1
|
Apostolopoulou A, Tranidou A, Chroni V, Tsakiridis I, Tsekitsidi E, Kalaitzopoulou I, Magriplis E, Bakaloudi D, Chrysoula L, Pazaras N, Dagklis T, Chourdakis M. Preconceptional micronutrient adequacy among women in Greece: a prospective epidemiological study. J Matern Fetal Neonatal Med 2024; 37:2343613. [PMID: 38637273 DOI: 10.1080/14767058.2024.2343613] [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: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The importance of micronutrient intake during the preconceptional and early pregnancy period for both maternal and fetal outcomes is well-known, however, relevant data are not available for Greek pregnant women. The aim of the present study is to delineate the nutritional status preceding conception among a representative cohort of Greek pregnant women. METHODS This was a prospective study of pregnant women from routine care, recruited at 11+0-13+6 gestational weeks, between December 2020 and October 2022, at the 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece. Eligible participants for the study included healthy pregnant women aged 20 years or older, possessing a proficient understanding of the Greek language, and not engaged in specific nutritional programs. A validated Food Frequency Questionnaire was applied to gather information regarding nutritional habits in the last 6 months prior to conception. The consumption of nutrients was compared to the reference intake levels suggested by the European Food Safety Authority. Further analyses between different participants' subgroups were performed. RESULTS Overall, 1100 pregnant women (mean age: 32.4 ± 4.9 years) were enrolled. Almost all examined micronutrients' intake was significantly different from dietary reference values. Furthermore, nutrient adequacy ratio was below 60% in 6 out of 22 micronutrients examined, and Mean Adequacy Ratio was 93%. However, Mean Adequacy Ratio is characterized by extreme variance between the examined values. Iodine, folic acid, potassium, and vitamin D intake levels were significantly lower than the recommended intake levels (p < .001 for all), while vitamin K and niacin (p < .001 for both) were consumed in great extent. Sodium median intake, without calculating extra salt addition also exceeded the reference value levels (p = .03). Notably, magnesium intake exceeded the upper safety limits in 12.4% of the sample. CONCLUSION Potential inadequacies in important micronutrients for uneventful pregnancy outcomes have been revealed.. Special attention is needed for magnesium to balance possible toxicity with evident benefits.
Collapse
Affiliation(s)
- Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antigoni Tranidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Violeta Chroni
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioustini Kalaitzopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Dimitra Bakaloudi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lydia Chrysoula
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Pazaras
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
2
|
Hamilton K, Harper JC. Young adult's views on using a poster to learn about fertility: redesigning the fertility education poster. HUM FERTIL 2024; 27:2345675. [PMID: 38804247 DOI: 10.1080/14647273.2024.2345675] [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: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 05/29/2024]
Abstract
Fertility awareness should be taught to everyone. The International Reproductive Health Education Collaboration (IRHEC) designed a fertility poster in 2019 but did not have a specific target group in mind. Studies have been conducted in Denmark and Sweden to determine how the poster can be redesigned. In this study, we carried out focus groups with young adults in the UK to ask their views of the poster, with the aim of redesigning it. Six focus groups were undertaken with twenty seven, 18-25 year olds. Five questions were asked: 1. What are your thoughts, feelings, and reactions to the poster? 2. Did you learn anything from the poster? 3. How has reading the poster impacted your opinions or thoughts about having children? 4. What are your opinions about using a poster format to inform and start reflections regarding family building? 5. Reading through each point are there any changes to be made? Content analysis was performed. Themes identified revealed the information on the poster gave the participants some anxiety and apprehension, especially regarding the effect of age on fertility, perceptions of IVF, and gaps in knowledge. The fertility education poster is a good resource for education, but other resources should be developed.
Collapse
Affiliation(s)
- Katie Hamilton
- EGA Institute for Women's Health, University College London, London, UK
| | - Joyce C Harper
- EGA Institute for Women's Health, University College London, London, UK
| |
Collapse
|
3
|
O'Connor H, Willcox JC, de Jersey S, Wright C, Wilkinson SA. Digital preconception interventions targeting weight, diet and physical activity: A systematic review. Nutr Diet 2024; 81:244-260. [PMID: 37845187 DOI: 10.1111/1747-0080.12842] [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: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
AIM Optimising preconception health increases the likelihood of conception, positively influences short- and long-term pregnancy outcomes and reduces intergenerational chronic disease risk. Our aim was to synthesise study characteristics and maternal outcomes of digital or blended (combining face to face and digital modalities) interventions in the preconception period. METHODS We searched six databases (PubMed, Cochrane, Embase, Web of Science, CINHAL and PsycINFO) from 1990 to November 2022 according to the PRISMA guidelines for randomised control trials, quasi-experimental trials, observation studies with historical control group. Studies were included if they targeted women of childbearing age, older than 18 years, who were not currently pregnant and were between pregnancies or/and actively trying to conceive. Interventions had to be delivered digitally or via digital health in combination with face-to-face delivery and aimed to improve modifiable behaviours, including dietary intake, physical activity, weight and supplementation. Studies that included women diagnosed with type 1 or 2 diabetes were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality criteria checklist. Study characteristics, intervention characteristics and outcome data were extracted. RESULTS Ten studies (total participants n=4,461) were included, consisting of nine randomised control trials and one pre-post cohort study. Seven studies received a low risk of bias and two received a neutral risk of bias. Four were digitally delivered and six were delivered using blended modalities. A wide range of digital delivery modalities were employed, with the most common being email and text messaging. Other digital delivery methods included web-based educational materials, social media, phone applications, online forums and online conversational agents. Studies with longer engagement that utilised blended delivery showed greater weight loss. CONCLUSION More effective interventions appear to combine both traditional and digital delivery methods. More research is needed to adequately test effective delivery modalities across a diverse range of digital delivery methods, as high heterogeneity was observed across the small number of included studies.
Collapse
Affiliation(s)
- Hannah O'Connor
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Jane C Willcox
- Faculty of Health, Charles Darwin University, Darwin, Northwest Territories, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Charlotte Wright
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Lifestyle Maternity, Brisbane, Queensland, Australia
- Department of Obstetric Medicine, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
| |
Collapse
|
4
|
Dodd JM, Louise J, Deussen AR, Mitchell M, Poston L. Rethinking causal assumptions about maternal BMI, gestational weight gain, and adverse pregnancy outcomes. BMC Med 2024; 22:197. [PMID: 38750522 PMCID: PMC11094971 DOI: 10.1186/s12916-024-03410-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate commonly assumed causal relationships between body mass index (BMI), gestational weight gain (GWG), and adverse pregnancy outcomes, which have formed the basis of guidelines and interventions aimed at limiting GWG in women with overweight or obesity. We explored relationships between maternal BMI, total GWG (as a continuous variable and as 'excessive' GWG), and pregnancy outcomes (including infant birthweight measures and caesarean birth). METHODS Analysis of individual participant data (IPD) from the i-WIP (International Weight Management in Pregnancy) Collaboration, from randomised trials of diet and/or physical activity interventions during pregnancy reporting GWG and maternal and neonatal outcomes. Women randomised to the control arm of 20 eligible randomised trials (4370 of 8908 participants) from the i-WIP dataset of 36 randomised trials (total 12,240 women). The main research questions were to characterise the relationship between maternal BMI and (a) total GWG, (b) the risk of 'excessive' GWG (using the Institute of Medicine's guidelines), and (c) adverse pregnancy outcomes as mediated via GWG versus other pathways to determine the extent to which the observed effect of maternal BMI on pregnancy outcomes is mediated via GWG. We utilised generalised linear models and regression-based mediation analyses within an IPD meta-analysis framework. RESULTS Mean GWG decreased linearly as maternal BMI increased; however, the risk of 'excessive' GWG increased markedly at BMI category thresholds (i.e. between the normal and overweight BMI category threshold and between the overweight and obese BMI category threshold). Increasing maternal BMI was associated with increased risk of all pregnancy outcomes assessed; however, there was no evidence that this effect was mediated via effects on GWG. CONCLUSIONS There is evidence of a meaningful relationship between maternal BMI and GWG and between maternal BMI and adverse pregnancy outcomes. There is no evidence that the effect of maternal BMI on outcomes is via an effect on GWG. Our analyses also cast doubt on the existence of a relationship between 'excessive' GWG and adverse pregnancy outcomes. Our findings challenge the practice of actively managing GWG throughout pregnancy.
Collapse
Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Obstetrics and Gynaecology, Women's and Babies Division, The Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Jennie Louise
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Research Centre, Women's and Children's Hospital Research Network, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Megan Mitchell
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucilla Poston
- Women and Children's Health and School of Life Course Sciences, King's College London, London, UK
| |
Collapse
|
5
|
Castro Nascimento ND, Borges ALV, Fujimori E, Reis-Muleva B. Training in preconception care focused on primary health care providers: Effects on preconception care knowledge and provision. Heliyon 2024; 10:e30090. [PMID: 38711651 PMCID: PMC11070810 DOI: 10.1016/j.heliyon.2024.e30090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/31/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024] Open
Abstract
Objective To assess the effect of a rapid training intervention on the knowledge of health providers and the provision of preconception care in primary health care services. Methods Randomized community trial in eight primary health care facilities (four were randomly allocated to the intervention group and four to the control group) in 2020 in Brazil. The intervention consisted of rapid training in preconception health for all health providers in the intervention group. Health providers who had medicine and nursing backgrounds answered structured questionnaires about their knowledge and practices of preconception health-related topics, and reproductive-age women attending the services completed a questionnaire about their experience with preconception care in pre- and postintervention (three months after the intervention) periods. Findings The level of knowledge among health providers increased after the intervention, but providing information about preconception care and prescribing folic acid showed no significant change, with the exception of screening for future pregnancy intention. Key conclusions and implications for practice Although the knowledge of health providers on preconception care is a fundamental requirement for its provision in primary health care settings, rapid training focused on preconception health topics was not sufficient to change their practices, with the exception of pregnancy intention screening, which experienced a slight increase after the training. It appears that additional elements, such as the reorganization of primary health care services to prioritize non-pregnant women, the development and implementation of specific guidelines, along with strategies for the dissemination of preconception care awareness, may also play crucial roles for full preconception care implementation in addition to health providers' knowledge of such issues.
Collapse
Affiliation(s)
- Natália de Castro Nascimento
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil
| | - Ana Luiza Vilela Borges
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil
| | - Elizabeth Fujimori
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil
| | - Belarmina Reis-Muleva
- Lúrio University of Nampula, Mozambique, Bairro de Marrere, R Nr. 4250, Km 2,3, Nampula, Mozambique
| |
Collapse
|
6
|
Furness D, Huynh NKT, Kaufmann L, Liu J, Nguyen TBN, Schaefer E, Tan L, Yau CD, Yu Q. Real-world insights on nutritional awareness and behaviors among preconception and pregnant women in three Asia Pacific countries. Front Glob Womens Health 2024; 5:1332555. [PMID: 38813069 PMCID: PMC11135049 DOI: 10.3389/fgwh.2024.1332555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction In many parts of Asia Pacific (APAC), insufficient intake of micronutrients that are important for conception and pregnancy remains a prevalent issue among women of reproductive age. It is crucial to gain insights into women's nutritional awareness and nutrition-related behaviors, as well as how these relate to their health literacy (HL). This understanding can help identify gaps and guide the development of appropriate intervention strategies. However, there appears to be limited relevant data available for the APAC region. We therefore examined nutritional awareness and behaviors among preconception and pregnant women in three APAC countries, and explored how these were related to women's HL. Methods Cross-sectional online surveys were conducted among preconception (i.e., planning to conceive within the next 12 months or currently trying to conceive) and pregnant women in Australia (N = 624), China (N = 600), and Vietnam (N = 300). The survey questionnaire included a validated tool for HL (Newest Vital Sign) and questions to examine awareness and behaviors relating to healthy eating and prenatal supplementation during preconception and pregnancy. Results Despite recommendations for a quality diet complemented by appropriate supplementation during preconception and pregnancy, many respondents in each country were not aware of the specific impact of adequate nutrition during these stages. While many respondents reported changes in their diet to eat more healthily during preconception and pregnancy, a substantial proportion were not taking prenatal supplements. Higher HL was related to greater nutritional awareness and higher use of prenatal supplements. Discussion Our findings suggest that there are gaps in nutritional awareness and practices of many preconception or pregnant women in the three countries. Interventions to improve HL would be valuable to complement conventional knowledge-centric nutrition education, and enhance understanding and empower women to adopt appropriate nutritional practices throughout their preconception/pregnancy journey.
Collapse
Affiliation(s)
- Denise Furness
- Nutritionist and Molecular Geneticist, Your Genes and Nutrition, Doonan, QLD, Australia
| | - Nguyen Khanh Trang Huynh
- Department of Obstetrics and Gynaecology, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
| | - Ligaya Kaufmann
- Department of Regulatory, Medical, Safety, Quality & Compliance (RMSQC), Bayer Consumer Care AG, Basel, Switzerland
| | - Jue Liu
- Department of Regulatory, Medical, Safety, Quality & Compliance (RMSQC), Bayer Healthcare Company Limited, Shanghai, China
| | - Thi Bich Ngoc Nguyen
- Department of Regulatory, Medical, Safety, Quality & Compliance (RMSQC), Bayer Vietnam Limited, Bien Hoa, Dong Nai, Vietnam
| | - Ella Schaefer
- Department of Regulatory, Medical, Safety, Quality & Compliance (RMSQC), Bayer Consumer Care AG, Basel, Switzerland
| | - Lucy Tan
- Department of Regulatory, Medical, Safety, Quality & Compliance (RMSQC), Bayer Australia Limited, Pymble, NSW, Australia
| | - Ching Danica Yau
- Department of Regulatory, Medical, Safety, Quality & Compliance (RMSQC), Bayer Healthcare Limited, Consumer Health, Hong Kong, Hong Kong SAR, China
| | - Qi Yu
- Gynecological Endocrinology and Reproductive Medicine Center, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
7
|
Puliani R, Bhatt Y, Gupta S, R N A, B D T, Jayanna K. A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs. Asia Pac J Public Health 2024:10105395241252867. [PMID: 38736330 DOI: 10.1177/10105395241252867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examines the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.
Collapse
Affiliation(s)
- Reedhika Puliani
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Yogita Bhatt
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Soumya Gupta
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun, India
| | - Agnita R N
- Karnataka Health Promotion Trust, Bengaluru, India
| | - Tejaswini B D
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Krishnamurthy Jayanna
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| |
Collapse
|
8
|
Mekonnen BD, Tsega SS. Association between preconception care and family planning and previous adverse birth outcomes in Ethiopia: systematic review and meta-analysis. BMJ Open 2024; 14:e078299. [PMID: 38719286 PMCID: PMC11086204 DOI: 10.1136/bmjopen-2023-078299] [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: 07/31/2023] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Inconsistent findings on the associations of preconception care with the utilisation of family planning and previous adverse birth outcomes have not been systematically reviewed in Ethiopia. Thus, this review aims to estimate the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes in Ethiopia. DESIGN Systematic review and meta-analysis of observational studies. DATA SOURCES MEDLINE Complete, CINAHL Complete, Scopus and Global Health were searched from inception to 28 July 2023. ELIGIBILITY CRITERIA Observational studies that reported preconception care as an outcome variable and the use of family planning before pregnancy or previous adverse birth outcomes as exposure variables were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently conducted study screening, data extraction and quality assessment. A fixed-effects model was used to determine the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes. RESULTS Eight studies involving a total of 3829 participants were included in the review. The pooled meta-analysis found that women with a history of family planning use had a higher likelihood of using preconception care (OR 2.09, 95% CI 1.74 to 2.52) than those women who did not use family planning before their current pregnancy. Likewise, the pooled meta-analysis found that women with prior adverse birth outcomes had a higher chance of using preconception care (OR 3.38, 95% CI 1.06 to 10.74) than women with no history of prior adverse birth outcomes. CONCLUSION This review indicated that utilisation of preconception care had a positive association with previous use of family planning and prior adverse birth outcomes. Thus, policymakers and other relevant stakeholders should strengthen the integration of preconception care with family planning and other maternal healthcare services. PROSPERO REGISTRATION NUMBER CRD42023443855.
Collapse
Affiliation(s)
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
9
|
de Oliveira Melo NC, Cuevas-Sierra A, Souto VF, Martínez JA. Biological Rhythms, Chrono-Nutrition, and Gut Microbiota: Epigenomics Insights for Precision Nutrition and Metabolic Health. Biomolecules 2024; 14:559. [PMID: 38785965 PMCID: PMC11117887 DOI: 10.3390/biom14050559] [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: 04/17/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Circadian rhythms integrate a finely tuned network of biological processes recurring every 24 h, intricately coordinating the machinery of all cells. This self-regulating system plays a pivotal role in synchronizing physiological and behavioral responses, ensuring an adaptive metabolism within the environmental milieu, including dietary and physical activity habits. The systemic integration of circadian homeostasis involves a balance of biological rhythms, each synchronically linked to the central circadian clock. Central to this orchestration is the temporal dimension of nutrient and food intake, an aspect closely interwoven with the neuroendocrine circuit, gut physiology, and resident microbiota. Indeed, the timing of meals exerts a profound influence on cell cycle regulation through genomic and epigenetic processes, particularly those involving gene expression, DNA methylation and repair, and non-coding RNA activity. These (epi)genomic interactions involve a dynamic interface between circadian rhythms, nutrition, and the gut microbiota, shaping the metabolic and immune landscape of the host. This research endeavors to illustrate the intricate (epi)genetic interplay that modulates the synchronization of circadian rhythms, nutritional signaling, and the gut microbiota, unravelling the repercussions on metabolic health while suggesting the potential benefits of feed circadian realignment as a non-invasive therapeutic strategy for systemic metabolic modulation via gut microbiota. This exploration delves into the interconnections that underscore the significance of temporal eating patterns, offering insights regarding circadian rhythms, gut microbiota, and chrono-nutrition interactions with (epi)genomic phenomena, thereby influencing diverse aspects of metabolic, well-being, and quality of life outcomes.
Collapse
Affiliation(s)
| | - Amanda Cuevas-Sierra
- Precision Nutrition Program, Research Institute on Food and Health Sciences IMDEA Food, CSIC-UAM, 28049 Madrid, Spain;
| | - Vitória Felício Souto
- Department of Nutrition at the Federal University of Pernambuco, Recife 50670-901, PE, Brazil; (N.C.d.O.M.); (V.F.S.)
| | - J. Alfredo Martínez
- Precision Nutrition Program, Research Institute on Food and Health Sciences IMDEA Food, CSIC-UAM, 28049 Madrid, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centre of Medicine and Endocrinology, University of Valladolid, 47002 Valladolid, Spain
| |
Collapse
|
10
|
Whiteoak B, Dawson SL, Callaway L, de Jersey S, Eley V, Evans J, Kothari A, Navarro S, Gallegos D. Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study. Nutrients 2024; 16:1319. [PMID: 38732568 PMCID: PMC11085356 DOI: 10.3390/nu16091319] [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: 03/24/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = -1.9, -3.6, and -5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = -0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49-0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19-0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.
Collapse
Affiliation(s)
- Bree Whiteoak
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD 4059, Australia;
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
- QIMR Berghofer Medical Research Institute, 300 Herston Rd., Herston, QLD 4006, Australia
| | - Samantha L. Dawson
- Food & Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia;
| | - Leonie Callaway
- Women’s and Newborns Services, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia;
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
| | - Susan de Jersey
- Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia;
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia
| | - Victoria Eley
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
| | - Joanna Evans
- Maternity Services, Caboolture Hospital, McKean Street, Caboolture, QLD 4510, Australia;
| | - Alka Kothari
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
- Redcliffe Hospital, Anzac Avenue, Redcliffe, QLD 4020, Australia
| | - Severine Navarro
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
- QIMR Berghofer Medical Research Institute, 300 Herston Rd., Herston, QLD 4006, Australia
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD 4059, Australia;
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
| |
Collapse
|
11
|
Subasinghe AK, Black KI, Dorney E, Boyle JA. Assessing preconception health in Australia to support better outcomes in the first 2000 days - A critical need for building a core indicator framework. Aust N Z J Obstet Gynaecol 2024. [PMID: 38641973 DOI: 10.1111/ajo.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/20/2024] [Indexed: 04/21/2024]
Abstract
In 2021, the Preconception Health Network Australia co-developed preconception health core indicators identified as critical to ensuring optimal maternal and child outcomes following conception. We conducted an audit of perinatal databases across each state and territory to identify whether preconception core indicator data were available. Seven health domains co-developed by the Preconception Health Network were mapped against the data collected in the perinatal databases. Indicator data were lacking across all seven health domains, with data missing for social determinants of health indicators. Better data linkage and developing a national evidence-based framework would allow ongoing monitoring of women's preconception health nationally.
Collapse
Affiliation(s)
- Asvini K Subasinghe
- Department of Health Systems and Equity, Eastern Health Clinical SchoolMonash University, Melbourne, Victoria, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, New South Wales, Australia
| | - Edwina Dorney
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline A Boyle
- Department of Health Systems and Equity, Eastern Health Clinical SchoolMonash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Abualsaud RM, Aldhubabian NA, Alharthi AM, Alzahrani MA, Balto GE, Malak MM. The impact of the COVID-19 pandemic on reproductive intentions and contraceptive use among females in Jeddah, Saudi Arabia. Int J Gynaecol Obstet 2024. [PMID: 38634286 DOI: 10.1002/ijgo.15542] [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: 12/06/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Pandemics have affected many people's social and emotional lives. Conception planning, contraceptive usage, and pregnancy intentions are activities with minimal research. This study is the first to evaluate how the COVID-19 pandemic influenced reproductive plans and contraceptive use among women during the pandemic in Jeddah, Saudi Arabia, in 2022. METHODS A cross-sectional survey was conducted by sending an online questionnaire to married women from Jeddah, Saudi Arabia. The questionnaire included demographics, personal obstetrics information, changes in pregnancy intentions owing to the COVID-19 pandemic, and questions about contraceptive usage. Qualitative data were presented as frequencies, and a χ2 test was performed to determine the relationships among the variables. RESULTS A total of 639 women enrolled in the study; most participants were 25-34 years old, and most indicated they changed their reproductive intentions during the pandemic (49%). Family planning accounted for 25.8% of participants who changed their reproductive intentions. Only 17.5% changed their choices because of fear of the COVID-19 impact. The percentage of women using contraception was significantly reduced during the lockdown, to 36.8%. Oral contraceptive pills were the most frequently used method during the curfew period (17.5%). CONCLUSION The COVID-19 lockdown affected the reproductive intentions of most women in Jeddah, and it significantly reduced contraceptive use.
Collapse
Affiliation(s)
- Renad M Abualsaud
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | | | | | - Mohammed M Malak
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
13
|
Hall JA, Wilkinson K, Haddon C, Barrett G. How, when, and who should ask about pregnancy intentions in primary care? A qualitative study of women's preferences. Fam Pract 2024; 41:131-138. [PMID: 38124485 PMCID: PMC11017777 DOI: 10.1093/fampra/cmad114] [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] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND For health services to help people plan for or prevent pregnancy, health professionals need an acceptable way to identify individuals' preferences. OBJECTIVE To assess women's views on the acceptability of specific questions about pregnancy preferences when asked by health professionals in a variety of primary care contexts. METHODS One-to-one in-depth interviews with 13 women aged 18-48 from across the UK, involving role-play scenarios and ranking exercises. Interviews covered a range of settings and health professionals, different question wording, and ways of asking (in person or digitally). We conducted a thematic Framework Analysis, focussing on themes relating to feelings and preferences. RESULTS Women were generally open to being asked about pregnancy preferences if they understood the rationale, it was asked in a relevant context, such as in women's health-related consultations, and there was follow-up. After signposting, an open question, such as 'How would you feel about having a baby in the next year?' was preferred in a face-to-face context as it enabled discussion. While some women valued a face-to-face discussion with a health professional, for others the privacy and convenience of a digital option was preferred; methods should be tailored to the target population. CONCLUSION Discussion of pregnancy preferences via a range of formats is acceptable to, and valued by, women in the UK across a range of primary care settings. Acceptability to health professionals and feasibility of implementation needs further exploration and would benefit from greater public awareness of the benefits of pregnancy planning.
Collapse
Affiliation(s)
- Jennifer A Hall
- UCL EGA Institute for Women’s Health, Reproductive Health Research Department, Sexual and Reproductive Health Research Team, London, United Kingdom
| | | | | | - Geraldine Barrett
- UCL EGA Institute for Women’s Health, Reproductive Health Research Department, Sexual and Reproductive Health Research Team, London, United Kingdom
| |
Collapse
|
14
|
Gaillard R. Optimising gestational weight gain among pregnant women with obesity. Lancet 2024; 403:1423-1425. [PMID: 38555926 DOI: 10.1016/s0140-6736(24)00470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Romy Gaillard
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Paediatrics, Sophia Children's Hospital, Erasmus University Medical Center, 3015 CN Rotterdam, Netherlands.
| |
Collapse
|
15
|
Guo R, Feng R, Yang J, Xiao Y, Yin C. Genetic correlation and Mendelian randomization analyses support causal relationships between dietary habits and age at menarche. Sci Rep 2024; 14:8425. [PMID: 38600095 PMCID: PMC11006932 DOI: 10.1038/s41598-024-58999-4] [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: 06/12/2023] [Accepted: 04/05/2024] [Indexed: 04/12/2024] Open
Abstract
Dietary habits are essential in the mean age at menarche (AAM). However, the causal relationship between these factors remains unclear. Therefore, this study aimed to elucidate the genetic relationship between dietary habits and AAM. Genetic summary statistics for dietary habits were obtained from the UK Biobank. GWAS summary data for AAM was obtained from the ReproGen Consortium. Linkage disequilibrium score regression was used to test genetic correlations between dietary habits and AAM. The Mendelian randomization (MR) analyses used the inverse-variance weighted method. Genetic correlations with AAM were identified for 29 candi-date dietary habits, such as milk type (skimmed, semi-skimmed, full cream; coefficient = 0.2704, Pldsc = 1.13 × 10-14). MR evaluations revealed that 19 dietary habits were associated with AAM, including bread type (white vs. any other; OR 1.71, 95% CI 1.28-2.29, Pmr = 3.20 × 10-4), tablespoons of cooked vegetables (OR 0.437, 95% CI 0.29-0.67; Pmr = 1.30 × 10-4), and cups of coffee per day (OR 0.72, 95% CI 0.57-0.92, Pmr = 8.31 × 10-3). These results were observed to be stable under the sensitivity analysis. Our study provides potential insights into the genetic mechanisms underlying AAM and evidence that dietary habits are associated with AAM.
Collapse
Affiliation(s)
- Ruilong Guo
- Department of Pediatrics, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, 710054, Shanxi, China
| | - Ruoyang Feng
- Department of Joint Surgery, Xi'an Jiaotong University Hong Hui Hospital, Xi'an, 710054, Shanxi, China
| | - Jiong Yang
- Department of Pediatrics, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, 710054, Shanxi, China
| | - Yanfeng Xiao
- Department of Pediatrics, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, 710054, Shanxi, China.
| | - Chunyan Yin
- Department of Pediatrics, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, 710054, Shanxi, China.
| |
Collapse
|
16
|
Coppi F, Bucciarelli V, Solodka K, Selleri V, Zanini G, Pinti M, Nasi M, Salvioli B, Nodari S, Gallina S, Mattioli AV. The Impact of Stress and Social Determinants on Diet in Cardiovascular Prevention in Young Women. Nutrients 2024; 16:1044. [PMID: 38613078 PMCID: PMC11013318 DOI: 10.3390/nu16071044] [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: 02/17/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
The prevention of cardiovascular diseases is a fundamental pillar for reducing morbidity and mortality caused by non-communicable diseases. Social determinants, such as socioeconomic status, education, neighborhood, physical environment, employment, social support networks, and access to health care, play a crucial role in influencing health outcomes and health inequities within populations. Social determinants and stress in women are interconnected factors that can significantly impact women's health and well-being. Pregnancy is a good time to engage young women and introduce them to beneficial behaviors, such as adopting essential life skills, especially diet, and learning stress management techniques. Stress influences diet, and women are more likely to engage in unhealthy eating behaviors such as emotional eating or coping with stress with food. Strong action is needed to improve women's lifestyle starting at a young age considering that this lays the foundation for a lower cardiovascular risk in adults and the elderly. The objective of this review is to examine cardiovascular primary prevention in young healthy women, focusing particularly on unresolved issues and the influence of social determinants, as well as the correlation with stressors and their influence on diet.
Collapse
Affiliation(s)
- Francesca Coppi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60166 Ancona, Italy;
| | - Kateryna Solodka
- Istituto Nazionale per le Ricerche Cardiovascolari, 40126 Bologna, Italy (M.P.); (S.G.)
| | - Valentina Selleri
- Department of Life Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (V.S.); (G.Z.)
| | - Giada Zanini
- Department of Life Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (V.S.); (G.Z.)
| | - Marcello Pinti
- Istituto Nazionale per le Ricerche Cardiovascolari, 40126 Bologna, Italy (M.P.); (S.G.)
- Department of Life Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (V.S.); (G.Z.)
| | - Milena Nasi
- Department of Surgical, Medical and Dental Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Beatrice Salvioli
- Department of Quality of Life Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy;
| | - Sabina Gallina
- Istituto Nazionale per le Ricerche Cardiovascolari, 40126 Bologna, Italy (M.P.); (S.G.)
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66013 Chieti, Italy
| | - Anna Vittoria Mattioli
- Istituto Nazionale per le Ricerche Cardiovascolari, 40126 Bologna, Italy (M.P.); (S.G.)
- Department of Quality of Life Sciences, University of Bologna, 40126 Bologna, Italy;
| |
Collapse
|
17
|
Dorney E, I Black K, Haas M, Street D, Church J. The preferences of people in Australia to respond and engage with advertisements to promote reproductive health: Results of a discrete choice experiment. Prev Med Rep 2024; 40:102657. [PMID: 38444564 PMCID: PMC10912617 DOI: 10.1016/j.pmedr.2024.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Objectives The health of people prior to pregnancy impacts pregnancy outcomes and childhood health, making the preconception period an important time to optimise health behaviours. Low awareness of the importance of this issue is a recognised barrier to achieving good preconception health. Public health messaging can help to address this barrier. Methods A discrete choice experiment to assess the preferences of people of reproductive age for a health promotion advertisement for preconception health was conducted. Attributes of the advertisement image, title, additional text content and positioning, and the location of advertisement were assessed by fitting a mixed logit model to the choices made. Results Three hundred and thirty-four responses were obtained, from people of reproductive age, both planning and not planning a pregnancy, in Australia. Participants placed most importance on the image, and the location in which they saw the advertisement. An image of adult and baby hands was preferred to adult hands only, and healthcare settings were preferred to more general media locations such as advertising online or on public transport. Preference was also given to the advertisement title of "Healthy you, Healthy baby", closely followed by "Are you ready for pregnancy?". The location and content of additional text did not significantly impact engagement with the advertisement. Conclusion The image and title on the advertisement, and the locations in which they are placed were the most significant features to impact engagement with a health promotion advertisement for preconception health. This can inform health promotion efforts for preconception health.
Collapse
Affiliation(s)
- Edwina Dorney
- Faculty of Medicine and Health, Central Clinical School, The Tavern, The University of Sydney, Medical Foundation Building K25, Sydney, New South Wales 2006, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, Central Clinical School, The Tavern, The University of Sydney, Medical Foundation Building K25, Sydney, New South Wales 2006, Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, New South Wales 2007, Australia
| | - Deborah Street
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, New South Wales 2007, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, New South Wales 2007, Australia
| |
Collapse
|
18
|
Saavedra LPJ, Piovan S, Moreira VM, Gonçalves GD, Ferreira ARO, Ribeiro MVG, Peres MNC, Almeida DL, Raposo SR, da Silva MC, Barbosa LF, de Freitas Mathias PC. Epigenetic programming for obesity and noncommunicable disease: From womb to tomb. Rev Endocr Metab Disord 2024; 25:309-324. [PMID: 38040983 DOI: 10.1007/s11154-023-09854-w] [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] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
Several epidemiological, clinical and experimental studies in recent decades have shown the relationship between exposure to stressors during development and health outcomes later in life. The characterization of these susceptible phases, such as preconception, gestation, lactation and adolescence, and the understanding of factors that influence the risk of an adult individual for developing obesity, metabolic and cardiovascular diseases, is the focus of the DOHaD (Developmental Origins of Health and Disease) research line. In this sense, advancements in molecular biology techniques have contributed significantly to the understanding of the mechanisms underlying the observed phenotypes, their morphological and physiological alterations, having as a main driving factor the epigenetic modifications and their consequent modulation of gene expression. The present narrative review aimed to characterize the different susceptible phases of development and associated epigenetic modifications, and their implication in the development of non-communicable diseases. Additionally, we provide useful insights into interventions during development to counteract or prevent long-term programming for disease susceptibility.
Collapse
Affiliation(s)
- Lucas Paulo Jacinto Saavedra
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Silvano Piovan
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Veridiana Mota Moreira
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Gessica Dutra Gonçalves
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Anna Rebeka Oliveira Ferreira
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Maiara Vanusa Guedes Ribeiro
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Maria Natália Chimirri Peres
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Douglas Lopes Almeida
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Scarlett Rodrigues Raposo
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Mariane Carneiro da Silva
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Letícia Ferreira Barbosa
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil
| | - Paulo Cezar de Freitas Mathias
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, 5790 Av Colombo, Sala 19, Maringá, PR, 87020-900, Brazil.
| |
Collapse
|
19
|
Cheney K, Mignacca E, Black KI, Homer C, Bradfield Z. An exploration of the contraceptive counselling practices of midwives who provide postpartum care in Australia. Midwifery 2024; 131:103948. [PMID: 38335692 DOI: 10.1016/j.midw.2024.103948] [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: 06/03/2023] [Revised: 12/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE We sought to explore and describe midwives' attitudes and practices relating to their provision of postpartum contraception counselling. DESIGN We used an exploratory cross-sectional design. Recruitment used an anonymous online survey using electronic communication platforms of professional, and special-interest organisations, over six months . Descriptive and quantitative analysis was used. SETTING AND PARTICIPANTS Australian Midwives who provide postpartum care. MEANING AND FINDINGS A total of 289 complete responses were included. Findings from this national survey of midwives showed that almost 75% of Australian midwives reported providing some contraceptive advice to women. Those working in continuity of care models were significantly more likely to fulfil this responsibility. More than half (67%) indicated they had not received any formal contraception education or training. Those working in private obstetric-led settings were significantly less likely to have received education compared to midwives in community settings. Systems barriers preventing the provision of contraceptive counselling included: clinical workload; lack of management support; lack of education; and models of care. KEY CONCLUSIONS Most midwives (82%) wanted to provide postpartum contraception counselling as part of their role. They cited barriers from within the health system, ambiguity about roles and responsibilities and offered solutions to improve the provision of postnatal contraception counselling. IMPLICATIONS FOR PRACTICE Recommendations include the development of education programs for midwives. Continuity of care models provided the time, autonomy and opportunity for midwives to undertake contraceptive counselling and fulfil this part of their professional scope. Consideration should be given to expanding access and provision of continuity of midwifery care. An urgent investment in the education and skills of midwives is recommended to ensure all women across acute and community services benefit from improved outcomes associated with pregnancy spacing.
Collapse
Affiliation(s)
- Kate Cheney
- The Sydney School of Nursing and Midwifery, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia.
| | - Emily Mignacca
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
| | - Kirsten I Black
- The Sydney Medical School, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne 3004, Australia
| | - Zoe Bradfield
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
| |
Collapse
|
20
|
Benedetto C, Borella F, Divakar H, O'Riordan SL, Mazzoli M, Hanson M, O'Reilly S, Jacobsson B, Conry JA, McAuliffe FM. FIGO Preconception Checklist: Preconception care for mother and baby. Int J Gynaecol Obstet 2024; 165:1-8. [PMID: 38426290 DOI: 10.1002/ijgo.15446] [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] [Indexed: 03/02/2024]
Abstract
The preconception period is a unique and opportunistic time in a woman's life when she is motivated to adopt healthy behaviors that will benefit her and her child, making this time period a critical "window of opportunity" to improve short- and long-term health. Improving preconception health can ultimately improve both fetal and maternal outcomes. Promoting health before conception has several beneficial effects, including an increase in seeking antenatal care and a reduction in neonatal mortality. Preconception health is a broad concept that encompasses the management of chronic diseases, including optimal nutrition, adequate consumption of folic acid, control of body weight, adoption of healthy lifestyles, and receipt of appropriate vaccinations. Use of the FIGO Preconception Checklist, which includes the key elements of optimal preconception care, will empower women and their healthcare providers to better prepare women and their families for pregnancy.
Collapse
Affiliation(s)
- Chiara Benedetto
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
- FIGO Committee on Well Woman Health Care, London, UK
| | - Fulvio Borella
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
| | - Hema Divakar
- FIGO Committee on Well Woman Health Care, London, UK
| | - Sarah L O'Riordan
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- FIGO Committee on the Impact of Pregnancy on Long-Term Health, London, UK
| | - Martina Mazzoli
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Sharleen O'Reilly
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Bo Jacobsson
- FIGO Division of Maternal and Newborn Health, London, UK
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Jeanne A Conry
- The Environmental Health Leadership Foundation, California, USA
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- FIGO Committee on the Impact of Pregnancy on Long-Term Health, London, UK
| |
Collapse
|
21
|
Jin F, Sun J, Yang Y, Li R, Luo M, Huang Q, Liu X. Development and validation of a clinical model to predict preconception risk of gestational diabetes mellitus in nulliparous women: A retrospective cohort study. Int J Gynaecol Obstet 2024; 165:256-264. [PMID: 37787506 DOI: 10.1002/ijgo.15134] [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: 01/25/2023] [Revised: 08/12/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To develop and validate a model to predict the preconception risk of gestational diabetes mellitus (GDM) in nulliparous women. METHODS This was a retrospective cohort study. A total of 1565 women in early pregnancy who underwent preconception health examinations in the Women and Children's Hospital of Chongqing Medical University between January 2020 and June 2021 were invited to participate in a questionnaire survey. Logistic regression analysis was performed to determine the preconception risk factors for GDM. These factors were used to construct a model to predict GDM risk in nulliparous women. Then, the model was used to assess the preconception risk of GDM in 1060 nulliparous women. RESULTS Independent preconception risk factors for GDM included the following: age 35 years or greater, diastolic blood pressure 80 mm Hg or greater, fasting plasma glucose 5.1 mmol/L or greater, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) 24 or greater, weight gain 10 kg or greater in the year before pregnancy, age of menarche 15 years or greater, three or more previous pregnancies, daily staple food intake 300 g or greater, fondness for sweets, and family history of diabetes. BMI less than 18.5, daily physical activity duration 1 h or greater, and high-intensity physical activity were protective factors. These factors were used to construct a model to predict GDM risk in nulliparous women, and the incidence of GDM significantly increased as the risk score increased. The area under the curve of the prediction model was 0.82 (95% confidence interval 0.80-0.85). CONCLUSION The preconception GDM risk prediction model demonstrated good predictive efficacy and can be used to identify populations at high risk of GDM before pregnancy, which provides the possibility for preconception intervention.
Collapse
Affiliation(s)
- Fengzhen Jin
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- National Key Clinical Specialty Construction Project (Obstetrics and Gynecology), Chongqing, China
- Chongqing Research Center for Prevention & Control of Maternal and Child Diseases and Public Health, Chongqing, China
| | - Junjie Sun
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- National Key Clinical Specialty Construction Project (Obstetrics and Gynecology), Chongqing, China
- Chongqing Research Center for Prevention & Control of Maternal and Child Diseases and Public Health, Chongqing, China
| | - Yuanpei Yang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- National Key Clinical Specialty Construction Project (Obstetrics and Gynecology), Chongqing, China
- Chongqing Research Center for Prevention & Control of Maternal and Child Diseases and Public Health, Chongqing, China
| | - Ruiyue Li
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- National Key Clinical Specialty Construction Project (Obstetrics and Gynecology), Chongqing, China
- Chongqing Research Center for Prevention & Control of Maternal and Child Diseases and Public Health, Chongqing, China
| | - Mi Luo
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qiao Huang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Liu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- National Key Clinical Specialty Construction Project (Obstetrics and Gynecology), Chongqing, China
- Chongqing Research Center for Prevention & Control of Maternal and Child Diseases and Public Health, Chongqing, China
| |
Collapse
|
22
|
Soepnel LM, Norris SA, Mabetha K, Motlhatlhedi M, Nkosi N, Lye S, Draper CE. A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002578. [PMID: 38483881 PMCID: PMC10939222 DOI: 10.1371/journal.pgph.0002578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
Community health workers (CHWs) play an important role in health systems in low- and middle-income countries, including South Africa. Bukhali is a CHW-delivered intervention as part of a randomised controlled trial, to improve the health trajectories of young women in Soweto, South Africa. This study aimed to qualitatively explore factors influencing implementation of the preconception and pregnancy phases of Bukhali, from the perspective of the CHWs (Health Helpers, HHs) delivering the intervention. As part of the Bukhali trial process evaluation, three focus group discussions were conducted with the 13 HHs employed by the trial. A thematic approach was used to analyse the data, drawing on elements of a reflexive thematic and codebook approach. The following six themes were developed, representing factors impacting implementation of the HH roles: interaction with the existing public healthcare sector; participant perceptions of health; health literacy and language barriers; participants' socioeconomic constraints; family, partner, and community views of trial components; and the HH-participant relationship. HHs reported uses of several trial-based tools to overcome implementation challenges, increasing their ability to implement their roles as planned. The relationship of trust between the HH and participants seemed to function as one important mechanism for impact. The findings supported a number of adaptations to the implementation of Bukhali, such as intensified trial-based follow-up of referrals that do not receive management at clinics, continued HH training and community engagement parallel to trial implementation, with an increased emphasis on health-related stigma and education. HH perspectives on intervention implementation highlighted adaptations across three broad strategic areas: navigating and bridging healthcare systems, adaptability to individual participant needs, and navigating stigma around disease. These findings provide recommendations for the next phases of Bukhali, for other CHW-delivered preconception and pregnancy trials, and for the strengthening of CHW roles in clinical settings with similar implementation challenges. Trial registration: Pan African Clinical Trials Registry; PACTR201903750173871, Registered March 27, 2019.
Collapse
Affiliation(s)
- Larske M. Soepnel
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Shane A. Norris
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Khuthala Mabetha
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nokuthula Nkosi
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Lye
- Department of Physiology and Medicine, Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Catherine E. Draper
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
23
|
Omoto T, Kyozuka H, Murata T, Fukuda T, Isogami H, Okoshi C, Yasuda S, Yamaguchi A, Sato A, Ogata Y, Nagasaka Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K, The Japan Environment And Children's Study Group. Association between Preconception Dietary Fiber Intake and Preterm Birth: The Japan Environment and Children's Study. Nutrients 2024; 16:713. [PMID: 38474840 DOI: 10.3390/nu16050713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. Therefore, this study aimed to determine whether preconception dietary fiber intake is associated with PTB. This was a prospective cohort Japan Environmental and Children's Study (JECS). The study population comprised 85,116 singleton live-birth pregnancies from the JECS database delivered between 2011 and 2014. The participants were categorized into five groups based on their preconception dietary fiber intake quintiles (Q1 and Q5 were the lowest and highest groups, respectively). Multiple logistic regression analysis was performed to determine the association between preconception dietary fiber intake and PTB. Multiple logistic regression analysis revealed that the risk for PTB before 34 weeks was lower in the Q3, Q4, and Q5 groups than in the Q1 group (Q3: adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.62-0.997; Q4: aOR 0.74, 95% CI 0.57-0.95; Q5: aOR 0.68, 95% CI 0.50-0.92). However, there was no significant difference between preconception dietary fiber intake and PTB before 37 weeks. In conclusion, higher preconception dietary fiber intake correlated with a reduced the risk for PTB before 34 weeks. Therefore, new recommendations on dietary fiber intake as part of preconception care should be considered.
Collapse
Affiliation(s)
- Takahiro Omoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hirotaka Isogami
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Chihiro Okoshi
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
| | - Yuichi Nagasaka
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima 960-1295, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | | |
Collapse
|
24
|
Jokelainen M, Kautiainen H, Nenonen A, Stach-Lempinen B, Klemetti MM. First-trimester HbA 1c in relation to plasma glucose concentrations in an oral glucose tolerance test at 12 to 16 weeks' gestation-a population-based study. Diabetol Metab Syndr 2024; 16:53. [PMID: 38414049 PMCID: PMC10898079 DOI: 10.1186/s13098-024-01290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Early-onset GDM often requires pharmacological treatment and is associated with adverse perinatal outcomes, but data is insufficient regarding the best methods to identify high-risk women requiring early GDM screening. The aim of this study was to analyze the diagnostic accuracy of HbA1c in the prediction of (1) plasma glucose concentrations > 90th percentile in an oral glucose tolerance test (OGTT) at 12-16 weeks' gestation; and (2) pharmacologically treated early- or late-onset GDM. METHODS HbA1c was measured at 8-14 weeks' gestation in a population-based cohort of 1394 Finnish women recruited for the Early Diagnosis of Diabetes in Pregnancy (EDDIE) study between 3/2013 and 12/2016. Information on maternal risk factors were collected at recruitment. Subsequently, a 2-hour 75 g OGTT was performed at 12-16 weeks' gestation (OGTT1), and if normal, repeated at 24-28 weeks' gestation (OGTT2). Early- and late-onset GDM were diagnosed using the same nationally endorsed cut-offs for fasting, 1 h- and 2 h-plasma glucose: ≥5.3, ≥ 10.0mmol/l, and/or ≥ 8.6mmol/l, respectively. In total, 52/1394 (3.7%) women required metformin or insulin treatment for GDM, including 39 women with early-onset GDM diagnosed at OGTT1 and 13 women with late-onset GDM diagnosed at OGTT2. RESULTS Maternal early-pregnancy HbA1c ≥ 35mmol/mol (≥ 5.4%) was the best cut-off to predict fasting or post-load plasma glucose > 90th percentile in OGTT1, but its diagnostic accuracy was low [AUC (95% CI) 0.65 (0.62 to 0.69), sensitivity 0.55 (0.49 to 0.60) and specificity 0.67 (0.64 to 0.70)] both alone and in combination with other maternal risk factors. However, HbA1c ≥ 35mmol/mol correlated positively with plasma glucose concentrations at all time points of OGTT1 and predicted pharmacologically treated GDM diagnosed at OGTT1 or OGTT2; AUC (95% CI) 0.75 (0.68 to 0.81), sensitivity 0.75 (0.61 to 0.86), specificity 0.64 (0.61 to 0.66). CONCLUSIONS In our population-based cohort, early-pregnancy HbA1c ≥ 35mmol/mol was positively associated with fasting and post-load plasma glucose concentrations in an OGTT at 12-16 weeks' gestation and predicted pharmacologically-treated early- and late-onset GDM, suggesting potential utility in first-trimester identification of women at high risk of severe GDM subtypes.
Collapse
Affiliation(s)
- Mervi Jokelainen
- Obstetrics and Gynecology, South Karelia Central Hospital, Valto Käkelän katu 1, Lappeenranta, 53130, Finland
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Centre, Haartmaninkatu 8, Helsinki, 000290, Finland
- Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, Kuopio, FI, 70029 KYS, Finland
| | - Arja Nenonen
- Laboratory Center, South Karelia Central Hospital, Valto Käkelän katu 1, Lappeenranta, 53130, Finland
| | - Beata Stach-Lempinen
- Obstetrics and Gynecology, South Karelia Central Hospital, Valto Käkelän katu 1, Lappeenranta, 53130, Finland
| | - Miira M Klemetti
- Obstetrics and Gynecology, South Karelia Central Hospital, Valto Käkelän katu 1, Lappeenranta, 53130, Finland.
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland.
| |
Collapse
|
25
|
Ruiz OA, Ancira-Moreno M, Omaña-Guzmán I, Cordero SH, Morales ACB, Navarro CP, Méndez SB, Flores EM, Trejo A, Kaufer-Horwitz M, Cajero A, Sánchez B, Bernat C, Salgado-Amador E, Hoyos-Loya E, Mazariegos M, Manrique CM, Cruz RP, Mendoza E, Brero M, Sachse M, Armijo FC. Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders. Int J Equity Health 2024; 23:35. [PMID: 38388936 PMCID: PMC10885649 DOI: 10.1186/s12939-024-02129-z] [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: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. METHODS We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. RESULTS Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. CONCLUSIONS These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.
Collapse
Affiliation(s)
- Omar Acosta Ruiz
- Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Monica Ancira-Moreno
- Health Department, Universidad Iberoamericana, Mexico City, Mexico.
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico.
| | - Isabel Omaña-Guzmán
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México, "Dr. Eduardo Liceaga,", Mexico City, Mexico
| | - Sonia Hernández Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | | | | | - Soraya Burrola Méndez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Eric Monterrubio Flores
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Trejo
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Martha Kaufer-Horwitz
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ariana Cajero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Belén Sánchez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Constanza Bernat
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Elder Salgado-Amador
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Cinthya Muñoz Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Royer Pacheco Cruz
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Instituto de Nutrición, Universidad de la Sierra Sur, Oaxaca, México
| | - Elvia Mendoza
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Matthias Sachse
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Fernanda Cobo Armijo
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| |
Collapse
|
26
|
Brammall BR, Garad RM, Teede HJ, Baker SE, Harrison CL. OptimalMe Program: A Mixed Method Investigation into the Engagement and Acceptability of a Preconception Digital Health Lifestyle Intervention with Individual Coaching for Women's Health and Behaviour Change. Nutrients 2024; 16:572. [PMID: 38474701 DOI: 10.3390/nu16050572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
Preconception interventions, specifically addressing general health, lifestyle behaviours and weight management, are limited despite their importance in optimising women's health. The objective of this study is to evaluate the engagement and acceptability of OptimalMe, a digital preconception intervention. Participants, (n = 298) Australian women aged 18-44 with private health insurance planning to conceive within 12 months, received a standardised intervention, including access to a digital healthy lifestyle platform (educational materials, behaviour change activities, and self-monitoring resources), ongoing text messaging, and remotely delivered health coaching (two appointments) with randomised delivery methods (telephone/videoconference). Engagement and acceptability were assessed through mixed method analyses. The results show that 76.2% attended both coaching sessions, with similar participation rates for telehealth (75.2%) and videoconferencing (77.2%) (p = 0.469). All participants logged into the digital platform, with 90.6% accessing educational materials and 91.3% using behaviour change tools. Digital platform engagement declined over time, suggesting potential benefits from additional health coaching support for ongoing participation. The post-intervention evaluation (n = 217 participants) demonstrated that approximately 90% found the digital module engaging, meeting information needs, would recommend the program, and were satisfied with the support. OptimalMe demonstrated positive acceptability and engagement; however, further research is warranted to explore strategies for sustaining engagement with the digital interventions.
Collapse
Affiliation(s)
- Bonnie R Brammall
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Rhonda M Garad
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Susanne E Baker
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia
| |
Collapse
|
27
|
Hörnell A, Lagström H. Infant feeding-a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10456. [PMID: 38370110 PMCID: PMC10870977 DOI: 10.29219/fnr.v68.10456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/11/2022] [Accepted: 12/20/2023] [Indexed: 02/20/2024] Open
Abstract
The 2012 edition of the Nordic Nutrition Recommendations (NNR) included recommendations on breastfeeding, based on the most recent guidelines and recommendations from major national food and health authorities and organizations, systematic reviews, and some original research. For NNR 2023, the scope has been expanded and also includes formula feeding and the introduction of solid food. The main focus in this scoping review is on infants aged 0-12 months but also considers parts both before and beyond the first year, as the concept of 'the first 1000 days' emphasizes the importance of factors during pregnancy and the first 2 years of life for immediate and later health: physical as well as emotional and mental health. Breastmilk is the natural and sustainable way to feed an infant during the first months of life. Numerous studies have indicated immediate as well as long-term beneficial effects of breastfeeding on health for both the infant and the breastfeeding mother, and from a public health perspective, it is therefore important to protect, support, and promote breastfeeding. For full-term, normal weight infants, breastmilk is sufficient as the only form of nutrition for the first 6 months, except for vitamin D that needs to be given as supplement. The World Health Organization (WHO) and several other authoritative bodies therefore recommend exclusive breastfeeding during the first 6 months. Starting solids at about 6 months is necessary for both nutritional and developmental reasons. According to the European Food Safety Authority (EFSA) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), solid foods are safe to give from 4 months although exclusive breastfeeding until 6 months is the desirable goal. Breastfeeding can continue together with complementary foods as long as it is mutually desired by the mother and child. If breastfeeding is not enough or for some reason discontinued before the infant is 4 months of age, the infant should be fed infant formula, and, when possible, breastfeeding should be continued alongside the formula feeding. If the infant is 4 months or older, starting with solids together with continued breastfeeding and/or formula feeding is an option. Infant formulas have been developed for infants who are not breastfed or do not get enough breastmilk. Home-made formula should not be given.
Collapse
Affiliation(s)
- Agneta Hörnell
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
| | - Hanna Lagström
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
28
|
Lewis K, Carter LS, Bradley A, Dewhurst R, Forde N, Hyde R, Kaler J, March MD, Mason C, O'Grady L, Strain S, Thompson J, Green M. Quantification of the effect of in-utero events on lifetime resilience in dairy cows. J Dairy Sci 2024:S0022-0302(24)00062-6. [PMID: 38310963 DOI: 10.3168/jds.2023-24215] [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: 09/19/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024]
Abstract
Currently, the dairy industry is facing many challenges that could affect its sustainability, including climate change and public perception of the industry. As a result, interest is increasing in the concept of identifying resilient animals, those with a long productive lifespan, good reproductive performance and milk yield. There is much evidence that events in utero, i.e., the Developmental Origins of Health and Disease (DOHaD), alter life-course health of offspring and we hypothesized that these could alter resilience in calves, where resilience is identified using lifetime data. The aim of this study was to quantify lifetime resilience scores (LRS) using an existing scoring system based on longevity with secondary corrections for age at first calving and calving interval and to quantify the effects of in-utero events on the LRS using 2 data sets. The first was a large data set of cattle in 83 farms in Great Britain born from 2006 to 2015 and the second was a smaller, more granular data set of cattle born between 2003 and 2015 in the Langhill research herd at Scotland's Rural College. Events during dam's pregnancy included health events (lameness, mastitis, use of an antibiotic or anti-inflammatory medication), the impact of heat stress as measured by temperature-humidity index and perturbations in milk yield and quality (somatic cell count, percentage fat, percentage protein and fat:protein ratio). Daughters born to dams that experienced higher temperature-humidity indexes while they were in-utero during the first and third trimesters of pregnancy had lower LRS. Daughter LRS scores were also lower where milk yields or median fat percentages in the first trimester were low, and when milk yields were high in the third trimester. Dam LRS was positively associated with LRS of their offspring, however, as parity of the dam increased, LRS of their calves decreased. Similarly, in the Langhill herd, dams of a higher parity produced calves with lower LRS. Additionally, dams which recorded a high max locomotion score in the third trimester of pregnancy were negatively associated with lower calf LRS in the Langhill herd. Our results suggest that events that occur during pregnancy have lifelong consequences for the calf's lifetime performance. However, experience of higher temperature-humidity indexes, higher dam LRS scores and mothers in higher parities explained a relatively small proportion of variation in offspring LRS, which suggests that other factors play a substantial role in determining calf LRS scores. While 'big data' can contain a considerable amount of noise, similar findings between the 2 data sets indicate it is likely these findings are real.
Collapse
Affiliation(s)
- Kate Lewis
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom.
| | | | - Andrew Bradley
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom; Quality Milk Management Services, Cedar Barn, Easton, Wells, United Kingdom
| | | | - Niamh Forde
- Discovery and Translational Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Robert Hyde
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Jasmeet Kaler
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | | | - Colin Mason
- Scotland's Rural College, Edinburgh, United Kingdom
| | - Luke O'Grady
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Sam Strain
- Animal Health and Welfare Northern Ireland
| | - Jake Thompson
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Martin Green
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
29
|
Xia Y, Huang L, Long Z, Chen Y, Gao L, Hua R, Li S, Wang Y. The association of preconceptional folic acid supplementation with gestational age and preterm birth risk in twin pregnancies: a prospective cohort study in China. Eur J Nutr 2024; 63:107-119. [PMID: 37733259 DOI: 10.1007/s00394-023-03223-8] [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: 08/28/2022] [Accepted: 07/24/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE This study aims to explore the association of maternal preconceptional folic acid (FA) supplementation with gestational age and preterm birth in twin pregnancies, and whether the association varies by chorionicity or conception mode. METHODS From November 2018 to December 2021, the information of FA supplementation and pregnancy outcomes were collected in twin pregnant women. The linear regression models and the logistic regression were used to test the association of preconceptional FA supplementation with gestational age at delivery and preterm birth and premature rupture of membranes (PROM). RESULTS A total of 416 twin pregnancies were included. Compared with no use in twins, maternal preconceptional FA use was associated with a 0.385-week longer gestational age (95% CI 0.019-0.751) and lower risk of preterm birth < 36 weeks (adjusted OR 0.519; 95% CI 0.301-0.895) and PROM (adjusted OR 0.426; 95% CI 0.215-0.845). The protective effect on preterm birth < 36 weeks and PROM is similar whether taking FA supplements alone or multivitamins. However, the associations varied by chorionicity and conception mode of twins or compliance with supplementation. The positive associations between preconceptional FA use and gestational age only remained significant among twins via assisted reproductive technology or dichorionic diamniotic twins. Significant protective effects on preterm birth < 36 weeks and PROM were only found among women who took FA at least 4 times a week before conception. CONCLUSION Maternal preconceptional FA supplementation was associated with longer gestation duration and lower risk of preterm birth < 36 weeks and PROM in twin pregnancies. To improve the success of their pregnancies, reproductive women should start taking FA supplements well before conception and with good compliance.
Collapse
Affiliation(s)
- Yuanqing Xia
- Division of Maternal-Fetal Fetal Medicine, Prenatal Diagnosis Department, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Xuhui District, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China
| | - Lili Huang
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - Zichong Long
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - Yiting Chen
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - Li Gao
- Division of Maternal-Fetal Fetal Medicine, Prenatal Diagnosis Department, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Xuhui District, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China
| | - Renyi Hua
- Division of Maternal-Fetal Fetal Medicine, Prenatal Diagnosis Department, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Xuhui District, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Huangpu District, Shanghai, 200025, China.
| | - Yanlin Wang
- Division of Maternal-Fetal Fetal Medicine, Prenatal Diagnosis Department, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Xuhui District, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
- Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China.
| |
Collapse
|
30
|
Sneed NM, Heerman WJ, Shaw PA, Han K, Chen T, Bian A, Pugh S, Duda S, Lumley T, Shepherd BE. Associations Between Gestational Weight Gain, Gestational Diabetes, and Childhood Obesity Incidence. Matern Child Health J 2024; 28:372-381. [PMID: 37966561 PMCID: PMC10922599 DOI: 10.1007/s10995-023-03853-8] [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] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Excessive maternal gestational weight gain (GWG) is strongly correlated with childhood obesity, yet how excess maternal weight gain and gestational diabetes mellitus (GDM) interact to affect early childhood obesity is poorly understood. The purpose of this study was to investigate whether overall and trimester-specific maternal GWG and GDM were associated with obesity in offspring by age 6 years. METHODS A cohort of 10,335 maternal-child dyads was established from electronic health records. Maternal weights at conception and delivery were estimated from weight trajectory fits using functional principal components analysis. Kaplan-Meier curves and Cox regression, together with generalized raking, examined time-to-childhood-obesity. RESULTS Obesity diagnosed prior to age 6 years was estimated at 19.7% (95% CI: 18.3, 21.1). Maternal weight gain during pregnancy was a strong predictor of early childhood obesity (p < 0.0001). The occurrence of early childhood obesity was lower among mothers with GDM compared with those without diabetes (adjusted hazard ratio = 0.58, p = 0.014). There was no interaction between maternal weight gain and GDM (p = 0.55). Higher weight gain during the first trimester was associated with lower risk of early childhood obesity (p = 0.0002) whereas higher weight gain during the second and third trimesters was associated with higher risk (p < 0.0001). DISCUSSION Results indicated total and trimester-specific maternal weight gain was a strong predictor of early childhood obesity, though obesity risk by age 6 was lower for children of mothers with GDM. Additional research is needed to elucidate underlying mechanisms directly related to trimester-specific weight gain and GDM that impede or protect against obesity prevalence during early childhood.
Collapse
Affiliation(s)
- Nadia M Sneed
- Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA.
- Center for Research Development and Scholarship, Vanderbilt University School of Nursing, 319E Godchaux Hall, Nashville, TN, 37240, USA.
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA
| | - Pamela A Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, USA
| | - Kyunghee Han
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, 851 S Morgan St, 503 Science and Engineering Offices, Chicago, IL, 60607, USA
| | - Tong Chen
- Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA
| | - Shannon Pugh
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Stephany Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Nashville, TN, 37203, USA
| | - Thomas Lumley
- Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA
| |
Collapse
|
31
|
Bodnar LM, Kirkpatrick SI, Parisi SM, Jin Q, Naimi AI. Periconceptional Dietary Patterns and Adverse Pregnancy and Birth Outcomes. J Nutr 2024; 154:680-690. [PMID: 38122847 PMCID: PMC10900249 DOI: 10.1016/j.tjnut.2023.12.013] [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: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The periconceptional period is a critical window for the origins of adverse pregnancy and birth outcomes, yet little is known about the dietary patterns that promote perinatal health. OBJECTIVE We used machine learning methods to determine the effect of periconceptional dietary patterns on risk of preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age (SGA) birth, and a composite of these outcomes. METHODS We used data from 8259 participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (8 US medical centers, 2010‒2013). Usual daily periconceptional intake of 82 food groups was estimated from a food frequency questionnaire. We used k-means clustering with a Euclidean distance metric to identify dietary patterns. We estimated the effect of dietary patterns on each perinatal outcome using targeted maximum likelihood estimation and an ensemble of machine learning algorithms, adjusting for confounders including health behaviors and psychological, neighborhood, and sociodemographic factors. RESULTS The 4 dietary patterns that emerged from our data were identified as "Sandwiches and snacks" (34% of the sample); "High fat, sugar, and sodium" (29%); "Beverages, refined grains, and mixed dishes" (21%); and "High fruits, vegetables, whole grains, and plant proteins" (16%). One-quarter of pregnancies had preeclampsia (8% incidence), gestational diabetes (5%), preterm birth (8%), or SGA birth (8%). Compared with the "High fat, sugar, and sodium" pattern, there were 3.3 to 4.3 fewer cases of the composite adverse outcome per 100 pregnancies among participants following the "Beverages, refined grains and mixed dishes" pattern (risk difference -0.043; 95% confidence interval -0.078, -0.009), "High fruits, vegetables, whole grains and plant proteins" pattern (-0.041; 95% confidence interval -0.078, -0.004), and "Sandwiches and snacks" pattern (-0.033; 95% confidence interval -0.065, -0.002). CONCLUSIONS Our results highlight that there are a variety of periconceptional dietary patterns that are associated with perinatal health and reinforce the negative health implications of diets high in fat, sugars, and sodium.
Collapse
Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Sara M Parisi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Qianhui Jin
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ashley I Naimi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| |
Collapse
|
32
|
Xu J, Wang H, Bian J, Xu M, Jiang N, Luo W, Zu P, Yin W, Zhu P. Association between the Maternal Mediterranean Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100159. [PMID: 38042258 PMCID: PMC10801312 DOI: 10.1016/j.advnut.2023.100159] [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: 06/01/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Abstract
The Mediterranean diet is a global, well-known healthy dietary pattern. This review aims to synthesize the existing evidence on the relationship between the maternal Mediterranean diet during pregnancy and perinatal outcomes, including randomized controlled trials (RCTs) and cohort studies. PubMed, Web of Science, and the Cochrane Library were searched from inception to 10 March, 2023, supplemented by manual screening. A random-effect model was used to estimate pooled sizes with 95% confidence intervals (CIs) for specific outcomes of interest. Data from 5 RCTs and 18 cohort studies with 107,355 pregnant participants were synthesized. In RCTs, it was observed that the maternal Mediterranean diet significantly reduced the incidence of gestational diabetes mellitus [odds ratio (OR), 0.56; 95% CI: 0.34, 0.93], as well as small for gestational age (0.55; 95% CI: 0.35, 0.88). In cohort studies, the highest adherence score to the maternal Mediterranean diet was inversely associated with a lower risk of various adverse pregnancy outcomes, including gestational diabetes mellitus (OR, 0.82; 95% CI: 0.67, 1.00), pregnancy-induced hypertension (0.73; 95% CI: 0.60, 0.89), pre-eclampsia (0.77; 95% CI: 0.64, 0.93), preterm delivery (0.67; 95% CI: 0.49, 0.91), low birth weight (0.70; 95% CI: 0.64, 0.78), intrauterine growth restriction (0.46; 95% CI: 0.23, 0.91), and increased gestational age at delivery (weighted mean difference, 0.11 wk; 95% CI: 0.03, 0.20). Meta-regression analyses did not identify the adjustment for confounders and geographical location as predictive factors for heterogeneity. The results suggest that adherence to the Mediterranean diet during pregnancy appears to be beneficial for perinatal outcomes. Future, larger, and higher-quality RCTs and cohort studies are warranted to confirm the present findings. PROSPERO registration no.: CRD42023406317.
Collapse
Affiliation(s)
- Jirong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China; Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China
| | - Haixia Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Jingfeng Bian
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ming Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Nan Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Wei Luo
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ping Zu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Wanjun Yin
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China; Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China.
| |
Collapse
|
33
|
Sandsæter HL, Eik-Nes TT, Getz LO, Haugdahl HS, Magnussen EB, Rich-Edwards JW, Horn J. Weight development from childhood to motherhood-embodied experiences in women with pre-pregnancy obesity: a qualitative study. Reprod Health 2024; 21:15. [PMID: 38291504 PMCID: PMC10826130 DOI: 10.1186/s12978-024-01742-z] [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: 08/02/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Pre-pregnancy obesity increases the risk of perinatal complications. Post-pregnancy is a time of preparation for the next pregnancy and lifestyle advice in antenatal care and postpartum follow-up is therefore recommended. However, behavioral changes are difficult to achieve, and a better understanding of pregnant women's perspectives and experiences of pre-pregnancy weight development is crucial. METHODS We used a qualitative design and conducted semi-structured interviews with 14 women in Norway with pre-pregnancy obesity 3-12 months postpartum. Data were analyzed using thematic analysis. RESULTS Four themes addressing women's experiences and understanding of their weight development were generated: (1) Unmet essential needs, (2) Genetic predisposition for obesity, challenging life course transitions and turning points, (3) Under a critical eye: an ever-present negative bodily awareness, and (4) Wrestling with food. Parents' inability to meet children's essential needs caused weight gain through an unbalanced diet, increased stress, and emotional eating patterns. Body criticism and a feeling of not belonging led to negative body awareness that influenced behavioral patterns and relationships. Participants reporting having had a good childhood more often described their weight development as a result of genetic predisposition, challenging life course transitions and turning points, such as illness and injuries. Nevertheless, these participants also described how eating patterns were influenced by stress and negative emotions. CONCLUSIONS Healthcare providers should pay attention to the insider perspectives of pre-pregnancy weight development. An open and shared understanding of the root causes of these women's weight development can form a basis for more successful lifestyle guidance.
Collapse
Affiliation(s)
- Heidi L Sandsæter
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
| | - Trine Tetlie Eik-Nes
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway
| | - Linn Okkenhaug Getz
- Research Unit for General Practice, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hege S Haugdahl
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Elisabeth Balstad Magnussen
- Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Janet W Rich-Edwards
- Division of Women's Health and Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiologi, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julie Horn
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| |
Collapse
|
34
|
Gan Y, Chen Y, Zhong H, Liu Z, Geng J, Wang H, Wang W. Gut microbes in central nervous system development and related disorders. Front Immunol 2024; 14:1288256. [PMID: 38343438 PMCID: PMC10854220 DOI: 10.3389/fimmu.2023.1288256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/22/2023] [Indexed: 02/15/2024] Open
Abstract
The association between gut microbiota and central nervous system (CNS) development has garnered significant research attention in recent years. Evidence suggests bidirectional communication between the CNS and gut microbiota through the brain-gut axis. As a long and complex process, CNS development is highly susceptible to both endogenous and exogenous factors. The gut microbiota impacts the CNS by regulating neurogenesis, myelination, glial cell function, synaptic pruning, and blood-brain barrier permeability, with implication in various CNS disorders. This review outlines the relationship between gut microbiota and stages of CNS development (prenatal and postnatal), emphasizing the integral role of gut microbes. Furthermore, the review explores the implications of gut microbiota in neurodevelopmental disorders, such as autism spectrum disorder, Rett syndrome, and Angelman syndrome, offering insights into early detection, prompt intervention, and innovative treatments.
Collapse
Affiliation(s)
- Yumeng Gan
- Department of Infectious Disease and Hepatic Disease, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yao Chen
- Department of Infectious Disease and Hepatic Disease, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Huijie Zhong
- Department of Infectious Disease and Hepatic Disease, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Zhuo Liu
- Department of Infectious Disease and Hepatic Disease, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jiawei Geng
- Department of Infectious Disease and Hepatic Disease, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Huishan Wang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Wenxue Wang
- Department of Infectious Disease and Hepatic Disease, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
- School of Basic Medicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| |
Collapse
|
35
|
Maslin K, Hart KH, Shawe J. Tackling the dual burden of malnutrition in pregnancy - pregnancy after weight loss surgery. Proc Nutr Soc 2024:1-9. [PMID: 38240086 DOI: 10.1017/s0029665124000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively; however, there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required, and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review, we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.
Collapse
Affiliation(s)
- Kate Maslin
- School of Nursing and Midwifery, University of Plymouth, Plymouth, Devon, UK
- Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, UK
| | - Kathryn H Hart
- School of Biosciences, University of Surrey, Guildford, UK
| | - Jill Shawe
- School of Nursing and Midwifery, University of Plymouth, Plymouth, Devon, UK
- Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
| |
Collapse
|
36
|
Steel A, Gibson H, Adams J, Schoenaker D. What preconception health services would the public find when searching the internet in Australia?: results from a simulated internet-search study. BMC Health Serv Res 2024; 24:93. [PMID: 38233803 PMCID: PMC10795199 DOI: 10.1186/s12913-024-10559-2] [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: 04/14/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Australian preventive health strategy outlines the importance of preconception health in improving health in the community, across multiple generations and places primary and community healthcare services as a central pillar to effective preconception care. However, there is no national implementation plan to see preconception care proactively offered in healthcare settings in Australia. Instead, there is evidence that most women search the internet for information about pregnancy planning and preparation. In response, this study explores the availability and characteristics of health services found by searching for preconception care online in Australia. METHOD Simulated Google searches were conducted using search terms 'preconception' and the name of a city/town with a population > 50,000. Related terms, 'fertility' and 'pregnancy' were also searched. Characteristics of the health services and the information available on relevant websites were extracted and reported descriptively. RESULTS The searches identified 831 website links, including 430 websites for health services. The health services were most often located in cities/towns with populations equal to or less than 200 000 (54.2%), and housing multiple health professionals (69.8%) including a specialist doctor (66.5%), nurse (20.9%), psychologist/counsellor (2.0%) and/or naturopath (13.0%). All the health services identified online explicitly mentioned women among their target populations, while 69.1% (n = 297) also referred to providing services for men or partners. More than one third of websites included blogs (36.9%) while external links were included in 10.8% of the online sites. CONCLUSIONS This study provides a preliminary examination of health services that may be found through internet-based searching by Australian consumers seeking health advice or support prior to becoming pregnant. Our descriptive results suggest couples may find a variety of health professionals when seeking health services for preconception care. Future research involving co-design of search terms with consumers, ongoing monitoring of health services and ensuring access to meaningful, and accurate information found through internet-searching are all necessary to ensure people of reproductive age are able to access the preconception health information and care they need.
Collapse
Affiliation(s)
- Amie Steel
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Harriet Gibson
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
37
|
Brammall BR, Garad RM, Teede HJ, Harrison CL. Evaluating Preconception Health and Behaviour Change in Australian Women Planning a Pregnancy: The OptimalMe Program, a Digital Healthy Lifestyle Intervention with Remotely Delivered Coaching. Nutrients 2024; 16:155. [PMID: 38201984 PMCID: PMC10780803 DOI: 10.3390/nu16010155] [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: 12/05/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
OptimalMe is a digital healthy lifestyle intervention for women planning a pregnancy, with remotely delivered coaching. This follow-up study of Australian women, stratified by coaching delivery mode (phone vs. videoconferencing), assessed alignment to preconception care guidelines and self-reported behaviour change. Overall, 298 women enrolled with a mean (SD) age of 31.8 (4.3) years and mean BMI of 25.7 (6.1) kg/m2. Suboptimal preconception behaviours were reported at baseline, including alcohol consumption (57.2%), infrequent weighing (37.2%) and incomplete cervical cancer screening (15.8%) and prenatal supplementation (38.5). At follow-up (4.5 months) (n = 217), a statistically significant shift towards desired behaviours was reported for alcohol consumption (z = -2.6045, p = 0.00932), preconception supplementation (z = -2.7288, p = 0.00634) and frequent weight monitoring (z = -5.2911, p < 0.00001). An insignificant shift towards adherence to cervical cancer screening (z = -1.8679, p = 0.06148) was observed, with a positive trend towards adherence. Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy and general health and lifestyle improvement. Women demonstrated improvement in lifestyle behaviours and self-monitoring, indicating the uptake of low-intensity, non-prescriptive information provision. Supporting the provision of knowledge-enhancing tools and general healthy lifestyle information combines with skilled health coaching as an effective method for behaviour change and self-management. OptimalMe also shows significant improvements in rates of healthcare engagement, which suggests coaching-based digital health interventions may decrease women's barriers for preconception care and improve engagement in clinical settings.
Collapse
Affiliation(s)
| | | | | | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, Monash University and Monash Health, Melbourne, VIC 3168, Australia; (B.R.B.); (R.M.G.); (H.J.T.)
| |
Collapse
|
38
|
Fraga ACSA, Bastos MP, Theme-Filha MM. Increased consumption of ultra-processed foods during pregnancy is associated with sociodemographic, behavioral, and obstetric factors: A cohort study. Nutr Res 2024; 121:28-38. [PMID: 38039599 DOI: 10.1016/j.nutres.2023.10.006] [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: 05/19/2023] [Revised: 10/28/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
A diet based on ultra-processed food (UPF) does not meet nutritional needs, especially during pregnancy. The aim of this study is to assess the change in UPF consumption from preconception to pregnancy and associated factors. Our hypothesis is that women tend to adopt a healthier eating pattern during pregnancy, decreasing the intake of UPF and increasing the intake of unprocessed/minimally processed foods. A prospective cohort study with 326 participants was carried out from 2016 to 2019 in 2 health units in Rio de Janeiro, Brazil. Pregestational food consumption assessed using the food frequency questionnaire in the prenatal interview in women up to 20 gestational weeks and gestational consumption in the interview 2 months after delivery. Food items classified according to the NOVA system. For the mean variation from preconception to gestational UPF consumption, we used the generalized estimating equations model with linear distribution. Control of confounding variables was based on the literature on factors associated with UPF consumption, using a 3-level hierarchical model. The proportion of UPF energy consumption was 28.9% in preconception and 33% during pregnancy. Older and more educated women had a lower mean variation in the consumption of UPF during the pregnancy. A higher average consumption of UPF observed among women physically inactive before pregnancy, who smoked during pregnancy, were multiparous, and with had a low pregestational weight. These results reflect similar behavior to that of the general population, aggravated by a significant increase during pregnancy. However, older and more educated women and those with healthy behaviors showed lower UPF intake in pregnancy.
Collapse
|
39
|
Valen EN, Øverby NC, Hardy‐Johnson P, Vik FN, Salvesen L, Omholt ML, Barker ME, Hillesund ER. Lessons learned from talking with adults about nutrition: A qualitative study in the PREPARED project. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 2:e13540. [PMID: 37277971 PMCID: PMC10765357 DOI: 10.1111/mcn.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Improving diet and dietary behaviour of men and women before pregnancy has the potential to benefit both their current and long-term health and the health of their children. Little is known, however, about adults' perception of diet's role in prepregnancy health. This study aimed to explore the state of knowledge and awareness of preconception nutritional health in adults within the fertile age range and what they perceived could motivate healthy eating using the self-determination theory as a theoretical framework. We analysed 33 short exploratory interviews with men (n = 18) and women (n = 15) aged 18-45 years. Participants were grab sampled from three different public locations in the southern part of Norway. Interviews were audio-recorded, transcribed verbatim in 2020 and analysed using a thematic analysis with a semantic approach in 2022. The findings suggest that adults within the fertile age range are not intrinsically motivated to eat healthily, but when they do, it is because eating healthily often aligns with other goals consistent with their values, that is, getting fit or looking good. They possess some basic knowledge of healthy behaviours during pregnancy but are generally unaware of the importance of preconception health and nutrition. There is a need to increase awareness of the impact of preconception health on the health of this and future generations. Improved nutritional education on the significance of diet before conception might facilitate optimal conditions for conceiving and for pregnancy in the adult population within fertile age range.
Collapse
Affiliation(s)
- Erlend N. Valen
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Polly Hardy‐Johnson
- Medical Research Council Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Frøydis N. Vik
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Lorentz Salvesen
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Mona L. Omholt
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Mary Elizabeth Barker
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
- Medical Research Council Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Elisabet R. Hillesund
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| |
Collapse
|
40
|
Leader J, Mínguez-Alarcón L, Williams PL, Ford JB, Dadd R, Chagnon O, Bellinger DC, Oken E, Calafat AM, Hauser R, Braun JM. Paternal and maternal preconception and maternal pregnancy urinary phthalate metabolite and BPA concentrations in relation to child behavior. ENVIRONMENT INTERNATIONAL 2024; 183:108337. [PMID: 38088019 PMCID: PMC10868726 DOI: 10.1016/j.envint.2023.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Epidemiologic studies on health effects of parental preconception exposures are limited despite emerging evidence from toxicological studies suggesting that such exposures, including to environmental chemicals, may affect offspring health. OBJECTIVE We investigated whether maternal and paternal preconception and maternal pregnancy urinary phthalate metabolite and bisphenol A (BPA) concentrations were associated with child behavior. METHODS We analyzed data from the Preconception Environmental exposure And Childhood health Effects (PEACE) Study, an ongoing prospective cohort study of children aged 6-11 years whose parent(s) previously enrolled in the prospective preconception Environment and Reproductive Health (EARTH) study. Using linear mixed models, we estimated covariate-adjusted associations of 11 urinary phthalate metabolite and BPA concentrations collected prior to conception and during pregnancy with Behavioral Assessment System for Children-3 (BASC-3) T-scores (higher scores indicate more problem behaviors). RESULTS This analysis included 134 mothers, 87 fathers and 157 children (24 sets of twins); parents were predominantly non-Hispanic white (mothers and fathers86%). Higher maternal preconception or pregnancy monobenzyl phthalate (MBzP) concentrations were related to higher mean externalizing problems T-scores in their children (β = 1.3 per 1-loge unit increase; 95 % CI: -0.2, 2.4 and β = 2.1, 95 % CI: 0.7, 3.6, respectively). Higher maternal preconception monocarboxyoctyl phthalate (MCOP) was suggested to be related to lower mean externalizing problems T-scores (β = -0.9; 95 % CI: -1.8, 0.0). Higher paternal preconception MCOP was suggestively associated with lower internalizing problems (β = -0.9; 95 %CI:-1.9, 0.1) and lower Behavioral Symptoms Index (BSI) T-scores (β = -1.3; 95 % CI: -2.1, -0.4). CONCLUSION In this cohort, higher maternal preconception and pregnancy MBzP were associated with worse parent-reported child behavior, while higher maternal and paternal preconception MCOP concentrations were related to lower BASC-3 scores.
Collapse
Affiliation(s)
- Jordana Leader
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
| | - Paige L Williams
- Departments of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramace Dadd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olivia Chagnon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David C Bellinger
- Research Director Emeritus, Cardiac Neurodevelopment Program, Boston Children's Hospital, Boston, MA, USA; Professor of Neurology and Psychology, Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russ Hauser
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| |
Collapse
|
41
|
Pan K, Jukic AM, Mishra GD, Mumford SL, Wise LA, Schisterman EF, Ley SH, Charlton BM, Chavarro JE, Hart JE, Sidney S, Xiong X, Barbosa-Leiker C, Schliep K, Shaffer JG, Bazzano LA, Harville EW. The association between preconception cannabis use and gestational diabetes mellitus: The Preconception Period Analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium. Paediatr Perinat Epidemiol 2024; 38:69-85. [PMID: 37751914 PMCID: PMC11000150 DOI: 10.1111/ppe.13008] [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: 02/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis. OBJECTIVES We aimed to assess the association between preconception cannabis use and GDM incidence. METHODS We analysed individual-level data from eight prospective cohort studies. We identified the first, or index, pregnancy (lasting ≥20 weeks of gestation with GDM status) after cannabis use. In analyses of pooled individual-level data, we used logistic regression to estimate study-type-specific odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders using random effect meta-analysis to combine study-type-specific ORs and 95% CIs. Stratified analyses assessed potential effect modification by preconception tobacco use and pre-pregnancy body mass index (BMI). RESULTS Of 17,880 participants with an index pregnancy, 1198 (6.7%) were diagnosed with GDM. Before the index pregnancy, 12.5% of participants used cannabis in the past year. Overall, there was no association between preconception cannabis use in the past year and GDM (OR 0.97, 95% CI 0.79, 1.18). Among participants who never used tobacco, however, those who used cannabis more than weekly had a higher risk of developing GDM than those who did not use cannabis in the past year (OR 2.65, 95% CI 1.15, 6.09). This association was not present among former or current tobacco users. Results were similar across all preconception BMI groups. CONCLUSIONS In this pooled analysis of preconception cohort studies, preconception cannabis use was associated with a higher risk of developing GDM among individuals who never used tobacco but not among individuals who formerly or currently used tobacco. Future studies with more detailed measurements are needed to investigate the influence of preconception cannabis use on pregnancy complications.
Collapse
Affiliation(s)
- Ke Pan
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Anne Marie Jukic
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Gita D. Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Sunni L. Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Enrique F. Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sylvia H. Ley
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Brittany M. Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorge E. Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Xu Xiong
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Karen Schliep
- Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emily W. Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| |
Collapse
|
42
|
Zheng S, Armstrong HL. Exploring the association between sexual motivation and quality of life in China and the United Kingdom. PLoS One 2023; 18:e0293566. [PMID: 38117797 PMCID: PMC10732451 DOI: 10.1371/journal.pone.0293566] [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: 07/21/2023] [Accepted: 10/15/2023] [Indexed: 12/22/2023] Open
Abstract
Previous research suggests that different sexual motivations may be associated with different sexual behaviours and levels of sexual satisfaction, and these may vary with cultural differences. As such, sexual motivations and cultural factors might also be associated with quality of life (QoL); however, this has not yet been explored. Using a biopsychosocial approach, this study aimed to explore associations between sexual motivation and quality of life between participants in the United Kingdom and China. 276 participants (143 British, 133 Chinese, mean age = 21.5 years) completed an anonymous online survey including validated measures for sexual motivation (YSEX?-SF) and QoL (WHOQOL-BREF). In multivariable linear regressions, pleasure motivations for sex were associated with increased physical health QoL (aOR = 0.20, 95%CI:.15-.65), while love and commitment motivations were associated with increased psychological health QoL (aOR = 0.13, 95%CI:.01-.43). Both love and commitment motivations (aOR = 0.21, 95%CI:.09-.35) and pleasure motivations (aOR = 0.20, 95%CI:.08-.36) were associated with increased social support QoL. A significant interaction was found between emotional motivations and culture (p = 0.037) such that among individuals from China, emotional motivations (i.e., love and commitment and expression) were positively associated with psychological QoL. This suggests culture may differentially affect how sexual motivations are associated with QoL and warrants further consideration in future research.
Collapse
Affiliation(s)
- Shijun Zheng
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
43
|
Onayemi OM, Hapunda G. Socio-ecological drivers of vulnerabilities of children living within orphan homes and the implications for their nurturance care. Front Public Health 2023; 11:1203510. [PMID: 38148875 PMCID: PMC10749914 DOI: 10.3389/fpubh.2023.1203510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023] Open
Abstract
At the heart of the Sustainable Development Goals (SDG) is the vision to "leave no one behind, and to see that all children survive, thrive and transform. However, some categories of children may remain left behind owing to their disproportionate exposure to the risk of threats and deficit of attention to the social and ecological climate that characterizes the various systems in which they are found. This study is concerned with one major question: Despite diverse local and international instruments that favor full nurturance and development of children, what social forces play as threat to full nurturance care in the context of children living in Orphan homes? Nurturing care framework and Brofenbrener's ecological system theory were adopted as the analytical frameworks. Research design was exploratory. Data were collected through sessions of in-depth-interview with orphanage managers, caregivers, and social workers on the socio-ecology drivers of threat to children living within the orphan home space and its implications for nurturance care across the various complex systems of the child's environment. The study found various factors across the complex systems of child development - microsystem, mesosystem, exosystem, microsysm and lastly, chronosystem- which undermine caregivers' delivery and increases children's vulnerability and risk of missing out on effective nurturance care. These vulnerabilities are endemic realities of social, and bio-ecologcal space in which child development occurs. This study recommends specialized interventions and policy directives relevant for each identified threat. It also calls for a stronger political will in improving the conditions of this category of the children while within the orphan home space and ultimately, actions towards deinstitutionalization of children.
Collapse
Affiliation(s)
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| |
Collapse
|
44
|
AlWatban L, Alamer E. Are physicians creating a barrier to pre-conception care access? A qualitative study exploring patients' experiences and perspectives around pre-conception care. BMC Womens Health 2023; 23:651. [PMID: 38062409 PMCID: PMC10702085 DOI: 10.1186/s12905-023-02820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The pre-conception period is an unmissable opportunity to introduce preventive measures before pregnancy to improve maternal and fetal outcomes. Despite the global pre-conception initiatives and the 2030 Saudi national vision to promote maternal, fetal health and safety, various barriers still exist. This study focuses on exploring pre-conception care extensively from the patients' perspectives and their experience in accessing this type of care in the primary care setting. METHODS A qualitative study using interpretive thematic analysis was used to explore patients' perspectives, and experiences in accessing pre-conception care in the city of Riyadh from January 2019 to January 2020. A semi-structured interview guide and field notes were used to collect data. A step wise interpretive and iterative process was used for data analysis and thematic extraction. Theme saturation was achieved by the eleventh interview. RESULTS The participants' perspectives were influenced by their cultural beliefs, understanding of pre-conception, and their prevised barriers to approaching physicians. Three main themes emerged: A) Acceptance of pre-conception care; was heavily influenced by how they understood and defined per-conception care. B) Pre-conception health seeking behavior; demonstrated a clear disconnect between the patient and the physician. C) Expectation from health services; to raise awareness about pre-conception care and push physicians to initiate the conversation with their patients. CONCLUSIONS An appreciable gap in the patient-physician relationship was revealed as a source of inconsistency in accessing pre-conception care. Physicians are encouraged to take the first step in demonstrating to their patients both the importance of pre-conception care and their intent to offer respectful, empathetic, and culturally appropriate care.
Collapse
Affiliation(s)
- Lemmese AlWatban
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Family Medicine Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ebtihal Alamer
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia.
| |
Collapse
|
45
|
Pai H, Tayade S, Sharma S, Pai A, Vaz RP, Lahariya C. Pre-Conceptional and Antenatal Care for Improved Newborn and Child Survival in India: A Review. Indian J Pediatr 2023; 90:10-19. [PMID: 37700121 DOI: 10.1007/s12098-023-04841-0] [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: 04/21/2023] [Accepted: 06/23/2023] [Indexed: 09/14/2023]
Abstract
There is sufficient scientific evidence that quality pre-conceptional care and antenatal care can improve newborn survival. This review was conducted to understand the concept of pre-conceptional care and its implementation status in India. The review documents the specific interventions that have been proven to effectively improve pregnancy outcome when provided as pre-conception care. Healthcare providers, particularly obstetricians/gynecologists and general physicians, should prioritize pre-conception care as an essential component of healthcare for women. However, the lack of continuum of care and program linkages are some of the key barriers in ensuring pre-conceptional and ante-natal care in India. Culturally and linguistically appropriate care should be provided to ensure that all women can access and understand the information and services needed to optimize their reproductive health and improve pregnancy outcomes. Prioritizing pre-conception and prenatal care, healthcare providers can improve maternal and fetal outcomes, reduce healthcare costs, and promote lifelong health for women and their families. The primary healthcare reforms being done in India can be and should be used to strengthen pre-conceptional and ante-natal care services and quality.
Collapse
Affiliation(s)
- Hrishikesh Pai
- National President, Federation of Obstetrics and Gynecological Societies of India (FOGSI), Mumbai, India
- Blooms Hospital, Mumbai, India
| | - Surekha Tayade
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, DMIHER, Sawangi (Meghe), Wardha, 442102, India.
| | - Sakshi Sharma
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, DMIHER, Sawangi (Meghe), Wardha, 442102, India
| | - Arnav Pai
- Department of Obstetrics and Gynecology, DY Patil Medical College, Mumbai, India
| | - Rodney P Vaz
- Foundation for People-centric Health Systems, Safdarjung Enclave, New Delhi, 110029, India
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, 110001, India
| | - Chandrakant Lahariya
- Foundation for People-centric Health Systems, Safdarjung Enclave, New Delhi, 110029, India
| |
Collapse
|
46
|
Wang S, Mitsunami M, Ortiz-Panozo E, Leung CW, Manson JE, Rich-Edwards JW, Chvarro JE. Prepregnancy Healthy Lifestyle and Adverse Pregnancy Outcomes. Obstet Gynecol 2023; 142:1278-1290. [PMID: 37826849 PMCID: PMC10840639 DOI: 10.1097/aog.0000000000005346] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate the association of healthy lifestyle factors before pregnancy (body mass index [BMI] 18.5-24.9, nonsmoking, 150 min/wk or more of moderate-to-vigorous physical activity, healthy eating [top 40% of Dietary Approaches to Stop Hypertension score], no or low-to-moderate alcohol intake [less than 15 g/d], and use of multivitamins) with risk of adverse pregnancy outcomes. METHODS We conducted a secondary analysis of prospectively collected data for women without chronic diseases who are participating in an ongoing cohort in the United States (the NHSII [Nurses' Health Study II]). Healthy lifestyle factors preceding pregnancy were prospectively assessed every 2-4 years from 1991 to 2009 with validated measures. Reproductive history was self-reported in 2001 and 2009. A composite outcome of adverse pregnancy outcomes that included miscarriage, ectopic pregnancy, gestational diabetes, gestational hypertension, preeclampsia, preterm birth, stillbirth, or low birth weight was assessed. RESULTS Overall, 15,509 women with 27,135 pregnancies were included. The mean maternal age was 35.1±4.2 years. Approximately one in three pregnancies (n=9,702, 35.8%) was complicated by one or more adverse pregnancy outcomes. The combination of six low-risk factors was inversely associated with risk of adverse pregnancy outcomes in a dose-dependent manner ( P for trend <.001). Compared with women who had zero or one healthy lifestyle factor, those with six had a 37% lower risk of adverse pregnancy outcomes (relative risk 0.63, 95% CI 0.55-0.72), driven primarily by lower risks of gestational diabetes, gestational hypertension, and low birth weight. All prepregnancy healthy lifestyle factors, except avoiding harmful alcohol consumption and regular physical activity, were independently associated with lower risk of adverse pregnancy outcomes after mutual adjustment for each other. Healthy BMI, high-quality diet, and multivitamin supplementation showed the strongest inverse associations with adverse pregnancy outcomes. If the observed relationships were causal, 19% of adverse pregnancy outcomes could have been prevented by the adoption of all six healthy lifestyle factors (population attributable risk 19%, 95% CI 13-26%). CONCLUSION Prepregnancy healthy lifestyle is associated with a substantially lower risk of adverse pregnancy outcomes and could be an effective intervention for the prevention of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Siwen Wang
- Department of Nutrition and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, the Division of Women's Health, the Division of Preventive Medicine, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | |
Collapse
|
47
|
Din HN, Strong D, Singh-Carlson S, Corliss HL, Hartman SJ, Madanat H, Su HI. The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study. J Cancer Surviv 2023; 17:1660-1668. [PMID: 36289184 PMCID: PMC10539193 DOI: 10.1007/s11764-022-01281-1] [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: 07/30/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors. METHODS A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations. RESULTS Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior. CONCLUSIONS Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA. IMPLICATIONS FOR CANCER SURVIVORS Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.
Collapse
Affiliation(s)
- Hena Naz Din
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA.
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., La Jolla, CA, 92037, USA
| | - Savitri Singh-Carlson
- School of Nursing, San Diego State University, 5500 Campanile Mall, San Diego, CA, 92182, USA
| | - Heather L Corliss
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Center for Research On Sexuality and Sexual Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., La Jolla, CA, 92037, USA
| | - Hala Madanat
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Division of Research & Innovation, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| |
Collapse
|
48
|
Zhang Y, Zhao Y, Duan Y, Liu C, Yang Z, Duan J, Cui Z. Effects of prepregnancy dietary patterns on infant birth weight: a prospective cohort study. J Matern Fetal Neonatal Med 2023; 36:2273216. [PMID: 37904502 DOI: 10.1080/14767058.2023.2273216] [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: 06/12/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns. OBJECTIVES This study aimed to explore the effects between prepregnancy dietary patterns on birth weight. METHODS This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother-Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI). RESULTS Four dietary patterns were identified based on 15 food groups. These patterns were named as "cereals-vegetables-fruits," "vegetables-poultry-aquatic products," "milk-meat-eggs," and "nuts-aquatic products-snacks." After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the "cereals-vegetables-fruits" pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the "nuts-aquatic products-snacks" pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, "cereals-vegetables-fruits" pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480). CONCLUSIONS An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy.
Collapse
Affiliation(s)
- Yiman Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yongli Zhao
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Yifan Duan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Changqing Liu
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Zhenyu Yang
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Jingtao Duan
- Department of Epidemiology, Wuqiang Center for Disease Control and Prevention, Hengshui, China
| | - Ze Cui
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| |
Collapse
|
49
|
Chopra H, Paul B, Virk A, Pandey G, Lahariya C. Triple Burden of Malnutrition among Children in India: Current Scenario and the Way Forward. Indian J Pediatr 2023; 90:95-103. [PMID: 37505406 DOI: 10.1007/s12098-023-04739-x] [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: 03/08/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023]
Abstract
The triple burden of malnutrition (undernutrition, overnutrition and micronutrient deficiency) or TBM among under-five (U5) children is an increasingly recognised public health challenge. A literature search was conducted to identify studies published from 1976 to 2022, which had focused on information regarding different factors of child malnutrition. The findings were analysed and contextualised from policy and programmatic perspective. There is a high burden of various forms of malnutrition in India. Insufficient dietary intake and illnesses are immediate and most common causes of triple burden of malnutrition (TBM): (undernutrition, overnutrition and micronutrient deficiency). The other key factors associated with the TBM are lifestyle, nutritional practices, unsafe water, food insecurity, lack of sanitation & basic hygiene, unhealthy feeding & caring practices, inadequate health infrastructure, and suboptimal implementation of government nutrition schemes etc. There is scientific evidence that TBM has long term consequences on physical and mental development of children and has high cost to any society. The situation of TBM persists inspite of multiple ongoing government programs to tackle these challenges. The health service provision needs to move from the first 1,000 d to the first 3,000 d as well as focus on the interventions aimed at early childhood development. Multi-sectoral interventions through Anganwadi centres and schools (through education department) need to be conducted. The public health programs and primary healthcare services need to be realigned and health interventions should be implemented along with tackling social determinants of health and sustained community engagement and participation. Tackling TBM should be made a political priority. The life cycle approach for healthier children and society needs to be fully implemented.
Collapse
Affiliation(s)
- Harivansh Chopra
- Indian Association of Preventive & Social Medicine, National Body, India
- Department of Community Medicine, LLRM Medical College, Meerut, UP, India
| | - Bobby Paul
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, India
| | - Amrit Virk
- Department of Community Medicine, Dr. B R Ambedkar State Institute Medical Sciences (AIMS), Mohali, Punjab, India
| | - Gargi Pandey
- Department of Community Medicine, LLRM Medical College, Meerut, UP, India.
| | - Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, India
| |
Collapse
|
50
|
James S, Watson C, Bernard E, Rathnasekara GK, Mazza D. Interconception care in Australian general practice: a qualitative study. Br J Gen Pract 2023; 73:e949-e957. [PMID: 37903638 PMCID: PMC10633660 DOI: 10.3399/bjgp.2022.0624] [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: 12/14/2022] [Accepted: 05/31/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND GPs provide care for women across the lifespan. This care currently includes preconception and postpartum phases of a woman's life. Interconception care (ICC) addresses women's health issues between pregnancies that then have impact on maternal and infant outcomes, such as lifestyle and biomedical risks, interpregnancy intervals, and contraception provision. However, ICC in general practice is not well established. AIM To explore GP perspectives about ICC. DESIGN AND SETTING Qualitative interviews were undertaken with GPs between May and July 2018. METHOD Eighteen GPs were purposively recruited from South-Eastern Australia. Audiorecorded semi- structured interviews were transcribed verbatim and analysed thematically using the Framework Method. RESULTS Most participants were unfamiliar with the concept of ICC. Delivery was mainly opportunistic, depending on the woman's presenting need. Rather than a distinct and required intervention, participants conceptualised components of ICC as forming part of routine practice. GPs described many challenges including lack of clarity about recommended ICC content and timing, lack of engagement and perceived value from mothers, and time constraints during consultations. Facilitators included care continuity and the availability of patient education material. CONCLUSION Findings indicate that ICC is not a familiar concept for GPs, who feel that they have limited capacity to deliver such care. Further research to evaluate patient perspectives and potential models of care is required before ICC improvements can be developed, trialled, and evaluated. These models could include the colocation of multidisciplinary services and services in combination with well-child visits.
Collapse
Affiliation(s)
- Sharon James
- National Health and Medical Research Council Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Victoria; Head, Department of General Practice, Monash University, Victoria
| | - Cathy Watson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Elodie Bernard
- National Health and Medical Research Council Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Victoria; Head, Department of General Practice, Monash University, Victoria
| | - Greasha K Rathnasekara
- National Health and Medical Research Council Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Victoria; Head, Department of General Practice, Monash University, Victoria
| | - Danielle Mazza
- National Health and Medical Research Council Centre of Research Excellence, School of Public Health and Preventive Medicine, Monash University, Victoria; Head, Department of General Practice, Monash University, Victoria
| |
Collapse
|