Ernährung und Bewegung von Säuglingen und stillenden Frauen: Aktualisierte Handlungsempfehlungen von „Gesund ins Leben – Netzwerk Junge Familie“, eine Initiative von IN FORM

[Epilepsy and pregnancy]

BACKGROUND

Regarding treatment of women of childbearing potential with epilepsy, several aspects of family planning and desire to have children have to be taken into account.

OBJECTIVE

Overview of current data on mutual implications of epileptic seizures, antiseizure medication (ASM), pregnancy and child development.

METHOD

Review of the current literature, discussion and presentation of resulting treatment recommendations.

RESULTS

Many ASMs bear the potential for clinically relevant interactions with both contraceptives and altered concentrations of sexual hormones and modified pharmacokinetics during pregnancy. All ASMs show an increased risk for congenital malformations; however, due to seizure-related risks for the mother and child effective ASM treatment during pregnancy is crucial.

CONCLUSION

When considering the special aspects of consultation and treatment of women of childbearing potential with epilepsy most pregnancies are uncomplicated.

[Prospects for the implementation of the Innovation Fund project GeMuKi - a cross sectional study on attitudes of health care providers regarding preventive lifestyle counselling in routine prenatal visits and infant check-ups]

INTRODUCTION

Overweight and obesity are major public health concerns in Germany. As patients can easily be accessed via physicians' offices, this setting provides a high potential for prevention. However, the limited implementation of prevention and health promotion interventions in physicians' offices so far indicates that barriers to implementation exist. This study therefore addresses how obesity prevention interventions should be designed and implemented so that health care providers perceive them as appropriate and are willing to adopt them in their daily practice. The study is performed by taking the Innovation Fund project "GeMuKi" as an example.

METHODS

A mixed-methods study was conducted. Data collection took place within the context of the GeMuKi training session that health care providers complete in preparation for implementing the intervention. Gynecologists, pediatricians, midwives, and medical assistants completed a questionnaire. The questions covered the implementation outcomes "appropriateness" and "adoption". Text entry fields were used to obtain information on feasibility as well as anticipated facilitating and hindering factors. In addition, observation protocols were prepared for each training session by the project team. The questionnaire was analyzed descriptively. Text entry fields and protocols were evaluated using qualitative content analysis.

RESULTS

Four hundred and one (n=401) training participants completed the questionnaire. Almost three quarters (73 %) of the health care providers indicate that they are motivated to implement the intervention. At the same time, concerns are expressed about organizational feasibility in everyday practice. Nevertheless, 72 % expect their care to improve as a result of the project.

CONCLUSION

The health care providers surveyed are positive about the implementation of the project in everyday practice. By documenting concerns about the implementation, the barriers identified can be addressed during the project course.

A mendelian randomization study on causal effects of 25(OH)vitamin D levels on attention deficit/hyperactivity disorder

BACKGROUND

While observational studies revealed an inverse association between serum 25(OH)vitamin D (25(OH)D) and the risk of attention deficit/hyperactivity disorder (ADHD), the causality of this relationship remains unclear.

METHODS

We conducted a bidirectional two-sample Mendelian Randomization (MR) study to examine whether 25(OH)D has an effect on the risk to develop ADHD or vice versa. Information on single nucleotide polymorphisms (SNP) associated with serum 25(OH)D was obtained from a genome-wide association study (GWAS) considering phenotype data from 79,366 individuals of European ancestry. Data on risk for ADHD were derived from a GWAS analysis with 20,183 individuals diagnosed with ADHD and 35,191 controls. For our analysis, we considered effect sizes based on the European participants (19,099 cases and 34,194 controls).

RESULTS

Single SNP analyses showed a causal effect of vitamin D on ADHD risk for only one SNP (rs12785878, p = 0.024). The overall MR estimates did not reveal a causal effect of 25(OH)D on risk for ADHD. In the reverse analysis, neither any single nor the multi-SNP MR analyses showed a causal effect of ADHD on 25(OH)D.

CONCLUSION

Results from this two-sample MR study did not confirm a causal effect of 25(OH)D on ADHD or vice versa. Accordingly, our study does not provide evidence that improving 25(OH)D via supplementation could reduce the risk of developing ADHD.

Vitamin-B12-Mangel im Neugeborenen- und Säuglingsalter – Ursachen, Früherkennung, Diagnostik und Vorstellung eines primär oralen Behandlungsschemas

Hintergrund

Ein Vitamin‑B12-Mangel ist bei Neugeborenen meist bedingt durch einen mütterlichen Vitamin‑B12-Mangel. Beim Kind führt ein schwerer, unerkannter Vitamin‑B12-Mangel zu irreversiblen neurologischen Schädigungen und einer dauerhaften Entwicklungsstörung, die meist erst im zweiten Lebenshalbjahr klinisch erkannt wird. Eine Früherkennung durch das Neugeborenenscreening wird derzeit in Pilotprojekten evaluiert.

Fragestellung

Der vorliegende Beitrag gibt einen Überblick über mögliche Ursachen eines Vitamin‑B12-Mangels und präsentiert erfolgreiche Ansätze zur Früherkennung durch das Neugeborenenscreening sowie Empfehlungen zur Diagnostik bei Mutter und Kind. Für die Behandlung des Vitamin‑B12-Mangels im Neugeborenen- und Säuglingsalter wird bislang häufig zunächst eine intramuskuläre Applikation von Vitamin B12 verwendet. Als Alternative wird von den Autoren ein ausschließlich orales Supplementationsschema mit Vitamin B12 vorgestellt.

Ergebnisse

Im Rahmen des Pilotprojektes „Neugeborenenscreening 2020“ am Screeningzentrum Heidelberg wurde für die Behandlung von Kindern mit Vitamin‑B12-Mangel nach Detektion über das Neugeborenenscreening ein standardisiertes ausschließlich orales Supplementationsschema mit Vitamin B12 entwickelt und erfolgreich angewendet. Dieses besteht in der Verabreichung von Vitamin B12 0,5 mg/Tag p.o. über 3 Tage in Form eines Flüssigpräparates, gefolgt von 0,1 mg/Tag p.o. Über die erste Woche erfolgt zusätzlich die Gabe von 0,4 mg Folsäure pro Tag p.o. Nach Normalisierung aller Parameter des Vitamin‑B12-Haushaltes (einschließlich der funktionellen Marker Homozystein und Methylmalonsäure) erfolgt während der Stillzeit eine Vitamin‑B12-Supplementation in Erhaltungsdosis von 5 µg/Tag p.o. bis zur sicheren Einführung fleischhaltiger Beikost bzw. von Vitamin‑B12-haltiger Nahrung.

Schlussfolgerung

Das hier dargestellte rein orale Behandlungsschema für den Vitamin‑B12-Mangel stellt eine effektive, kostengünstige, schmerzlose und damit besonders kinderfreundliche Behandlung dar.

Stillen und Stillberatung

Muttermilch (Stillen) stellt die Norm der Säuglingsernährung dar. Stillen ist die Standardernährungsform für den ersten Lebensabschnitt eines Menschen. In der Folge wird bei der Einführung von Beikost aus ausschließlichem Stillen weiterbegleitendes Stillen – bis zum vollständigen Übergang zur Familienkost. Die Zusammensetzung der Muttermilch und die hormonelle Steuerung der Milchbildung sind optimal auf das Kind abgestimmt. Stillen ist jedoch kein instinktives, sondern ein sozial erlerntes Verhalten und bedarf von Anbeginn an begleitender Information und Beratung der Mutter und der Familien. Medizinisches Fachpersonal wird als kompetent in Ernährungsfragen erachtet und sollte daher über ausreichende wissenschaftlich fundierte Kenntnis bezüglich der physiologischen Vorgänge im Zusammenhang mit Stillen sowie der Kurz- und Langzeitauswirkungen von Stillen auf die Gesundheit von Mutter und Kind verfügen. Ebenso sollten die Risiken von Formulaernährung (Säuglingsfertignahrung auf Kuhmilchbasis) für die Entwicklung und verschiedene Erkrankungen bekannt sein.

Effects of LC-PUFA supply via complementary food on infant development-a food based intervention (RCT) embedded in a total diet concept

BACKGROUND

With the introduction of complementary food, long-chain PUFA (LC-PUFA) supply usually decreases during the second 6 months of life. However, the need for LC-PUFA is still high for infant's rapid development. The aim of this randomized, controlled intervention trial was to examine the effects of an increased n-3 (LC-)PUFA supply using alternative complementary foods on infants' visual and cognitive development.

METHODS

Mother-child dyads of term infants were recruited in maternity hospitals and randomly assigned to one of three study groups, which all were fed according to the German dietary schedule for infant nutrition. Intervention group IG-R (n = 54) received jars of complementary food with rapeseed oil, IG-F (n = 48) jars with oily fish twice a week and the control group (CG, n = 58) the same jars as IG-R with corn oil instead of rapeseed oil during the intervention period (5th-10th month of age). The outcome measures were latencies of FVEP, Bayley's mental developmental index (MDI), and psychomotor developmental index (PDI).

RESULTS

At 10 months of age, there were no significant differences in latencies of FVEP, Bayley's MDI, or in PDI index between the intervention and control groups.

CONCLUSIONS

Fish and rapeseed oil used as (LC-)PUFA sources provided with complementary feeding embedded in a structured infant diet did not affect visual or cognitive development of term infants.

[The importance of breastfeeding for the infant]

Breastmilk is natural nutrition for infants. In addition to nutrients, breast milk contains a variety of immunomodulatory, anti-inflammatory and antimicrobial substances that help to reduce short- and long-term morbidity risks and positively influence the child's cognitive and psychomotor development. Studies show that breastfed children are at a significantly lower risk for lower respiratory tract infections, otitis media, and gastroenteritis compared with non-breastfed children. Also, the risk for sudden infant death syndrome is significantly reduced by breastfeeding. Breastfeeding does not have an influence on the risk of allergies, neither in the overall population nor in children with a familial predisposition. However, breastfeeding promotes brain development, especially of the white matter, and is associated with improved intelligence by about 2 IQ points. Furthermore, studies show an inverse correlation between breastfeeding and the subsequent risk for obesity, and there is evidence for a risk reduction of type 2 diabetes mellitus. Breastfed infants can largely regulate their food intake. This can have a positive effect on later eating behavior and the risk for becoming overweight. In view of the positive health effects of breastfeeding, it is recommended that infants be breast-fed exclusively during the first few months of life and that complementary feeding should be started at the earliest from the beginning of the 5th month and no later than at the beginning of the 7th month. Complementary food should be offered in a suitable form and with consideration of the signals of the child. Overall, breastfeeding can make a significant contribution to promoting public health and thereby to reducing healthcare costs.

[Breastfeeding protection according to the law on the reform of maternity protection]

On 1 January 2018, a new Maternity Protection Act came into force in Germany. The Maternity Protection Act has been made more appropriate and coherent by the reform. In addition, the regulations on maternity protection have been structured better and made clearer. The aim of the law remains to ensure a responsible balance between health protection for a pregnant or breastfeeding woman and her (unborn) child on the one hand and the self-determined decision of the woman about her employment on the other. To improve the effectiveness of the law in this sense, the hazards of a modern working world for pregnant and breastfeeding mothers and the duties of maternity protection had to be better contoured. It will improve women's opportunities and strengthen their rights to pursue their careers during pregnancy and breastfeeding without compromising their health and that of their child. The reform should ensure a uniform level of health protection during pregnancy, after delivery and during breastfeeding for all women, regardless of occupational group. In particular, the protection of breastfeeding women secured by the Maternity Protection Act is described in more detail in this article.