Diet during pregnancy, neonatal outcomes and later health

Food Records Show Daily Variation in Diet during Pregnancy: Results from the Temporal Research in Eating, Nutrition, and Diet during Pregnancy Study

BACKGROUND

Diet is critical for pregnant individuals and their offspring, but insight into diet during pregnancy mainly comes from questionnaires and recalls.

OBJECTIVES

To obtain detailed real-time dietary data during pregnancy to evaluate intra- and interindividual variation in intakes.

METHODS

Pregnant individuals were recruited from a New York City health system December 2020-June 2023. Participants collected dietary intakes for 14 d (mean gestational weeks = 17.6) and again roughly 4 wk later (mean gestational weeks = 24.5). Participants logged each eating occasion using a smartphone and study-developed app, and wore a smartwatch capturing physiologic data.

RESULTS

In total, 150 individuals completed ≥1 data collection round, with 134 completing both rounds. Mean daily eating window was 10.82 h, with weekends having a significantly shorter window than weekdays (P < 0.001). Eating window was correlated with energy intake (r = 0.401, P < 0.001), driven by later last eating occasions. There was high intraindividual variation in macro- and micronutrient intakes [intraclass correlation coefficient (ICC), range 0.11-0.40] and food type (ICC range: 0.08-0.34), and differences between weekdays and weekends (less protein and micronutrients on weekends). Few participants' mean intakes met daily recommended dietary allowances for key micronutrients (under 15% for iron, magnesium, vitamin D, and vitamin E; under 30% for calcium, folate, zinc, and vitamin A).

CONCLUSIONS

Dietary intakes varied substantially within and between individuals, and mean nutrient intake estimates did not capture nutrient adequacy for individuals or populations. Future work that examines individual daily dietary intakes throughout pregnancy among diverse populations is needed.

What are the changes in mothers' diets after the birth of a child: results from the NutriNet-Santé cohort

Childbirth is a major life-changing event, this period is an opportunity to improve eating habits. The aim of this longitudinal study was to identify and characterise dietary changes in women according to their parity status. Dietary intake data from 4194 women of childbearing age included in the NutriNet-Santé cohort were derived using a FFQ, administered in 2014 and 2018, distinguishing between organic and conventional food consumption. Women were classified into four groups: ‘previous children’, ‘multiparous’, ‘primiparous’ and ‘nulliparous’. Multi-adjusted ANCOVA models were used to estimate the changes according to the parity group. Changes in food consumption towards a more plant-based, healthier and organic diet were observed in all four groups of women, although to various degrees. In multivariable models, ‘Nulliparous’ women showed a greater improvement in terms of ‘sustainable’ food consumption than ‘previous children’ women. ‘Primiparous’ women significantly increased their energy intake (+349 (269–429) kcal/d) and their consumption of dairy products (+30 (3–56) g/d), and they significantly decreased their consumption of alcohol (–23 (–32–15) g/d), coffee and tea (–107 (–155–60) g/d). Regarding organic food, ‘nulliparous’ women increased their consumption more than ‘previous children’ and ‘primiparous’ women were those who were most frequently in the top quintile of organic food increase. Although there were dietary changes in all groups of women according to their parity, childless women have a shift moving towards a more sustainable diet. Women who had a first child reduced their alcohol and caffeine consumption.

Physical Activity and High-Sensitivity C-Reactive Protein in Pregnancy: Does It Matter during Leisure or Work?

INTRODUCTION

Physical activity (PA), regardless of domain, is recommended for pregnant individuals in clinical guidelines, but limited evidence is available for work-related PA. This study aimed to examine the associations of occupational (OPA) and leisure-time PA (LTPA) with plasma high-sensitivity C-reactive protein (hs-CRP), a risk marker for adverse pregnancy outcomes, among pregnant individuals.

METHODS

This longitudinal study included 257 workers in the fetal growth cohort. OPA/LTPA and hs-CRP were measured in each trimester. OPA/LTPA was divided into high and low groups by the median level. Multivariable linear regressions were applied to estimate the adjusted geometric mean differences of hs-CRP (mg·L-1) comparing high versus low OPA/LTPA in each trimester and the changes in OPA/LTPA over pregnancy.

RESULTS

OPA was positively associated with hs-CRP (high: 5.14 vs low: 3.59; P value: 0.001) in the first trimester, particularly for standing/walking or walking fast, regardless of carrying things. LTPA was negatively associated with hs-CRP in the second (high: 3.93 vs low: 5.08; 0.02) and third trimesters (high: 3.30 vs low: 4.40; 0.046). Compared with the low OPA + high LTPA group, hs-CRP was higher in both the high OPA + high LTPA and high OPA + low LTPA groups in the first trimester, and in the high OPA + low LTPA group only in the third trimester. The change in OPA during pregnancy was positively associated with hs-CRP, whereas the change in LTPA was negatively associated with hs-CRP from the second to the third trimester.

CONCLUSIONS

In pregnant individuals, LTPA was negatively associated with hs-CRP, whereas OPA was positively associated with hs-CRP. More research on OPA's health impact among pregnant individuals is needed, and guidelines may consider the potential unfavorable influence of OPA on pregnant individuals.

Marine derived Ca-Mg complex supplementation basal diet during four subsequent parities improved longevity and performance of sows and their litters

The aim of the present study was to evaluate the effects of dietary supplementation of Ca-Mg complex on the longevity and reproductive performance of sows. In total, seventy-two gilts ([Yorkshire × Landrace] × Duroc, average body weight 181 kg) were randomly allocated to 1 of 3 treatments during 4 successive parity in a 4 × 3 factorial arrangement. Treatments consisted of CON (basal diet), CM1 (basal diet -MgO - 0.3% limestone + 0.4% Ca-Mg complex), and CM2 (basal diet - MgO - 0.7% limestone + 0.4% Ca-Mg complex). A higher (p < 0.05) number of totals born and live piglets, and sows increased feed intake during gestation and lactation, increased backfat thickness, and increased estrus interval were observed (p < 0.05) during their third and fourth parity than during their first and second parity. Ca-Mg complex supplementation improved (p < 0.05) the number of total piglets during the first and second parity as well as live-born piglets during the first to third parity, reduction (p < 0.05) in backfat thickness during the third and fourth parity, a higher (p < 0.05) initial and final number of suckling piglets as well as higher weaning weight compared with sows fed CON diet during the first, second, and third parity. The average daily gain (ADG) was higher (p < 0.05) in piglets born to CM1 and CM2 sows regardless of parity. The treatment diets fed to sows lowered (p < 0.05) the duration of first to last piglet birth and placenta expulsion time compared with CON sows. A significant interactive effect (p = 0.042) between parities and treatment diets was observed for the first to last piglet birth. Thus, Ca-Mg complex supplementation by partially replacing limestone in the basal diet enhanced sow performance, specifically during their third and fourth parity, thereby improving sow longevity.

Effect of Maternal Triclosan Exposure on Neonatal Birth Weight and Children Triclosan Exposure on Children's BMI: A Meta-Analysis

Background: Triclosan (TCS) is an environmental chemical with endocrine disrupting effects and can enter the body through the skin or oral mucosa. Human data about the effect of TCS exposure during pregnancy on neonatal birth weight and TCS exposure during childhood on children's growth are scarce.

Objectives: To investigate the association between maternal urinary TCS level and neonatal birth weight, as well as children's urinary TCS level and children's body mass index (BMI).

Methods: A systematic literature search was conducted using PubMed, Cochrane Library, and Web of Science. Finally, seven epidemiological articles with 5,006 participants from September 25, 2014 to August 10, 2018 were included in the meta-analysis to identify the relationship between maternal exposure to TCS and neonatal birth weight. On the other hand, three epidemiological articles with 5,213 participants from July 22, 2014 to September 1, 2017 were included in another meta-analysis to identify the relationship between children's exposure to TCS and children's BMI. We used Stata 16.0 to test the heterogeneity among the studies and calculating the combined effect value 95% confidence interval (CI) of the selected corresponding models.

Results: TCS exposure during pregnancy was not significant associated with neonatal birth weight. The results of forest plots were as follows: ES (Estimate) = 0.41 (95% CI: −11.97–12.78). Children's urinary TCS level was also irrelevant associated with children's BMI: ES = 0.03 (95% CI: −0.54–0.60).

Conclusions: This meta-analysis demonstrated that there was no significant association between maternal TCS level and neonatal birth weight, also there has no relationship between children's urinary TCS level and children's BMI.

Associations Between Prenatal Food Insecurity and Prematurity, Pediatric Health Care Utilization, and Postnatal Social Needs

OBJECTIVE

Childhood food insecurity endangers child development and health outcomes. Food insecurity will grow increasingly common in the economic wake of the coronavirus pandemic and prenatal care represents an early, clinical opportunity to identify families at risk. However, longitudinal relationships between clinically-identified prenatal food insecurity and prematurity, pediatric health care utilization, and postnatal social needs have not been described.

METHODS

We examined longitudinal data from mother-child dyads who received prenatal and pediatric care and social needs screening at a large academically-affiliated safety net medical center between October 2018 and July 2019. Associations among household food insecurity and premature birth, pediatric inpatient and outpatient utilization, missed immunizations, and postnatal social needs were estimated using adjusted regression.

RESULTS

Among the 268 mothers, those who experienced prenatal household food insecurity had 3 times higher odds of having a child born prematurely (95% confidence interval [CI] 1.0-8.9, P = .05) and had children with higher inpatient hospitalizations (incidence rate ratio [IRR] 2.4, 95% CI 1.0-5.6, P = .04) and missed immunizations (IRR 3.4, 95% CI 1.1-10.3, P = .03) in the first 6 months of the child's life. These mothers also had higher odds of having any social needs in the pediatric setting (odds ratio 3.4; 95% CI 1.5-8.0, P = .004).

CONCLUSIONS

Prenatal household food insecurity was linked to future adverse perinatal and pediatric outcomes in low-income mother-child dyads. Food insecurity identifies children at social and medical risk, providing an early clinical opportunity to intervene.

Maternal diet during pregnancy and intestinal markers are associated with early gut microbiota

BACKGROUND

Diet has an important role in host-microbiome interplay, which may result in intestinal permeability changes and physiopathological effects at a systemic level. Despite the importance of maternal microbiota as the main contributor to the initial microbial seeding, little is known about the effects of maternal diet during pregnancy on maternal-neonatal microbiota.

OBJECTIVES

This study aimed at ascertaining the possible associations between maternal dietary intake during pregnancy and neonatal microbiota at birth and to evaluate the relationship with maternal intestinal markers.

METHODS

In a nested cross-sectional study in the longitudinal MAMI cohort, maternal-neonatal microbiota profiling at birth (n = 73) was assessed by 16S rRNA gene sequencing. Maternal intestinal markers as zonulin, intestinal alkaline phosphatase (IAP) activity and faecal calprotectin were measured in faeces. Furthermore, maternal-neonatal clinical and anthropometric data, as well as maternal nutrient intake during pregnancy obtained by FFQ questionnaires, were collected.

RESULTS

Maternal diet is associated with both maternal and neonatal microbiota at the time of birth, in a delivery mode-dependent manner. The existing link between maternal diet, intestinal makers and neonatal gut microbiota would be mainly influenced by the intake of saturated (SFA) and monounsaturated fatty acids (MUFA). Members of Firmicutes in the neonatal microbiota were positively associated with maternal fat intake, especially SFA and MUFA, and negatively correlated to fibre, proteins from vegetable sources and vitamins.

CONCLUSIONS

Maternal diet during pregnancy, mainly fat intake (SFA and MUFA), was related to intestinal markers, thus likely shifting the microbial transmission to the neonate and priming the neonatal microbial profile with potential health outcomes.

CLINICAL TRIAL REGISTRY

NCT03552939.

Diet in Early Pregnancy: Focus on Folate, Vitamin B12, Vitamin D, and Choline

Purpose: Prenatal multivitamins are recommended in pregnancy. This study assessed food and supplement intakes of folate, vitamin B12 (B12), vitamin D, and choline in pregnant women living in Southern Ontario in comparison with current recommendations. Methods: Women recruited to the Be Healthy in Pregnancy RCT (NCT01693510) completed 3-day diet/supplement records at 12-17 weeks gestation. Intakes of folate, B12, vitamin D, and choline were quantified and compared with recommendations for pregnant women. Results: Folate intake (median (min, max)) was 1963 μg/day dietary folate equivalents (153, 10 846); 90% of women met the Estimated Average Requirement (EAR) but 77% exceeded the Tolerable Upper Intake Level (UL) (n = 232). B12 intake was 12.1 μg/day (0.3, 2336); 96% of women met the EAR with 7% exceeding the EAR 100-fold (n = 232). Vitamin D intake was 564 IU/day (0.0, 11 062); 83% met the EAR, whereas 1.7% exceeded the UL (n = 232). Choline intake was 338 mg/day (120, 1016); only 18% met the Adequate Intake and none exceeded the UL (n = 158). Conclusion: To meet the nutrient requirements of pregnancy many women rely on prenatal vitamins. Reformulating prenatal multivitamin supplements to provide doses of vitamins within recommendations to complement a balanced healthy diet would ensure appropriate micronutrient intakes for pregnant women.

Influence of sows' parity on performance and humoral immune response of the offspring

Background

Primiparous sows (PP) have higher nutrient requirements, fewer piglets born with lower birth weight and growth performance than multiparous sows (MP). The aim of the current study was to investigate the effect of parity of sow (PP or MP) on the growth performance and humoral immune response of piglets. A total of 10 PP and 10 MP (3rd to 5th parity) sows were used. There were 4 treatments in a 2 × 2 factorial arrangement, with piglets from PP sows suckled by PP or MP sows, and piglets from MP sows suckled by PP or MP sows. Average daily gain (ADG) of piglets during the lactation period, and ADG, average daily feed intake (ADFI) and gain:feed ratio (G:F) from weaning to 144 days of age were controlled, and concentrations of immunoglobulins G (IgG) and major acute phase protein (Pig-MAP) were measured as markers of humoral immune response throughout the study.

Results

Total ADG was higher in piglets born from MP than in those born from PP (669 vs. 605 g/day; standard error of the mean (SEM) = 15.5, n = 5; P = 0.001) and in piglets suckled by MP than in piglets suckled by PP (655 vs. 620 g/day; SEM = 15.5, n = 5, P = 0.037). Total ADFI was higher for pigs born from MP than for those born from PP (1592 vs. 1438 g/d, SEM = 42.2, n = 5, P < 0.001). Total G:F tended to be higher for pigs suckled by MP than for those suckled by PP (0.43 vs. 0.41, SEM = 0.006, n = 5, P = 0.076). At weaning, IgG serum concentration was higher (30.0 vs. 17.8 mg/mL, SEM = 4.98, n = 15, P = 0.013) in pigs suckled by MP than in piglets suckled by PP. However, IgG concentrations were higher for pigs born from PP than for pigs born from MP on days 116 (P < 0.001) and 144 (P = 0.088). Pig-MAP tended to be lower in pigs suckled by MP than in pigs suckled by PP on days 40 and 60 of age (P < 0.10).

Conclusions

The research indicates that the growth performance and humoral immune response of the offspring of PP is improved by cross-fostering with MP. These results open the possibility of an interesting strategy for improving the growth of litters from PP, that is easier to apply than current programs based on parity segregation, which implies a separate building site to house gilts, first parity sows and their offspring.

Timing and Duration of Pre- and Postnatal Homelessness and the Health of Young Children

: media-1vid110.1542/5804912861001PEDS-VA_2017-4254Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear.

METHODS

We interviewed 20 571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months.

RESULTS

After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18-1.69), fair or poor child health (aOR 1.97; CI 1.58-2.47), and developmental delays (aOR 1.48; CI 1.16-1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76-1.18) or overweight status (aOR 1.07; CI 0.84-1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05-4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38-2.58).

CONCLUSIONS

After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.

Increased susceptibility to cardiovascular disease in offspring born from dams of advanced maternal age

KEY POINTS

Advanced maternal age increases the risk of pregnancy complications such as fetal growth restriction, hypertension and premature birth. Offspring born from compromised pregnancies are at increased risk of cardiovascular disease as adults. However, the effect of advanced maternal age on later-onset disease in offspring has not been investigated. In adulthood, male but not female offspring born to dams of advanced maternal age showed impaired recovery from cardiac ischaemia/reperfusion injury. Endothelium-dependent relaxation was also impaired in male but not female offspring born from aged dams. Oxidative stress may play a role in the developmental programming of cardiovascular disease in this model. Given the increasing trend toward delayed parenthood, these findings have significant population and health care implications and warrant further investigation.

ABSTRACT

Exposure to prenatal stressors, including hypoxia, micro- and macronutrient deficiency, and maternal stress, increases the risk of cardiovascular disease in adulthood. It is unclear whether being born from a mother of advanced maternal age (≥35 years old) may also constitute a prenatal stress with cardiovascular consequences in adulthood. We previously demonstrated growth restriction in fetuses from a rat model of advanced maternal age, suggesting exposure to a compromised in utero environment. Thus, we hypothesized that male and female offspring from aged dams would exhibit impaired cardiovascular function as adults. In 4-month-old offspring, we observed impaired endothelium-dependent relaxation in male (P < 0.05) but not female offspring born from aged dams. The anti-oxidant polyethylene glycol superoxide dismutase improved relaxation only in arteries from male offspring of aged dams (ΔE_max : young dam -1.63 ± 0.80 vs. aged dam 11.75 ± 4.23, P < 0.05). Furthermore, endothelium-derived hyperpolarization-dependent relaxation was reduced in male but not female offspring of aged dams (P < 0.05). Interestingly, there was a significant increase in nitric oxide contribution to relaxation in females born from aged dams (ΔE_max : young dam -24.8 ± 12.1 vs. aged dam -68.7 ± 7.7, P < 0.05), which was not observed in males. Recovery of cardiac function following an ischaemia-reperfusion insult in male offspring born from aged dams was reduced by ∼57% (P < 0.001), an effect that was not evident in female offspring. These data indicate that offspring born from aged dams have an altered cardiovascular risk profile that is sex-specific. Given the increasing trend toward delaying pregnancy, these findings may have significant population and health care implications and warrant further investigation.

Is dietary macronutrient composition during pregnancy associated with offspring birth weight? An observational study

There is lack of evidence on the differential impact of maternal macronutrient consumption: carbohydrates (CHO), fats and protein on birth weight. We investigated the association between maternal dietary macronutrient intakes and their sub-components such as saccharides and fatty acids and birth weight. This analyses included 1,196 women with singleton pregnancies who were part of the CAffeine and REproductive health study in Leeds, UK between 2003 and 2006. Women were interviewed in each trimester. Dietary information was collected twice using a 24-h dietary recall about 8–12 weeks and 13–27 weeks of gestation. Multiple linear regression models adjusted for alcohol and smoking in trimester 1, showed that each additional 10 g/d CHO consumption was associated with an increase of 4 g (95 % CI 1, 7;P=0·003) in birth weight. Conversely, an additional 10 g/d fat intake was associated with a lower birth weight of 8 g (95 % CI 0, 16;P=0·04) when we accounted for energy contributing macronutrients in each model, and maternal height, weight, parity, ethnicity, gestational age at delivery and sex of the baby. There was no evidence of an association between protein intake and birth weight. Maternal diet in trimester 2 suggested that higher intakes of glucose (10 g/d) and lactose (1 g/d) were both associated with higher birth weight of 52 g (95 % CI 4, 100;P=0·03) and 5 g (95 % CI 2, 7;P<0·001) respectively. These results show that dietary macronutrient composition during pregnancy is associated with birth weight outcomes. An appropriately balanced intake of dietary CHO and fat during pregnancy could support optimum birth weight.

Reduced maternal calcium intake through nutrition and supplementation is associated with adverse conditions for both the women and their infants in a Chinese population

Effective nutritional guidelines for pregnant women in China are lacking. The aim of this study was to investigate the effect of dietary nutrition on the health condition of pregnant women and infants in China.In total, 331 pregnant women who had prenatal examinations were included in this study. Data, including dietary nutrition questionnaires, the weight, height, age, and health condition of the pregnant women as well as the health condition of the infants, were recorded.The average intake of milk, poultry and meat, fish and prawns, eggs, and bean products were 297.28 ± 129.67 mL/day, 123.34 ± 52.04 g/day, 157.31 ± 70.04 g/day, 67.34 ± 45.28 g/day, and 1.21 ± 0.62 per day, respectively. Among the 331 pregnant women, the intake rates of supplemental calcium and VD were 86.7% and 69.8%, respectively. The intake of milk, bean products, and meats was obviously lower (all P < .05) in the pregnant women with systremma compared to those without it. In addition, the body weight before and after delivery was higher (all P < .05) in the pregnant women with systremma. The calcium intake of the pregnant women and the infants' BMD were remarkably lower in the infants with pillow baldness or a wider anterior fontanelle (P < .01) compared to those without the features.The intake of milk, poultry and meat, fish and prawns, eggs, and bean products by pregnant women should be monitored, and in particular, the proper intake of milk, bean products, and meats, as well as calcium supplements, might decrease the occurrence of systremma in pregnant women and reduce the rate pillow baldness and a wider anterior fontanelle in infants.

Use of micronutrient supplements among pregnant women in Alberta: results from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort

Maternal nutrient intake in the prenatal period is an important determinant of fetal growth and development and supports maternal health. Many women, however, fail to meet their prenatal nutrient requirements through diet alone and are therefore advised to consume nutrient supplements. The purpose of this study was to describe the use of natural health products (NHP) by pregnant women in each trimester of pregnancy. Women (n = 599) participating in the first cohort of the Alberta Pregnancy Outcomes and Nutrition (APrON) study completed an interviewer-administered supplement intake questionnaire during each trimester of pregnancy. NHP use was high, with >90% taking multivitamin/mineral supplements, and nearly half taking at least one additional single-nutrient supplement. Compliance with supplementation guidelines was high for folic acid (>90%), vitamin D (∼70%) and calcium (∼80%), but low for iron (<30%) and for all four nutrients together (≤11%). On average, women met or exceeded the recommended dietary allowance for folic acid, vitamin D and iron from NHPs alone, with median daily intakes of 1000 μg, 400 IU and 27 mg, respectively. The median calcium intake was 250 mg d(-1) . Up to 26% of women exceeded the tolerable upper intake level for folic acid and up to 19% did so for iron at some point of their pregnancy. Findings highlight the need to consider both dietary and supplemental sources of micronutrients when assessing the nutrient intakes of pregnant women.

Impact of singlehood during pregnancy on dietary intake and birth outcomes- a study in the Norwegian Mother and Child Cohort Study

Background

Little attention has been given to the impact of singlehood during pregnancy. The aim of this study was to examine the impact of marital status on diet during pregnancy and pregnancy outcome.

Methods

The study population comprised 62,773 women participating in the Norwegian Mother and Child Cohort Study. Marital status was categorised into singles living alone, singles living with parents and married/cohabiting (reference group). Participants answered a general health questionnaire in gestational week 15–17 and a food frequency questionnaire in gestational week 22. We used nonparametric tests to compare dietary intakes by marital status, and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for infants being small for gestational age (SGA), large for gestational age (LGA), and preterm delivery (defined as delivery before gestational week 37).

Results

Single women living with parents had lower intakes of fruits and vegetables, higher intake of total energy, higher proportion of energy from added sugar, and lower intake of fibre than the reference group. Singles living alone also had a higher intake of added sugar. In both of the single groups, daily smoking was more prevalent than in women living with a partner. In analyses adjusted for maternal age, pre-pregnancy BMI, energy intake, energy contributed by protein, education, income, parity and nausea, single women living alone had increased risk of SGA with OR = 1.27 (95% CI: 1.05, 1.55). When smoking was included among the confounding variables, the association was no longer significant. Likewise, singles living alone had increased risk of preterm delivery, with OR = 1.32 (95% CI: 1.01, 1.72) in a partly adjusted model, but the association did not remain significant in a model fully adjusted for confounding variables.

Conclusions

Single mothers had lower dietary quality and included more smokers than women who lived with a partner. Single mothers living alone had higher prevalence of SGA and preterm delivery, but the associations with adverse pregnancy outcomes were confounded by other variables. This study shows that single mothers should be given special attention during antenatal care and counselling.

Impact of the periconceptional environment on the programming of adult disease

The periconceptional period of mammalian development has been identified as an early 'developmental window' during which environmental conditions may influence the pattern of future growth and physiology. Studies in humans and animal models have revealed that factors such as maternal nutritional status or in vitro culture and manipulation of developing gametes and preimplantation embryos can impact upon the long-term health and physiology of the offspring. However, the mechanisms involved in the programming of adult disease in response to altered periconceptional development require increased investigation. The role of epigenetic modifications to DNA and chromatin organisation has been identified as a likely mechanism through which environmental perturbations can affect gene expression patterns resulting in phenotypic change. This study will highlight the sensitivity of two critical stages in early mammalian development, gametogenesis and preimplantation development. We will detail how changes to the immediate environment can not only impact upon developmental processes taking place at that time, but can also affect long-term aspects of offspring health and physiology. We will also discuss the emerging role of epigenetics as a mechanistic link between the environment and the later phenotype of the developing organism.

The changing prevalence of infertility

Infertility is a major, multifaceted issue worldwide whose prevalence is increasing in both high- and low-income countries. The reasons are numerous, and may differ among world regions, but lifestyle and nutritional factors, epidemic infections, and sexually transmitted diseases are major determinants in most latitudes. Three other reasons may explain the increasing incidence of infertility. First, owing to the widespread use of contraception, the choice of delaying the first pregnancy until the third decade of life places men and women at higher risk for sexually transmitted diseases, and women at higher risk for uterine fibroids, endometriosis, polycystic ovary syndrome, and chronic anovulation. Second, prolonged exposure to chronic stress and environmental pollutants may play a critical role in decreasing fertility. Third, gonadotoxic oncologic treatments allow many patients to survive cancer, at the cost of their fertility. This consideration may justify the development of treatments that preserve fertility.

Listeria monocytogenes and diet during pregnancy; balancing nutrient intake adequacy v. adverse pregnancy outcomes

OBJECTIVE

To evaluate the impact of adherence to public health recommendations on Listeria monocytogenes food safety to limit exposure to potential food sources on micronutrient intakes of pregnant women and whether more frequent consumption of 'high-risk' foods increases risk for adverse pregnancy outcomes.

DESIGN

A cohort study in women assessing Listeria exposure from an FFQ based on consumption of potential Listeria-containing food sources, the Listeria Food Exposure Score (LFES). Pregnancy status was defined as pregnant, trying to conceive, had a baby within the previous 12 months, or other. Nutrient intakes were compared with Nutrient Reference Values and self-reported pregnancy outcome history three years later.

SETTING

Australia.

SUBJECTS

Women aged 25-30 years (n 7486) participating in the Australian Longitudinal Study on Women's Health.

RESULTS

There were weak positive correlations (r = 0.13-0.37, P < 0.001) between LFES and all nutrients, with fibre, folate, Fe and vitamin E intakes consistently below the Nutrient Reference Values in every quintile of LFES. Women in the highest quintile of LFES reported 19 % more miscarriages (rate ratio = 1.19; 95 % CI 1.02, 1.38) than those in the lowest quintile, after adjusting for important confounding factors.

CONCLUSIONS

More frequent consumption of foods potentially containing L. monocytogenes is associated with higher nutrient intakes, but an increased risk of miscarriage. L. monocytogenes pregnancy recommendations require review and should include the list of 'risky' food items in addition to low-risk alternatives that would adequately replace nutrient intakes which may be reduced through avoidance strategies.

Prepregnancy maternal body mass index and preterm delivery

OBJECTIVE

The purpose of this study was to determine the influence of maternal prepregnancy body mass index on preterm delivery (PTD), controlling for health and lifestyle variables.

STUDY DESIGN

Prospective data were from 83,544 pregnancies in the Norwegian Mother and Child Cohort Study. PTD was divided into early PTD (22 + 0 to 31 + 6 weeks' gestation) and late PTD (32 + 0 to 36 + 6 weeks' gestation).

RESULTS

The overall prevalence of PTD was 5.1%. Increased body mass index was associated with an increased risk of PTD; adjusted odds ratio (aOR) ranged from 1.11 (95% confidence interval [CI], 1.03-1.20) for preobesity to 2.00 (95% CI, 1.48-2.71) for grade-III obesity in the group that included all PTD subgroups. Grade-III obese women had an increased risk of both early and late PTD: aOR, 3.24 (95% CI, 1.71-6.14) and 1.81 (95% CI, 1.29-2.54), respectively.

CONCLUSION

Prepregnancy maternal overweight increases the risk of both early and late PTD.

Food patterns and dietary quality associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway

BACKGROUND

Little is known about the consumption of organic food during pregnancy. The aim of this study was to describe dietary characteristics associated with frequent consumption of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa).

METHODS

The present study includes 63 808 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational weeks 15 and a food frequency questionnaire at weeks 17-22. The exploration of food patterns by Principal component analyses (PCA) was followed by ANOVA analyses investigating how these food patterns as well as intake of selected food groups were associated with consumption of organic food.

RESULTS

The first principal component (PC1) identified by PCA, accounting for 12% of the variation, was interpreted as a 'health and sustainability component', with high positive loadings for vegetables, fruit and berries, cooking oil, whole grain bread and cereal products and negative loadings for meat, including processed meat, white bread, and cakes and sweets. Frequent consumption of organic food, which was reported among 9.1% of participants (n = 5786), was associated with increased scores on the 'health and sustainability component' (p < 0.001). The increase in score represented approximately 1/10 of the total variation and was independent of sociodemographic and lifestyle characteristics. Participants with frequent consumption of organic food had a diet with higher density of fiber and most nutrients such as folate, beta-carotene and vitamin C, and lower density of sodium compared to participants with no or low organic consumption.

CONCLUSION

The present study showed that pregnant Norwegian women reporting frequent consumption of organically produced food had dietary pattern and quality more in line with public advice for healthy and sustainable diets. A methodological implication is that the overall diet needs to be included in future studies of potential health outcomes related to consumption of organic food during pregnancy.

Methodological aspects of the study of dietary patterns during pregnancy and maternal and infant health outcomes. A systematic review

The objective of the present study was to systematically review the literature exploring the associations between different dietary patterns obtained from Food Frequency Questionnaires during pregnancy and the development of health-related maternal and infant outcomes in the Framework of the EURRECA Network of Excellence. A systematic search was conducted on Pubmed for literature published up to September 2009. The search strategy resulted in an initial amount of 2048 articles. After applying the selection criteria, seven studies were finally identified. Five articles were based on prospective cohort studies and the other two were case-control studies. The methods used to elaborate the dietary pattern could be classified as hypothesis-oriented (three studies) or empirically-derived (four studies). The different food frequency questionnaires used for diet assessment were self-administered, semi-quantitative and had been previously validated, but just four studies employed questionnaires validated specifically for their use in a pregnant population. The divergent methods used to assess the dietary patterns make it difficult to compare results. However, some resulting recommendations can be applied when dietary patterns during pregnancy are analyzed: to employ a validated food frequency questionnaire designed for use in pregnancy, to consider the special role exerted by mineral and vitamin supplements in this particular population group, to adequately select the time in which dietary data is collected, to adjust the results for life-style and educational characteristics, and in the case of hypothesis-oriented dietary patterns, to correctly choose the components comprising the score.

Effect of dietary factors in pregnancy on risk of pregnancy complications: results from the Norwegian Mother and Child Cohort Study

There has been a thrilling development , as well as profound changes, in our understanding of the effect of fetal nutrition on the development and health of the child. The Norwegian Mother and Child Cohort Study (MoBa) is an ongoing nationwide population-based pregnancy cohort study that between 1999 and 2008 recruited 90,723 women with 106,981 pregnancies and 108,487 children. The objective of MoBa is to test specific etiologic hypotheses by estimating the association between exposures and diseases with a special focus on disorders that may originate in early life. An important aspect in this regard is maternal diet and nutritional status during pregnancy. Nutritional factors have long been considered to be important determinants of maternal and fetal health, and dietary information is currently being collected in a number of pregnancy cohorts in Europe and the United States. Thus far, pregnancy complications studied in MoBa are preterm birth, preeclampsia, and fetal growth; and the aim of this article is to report results of recently published studies of dietary factors in relation to these outcomes. Numerous studies are planned using MoBa data, and the aim is to add to the knowledge of the interplay between dietary factors, nonnutrients, and toxic dietary substances and epigenetic modulation on fetal development and health later in life.

A comparative analysis of dietary intakes during pregnancy in Europe: a planned pooled analysis of birth cohort studies

BACKGROUND

There is growing evidence that despite the absence of marked deficiencies, diet during pregnancy has important implications for maternal and child health in industrialized countries. At present, relatively little is known about prevailing patterns of intake across groups with diverse sociodemographic and lifestyle patterns in these settings.

OBJECTIVES

The aims of this study were to develop methods for the standardization of food group intake data and to describe the process of applying these methods to existing pregnancy cohort studies, which included >200,000 women across Europe.

DESIGN

The study developed a detailed standardization protocol to harmonize intakes of selected food groups, which included fruit, vegetables, meats, seafood, and dairy products. Standardization is necessary to facilitate valid comparisons of intake patterns and disparities across countries and will lead to the development of harmonized databases for possible future pooled analyses.

RESULTS

On the basis of comparisons with previously coordinated multicountry studies, preliminary data suggest that the standardization process yielded sufficiently comparable intake data, which indicate differences in food cultures across the countries that participated.

CONCLUSIONS

This project provides lessons on the feasibility of harmonizing dietary intake data from existing studies, which can be applied in future post hoc standardization efforts. The data yielded in this analysis will also provide useful information for the development of food and nutrition policies for pregnant women in Europe, including the identification of population subgroups in which dietary inadequacies during pregnancy may be widespread.

Maternal behaviors during pregnancy impact offspring obesity risk

This study investigated the effects of maternal changes during pregnancy in diet, exercise, and psychosocial factors on offspring weight parameters at birth and 6 months. In overweight/obese (OW/OB; n = 132) mothers, greater % kcal from sweets early in pregnancy was the strongest, independent predictor of higher weight for age (WFA) (beta = 0.19; P = 0.004), higher odds of macrosomia (OR = 1.1 (1.0-1.2); P = 0.004) and WFA >90th percentile at birth (OR = 1.2 (1.1-1.3); P = 0.002) and higher WFA at 6 months (beta = 0.30; P = 0.002). In normal weight (n = 153) mothers, higher intake of soft drinks was the strongest predictor of higher offspring WFA at birth (beta = 0.16; P = 0.04) but not at 6 months. Prenatal physical activity, depressive symptoms, and sleep-related variables did not significantly predict offspring weight outcomes. Mothers' eating behaviors during pregnancy, especially intake of sweets in OW/OB mothers, may have a lasting effect on child weight.

Venous liver blood flow and regulation of human fetal growth: evidence from macrosomic fetuses

OBJECTIVE

Experimental studies show that fetal liver venous perfusion is a determinant for growth in utero. Here we explore the relationship between fetal venous blood flow to the liver and macrosomia.

STUDY DESIGN

From diameter and blood flow velocity measurements, we derived liver venous blood flow in a longitudinal ultrasound study of 25 macrosomic fetuses of nondiabetic mothers during the second half of pregnancy.

RESULTS

Compared with appropriately growing fetuses, macrosomic fetuses directed more umbilical blood to the liver tissue, with correspondingly less contribution from the portal circulation when normalized for fetal weight. Whereas total venous liver blood flow showed no late gestation rise in the reference population, it continued to increase in macrosomic fetuses and was accompanied by greater fetal weight.

CONCLUSION

The direct relationship between venous liver blood flow and macrosomia in the fetus supports the concept that intrauterine growth is linked to the amount and distributional pattern of venous liver perfusion.

Effects of iron deficiency on neonatal behavior at different stages of pregnancy

Animal and human studies have shown that prenatal and postnatal iron deficiency is a risk factor for behavioral, emotional and cognitive development. The aim of this study was to determine the associations between iron status of pregnant women and the behavior of their newborn, taking into account the timing in which the deficit occurs. This study was conducted in Spain (developed country) where: the general population is well-nourished; during pregnancy routine obstetrical checks are carried out; and pregnant women are systematically iron supplemented. A total of 216 healthy and well-nourished pregnant women and their term, normal weight newborn participated in this study. The neonatal behavior was assessed by the Neonatal Behavior Assessment Scale (NBAS). The results showed that in the first and second trimesters of pregnancy, iron deficiency was a weak and significant predictor of the NBAS autonomous nervous system cluster score, and in the third trimester, this condition predicted the NBAS motor and state organization clusters score and the NBAS robustness and endurance supplementary item. In conclusion, iron deficiency during pregnancy is related to the neonate's general autonomous response, motor performance and self regulation capabilities.

Characteristics associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway

Background

Little is known about the use of organic food during pregnancy. The aim of this study was to describe characteristics associated with the use of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa).

Methods

The present study includes 63,561 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational week 15 and a food frequency questionnaire at weeks 17-22. We used linear binomial regression with frequent versus rare use of organic food as outcome variable and characteristics of the respondent as independent variables. The outcome variable was derived from self-reported frequency of organic food use in six main food groups (milk/dairy, bread/cereal, eggs, vegetables, fruit and meat).

Results

Organic eggs and vegetables were the food items which were most frequently reported to be used "often" or "mostly". The proportion of women reporting frequent intake of organic food was 9.1% (n = 5754). This group included more women in the lower (<25 years) and higher (>40 years) age-groups, with normal or low body mass index, who were vegetarians, exercised regularly (3+times weekly), consumed alcohol and smoked cigarettes during pregnancy (p < 0.001 for all, except alcohol: p=0.044). Further, participants with frequent organic consumption included more women in the lower (≤12 years) or higher (17 years +) category of educational attainment, women who were students or had a partner being a student, who belonged to the lowest household income group (both respondent and her partner earned <300 000 NOK), who entered the study 2005-2007, and who lived in an urban area (p < 0.001 for all).

Conclusions

The socio-economic characteristics of pregnant Norwegian women with frequent organic consumption did not unambiguously follow those typically associated with better health, such as higher levels of education and income. Rather, lower household income, and both lowest and highest levels of education were associated with a higher prevalence of frequent organic consumption. The results indicate that personal and socio-economic characteristics are important covariates and need to be included in future studies of potential health outcomes related to organic food consumption during pregnancy.

Lifestyle factors in people seeking infertility treatment - A review

BACKGROUND

Clinical infertility is a prevalent problem with significant financial and psychosocial costs. Modifiable lifestyle factors exist that may affect a person's time to conception and their chance of having a healthy, live birth. However, no guideline delineates what preconception advice should be offered to people presenting for infertility treatment.

AIM

The aim of this article is to review the literature regarding modifiable lifestyle factors in people seeking infertility treatment.

RESULTS

A person's time to pregnancy and their chance of having a healthy, live birth may be affected by factors such as weight, vitamin and iodine intake, alcohol and caffeine consumption, smoking, substance abuse, stress, environmental pollutants, vaccinations and oxidative stress.

CONCLUSIONS

Advice on modifiable lifestyle factors should be given to people presenting for infertility treatment to help them make positive changes that may improve their chances of pregnancy and delivering a healthy, live baby. Developing a guideline for this would be a prudent step towards helping clinicians to implement this aspect of preconception care.

Maternal preconceptional nutrition leads to variable fat deposition and gut dimensions of adult offspring mice (C57BL/6JBom)

BACKGROUND

Maternal nutrition during pregnancy or lactation may affect the chance of offspring becoming obese as adults, but little is known regarding the possible role of maternal nutrition before conception. In this study, we investigate how variable protein and carbohydrate content of the diet consumed before pregnancy affects fat deposition and gut dimensions of offspring mice.

METHODS

Eight-week-old female mice (C57BL/6JBom) were fed isocaloric low protein (8.4% protein; LP), standard protein (21.5% protein; ST) or high protein (44.2% protein; HP) diets. After 8 weeks of feeding, females were mated and fed a standard laboratory chow diet (22.5% protein) throughout periods of mating, gestation, lactation and weaning. Offspring mice were fed the same standard diet up to 46 days of age. Then offspring were killed and measures of dissected fat deposits and of the digestive system were taken.

RESULTS

Fat deposition of the offspring was significantly affected by preconceptional maternal nutrition and the effects differed between sexes. Male offspring deposited most fat when mothers were fed the LP diet, whereas female offspring deposited most fat when mothers were fed the ST diet. The mass and length of the digestive organs were affected by preconceptional maternal nutrition. Total gut from pyloric sphincter to anus was significantly shorter and dry mass was heavier in mice whose mothers were fed LP diets compared with offspring of mothers fed ST diets or HP diets. There was no significant effect of maternal nutrition on dry mass of the stomach or ceca.

CONCLUSION

Our study shows that preconceptional nutrition can have important influence on several body features of offspring in mice, including body composition and dimensions of the digestive system.

Significant effects of implementation of health-promoting schools on schoolteachers' nutrition knowledge and dietary intake in Taiwan

OBJECTIVE

Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers' nutrition knowledge and diets.

DESIGN

One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78.4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis.

RESULTS

Teachers in the HP-D group had a mean score of 21.1 on a range of 0-30 for nutrition knowledge, which was significantly higher than the mean scores of 18.5 in the HP-ND group and 19.1 in the NHP group (P < 0.001). Better dietary behaviours were also observed among HP-D teachers. Further, being a 'health education' course instructor was associated with significantly higher scores on nutrition knowledge (beta = 2.6, P < 0.001) and vegetable and fruit consumption (beta = 1.4, P = 0.02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group.

CONCLUSIONS

Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers' nutrition knowledge and dietary intake.

Impact of maternal undernutrition on diabetes and cardiovascular disease risk in adult offspring

Epidemiological, clinical, and experimental observations have led to the hypothesis that the risk of developing chronic diseases in adulthood is influenced not only by genetic and adult lifestyle factors, but also by environmental factors during early life. Low birth weight, a marker of intrauterine stress, has been linked to predisposition to cardiovascular disease (CVD) and diabetes. The compelling animal evidence and significant human data to support this conclusion are reviewed. Specifically, the review discusses the role of maternal nutrition before and during pregnancy, placental insufficiencies and epigenetic changes in the increased predisposition to diabetes and CVD in adult life. The impact of low birth weight and catch-up growth as they pertain to risk of disease in adult life is also discussed. In addition, adult disease risk in the overnourished fetus is also mentioned. Reference is made to some of the mechanisms of the induction of diabetes and CVD phenotype. It is proposed that fetal nutrition, growth and development through efficient maternal nutrition before and during pregnancy could constitute the basis for nutritional strategies for the primary prevention of diabetes and CVD.

Prenatal growth and early postnatal influences on adult motor cortical excitability

OBJECTIVE

Suboptimal prenatal growth may adversely influence motor neurophysiologic development and predispose the individual to greater risk of neurodegenerative disorders in later life. We investigated the influences of prenatal growth and the postnatal environment on motor cortical function in young adults.

METHODS

Transcranial magnetic stimulation was used to construct corticospinal stimulus-response curves for 35 young adults (mean age: 28 +/- 0.5 years; 19 males) born >or=37 weeks' gestation. Birth weight centile was calculated relative to maternal size, parity, ethnicity, gender, and gestation. Handgrip strength and dexterity were measured separately. Regression analyses assessed the influence of prenatal (birth weight centile and gestation) and postnatal (socioeconomic indices and maternal education) factors on corticospinal parameters, strength, and dexterity scores.

RESULTS

Lower birth weight was associated with increased interhemispheric asymmetry in motor threshold and increased cortical stimulus-response curve slope. A shorter gestation predicted a larger area under this curve in the right hand. High motor threshold was predicted by greater environmental adversity in early postnatal life, but not by prenatal factors. Higher birth weight centile and lower motor threshold were associated with greater educational achievement.

CONCLUSIONS

Poor in utero growth and mild prematurity are associated with altered corticospinal excitability in adulthood. An early postnatal environment with less early postnatal socioeconomic disadvantage and having a mother with a completed high school education partly ameliorates this. While altered cortical development has some functional consequences already evident in early adulthood, it may have a later, additional adverse impact on aging-related changes in motor function.

Dietary intake and nutritional adequacy prior to conception and during pregnancy: a follow-up study in the north of Portugal

Objective

To assess maternal diet and nutritional adequacy prior to conception and during pregnancy.

Design

Follow-up of a cohort of pregnant women with collection of questionnaire data throughout pregnancy and after delivery.

Setting

Antenatal clinics at two public hospitals in Porto, Portugal.

Subjects

Two hundred and forty-nine pregnant women who reported a gestational age below 13 weeks at the time they attended their first antenatal visit.

Results

Intakes of energy and macronutrients were within recommended levels for most women. Pregnancy was accompanied by increases in the dietary intake of vitamins A and E, riboflavin, folate, Ca and Mg, but declines in the intake of alcohol and caffeine. The micronutrients with higher inadequacy prevalences prior to pregnancy were vitamin E (83 %), folate (58 %) and Mg (19 %). These three micronutrients, together with Fe, were also those with the highest inadequacy prevalences during pregnancy (91 %, 88 %, 73 % and 21 %, respectively, for folate, Fe, vitamin E and Mg). Ninety-seven per cent of the women reported taking supplements of folic acid during the first trimester, but the median gestational age at initiation was 6·5 (interquartile range 5, 9) weeks. Self-reported prevalences of Fe and Mg supplementation were high, and increased throughout pregnancy.

Conclusion

The study identified low dietary intakes of vitamin E, folate and Mg both in the preconceptional period and during pregnancy, and low intake of Fe during pregnancy only. The low dietary intake of folate and the late initiation of supplementation indicate that current national guidelines are unlikely to be effective in preventing neural tube defects.

Innovative approaches in public health research: applying life course epidemiology to aboriginal health research

A life course epidemiology approach embraces the complexity of disease risk and acknowledges the long-term effects of physical, social, psychological, and behaviour pathways, operating across an individual's life, a community's generation, and a population's development, on health and well-being. Researchers who adopt a life course epidemiology approach broaden their ability to understand, explain, and prescribe ways to mitigate the effects of chronic diseases and reduce risk factor development and interaction. Although there are many diseases that explicate the importance and usefulness of a life course approach for Aboriginal health research, this commentary focuses on the benefits for understanding chronic respiratory diseases in Aboriginal populations. The hope is that this will expose the benefits of a life course approach for the study of Aboriginal health research and draw attention to the need for well-rounded, high-quality Aboriginal respiratory health research.

Dietary behaviors, physical activity, and cigarette smoking among pregnant Puerto Rican women

BACKGROUND

Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women.

OBJECTIVE

We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients.

DESIGN

Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings.

RESULTS

Approximately 13% of women met physical activity guidelines [>or=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9).

CONCLUSION

Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.

Methodological challenges when monitoring the diet of pregnant women in a large study: experiences from the Norwegian Mother and Child Cohort Study (MoBa)

The aim of this article is to describe the main methodological challenges in the monitoring of dietary intake in the Norwegian Mother and Child Cohort Study (MoBa), a pregnancy cohort aiming to include 100 000 participants. The overall challenge was to record dietary patterns in sufficient detail to support future testing of a broad range of hypotheses, while at the same time limiting the burden on the participants. The main questions to be answered were: which dietary method to choose, when in pregnancy to ask, which time period should the questions cover, which diet questions to include, how to perform a validation study, and how to handle uncertainties in the reporting. Our decisions were as follows: using a semi-quantitative food frequency questionnaire (FFQ) (in use from 1 March 2002), letting the participants answer in mid-pregnancy, and asking the mother what she has eaten since she became pregnant. The questions make it possible to estimate intake of food supplements, antioxidants and environmental contaminants in the future. Misreporting is handled by consistency checks. Reports with a calculated daily energy intake of <4.5 and >20 MJ day(-1) are excluded, about 1% in each end of the scale. A validation study confirmed that the included intakes are realistic. The outcome of our methodological choices indicates that our FFQ strikes a reasonable balance between conflicting methodological and scientific interests, and that our approach therefore may be of use to others planning to monitor diet in pregnancy cohorts.

Taking the long view: the prenatal environment and early adolescent overweight

The purpose of this study was to assess the independent effects of the prenatal environment and cumulated social risks on the likelihood of being overweight at age 12/13 years. Maternal prepregnancy weight and smoking during pregnancy were the measures of prenatal exposures. Average lifetime per capita income and mother's lifetime marital status were the measures of cumulative social risks. Analysis of data from the National Longitudinal Survey of Youth's Child-Mother file indicated that exposures to tobacco smoke in utero, maternal prepregnancy overweight/obesity, and maternal unmarried status were significant risks for adolescent overweight. The risk for overweight was reduced by breastfeeding if the mother was overweight/obese prepregnancy. Prenatal and early life factors were related to adolescent overweight, providing an important window for intervention.

Does the measure of economic disadvantage matter? Exploring the effect of individual and relative deprivation on intrauterine growth restriction

This paper examines the relation between health, individual income, and relative deprivation. Three alternative measures of relative deprivation are described, Yitzhaik relative deprivation, Deaton relative deprivation, and log income difference relative deprivation, with attention to problems in measuring permanent disadvantage when the underlying income distribution is changing over time. We used data from the National Longitudinal Surveys of Youth, a US-based longitudinal survey, to examine the associations between disadvantage, measured cross-sectionally and aggregated over the life course, and intrauterine growth restriction (IUGR). We reject the hypotheses that any of the economic measures, whether permanent/contemporaneous or individual/relative, have different associations with IUGR in terms of sign and significance. There was some evidence that permanent economic disadvantage was associated with greater risk of IUGR than those on the corresponding contemporaneous measures. The fitted values from logistic regressions on each measure of disadvantage were compared with the two-way plots of the observed IUGR-income pattern. Deaton relative deprivation and log income difference tracked the observed probability of IUGR as a function of income more closely than the other two measures of relative deprivation. Finally, we examined the determinants of each measure of disadvantage. Observed characteristics in childhood and adulthood explained more of the variance in log income difference and Deaton relative deprivation than in the other two measures of disadvantage. They also explained more of the variance in permanent disadvantage than in the contemporaneous counterpart.

Seasonal variation of nutrient intake in pregnancy: effects on infant measures and possible influence on diseases related to season of birth

OBJECTIVES

To determine, firstly, if there was any seasonal effect on nutrient intake during pregnancy and birth measures, secondly, if there was any relationship between maternal nutrient intake and infant birth measures according to season and thirdly, to consider the hypothesis that seasonal change in nutrient intake during pregnancy might affect health in later life of some women's offspring.

DESIGN

Pilot study to determine number of days required to characterize group intake followed by a prospective cohort study.

SETTING

Patients attending a city ante-natal clinic in the lower North Island, New Zealand.

SUBJECTS

A total of 214 healthy mostly European pregnant women volunteers, entering the second trimester of pregnancy, of whom 10 miscarried and seven withdrew.

METHODS

Subjects were visited in months 4 and 7 of pregnancy, and months 2, 6 and 12 after birth. Height, weight and skinfolds were measured and questionnaires to determine personal details administered at these times. Subjects recorded 8 days of weighed diets in both the fourth and seventh month. Health records were used to supply infant measures.

RESULTS

Significant (P</=0.05) seasonal variations in fat, carbohydrate, vitamin C and D, B vitamins, beta-carotene, sodium, potassium, calcium, phosphorous, sulfur, sodium, chloride, zinc and selenium intakes were found. No significant 'main effect' difference in gestational age, infant birthweight, and head circumference was found with season. However, there were significant interactions (P</=0.05) for each birth season between birth measures and specific maternal nutrients at months 4 and 7 of pregnancy.

CONCLUSION

The significant seasonal variations in nutrient intake in pregnant women, and significant influence of nutrient intake on birth measures in different seasons, suggests seasonal nutrient variation may also affect fetal development at a cellular level. This supports our hypothesis that the development of conditions related to season of birth, including schizophrenia, multiple sclerosis, type I diabetes and longevity, may be influenced by seasonal variation in nutrient intake during pregnancy.

Nutrition in pregnant teenagers: how can nurses help

Teenage birth rates in the UK are some of the highest in Europe. This article summarizes how the diet of pregnant British teenagers is currently inadequate and may impact upon maternal and infant health in the short and long term. The review highlights the value of an adequate diet during teenage pregnancies and explains how specific nutrient requirements can be met.

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however, are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.

The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review

This evidence-based review focuses on the impact of potentially modifiable, non-communicable lifestyle factors on reproductive performance in the general population and the infertile population undergoing assisted reproductive technology (ART) treatment. The impact of several lifestyle factors including; age, weight, smoking, diet, exercise, psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants are included in the review. The databases of Medline, PubMed and Cinahl were searched to identify relevant publications. There is strong evidence that age, weight and smoking impact on general health and adversely on reproductive performance. However there is a need for further research focusing specifically on the relationship between diet and various levels of exercise on reproductive performance. There are several other factors such as psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants that have been implicated but the evidence is equivocal. It is concluded that lifestyle modification can assist couples to conceive spontaneously or optimize their chances of conception with ART treatment.

Targeting postprandial hyperglycemia

In healthy individuals, blood glucose levels in the fasting state are maintained by the continuous basal-level insulin secretion. After a meal, the rise in postprandial glucose (PPG) is controlled by the rapid pancreatic release of insulin, stimulated by both glucose and the intestinal production of the incretins glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1. In diabetic individuals, postprandial insulin secretion is insufficient to suppress an excessive rise in PPG. There is increasing evidence that elevated PPG exerts a more deleterious effect on the vascular system than elevation of fasting plasma glucose. In particular, individuals with normal fasting plasma glucose but impaired glucose tolerance have significantly increased risk of cardiovascular events. With the recognition of the importance of PPG and the availability of new pharmacologic options, management of diabetes will shift to greater attention to PPG levels. The prototype for such an approach is in the treatment of gestational diabetes and diabetic pregnancies where PPG is the primary target of efforts at glycemic control. These efforts have been extremely successful in improving the outlook for diabetic pregnant women. There are many approaches to reduction of PPG; dietary management and promotion of exercise are very effective. Sulfonylureas, meglitinides, metformin, thiazolidinediones, and disaccharidase inhibitors all counteract PPG elevation. The development of glucagon-like peptide 1 agonists such as exendin and dipeptidyl peptidase IV inhibitors such as vildagliptin offers a new approach to suppression of PPG elevation. New semisynthetic insulin analogues permit a more aggressive response to postprandial glucose elevation, with lower risk of hypoglycemia, than with regular insulin. Inhaled insulin also has a rapid onset of action and offers benefits in PPG control. It is proposed that an aggressive treatment approach focusing on PPG, similar to the current standards for diabetic pregancies, be directed at individuals with diabetes and impaired glucose tolerance.