain
- Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (M.R.); (G.G.M.)
| | - Jean-Marie Galano
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, Université de Montpellier, ENSCM, 34093 Montpellier, France; (C.V.); (G.R.); (C.O.); (J.-M.G.); (T.D.)
| | - Thierry Durand
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, Université de Montpellier, ENSCM, 34093 Montpellier, France; (C.V.); (G.R.); (C.O.); (J.-M.G.); (T.D.)
| | - Giulio G. Muccioli
- Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (M.R.); (G.G.M.)
| | - Adam Ismail
- Global Organization for EPA and DHA Omega-3s (GOED), Salt Lake City, UT 84105, USA;
| | - Selina C. Wang
- Department of Food Science and Technology, University of California, Davis, CA 95616, USA
- Correspondence: (G.B.); (S.C.W.)
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50
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Araujo P, Kjellevold M, Nerhus I, Dahl L, Aakre I, Moe V, Smith L, Markhus MW. Fatty Acid Reference Intervals in Red Blood Cells among Pregnant Women in Norway-Cross Sectional Data from the 'Little in Norway' Cohort. Nutrients 2020; 12:nu12102950. [PMID: 32993043 PMCID: PMC7601079 DOI: 10.3390/nu12102950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
There is a growing interest in determining fatty acid reference intervals from pregnancy cohort, especially considering the lack of reference values for pregnant women in the literature and the generalized misconception of equating reference intervals for nonpregnant women as equivalent to pregnant women. Seafood and supplements are important dietary sources for the omega-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA), such as eicosapentaenoic acid (EPA, 20:5ω-3), docosapentaenoic acid (DPA, 22:55ω-3), and docosahexaenoic acid (DHA, 22:6ω-3). Sufficient intake of EPA and DHA is vital during pregnancy for the development of the fetus, as well as for maintaining adequate levels for the mother. This study describes the fatty acid status and suggests reference values and cut-offs for fatty acids in red blood cells (RBC) from pregnant women (n = 247). An electronic food frequency questionnaire (e-FFQ) mapped the dietary habits of the participants, and gas chromatography was used to determine the fatty acid levels in RBC. The association between e-FFQ variables and fatty acid concentrations was established using a principal component analysis (PCA). Twenty-nine-point-one percent (29.1%) of the participants reported eating seafood as dinner according to the Norwegian recommendations, and they added in their diet as well a high percentage (76.9%) intake of ω-3 supplements. The concentration levels of fatty acids in RBC were in agreement with those reported in similar populations from different countries. The reference interval 2.5/97.5 percentiles for EPA, DPA, DHA were 0.23/2.12, 0.56/2.80, 3.76/10.12 in relative concentration units (%), and 5.99/51.25, 11.08/61.97, 64.25/218.08 in absolute concentration units (µg/g), respectively. The number of participants and their selection from all over Norway vouch for the representativeness of the study and the validity of the proposed reference values, and therefore, the study may be a useful tool when studying associations between fatty acid status and health outcome in future studies. To the best of our knowledge, this is the first PCA study reporting a direct association between ω-3 LCPUFA and intake of seafood and ω-3 supplements in a pregnancy cohort.
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Affiliation(s)
- Pedro Araujo
- Institute of Marine Research, 1870 Nordnes, N-5817 Bergen, Norway; (I.N.); (L.D.); (I.A.); (M.W.M.)
- Correspondence: (P.A.); (M.K.); Tel.: +47-47645029 (P.A.); +47-40854582 (M.K.)
| | - Marian Kjellevold
- Institute of Marine Research, 1870 Nordnes, N-5817 Bergen, Norway; (I.N.); (L.D.); (I.A.); (M.W.M.)
- Correspondence: (P.A.); (M.K.); Tel.: +47-47645029 (P.A.); +47-40854582 (M.K.)
| | - Ive Nerhus
- Institute of Marine Research, 1870 Nordnes, N-5817 Bergen, Norway; (I.N.); (L.D.); (I.A.); (M.W.M.)
| | - Lisbeth Dahl
- Institute of Marine Research, 1870 Nordnes, N-5817 Bergen, Norway; (I.N.); (L.D.); (I.A.); (M.W.M.)
| | - Inger Aakre
- Institute of Marine Research, 1870 Nordnes, N-5817 Bergen, Norway; (I.N.); (L.D.); (I.A.); (M.W.M.)
| | - Vibeke Moe
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0317 Oslo, Norway; (V.M.); (L.S.)
| | - Lars Smith
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0317 Oslo, Norway; (V.M.); (L.S.)
| | - Maria Wik Markhus
- Institute of Marine Research, 1870 Nordnes, N-5817 Bergen, Norway; (I.N.); (L.D.); (I.A.); (M.W.M.)
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