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Krupa C, Qamar H, O'Callaghan KM, Onoyovwi A, Al Mahmud A, Ahmed T, Gernand AD, Roth DE. Prenatal but not continued postpartum vitamin D supplementation reduces maternal bone resorption as measured by C-terminal telopeptide of type 1 collagen without effects on other biomarkers of bone metabolism. Endocr Metab Sci 2024; 14:None. [PMID: 38558882 PMCID: PMC10914667 DOI: 10.1016/j.endmts.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 04/04/2024] Open
Abstract
Vitamin D is a key regulator of bone mineral homeostasis and may modulate maternal bone health during pregnancy and postpartum. Using previously-collected data from the Maternal Vitamin D for Infant Growth (MDIG) trial in Dhaka, Bangladesh, we aimed to investigate the effects of prenatal and postpartum vitamin D3 supplementation on circulating biomarkers of bone formation and resorption at delivery and 6 months postpartum. MDIG trial participants were randomized to receive a prenatal;postpartum regimen of placebo or vitamin D3 (IU/week) as either 0;0 (Group A), 4200;0 (B), 16,800;0 (C), 28,000;0 (D) or 28,000;28,000 (E) from 17 to 24 weeks' gestation to 6 months postpartum. As this sub-study was not pre-planned, the study sample included MDIG participants who had data for at least 1 biomarker of interest at delivery or 6 months postpartum, with a corresponding baseline measurement (n = 690; 53 % of 1300 enrolled trial participants). Biomarkers related to bone turnover were measured in maternal venous blood samples collected at enrolment, delivery, and 6 months postpartum: osteoprotegerin (OPG), osteocalcin (OC), receptor activator nuclear factor kappa-B ligand (RANKL), fibroblast growth factor 23 (FGF23), procollagen type 1 N-terminal propeptide, (P1NP) and carboxy terminal telopeptide of type 1 collagen (CTx). Supplementation effects were expressed as percent differences between each vitamin D group and placebo with 95 % confidence intervals (95 % CI). Of 690 participants, 64 % had 25-hydroxyvitamin D concentrations (25OHD) <30 nmol/L and 94 % had 25OHD < 50 nmol/L at trial enrolment. At delivery, mean CTx concentrations were 27 % lower in group E versus placebo (95 % CI: -38, -13; P < 0.001), adjusting for enrolment concentrations. However, at 6 months postpartum, CTx concentrations were not statistically different in group E versus placebo (14 %; 95 % CI: -5.3, 37; P = 0.168), adjusting for delivery CTx concentrations. Effects on other biomarkers at delivery or postpartum were not statistically significant. In conclusion, prenatal high-dose vitamin D supplementation reduced bone resorption during pregnancy, albeit by only one biomarker, and without evidence of a sustained effect in the postpartum period. However, further evidence is needed to substantiate potential maternal bone health benefits of vitamin D in the postpartum period.
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Affiliation(s)
- Christine Krupa
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Huma Qamar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Karen M. O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, King's College London, United Kingdom
| | - Akpevwe Onoyovwi
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, PA, United States
| | - Daniel E. Roth
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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O'Callaghan KM, Qamar H, Gernand AD, Onoyovwi AK, Zlotkin S, Mahmud AA, Ahmed T, Keya FK, Roth DE. Maternal prenatal, with or without postpartum, vitamin D3 supplementation does not improve maternal iron status at delivery or infant iron status at 6 months of age: secondary analysis of a randomised controlled trial. BMJ Nutr Prev Health 2023; 6:282-292. [PMID: 38264359 PMCID: PMC10800272 DOI: 10.1136/bmjnph-2023-000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
Background Vitamin D may modify iron status through regulation of hepcidin and inflammatory pathways. This study aimed to investigate effects of maternal vitamin D supplementation on iron status in pregnancy and early infancy. Methods In a trial in Dhaka, Bangladesh, women (n=1300) were randomised to one of five vitamin D3 regimens from 17 to 24 weeks' gestation until 26 weeks postpartum (prenatal; postpartum doses): 0;0, 4200;0, 16 800;0, 28 000;0 or 28 000;28 000 IU/week. All participants received standard iron-folic acid supplementation. In this secondary analysis (n=998), we examined effects of prenatal;postpartum vitamin D on serum ferritin and other biomarkers of maternal iron status (transferrin saturation, total iron binding capacity, soluble transferrin receptor and hepcidin) at delivery, and infant ferritin and haemoglobin at 6 months of age. Using linear regression, we estimated per cent mean differences between each intervention group and placebo with 95% CIs, with and without adjustment for baseline ferritin or inflammatory biomarkers (C reactive protein and α-1-acid glycoprotein (AGP)). Results At delivery, ferritin concentrations were similar between each intervention group and placebo in unadjusted (n=998) and baseline ferritin-adjusted analyses (n=992; p>0.05). Compared with placebo, AGP was lower in each intervention group (per cent difference (95% CI) = -11% (-21 to -1.0), -14% (-23 to -3.5) and -11% (-19 to -2.0) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=779). In the subgroup of women with baseline 25-hydroxyvitamin D < 30 nmol/L, ferritin was lower in each intervention group versus placebo (-23% (-37 to -5.0), -20% (-35 to -1.9) and -20% (-33 to -4.1) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=645); effects were slightly attenuated after adjustment for inflammation (n=510). There were no effects of vitamin D on other iron biomarkers among women at delivery or infants aged 6 months. Conclusion These findings do not support improvement of iron status by vitamin D. The effect of prenatal vitamin D supplementation on ferritin may reflect an anti-inflammatory mechanism.
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Affiliation(s)
- Karen M O'Callaghan
- Department of Nutritional Sciences, King's College London, London, UK
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - AK Onoyovwi
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stanley Zlotkin
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Abdullah A Mahmud
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farhana K Keya
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Roberts JM, King TL, Barton JR, Beck S, Bernstein IM, Buck TE, Forgues-Lackie MA, Facco FL, Gernand AD, Graves CR, Jeyabalan A, Hauspurg A, Manuck TA, Myers JE, Powell TM, Sutton EF, Tinker E, Tsigas E, Myatt L. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol 2023; 229:193-213. [PMID: 37120055 DOI: 10.1016/j.ajog.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
Preeclampsia is a multisystemic disorder of pregnancy that affects 250,000 pregnant individuals in the United States and approximately 10 million worldwide per annum. Preeclampsia is associated with substantial immediate morbidity and mortality but also long-term morbidity for both mother and offspring. It is now clearly established that a low dose of aspirin given daily, beginning early in pregnancy modestly reduces the occurrence of preeclampsia. Low-dose aspirin seems safe, but because there is a paucity of information about long-term effects on the infant, it is not recommended for all pregnant individuals. Thus, several expert groups have identified clinical factors that indicate sufficient risk to recommend low-dose aspirin preventive therapy. These risk factors may be complemented by biochemical and/or biophysical tests that either indicate increased probability of preeclampsia in individuals with clinical risk factors, or more importantly, identify increased likelihood in those without other evident risk. In addition, the opportunity exists to provide this population with additional care that may prevent or mitigate the short- and long-term effects of preeclampsia. Patient and provider education, increased surveillance, behavioral modification, and other approaches to improve outcomes in these individuals can improve the chance of a healthy outcome. We assembled a group with diverse, relevant expertise (clinicians, investigators, advocates, and public and private stakeholders) to develop a care plan in which providers and pregnant individuals at risk can work together to reduce the risk of preeclampsia and associated morbidities. The plan is for care of individuals at moderate to high risk for developing preeclampsia, sufficient to receive low-dose aspirin therapy, as identified by clinical and/or laboratory findings. The recommendations are presented using the GRADE methodology with the quality of evidence upon which each is based. In addition, printable appendices with concise summaries of the care plan's recommendations for patients and healthcare providers are provided. We believe that this shared approach to care will facilitate prevention of preeclampsia and its attendant short- and long-term morbidity in patients identified as at risk for development of this disorder.
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Affiliation(s)
- James M Roberts
- Magee-Womens Research Institute and Clinical and Translational Science Institute, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
| | - Tekoa L King
- School of Nursing, University of California, San Francisco, Oakland, CA
| | - John R Barton
- Maternal-Fetal Medicine, Baptist Health, Lexington, KY
| | - Stacy Beck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT
| | | | | | - Francesca L Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alison D Gernand
- Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Cornelia R Graves
- Division of Maternal-Fetal Medicine, University of Tennessee College of Medicine, Nashville, TN
| | - Arundhati Jeyabalan
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Tracy A Manuck
- Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jenny E Myers
- Division of Developmental Biology and Medicine, University of Manchester, Manchester, United Kingdom
| | - Trashaun M Powell
- National Racial Disparity Taskforce, Preeclampsia Foundation and New Jersey Family Planning League, Somerset, NJ
| | | | | | | | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Sidiqi A, Fariha F, Shanta SS, Dasiewicz A, Mahmud AA, Moore DR, Shankaran M, Hellerstein MK, Evans WJ, Gernand AD, Islam MM, Abrams SA, Harrington J, Nyangau E, Roth DE, O'Callaghan KM. Estimation of skeletal muscle mass in 4-year-old children using the D 3-creatine dilution method. Pediatr Res 2023; 94:1195-1202. [PMID: 37037953 PMCID: PMC10444613 DOI: 10.1038/s41390-023-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Given limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh. METHODS Following D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer. RESULTS SMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91). CONCLUSIONS The D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach. IMPACT The D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.
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Affiliation(s)
- Aysha Sidiqi
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alison Dasiewicz
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel R Moore
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Marc K Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Jennifer Harrington
- Department of Pediatrics, Women's and Children's Health Network and University of Adelaide, Adelaide, SA, Australia
| | - Edna Nyangau
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel E Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Nutritional Sciences, King's College London, London, UK.
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Gallagher K, Aruma JFC, Oji-Mmuo CN, Pauli JM, Curtin WM, Goldstein JA, Stuckey HL, Gernand AD. Placental pathology reports: A qualitative study in a US university hospital setting on perceived clinical utility and areas for improvement. PLoS One 2023; 18:e0286294. [PMID: 37289756 PMCID: PMC10249791 DOI: 10.1371/journal.pone.0286294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/12/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To explore how placental pathology is currently used by clinicians and what placental information would be most useful in the immediate hours after delivery. STUDY DESIGN We used a qualitative study design to conduct in-depth, semi-structured interviews with obstetric and neonatal clinicians who provide delivery or postpartum care at an academic medical center in the US (n = 19). Interviews were transcribed and analyzed using descriptive content analysis. RESULTS Clinicians valued placental pathology information yet cited multiple barriers that prevent the consistent use of pathology. Four main themes were identified. First, the placenta is sent to pathology for consistent reasons, however, the pathology report is accessed by clinicians inconsistently due to key barriers: difficult to find in the electronic medical record, understand, and get quickly. Second, clinicians value placental pathology for explanatory capability as well as for contributions to current and future care, particularly when there is fetal growth restriction, stillbirth, or antibiotic use. Third, a rapid placental exam (specifically including placental weight, infection, infarction, and overall assessment) would be helpful in providing clinical care. Fourth, placental pathology reports that connect clinically relevant findings (similar to radiology) and that are written with plain, standardized language and that non-pathologists can more readily understand are preferred. CONCLUSION Placental pathology is important to clinicians that care for mothers and newborns (particularly those that are critically ill) after birth, yet many problems stand in the way of its usefulness. Hospital administrators, perinatal pathologists, and clinicians should work together to improve access to and contents of reports. Support for new methods to provide quick placenta information is warranted.
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Affiliation(s)
- Kelly Gallagher
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Jane-Frances C. Aruma
- College of Medicine, Pennsylvania State University College of Medicine University Park Campus, Hershey, Pennsylvania, United States of America
| | - Christiana N. Oji-Mmuo
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Jaimey M. Pauli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - William M. Curtin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
- Division of Maternal-Fetal Medicine, Department of Pathology and Laboratory Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Jeffery A. Goldstein
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Heather L. Stuckey
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
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Ciulei MA, Smith ER, Perumal N, Jakazi CS, Sudfeld CR, Gernand AD. Nutritious Supplemental Foods for Pregnant Women from Food Insecure Settings: Types, Nutritional Composition, and Relationships to Health Outcomes. Curr Dev Nutr 2023; 7:100094. [PMID: 37250388 PMCID: PMC10209485 DOI: 10.1016/j.cdnut.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
There is growing evidence that the provision of nutritious supplemental foods to undernourished pregnant women can improve maternal and infant outcomes. However, comparing and synthesizing the evidence base is complicated by differences in interventions and products and the use of ambiguous terminology. We aimed to define 2 common types of nutritious supplemental foods used in pregnancy, balanced energy-protein (BEP) supplements and lipid-based nutrient supplements (LNS), and to review the evidence supporting each via a narrative review of systematic reviews and meta-analyses (SRMAs). Information about the nutritional composition of the food supplements and their effects on maternal and infant outcomes was abstracted. Five SRMAs (n = 20 trials) evaluated the effect of BEP compared with no BEP/control (comparison group commonly received iron and folic acid [IFA]). BEP foods/products ranged in calories (118-1017 kcals), protein (3-50 g), fat (6-57 g), and micronutrient content. Overall, maternal BEP improved birth weight and reduced the risk of stillbirth and small for gestational age when compared with no BEP/control in pregnancy. Three SRMAs (n = 5 trials) evaluated the effect of LNS compared with IFA or multiple micronutrients (MMNs). The LNS interventions comprised small- and large-quantity LNS that ranged in calories (118-746 kcals), protein (3-21 g), fat (10-53 g), and micronutrient content. LNS compared with IFA increased pregnancy duration, birth weight, and birth length and reduced the risk of small for gestational age and infant stunting; however, no beneficial effect of LNS was identified when compared with MMN. Despite heterogeneity in the nutritional composition of BEP supplements, the evidence suggests that in nutritionally at-risk populations, these products may improve birth outcomes in pregnant women. The evidence is limited but promising when LNS is compared with IFA in improving maternal and infant outcomes. Overall, BEP, compared with MMN or LNS, are key areas that have not been studied and deserve attention.
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Affiliation(s)
- Mihaela A. Ciulei
- Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA, United States
| | - Emily R. Smith
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
- Department of Exercise and Nutrition Sciences, George Washington University Milken Institute School of Public Health, Washington, DC, United States
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Nandita Perumal
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Chioniso S. Jakazi
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA, United States
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Aguree S, Murray-Kolb LE, Diaz F, Gernand AD. Menstrual Cycle-Associated Changes in Micronutrient Biomarkers Concentration: A Prospective Cohort Study. J Am Nutr Assoc 2023; 42:339-348. [PMID: 35512771 DOI: 10.1080/07315724.2022.2040399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
To evaluate variations in micronutrient biomarker concentrations and deficiencies across the menstrual cycle in a cohort of healthy women. This prospective cohort study was conducted among healthy women of reproductive age living in the State College area, Pennsylvania, (n = 45). Data collection occurred at the early follicular phase, the late follicular phase, and the midluteal phase. Fasting blood samples were collected to measure micronutrient biomarkers. At the early follicular phase, the mean ± SD concentrations for zinc, copper, magnesium, and retinol were 81.8 ± 16.2 µg/dL, 80.1 ± 12.8 µg/dL, 17.9 ± 1.4 mg/L, and 39.4 ± 9.3 µg/dL, respectively. The geometric mean (95% CI) for manganese, iron and ferritin concentrations were 1.51 [1.21, 1.87] µg/L, 106.7 [90.8, 125.4] µg/dL, and 26.4 [20.5, 34.0] µg/L, respectively. Mean concentrations of zinc and magnesium declined by 6.6% (p = 0.009) and 4.6% (p < 0.001) from the early follicular phase to the midluteal phase, respectively. Other biomarkers remained relatively constant across the cycle. At the early follicular phase, the prevalence of low serum concentrations for zinc, copper, magnesium, manganese, iron, and ferritin was 22%, 7%, 29%, 13%, 14%, and 28%, respectively. Also, in early follicular phase, 36% had anemia, and 13% specifically had iron deficiency anemia. The prevalence of magnesium deficiency was significantly higher at the midluteal phase vs. the early follicular phase (p = 0.025). Our study suggests that while many micronutrient concentrations are relatively constant across the menstrual cycle in healthy women, zinc and magnesium decline, and the prevalence of magnesium deficiency increases. Supplemental data for this article is available online at.
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Affiliation(s)
- Sixtus Aguree
- Department of Food Science and Human Nutrition, Iowa State University, Ames, Iowa, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Francisco Diaz
- Department of Animal Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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Gernand AD, Gallagher K, Bhandari N, Kolsteren P, Lee AC, Shafiq Y, Taneja S, Tielsch JM, Abate FW, Baye E, Berhane Y, Chowdhury R, Dailey-Chwalibóg T, de Kok B, Dhabhai N, Jehan F, Kang Y, Katz J, Khatry S, Lachat C, Mazumder S, Muhammad A, Nisar MI, Sharma S, Martin LA, Upadhyay RP, Christian P. Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection. BMC Pregnancy Childbirth 2023; 23:107. [PMID: 36774497 PMCID: PMC9919738 DOI: 10.1186/s12884-023-05366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.
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Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA.
| | - Kelly Gallagher
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sunita Taneja
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - James M Tielsch
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, D.C, USA
| | - Firehiwot Workneh Abate
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Estifanos Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Ranadip Chowdhury
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Neeta Dhabhai
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Subarna Khatry
- Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sitanshi Sharma
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Leigh A Martin
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Walker RE, Harvatine KJ, Ross AC, Wagner EA, Riddle SW, Gernand AD, Nommsen-Rivers LA. Fatty Acid Transfer from Blood to Milk Is Disrupted in Mothers with Low Milk Production, Obesity, and Inflammation. J Nutr 2023; 152:2716-2726. [PMID: 36208911 PMCID: PMC9840005 DOI: 10.1093/jn/nxac220] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/26/2022] [Accepted: 09/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Obesity is associated with chronic inflammation and is a risk factor for insufficient milk production. Inflammation-mediated suppression of LPL could inhibit mammary uptake of long-chain fatty acids (LCFAs; >16 carbons). OBJECTIVES In an ancillary case-control analysis, we investigated whether women with low milk production despite regular breast emptying have elevated inflammation and disrupted transfer of LCFAs from plasma into milk. METHODS Data and specimens from a low milk supply study and an exclusively breastfeeding control group were analyzed, with milk production measured by 24-h test-weighing at 2-10 wk postpartum. Low milk supply groups were defined as very low (VL; <300 mL/d; n = 23) or moderate (MOD; ≥300 mL/d; n = 20) milk production, and compared with controls (≥699 mL/d; n = 18). Serum and milk fatty acids (weight% of total) were measured by GC, serum and milk TNF-α by ELISA, and serum high-sensitivity C-reactive protein (hsCRP) by clinical analyzer. Group differences were assessed by linear regression models, chi-square exact tests, and Kruskal-Wallis nonparametric tests. RESULTS VL cases, as compared with MOD cases and controls, had higher prevalence of elevated serum hsCRP (>5 mg/L; 57%, 15%, and 22%, respectively; P = 0.004), detectable milk TNF-α (67%, 32%, and 33%, respectively; P = 0.04), and obesity (78%, 40%, and 22%, respectively; P = 0.003). VL cases had lower mean ± SD LCFAs in milk (60% ± 3%) than MOD cases (65% ± 4%) and controls (66% ± 5%) (P < 0.001). Milk and serum LCFAs were strongly correlated in controls (r = 0.82, P < 0.001), but not in the MOD (r = 0.25, P = 0.30) or VL (r = 0.20, P = 0.41) groups (Pint < 0.001). CONCLUSIONS Mothers with very low milk production have significantly higher obesity and inflammatory biomarkers, lower LCFAs in milk, and disrupted association between plasma and milk LCFAs. These data support the hypothesis that inflammation disrupts normal mammary gland fatty acid uptake. Further research should address impacts of inflammation and obesity on mammary fatty acid uptake for milk production.
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Affiliation(s)
- Rachel E Walker
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Kevin J Harvatine
- Department of Animal Science, The Pennsylvania State University, University Park, PA, USA
| | - A Catharine Ross
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Erin A Wagner
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah W Riddle
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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10
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Young MF, Ou J, Duong C, Luo H, Beyh YS, Meng J, Gernand AD, Roth DE, Suchdev PS. Assessment of Vitamin D status and association with inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2023; 117:175-181. [PMID: 36789936 DOI: 10.1016/j.ajcnut.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/05/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is unclear whether 25(OH)D concentrations in children and female adults may be influenced by inflammation and thus require adjustment when estimating the population prevalence of vitamin D deficiency. OBJECTIVES We examined correlations between inflammation biomarkers, CRP or alpha-1-acid glycoprotein (AGP), and serum 25(OH)D concentrations among preschool children (PSC; 6-59 mo) and nonpregnant females of reproductive age (FRA; 15-49 y). METHODS We analyzed cross-sectional data from 6 nationally representative nutrition surveys (Afghanistan, Cambodia, Pakistan, UK, USA, and Vietnam) conducted among PSC (n = 9880) and FRA (n = 14,749) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project. Rank correlations between CRP or AGP and 25(OH)D concentrations were examined while taking into account complex survey design effects. RESULTS Among both PSC and FRA, correlations between inflammation and vitamin D biomarkers were weak and inconsistent across surveys. For PSC, correlation coefficients between CRP and 25(OH)D concentrations ranged from -0.04 to 0.08, and correlations between AGP and 25(OH)D ranged from 0.01 to 0.05. Correlation coefficients between CRP and 25(OH)D for FRA ranged from -0.11 to 0.14, and correlations between AGP and 25(OH)D concentrations ranged from -0.05 to 0.01. CONCLUSIONS Based on the weak and inconsistent correlations between CRP or AGP and 25(OH)D, there is no rationale to adjust for these inflammation biomarkers when estimating population prevalence of vitamin D deficiency in PSC or FRA.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Jiangda Ou
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cam Duong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hanqi Luo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yara S Beyh
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jiawei Meng
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Daniel E Roth
- Department of Pediatrics and the Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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O'Callaghan KM, Shanta SS, Fariha F, Harrington J, Mahmud AA, Emdin AL, Gernand AD, Ahmed T, Abrams SA, Moore DR, Roth DE. Effect of maternal prenatal and postpartum vitamin D supplementation on offspring bone mass and muscle strength in early childhood: follow-up of a randomized controlled trial. Am J Clin Nutr 2021; 115:770-780. [PMID: 34849536 PMCID: PMC8895216 DOI: 10.1093/ajcn/nqab396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Maternal vitamin D status during pregnancy and lactation is a modifiable factor that may influence offspring musculoskeletal outcomes. However, few randomized trials have tested the effects of prenatal or postpartum vitamin D supplementation on offspring bone and muscle development. OBJECTIVES The aim was to examine hypothesized effects of improvements in early-life vitamin D status on childhood musculoskeletal health in Dhaka, Bangladesh. METHODS In a previously completed, double-blind, dose-ranging trial, healthy pregnant women (n = 1300) were recruited at 17-24 weeks' gestation and randomly assigned to a prenatal/postpartum regimen of 0/0, 4200/0, 16,800/0, 28,000/0, or 28,000/28,000 IU cholecalciferol (vitamin D3)/wk until 26 wk postpartum. In this new report, we describe additional follow-up at 4 y of age (n = 642) for longer-term outcomes. Bone mineral content (BMC) and areal bone mineral density (aBMD) were measured by DXA. Grip strength was tested using a hand-held dynamometer. The primary comparison was children of women assigned to 28,000 IU/wk prenatally compared with placebo. Differences are expressed as means and 95% CIs. RESULTS Total-body-less-head (TBLH) BMC, TBLH aBMD, and grip strength were similar in the combined high-dose prenatal (28,000/0 and 28,000/28,000 IU/wk) compared with placebo groups (mean difference [95% CI] = 0.61 g [-10.90, 12.13], 0.0004 g/cm2 [-0.0089, 0.0097], and 0.02 kg [-0.26, 0.31], respectively). In dose-ranging analyses, TBLH BMC and aBMD, whole-body BMC and aBMD, and grip strength in each of the prenatal vitamin D groups were not significantly different from placebo (P > 0.05 for all comparisons). Only head aBMD was greater in children of women assigned to the 28,000/28,000-IU regimen compared with placebo (mean difference [95% CI] = 0.024 g/cm2 [0.0009, 0.047], P = 0.042); the effect was attenuated upon adjustment for child height, weight, and sex (P = 0.11). CONCLUSIONS Maternal prenatal, with or without postpartum, vitamin D supplementation does not improve child BMC, aBMD, or grip strength at 4 y of age. The MDIG trial and present follow-up study were registered prospectively at www.clinicaltrials.gov as NCT01924013 and NCT03537443, respectively.
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Affiliation(s)
- Karen M O'Callaghan
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jennifer Harrington
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abby L Emdin
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | | | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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12
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Smith ER, He S, Klatt KC, Barberio MD, Rahnavard A, Azad N, Brandt C, Harker B, Hogan E, Kucherlapaty P, Moradian D, Gernand AD, Ahmadzia HK. Limited data exist to inform our basic understanding of micronutrient requirements in pregnancy. Sci Adv 2021; 7:eabj8016. [PMID: 34678054 PMCID: PMC8535830 DOI: 10.1126/sciadv.abj8016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Women and pregnant people have historically been underrepresented in research; this may extend to the basic research informing nutrient reference values, such as the United States’ and Canada’s Dietary Reference Intakes (DRIs). After screening the DRI reports for 23 micronutrients, we extracted metadata from 704 studies. Women were excluded in 23% of studies, and they accounted for a smaller proportion of the sample size (29%). Pregnant or lactating people were included in 17% of the studies. Studies that used rigorous design elements, such as controlled feeding and stable isotope studies, were the most likely to include men only. The majority of studies (>90%) did not report race and ethnicity. Although nutrient reference values are intended for use in the general population, we find that the basic science informing these values may not be generalizable. We call urgently upon funders and researchers to address fundamental gaps in knowledge with high-quality research.
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Affiliation(s)
- Emily R. Smith
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Siran He
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Kevin C. Klatt
- USDA Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Matthew D. Barberio
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Ali Rahnavard
- Computational Biology Institute, Departments of Biostatistics and Bioinformatics, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Negeena Azad
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Carolyn Brandt
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Bethany Harker
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
| | - Emily Hogan
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Padmini Kucherlapaty
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
| | - Dina Moradian
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16801, USA
| | - Homa K. Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
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13
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Levy B, O'Callaghan KM, Qamar H, Mahmud AA, Gernand AD, Islam MM, Roth DE. Basal Vitamin D Status and Supplement Dose Are Primary Contributors to Maternal 25-Hydroxyvitamin D Response to Prenatal and Postpartum Cholecalciferol Supplementation. J Nutr 2021; 151:3361-3378. [PMID: 34302350 PMCID: PMC8562081 DOI: 10.1093/jn/nxab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/28/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Variability in the 25-hydroxyvitamin D [25(OH)D] response to prenatal and postpartum vitamin D supplementation is an important consideration for establishing vitamin D deficiency prevention regimens. OBJECTIVES We aimed to examine interindividual variation in maternal and infant 25(OH)D following maternal vitamin D supplementation. METHODS In a randomized trial of maternal vitamin D supplementation (Maternal Vitamin D for Infant Growth Trial), healthy pregnant women (n = 1300) received a prenatal cholecalciferol (vitamin D-3) dose of 0, 4200, 16,800, or 28,000 IU/wk from 17 to 24 wk of gestation followed by placebo to 6 mo postpartum. A fifth group received 28,000 IU cholecalciferol/wk both prenatally and postpartum. In a subset of participants, associations of 25(OH)D with hypothesized explanatory factors were estimated in women at delivery (n = 655) and 6 mo postpartum (n = 566), and in their infants at birth (n = 502) and 6 mo of age (n = 215). Base models included initial 25(OH)D and supplemental vitamin D dose. Multivariable models were extended to include other individual characteristics and specimen-related factors. The model coefficient of determination (R2) was used to express the percentage of total variance explained. RESULTS Supplemental vitamin D intake and initial 25(OH)D accounted for the majority of variance in maternal 25(OH)D at delivery and postpartum (R2 = 70% and 79%, respectively). Additional characteristics, including BMI, contributed negligibly to remaining variance (<5% increase in R2). Variance in neonatal 25(OH)D was explained mostly by maternal delivery 25(OH)D and prenatal vitamin D intake (R2 = 82%). Variance in 25(OH)D in later infancy could only partly be explained by numerous biological, sociodemographic, and laboratory-related characteristics, including feeding practices (R2 = 43%). CONCLUSIONS Presupplementation 25(OH)D and vitamin D supplemental dose are the major determinants of the response to maternal prenatal vitamin D intake. Vitamin D dosing regimens to prevent maternal and infant vitamin D deficiency should take into consideration the mean 25(OH)D concentration of the target population.
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Affiliation(s)
- Benjamin Levy
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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14
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Bebell LM, Parks K, Le MH, Ngonzi J, Adong J, Boatin AA, Bassett IV, Siedner MJ, Gernand AD, Roberts DJ. Placental decidual arteriopathy and vascular endothelial growth factor A (VEGF-A) expression among women with and without HIV. J Infect Dis 2021; 224:S694-S700. [PMID: 33880547 DOI: 10.1093/infdis/jiab201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women with HIV (WHIV) are at higher risk of adverse birth outcomes. Proposed mechanisms for the increased risk include placental arteriopathy (vasculopathy) and maternal vascular malperfusion (MVM) due to antiretroviral therapy (ART) and medical comorbidities. However, these features and their underlying pathophysiologic mechanisms have not been well characterized in WHIV. METHODS We performed gross and histologic examination and immunohistochemistry staining for vascular endothelial growth factor A (VEGF-A), a key angiogenic factor, on placentas from women with one or more MVM risk factors including: weight <5 th percentile, histologic infarct or distal villous hypoplasia, nevirapine-based ART, hypertension, and pre-eclampsia/eclampsia during pregnancy. We compared pathologic characteristics by maternal HIV serostatus. RESULTS A total of 27/41 (66%) placentas assessed for VEGF-A were from WHIV. Mean maternal age was 27 years. Among WHIV, median CD4 T-cell count was 440 cells/mm 3 and HIV viral load was undetectable in 74%. Of VEGF-A stained placentas, both decidua and villous endothelium tissue layers were present in 36 (88%). VEGF-A was detected in 31/36 (86%) with decidua present, and 39/40 (98%) with villous endothelium present. There were no differences in VEGF-A presence in any tissue type by maternal HIV serostatus (P=0.28-1.0). MVM was more common in placentas selected for VEGF-A staining (51 versus 8%, P<0.001). CONCLUSIONS VEGF-A immunostaining was highly prevalent, and staining pattern did not differ by maternal HIV serostatus among those with MVM risk factors, indicating the role of VEGF-A in placental vasculopathy may not differ by maternal HIV serostatus.
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Affiliation(s)
- Lisa M Bebell
- Massachusetts General Hospital Division of Infectious Diseases, Boston, MA, USA.,MassGeneral Global Health, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Kalynn Parks
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Mylinh H Le
- Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Ngonzi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adeline A Boatin
- MassGeneral Global Health, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Department of Obstetrics and Gynecology, Boston, MA, USA
| | - Ingrid V Bassett
- Massachusetts General Hospital Division of Infectious Diseases, Boston, MA, USA.,Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Massachusetts General Hospital Division of Infectious Diseases, Boston, MA, USA.,MassGeneral Global Health, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
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15
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Taylor LA, Gallagher K, Ott KA, Gernand AD. How often is the placenta included in human pregnancy research? A rapid systematic review of the literature. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13215.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The placenta is a complex organ that plays a vital role not only in nutrient transfer but also in directing maternal and fetal physiological processes across pregnancy. Due to its multi-functionality, assessing the placenta can provide critical information about maternal and child health and risks of adverse outcomes. Objective: We aimed to quantify the percentage of human pregnancy studies that include placenta data. Methods: We conducted a rapid review of pregnancy studies conducted in the US that were published as original research in PubMed in 2018. Human studies conducted during the second trimester, third trimester, or labor and/or delivery were eligible. The systematic search produced 1,448 publications. After screening and full article review, 290 studies met all eligibility criteria. We then extracted data on study design, reporting of placenta data, time and type of data collection, and study objective categorization. Results: In total, 32% of studies were randomized controlled trials; the remaining were observational studies. Only 14% included placenta data of any kind. A total of 10% included placenta data during pregnancy and 7% included data after delivery; only 2% included both. Most data during pregnancy were collected by ultrasound and most data on the delivered placenta were from pathology exams. Study objectives were focused on maternal and/or infant outcomes (99.7%), while only one study had a placenta outcome. Conclusion: Based on this rapid review, a small proportion of pregnancy studies use placenta data in research. The placenta, an essential component of understanding healthy or adverse outcomes, deserves much more attention in pregnancy research.
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Qamar H, Perumal N, Papp E, Gernand AD, Al Mahmud A, Roth DE. Higher maternal parathyroid hormone concentration at delivery is not associated with smaller newborn size. Endocr Connect 2021; 10:345-357. [PMID: 33640873 PMCID: PMC8052570 DOI: 10.1530/ec-21-0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Abstract
Intrauterine growth restriction (IUGR) reflects inadequate growth in-utero and is prevalent in low resource settings. This study aimed to assess the association of maternal delivery parathyroid hormone (PTH) - a regulator of bone turnover and calcium homeostasis - with newborn anthropometry, to identify regulators of PTH, and to delineate pathways by which maternal PTH regulates birth size using path analysis. This was a cross-sectional analysis of data from participants (n = 537) enrolled in the Maternal Vitamin D for Infant Growth trial in Dhaka, Bangladesh. Primary exposures were maternal delivery intact PTH (iPTH) or whole PTH (wPTH) and outcomes were gestational age- and sex-standardized z-scores for birth length (LAZ), weight (WAZ), and head circumference (HCAZ). Hypothesized regulators of PTH included calcium and protein intake, vitamin D, magnesium, fibroblast-like growth factor-23 (FGF23), and C-reactive protein. Maternal iPTH was not associated with birth size in linear regression analyses; however, in path analysis models, every SD increase in log(iPTH) was associated with 0.08SD (95% CI: 0.002, 0.162) higher LAZ. In linear regression and path analysis models, wPTH was positively associated with WAZ. Vitamin D suppressed PTH, while FGF23 was positively associated with PTH. In path analysis models, higher magnesium was negatively associated with LAZ; FGF23 was positively associated and protein intake was negatively associated with LAZ, WAZ, and HCAZ. Higher maternal PTH in late pregnancy is unlikely to contribute to IUGR. Future studies should investigate maternal FGF23, magnesium and protein intake as regulators of fetal growth, particularly in settings where food insecurity and IUGR are public health problems.
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Affiliation(s)
- Huma Qamar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nandita Perumal
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eszter Papp
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Daniel E Roth
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Correspondence should be addressed to D E Roth:
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Aguree S, Gernand AD. A methodology for examining the association between plasma volume and micronutrient biomarker mass and concentration in healthy eumenorrheic women. PeerJ 2021; 8:e10535. [PMID: 33391876 PMCID: PMC7759127 DOI: 10.7717/peerj.10535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/19/2020] [Indexed: 01/01/2023] Open
Abstract
Background Accurate estimation and interpretation of nutritional biomarker concentrations are important in nutritional research, clinical care, and public health surveillance. Plasma volume (PV) may affect the interpretation of plasma biomarkers but is rarely measured. We aimed to examine the association between plasma volume (PV) and micronutrient biomarker concentrations and mass as part of pilot work to develop methods. Methods Nine healthy women with regular menstrual cycles provided fasting blood samples to measure micronutrient biomarkers. Indocyanine green was injected, and five timed blood draws were taken from 2 to 5 min to measure PV. Visits were scheduled around menstrual cycle day 2. Retinol, 25-hydroxyvitamin D, riboflavin, alpha-tocopherol, zinc, copper, magnesium, manganese, cobalt, iron, and ferritin concentrations were measured in serum. Total circulating micronutrient biomarker mass was calculated from PV and concentration. Results The mean PV was 2067 ± 470 mL. PV correlated positively with concentration of iron (r = 0.87, P = 0.005); other correlations were weaker with p > 0.05. PV and total mass of retinol (r = 0.90), 25(OH)D (r = 0.75), zinc (r = 0.88), copper (r = 0.83), magnesium (r = 0.93), manganese (r = 0.72), and iron (r = 0.92) were strongly correlated (all p < 0.05). PV was positively correlated with circulating micronutrient mass for most biomarkers, implying that concentrations are maintained at different volumes of plasma. Larger studies are needed to further examine these relationships. Conclusion Though there appear to be some association between micronutrient biomarker mass and plasma volume, we are unable to draw a firm conclusion about any relationship from these results because of the small sample size. We consider these findings as a preliminary analysis to establish methods for future studies.
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Affiliation(s)
- Sixtus Aguree
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States of America.,Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
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Subramanian A, Korsiak J, Murphy KE, Al Mahmud A, Roth DE, Gernand AD. Effect of vitamin D supplementation during pregnancy on mid-to-late gestational blood pressure in a randomized controlled trial in Bangladesh. J Hypertens 2021; 39:135-142. [PMID: 32773651 PMCID: PMC7752208 DOI: 10.1097/hjh.0000000000002609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/19/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the dose-dependent effect of maternal vitamin D during pregnancy on blood pressure from mid-to-late gestation within the context of a randomized, placebo-controlled trial of vitamin D supplementation in Bangladesh (n = 1298). METHODS Healthy women without hypertension were enrolled at 17-24 weeks gestation and randomized to one of four vitamin D doses during pregnancy: placebo, 4200, 16 800 or 28 000 IU/week. This substudy examined 1257 women with blood pressure measured at enrollment with at least one other timepoint (measurements included at 24 weeks, 30 weeks, and weekly from 36 weeks until delivery). Effects of vitamin D on SBP or DBP were analyzed using mixed-effects models. RESULTS Vitamin D did not have an effect on SBP or DBP at 24 or 30 weeks; blood pressure was higher at 36 weeks for the highest dose versus placebo [mean difference (95% CI) mmHg: SBP = 2.3 (0.9-3.7); DBP = 1.9 (0.7-3.0)]. The differences in changes in SBP and DBP between vitamin D groups and placebo across intervals were small (P > 0.10), but the difference for 28 000 IU/week versus placebo was the highest from 30 to 36 weeks [SBP 0.2 (-0.1 to 0.5) and DBP 0.2 (-0.0 to 0.4) mmHg]. CONCLUSION Vitamin D supplementation starting mid-pregnancy did not affect SBP or DBP until late gestation, and then only at the highest dose. These results do not support the clinical use of vitamin D in pregnancy to lower maternal blood pressure.
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Affiliation(s)
- Anita Subramanian
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jill Korsiak
- Centre for Global Child Health, Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Kellie E. Murphy
- Department of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto, Canada
| | | | - Daniel E. Roth
- Centre for Global Child Health, Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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Zhang Z, Davaasuren D, Wu C, Goldstein JA, Gernand AD, Wang JZ. Multi-region saliency-aware learning for cross-domain placenta image segmentation. Pattern Recognit Lett 2020; 140:165-171. [PMID: 33324026 PMCID: PMC7727399 DOI: 10.1016/j.patrec.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/04/2022]
Abstract
We propose a multi-region saliency-aware learning (MSL) method for cross-domain placenta image segmentation. Unlike most existing image-level transfer learning methods that fail to preserve the semantics of paired regions, our MSL incorporates the attention mechanism and a saliency constraint into the adversarial translation process, which can realize multi-region mappings in the semantic level. Specifically, the built-in attention module serves to detect the most discriminative semantic regions that the generator should focus on. Then we use the attention consistency as another guidance for retaining semantics after translation. Furthermore, we exploit the specially designed saliency-consistent constraint to enforce the semantic consistency by requiring the saliency regions unchanged. We conduct experiments using two real-world placenta datasets we have collected. We examine the efficacy of this approach in (1) segmentation and (2) prediction of the placental diagnoses of fetal and maternal inflammatory response (FIR, MIR). Experimental results show the superiority of the proposed approach over the state of the art.
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Affiliation(s)
- Zhuomin Zhang
- The Pennsylvania State University, University Park, PA, USA
| | | | - Chenyan Wu
- The Pennsylvania State University, University Park, PA, USA
| | | | | | - James Z. Wang
- The Pennsylvania State University, University Park, PA, USA
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He S, Klatt KC, Rahnavard A, Barberio MD, Gernand AD, Smith ER. Protocol for meta-research on the evidence informing micronutrient dietary reference intakes for pregnant and lactating women. Gates Open Res 2020; 4:171. [PMID: 33629039 PMCID: PMC7876347 DOI: 10.12688/gatesopenres.13199.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 01/28/2023] Open
Abstract
Nutrient reference values are important parameters that guide nutrition and public health work globally. Micronutrient requirements during the peri-conception period are generally increased, which is essential in ensuring maternal, fetal, and neonatal health. Nevertheless, the current dietary reference intakes (DRIs) may be limited in terms of the methods used and the populations included, particularly the DRIs for pregnancy and lactation. In this proposed review, we will examine the methods (rigor of design, utilization of molecular methods, and presence of modern methods) and the population (inclusion of women, and in particular, pregnant and lactating people) in the studies used to inform the current DRIs. We will apply meta-science methods to this review, which involves formally reviewing the current evidence, and identifying opportunities to improve how we fund, perform, evaluate, and incorporate nutrition science into public health programs for better outcomes.
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Affiliation(s)
- Siran He
- Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Kevin C Klatt
- USDA Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ali Rahnavard
- Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Matthew D Barberio
- Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | | | - Emily R Smith
- Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
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21
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Goldstein JA, Gallagher K, Beck C, Kumar R, Gernand AD. Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease. Front Immunol 2020; 11:531543. [PMID: 33281808 PMCID: PMC7691234 DOI: 10.3389/fimmu.2020.531543] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Events in fetal life impact long-term health outcomes. The placenta is the first organ to form and is the site of juxtaposition between the maternal and fetal circulations. Most diseases of pregnancy are caused by, impact, or are reflected in the placenta. The purpose of this review is to describe the main inflammatory processes in the placenta, discuss their immunology, and relate their short- and long-term disease associations. Acute placental inflammation (API), including maternal and fetal inflammatory responses corresponds to the clinical diagnosis of chorioamnionitis and is associated with respiratory and neurodevelopmental diseases. The chronic placental inflammatory pathologies (CPI), include chronic villitis of unknown etiology, chronic deciduitis, chronic chorionitis, eosinophilic T-cell vasculitis, and chronic histiocytic intervillositis. These diseases are less-well studied, but have complex immunology and show mechanistic impacts on the fetal immune system. Overall, much work remains to be done in describing the long-term impacts of placental inflammation on offspring health.
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Affiliation(s)
- Jeffery A. Goldstein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kelly Gallagher
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Celeste Beck
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Rajesh Kumar
- Section of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University, Chicago, IL, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
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22
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Chen Y, Zhang Z, Wu C, Davaasuren D, Goldstein JA, Gernand AD, Wang JZ. AI-PLAX: AI-based placental assessment and examination using photos. Comput Med Imaging Graph 2020; 84:101744. [PMID: 32634729 PMCID: PMC7533514 DOI: 10.1016/j.compmedimag.2020.101744] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/24/2022]
Abstract
Post-delivery analysis of the placenta is useful for evaluating health risks of both the mother and baby. In the U.S., however, only about 20% of placentas are assessed by pathology exams, and placental data is often missed in pregnancy research because of the additional time, cost, and expertise needed. A computer-based tool that can be used in any delivery setting at the time of birth to provide an immediate and comprehensive placental assessment would have the potential to not only to improve health care, but also to radically improve medical knowledge. In this paper, we tackle the problem of automatic placental assessment and examination using photos. More concretely, we first address morphological characterization, which includes the tasks of placental image segmentation, umbilical cord insertion point localization, and maternal/fetal side classification. We also tackle clinically meaningful feature analysis of placentas, which comprises detection of retained placenta (i.e., incomplete placenta), umbilical cord knot, meconium, abruption, chorioamnionitis, and hypercoiled cord, and categorization of umbilical cord insertion type. We curated a dataset consisting of approximately 1300 placenta images taken at Northwestern Memorial Hospital, with hand-labeled pixel-level segmentation map, cord insertion point and other information extracted from the associated pathology reports. We developed the AI-based Placental Assessment and Examination system (AI-PLAX), which is a novel two-stage photograph-based pipeline for fully automated analysis. In the first stage, we use three encoder-decoder convolutional neural networks with a shared encoder to address morphological characterization tasks by employing a transfer-learning training strategy. In the second stage, we employ distinct sub-models to solve different feature analysis tasks by using both the photograph and the output of the first stage. We evaluated the effectiveness of our pipeline by using the curated dataset as well as the pathology reports in the medical record. Through extensive experiments, we demonstrate our system is able to produce accurate morphological characterization and very promising performance on aforementioned feature analysis tasks, all of which may possess clinical impact and contribute to future pregnancy research. This work is the first for comprehensive, automated, computer-based placental analysis and will serve as a launchpad for potentially multiple future innovations.
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Affiliation(s)
- Yukun Chen
- The Pennsylvania State University, University Park, PN, USA.
| | - Zhuomin Zhang
- The Pennsylvania State University, University Park, PN, USA
| | - Chenyan Wu
- The Pennsylvania State University, University Park, PN, USA
| | | | | | | | - James Z Wang
- The Pennsylvania State University, University Park, PN, USA.
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23
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Schulze KJ, Gernand AD, Khan AZ, Wu LSF, Mehra S, Shaikh S, Ali H, Shamim AA, Sungpuag P, Udomkesmalee E, Labrique AB, West KP, Christian P. Newborn micronutrient status biomarkers in a cluster-randomized trial of antenatal multiple micronutrient compared with iron folic acid supplementation in rural Bangladesh. Am J Clin Nutr 2020; 112:1328-1337. [PMID: 32844185 PMCID: PMC7657323 DOI: 10.1093/ajcn/nqaa223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Daily antenatal multiple micronutrient (MM) compared with iron folic acid (IFA) supplementation from early pregnancy improved birth outcomes and maternal micronutrient status in rural Bangladesh, but effects on newborn status are unknown. OBJECTIVE We examined cord blood micronutrient biomarkers in relation to antenatal MM and IFA supplementation and maternal gestational micronutrient status in rural Bangladeshi newborns. DESIGN In a double-blinded, cluster-randomized trial of antenatal IFA or MM (with the same IFA content), we analyzed cord blood plasma from 333 singleton births, and corresponding maternal plasma at 32.5 ± 2.6 wk of gestation, for ferritin (iron stores), folate, cobalamin (vitamin B-12), retinol (vitamin A), 25-hydroxyvitamin D [25(OH)D, vitamin D status], α-tocopherol (vitamin E), zinc, thyroglobulin, and free thyroxine (iodine status). Intervention effects and associations were determined using linear regression, exploring maternal status as a mediator of intervention effects on cord biomarkers. RESULTS The MM intervention increased cord ferritin (mean: +12.4%; 95% CI: 1.3, 24.6%), 25(OH)D (mean: +14.7%; 95% CI: 4.8, 25.6%), and zinc (mean: +5.8%; 95% CI: 1.0, 10.8%). Cord folate (mean: +26.8%; 95% CI: 19.6, 34.5%), cobalamin (mean: +31.3%; 95% CI: 24.6, 38.3%), 25(OH)D (mean: +26.7%; 95% CI: 23.2, 30.3%), α-tocopherol (mean: +8.7%; 95% CI: 3.6, 13.7%), zinc (mean: +2.3%; 95% CI: 0.5, 4.2%), thyroglobulin (mean: +20.1%; 95% CI: 9.0, 32.2%) and thyroxine (mean: +1.5%; 95% CI: 0.0, 3.0%) increased per 1-SD increment in maternal status (all P < 0.05); ferritin and retinol changed by +2.0%; 95% CI: -8.9, 14.3%; P = 0.72; and +3.5%; 95% CI: -0.4, 7.3%; P = 0.07, respectively. Ferritin, folate, cobalamin, zinc, and thyroglobulin averaged 1.57-6.75 times higher and retinol, α-tocopherol, and 25(OH)D 0.30-0.84 times lower in cord than maternal plasma, suggesting preferential maternal-fetal transfer of iron, folate, cobalamin, and zinc; limited transfer of fat-soluble vitamins; and high fetal iodine demand. CONCLUSIONS Antenatal MM supplementation increased newborn ferritin, 25(OH)D, and zinc, while maternal and newborn folate, vitamins B-12, D, and E, zinc, and iodine biomarkers were positively related. Despite limited effects of MM, better maternal micronutrient status was associated with improved micronutrient status of Bangladeshi newborns. This trial was registered at clinicaltrials.gov as NCT00860470.
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Affiliation(s)
| | - Alison D Gernand
- Present address for ADG: Department of Nutritional Sciences, The Pennsylvania State University, 224 Chandlee Lab, University Park, PA 16802, USA
| | - Afreen Zaman Khan
- Present address for AZK: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Abu Ahmed Shamim
- Present address for AAS: BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Aguree S, Bethancourt HJ, Taylor LA, Rosinger AY, Gernand AD. Plasma volume variation across the menstrual cycle among healthy women of reproductive age: A prospective cohort study. Physiol Rep 2020; 8:e14418. [PMID: 32323928 PMCID: PMC7178826 DOI: 10.14814/phy2.14418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022] Open
Abstract
Increases in reproductive hormones like estrogen, play an important role in the remarkable increases in plasma volume observed in pregnancy. Accurate estimates of plasma volume expansion during pregnancy depend on correctly timing and measuring plasma volume in nonpregnant women. However, to date, there is no consensus on the pattern of plasma volume across the menstrual cycle. We prospectively measured plasma volume in 45 women across a single menstrual cycle. A urine-based fertility monitor was used to time three clinic visits to distinct points in the menstrual cycle: the early follicular phase (~day 2), periovulation (~day 12), and the mid-point of the luteal phase (~day 21)-based on a 28-day cycle length. Healthy women aged 18-41 years with regular menstrual cycles and a healthy body weight were enrolled in the study. At each visit, blood samples were collected before and after injection of 0.25 mg/kg body weight of indocyanine green dye (ICG). Pre- and post-ICG injection plasma samples were used to measure plasma volume. Preinjection samples were used to measure ovarian hormones and plasma osmolality. Mean plasma volume was highest during the early follicular phase (2,276 ± 478 ml); it declined to 2,232 ± 509 ml by the late follicular phase and to 2,228 ± 502 ml by the midluteal phase. This study found that overall variations in plasma volume are small across the menstrual cycle. Therefore, in clinical practice and research, the menstrual cycle phase may not be an important consideration when evaluating plasma volume among women of reproductive age.
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Affiliation(s)
- Sixtus Aguree
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Hilary J. Bethancourt
- Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Leigh A. Taylor
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Asher Y. Rosinger
- Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkPAUSA
- Department of AnthropologyThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Alison D. Gernand
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
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25
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Pobee RA, Aguree S, Colecraft EK, Gernand AD, Murray-Kolb LE. Food Insecurity and Micronutrient Status among Ghanaian Women Planning to Become Pregnant. Nutrients 2020; 12:nu12020470. [PMID: 32069820 PMCID: PMC7071299 DOI: 10.3390/nu12020470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 01/15/2023] Open
Abstract
We examined the association between food insecurity (FIS) and micronutrient status among Ghanaian women planning to become pregnant. A cross-sectional analysis was completed of 95 women aged 18-35 years, living in the Upper Manya Krobo District in the Eastern Region of Ghana. Questionnaires were administered to collect sociodemographic and food security data; weight and height were measured. Blood was drawn from an antecubital vein; one drop was used to assess hemoglobin via Hemocue. Zinc and copper were analyzed using flame atomic spectrophotometry while iron biomarkers, retinol and 25-hydroxyvitamin D were analyzed using ELISA, ultra-performance liquid chromatography and liquid chromatography-tandem mass spectrometry, respectively. Logistic regression models were used to determine the relationship between food insecurity (FIS) and micronutrient deficiencies. FIS was reported among 23% of the households, while micronutrient deficiencies ranged from 7-28% irrespective of FIS status. Retinol concentrations were negatively associated with FIS (p = 0.043) after controlling for covariates, although levels were within the normal range in both groups. No statistically significant associations between FIS and micronutrient deficiencies were found. Among those with FIS, 59% were deficient in at least one nutrient with 18% deficient in two nutrients. Unmarried women were at higher risk of FIS (p = 0.017) than married women. FIS was associated with retinol concentrations but not other micronutrient biomarkers in Ghanaian women expecting to become pregnant in the next 6 months.
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Affiliation(s)
- Ruth Adisetu Pobee
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Sixtus Aguree
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Esi Komeley Colecraft
- Department of Nutrition and Food Science, University of Ghana, 00233 Legon-Accra, Ghana
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Laura E. Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
- Correspondence: ; Tel.: +1-814-863-7132
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26
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Aguree S, Gernand AD. Plasma volume expansion across healthy pregnancy: a systematic review and meta-analysis of longitudinal studies. BMC Pregnancy Childbirth 2019; 19:508. [PMID: 31856759 PMCID: PMC6924087 DOI: 10.1186/s12884-019-2619-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Plasma volume expansion is an important physiologic change across gestation. High or low expansion has been related to adverse pregnancy outcomes, yet there is a limited understanding of normal/healthy plasma volume expansion. We aimed to evaluate the pattern of plasma volume expansion across healthy pregnancies from longitudinal studies. METHODS We conducted a systematic review and meta-analysis to identify original studies that measured plasma volume in singleton pregnancies of healthy women. Specifically, we included studies that measured plasma volume at least two times across gestation and one time before or after pregnancy in the same women. PubMed, Web of Science, Cochrane, CINAHL, and clinicaltrials.gov databases were searched from the beginning of each database to February 2019. We combined data across studies using a random effects model. RESULTS Ten observational studies with a total of 347 pregnancies were eligible. Plasma volume increased by 6% (95% CI 3-9) in the first trimester compared to the nonpregnant state. In the second trimester, plasma volume was increased by 18% (95% CI 12-24) in gestational weeks 14-20 and 29% (95% CI 21-36) in weeks 21-27 above the nonpregnant state. In the third trimester, plasma volume was increased by 42% (95% CI 38-46) in weeks 28-34 and 48% (95% CI 44-51) in weeks 35-38. The highest rate of increase occurred in the first half of the second trimester. Included studies were rated from moderate to high quality; 7 out of 10 studies were conducted over 30 years ago. CONCLUSIONS In healthy pregnancies, plasma volume begins to expand in the first trimester, has the steepest rate of increase in the second trimester, and peaks late in the third trimester. The patterns observed from these studies may not reflect the current population, partly due to the changes in BMI over the last several decades. Additional longitudinal studies are needed to better characterize the range of normal plasma volume expansion across maternal characteristics.
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Affiliation(s)
- Sixtus Aguree
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Alison D Gernand
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
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27
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Maric-Bilkan C, Abrahams VM, Arteaga SS, Bourjeily G, Conrad KP, Catov JM, Costantine MM, Cox B, Garovic V, George EM, Gernand AD, Jeyabalan A, Karumanchi SA, Laposky AD, Miodovnik M, Mitchell M, Pemberton VL, Reddy UM, Santillan MK, Tsigas E, Thornburg KLR, Ward K, Myatt L, Roberts JM. Research Recommendations From the National Institutes of Health Workshop on Predicting, Preventing, and Treating Preeclampsia. Hypertension 2019; 73:757-766. [PMID: 30686084 DOI: 10.1161/hypertensionaha.118.11644] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Christine Maric-Bilkan
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Vikki M Abrahams
- Department of Ob/Gyn and Reproductive Sciences, Yale University School of Medicine, New Haven, CT (V.M.A.)
| | - S Sonia Arteaga
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI (G.B.)
| | - Kirk P Conrad
- Department of Physiology and Functional Genomics and Ob/Gyn, University of Florida College of Medicine, Gainesville (K.P.C.)
| | - Janet M Catov
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
| | - Maged M Costantine
- Department of Ob/Gyn, University of Texas Medical Branch, Galveston (M.M.C.)
| | - Brian Cox
- Department of Physiology and Ob/Gyn, University of Toronto, ON, Canada (B.C.)
| | - Vesna Garovic
- Department of Internal Medicine and Division of Nephrology and Hypertension, Department of Ob/Gyn, Mayo Clinic, Rochester, MN (V.G.)
| | - Eric M George
- Department of Physiology and Biophysics and Cell and Molecular Biology, University of Mississippi Medical Center, Jackson (E.M.G.)
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University (A.D.G.)
| | - Arun Jeyabalan
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
| | - S Ananth Karumanchi
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (S.A.K.)
| | - Aaron D Laposky
- Division of Lung Diseases, National Center on Sleep Disorders Research (A.D.L.), National Institutes of Health, Bethesda, MD
| | - Menachem Miodovnik
- National Heart, Lung, and Blood Institute and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (M. Miodovnik, U.M.R.), National Institutes of Health, Bethesda, MD
| | - Megan Mitchell
- Division of Extramural Research Activities (M. Mitchell), National Institutes of Health, Bethesda, MD
| | - Victoria L Pemberton
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Uma M Reddy
- National Heart, Lung, and Blood Institute and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (M. Miodovnik, U.M.R.), National Institutes of Health, Bethesda, MD
| | - Mark K Santillan
- Department of Ob/Gyn, University of Iowa Carver College of Medicine (M.K.S.)
| | | | - Kent L R Thornburg
- Bob & Charlee Moore Institute for Nutrition & Wellness, Oregon Health and Science University, Portland (K.L.R.T.)
| | | | - Leslie Myatt
- Bob & Charlee Moore Institute for Nutrition & Wellness and Department of Ob/Gyn, Oregon Health and Science University, Portland (L.M.)
| | - James M Roberts
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
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28
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Bourassa MW, Osendarp SJM, Adu-Afarwuah S, Ahmed S, Ajello C, Bergeron G, Black R, Christian P, Cousens S, de Pee S, Dewey KG, Arifeen SE, Engle-Stone R, Fleet A, Gernand AD, Hoddinott J, Klemm R, Kraemer K, Kupka R, McLean E, Moore SE, Neufeld LM, Persson LÅ, Rasmussen KM, Shankar AH, Smith E, Sudfeld CR, Udomkesmalee E, Vosti SA. Antenatal multiple micronutrient supplementation: call to action for change in recommendation. Ann N Y Acad Sci 2019; 1465:5-7. [PMID: 31691295 PMCID: PMC7053381 DOI: 10.1111/nyas.14271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Saima Ahmed
- The New York Academy of Sciences, New York, New York
| | - Clayton Ajello
- The Vitamin Angels Alliance, Inc., Santa Barbara, California
| | | | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.,UN World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Kathryn G Dewey
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Reina Engle-Stone
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Alison D Gernand
- The Pennsylvania State University, University Park, Pennsylvania
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Rolf Klemm
- The Vitamin Angels Alliance, Inc., Santa Barbara, California.,Helen Keller International, Baltimore, Maryland
| | | | | | | | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | | | - Lars-Åke Persson
- London School of Hygiene and Tropical Medicine, Addis Ababa, Ethiopia
| | | | - Anuraj H Shankar
- Summit Institute of Development, Mataram, Indonesia.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Emily Smith
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Departments of Global Health, and Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, D.C
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
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29
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Gomes F, Bourassa MW, Adu-Afarwuah S, Ajello C, Bhutta ZA, Black R, Catarino E, Chowdhury R, Dalmiya N, Dwarkanath P, Engle-Stone R, Gernand AD, Goudet S, Hoddinott J, Kaestel P, Manger MS, McDonald CM, Mehta S, Moore SE, Neufeld LM, Osendarp S, Ramachandran P, Rasmussen KM, Stewart C, Sudfeld C, West K, Bergeron G. Setting research priorities on multiple micronutrient supplementation in pregnancy. Ann N Y Acad Sci 2019; 1465:76-88. [PMID: 31696532 PMCID: PMC7186835 DOI: 10.1111/nyas.14267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
Prenatal micronutrient deficiencies are associated with negative maternal and birth
outcomes. Multiple micronutrient supplementation (MMS) during pregnancy is a
cost-effective intervention to reduce these adverse outcomes. However, important knowledge
gaps remain in the implementation of MMS interventions. The Child Health and Nutrition
Research Initiative (CHNRI) methodology was applied to inform the direction of research
and investments needed to support the implementation of MMS interventions for pregnant
women in low- and middle-income countries (LMIC). Following CHNRI methodology guidelines,
a group of international experts in nutrition and maternal health provided and ranked the
research questions that most urgently need to be resolved for prenatal MMS interventions
to be successfully implemented. Seventy-three research questions were received, analyzed,
and reorganized, resulting in 35 consolidated research questions. These were scored
against four criteria, yielding a priority ranking where the top 10 research options
focused on strategies to increase antenatal care attendance and MMS adherence, methods
needed to identify populations more likely to benefit from MMS interventions and some
discovery issues (e.g., potential benefit of extending MMS through lactation). This
exercise prioritized 35 discrete research questions that merit serious consideration for
the potential of MMS during pregnancy to be optimized in LMIC.
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Affiliation(s)
| | | | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, Ontario, Canada.,Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | | | | | | | | | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Pernille Kaestel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mari S Manger
- IZiNCG, Children's Hospital Oakland Research Institute, Oakland, California
| | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Sophie E Moore
- Department of Women & Children's Health, King's College London, London, United Kingdom
| | | | | | | | | | | | | | - Keith West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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30
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Jeong JH, Korsiak J, Papp E, Shi J, Gernand AD, Al Mahmud A, Roth DE. Determinants of Vitamin D Status of Women of Reproductive Age in Dhaka, Bangladesh: Insights from Husband-Wife Comparisons. Curr Dev Nutr 2019; 3:nzz112. [PMID: 31723723 PMCID: PMC6834782 DOI: 10.1093/cdn/nzz112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is common among women of reproductive age (WRA) in Bangladesh, but the causes remain unclear. OBJECTIVE To explain the high prevalence of vitamin D deficiency in WRA in Dhaka, Bangladesh, we compared the vitamin D status of pregnant women with that of their husbands and between pregnant and nonpregnant states. METHODS This study was an observational substudy of the Maternal Vitamin D for Infant Growth trial conducted in Dhaka, Bangladesh. Women (n = 1300) were enrolled in the second trimester of pregnancy and randomly assigned to 1 of 5 arms consisting of different doses of vitamin D supplements or placebo, with 1 arm continuing supplementation until 6 mo postpartum. A subgroup of trial participants and their husbands with plasma 25-hydroxyvitamin D [25(OH)D] concentration measurements (n = 84), and placebo-group trial participants with serum 25(OH)D measured in the second trimester of pregnancy and 6 mo postpartum (n = 89) were studied using linear mixed-effects regression models. RESULTS The mean ± SD plasma 25(OH)D in pregnant women in the second trimester was 23 ± 11 nmol/L. Adjusting for age and season, 25(OH)D of pregnant women was 30 nmol/L lower (95% CI: -36, -25 nmol/L) than that of men. Only 9% of total variance in 25(OH)D was explained by factors shared by spousal pairs. Selected nonshared factors (BMI, time spent outdoors, involvement in an outdoor job, sunscreen use) did not explain the association of sex with 25(OH)D. Adjusting for age, season, and BMI, 25(OH)D was similar during pregnancy and 6 mo postpartum (mean difference: -2.4 nmol/L; 95% CI: -5.3, 0.4 nmol/L). CONCLUSIONS In Dhaka, WRA have substantially poorer vitamin D status than men. Variation in 25(OH)D is not greatly influenced by determinants shared by spouses. Measured nonshared characteristics or pregnancy did not account for the gender differential in 25(OH)D. This trial was registered at clinicaltrials.gov as NCT01924013.
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Affiliation(s)
- Joo-Hyun Jeong
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Jill Korsiak
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Eszter Papp
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Joy Shi
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Abdullah Al Mahmud
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Daniel E Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Hospital for Sick Children & University of Toronto, Toronto, ON, Canada
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31
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Gernand AD, Goldstein JA, Parks WT, Chen Y, Zhang Z, Davaasuren D, Wu C, Beck C, Taylor L, Wang JZ. AI-based rapid placental assessment tool. Placenta 2019. [DOI: 10.1016/j.placenta.2019.06.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Gernand AD, Aguree S, Pobee R, Colecraft EK, Murray-Kolb LE. Concurrent Micronutrient Deficiencies Are Low and Micronutrient Status Is Not Related to Common Health Indicators in Ghanaian Women Expecting to Become Pregnant. Curr Dev Nutr 2019; 3:nzz053. [PMID: 31187085 PMCID: PMC6554457 DOI: 10.1093/cdn/nzz053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Micronutrients are important for reproductive health and pregnancy, but the status of multiple vitamins and minerals is rarely measured in women before pregnancy. OBJECTIVES We aimed to assess the status and concurrent deficiencies of micronutrients among women before pregnancy and their relation with common health indicators. METHODS This was a cross-sectional study that recruited women who expected to become pregnant within the next 6 mo in Asesewa, Ghana, a semi-urban community. Women self-reported demographics and health history. We measured blood pressure, height, and weight and conducted a blood draw and hemoglobin assessment (n = 98). We measured serum/plasma concentrations of ferritin, iron, total iron binding capacity, zinc, copper, retinol, and 25-hydroxyvitamin D, in addition to markers of inflammation. We used established cutoffs for deficiency and insufficiency/low status for each micronutrient after adjusting ferritin, zinc, and retinol for inflammation. We compared biomarker distributions by common health indicators. RESULTS Forty percent of women had overweight/obesity, 33% were anemic, and 23% had elevated blood pressure. Overall, 27% had ≥1 deficiencies, whereas only 4% had 2 deficiencies. Fifty-eight percent of women had ≥1 insufficiencies and 18% had ≥2 insufficiencies. Prevalence of individual deficiencies was 12%, 7%, 7%, 4%, and 0% and prevalence of individual insufficiencies was 18%, 12%, 29%, 13%, and 13% for iron, copper, vitamin A, zinc, and vitamin D, respectively. Iron biomarkers and retinol concentrations differed by anemia status, and copper was higher in those with elevated blood pressure. Micronutrient concentrations were not associated with self-reported medical history (parity or history of anemia, malaria, or night blindness). CONCLUSIONS In Asesewa, Ghana, there was a relatively low prevalence of individual micronutrient deficiencies, but the majority of women were insufficient in ≥1 micronutrients. Iron and vitamin A status was lower in those with anemia, but otherwise, micronutrient status did not relate to common health markers.
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Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Sixtus Aguree
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Ruth Pobee
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Esi K Colecraft
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
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33
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Bilic M, Qamar H, Onoyovwi A, Korsiak J, Papp E, Al Mahmud A, Weksberg R, Gernand AD, Harrington J, Roth DE. Prenatal vitamin D and cord blood insulin-like growth factors in Dhaka, Bangladesh. Endocr Connect 2019; 8:745-753. [PMID: 31071681 PMCID: PMC6547305 DOI: 10.1530/ec-19-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
Abstract
Fetal growth restriction is linked to adverse health outcomes and is prevalent in low- and middle-income countries; however, determinants of fetal growth are still poorly understood. The objectives were to determine the effect of prenatal vitamin D supplementation on the insulin-like growth factor (IGF) axis at birth, to compare the concentrations of IGF-I in newborns in Bangladesh to a European reference population and to estimate the associations between IGF protein concentrations and birth size. In a randomized controlled trial in Dhaka, Bangladesh, pregnant women enrolled at 17-24 weeks of gestation were assigned to weekly oral vitamin D3 supplementation from enrolment to delivery at doses of 4200 IU/week, 16,800 IU/week, 28,000 IU/week or placebo. In this sub-study, 559 woman-infant pairs were included for analysis and cord blood IGF protein concentrations were quantified at birth. There were no significant effects of vitamin D supplementation on cord blood concentrations of IGF-I (P = 0.398), IGF-II (P = 0.525), binding proteins (BPs) IGFBP-1 (P = 0.170), IGFBP-3 (P = 0.203) or the molar ratio of IGF-I/IGFBP-3 (P = 0.941). In comparison to a European reference population, 6% of girls and 23% of boys had IGF-I concentrations below the 2.5th percentile of the reference population. IGF-I, IGF-II, IGFBP-3 and the IGF-I/IGFBP-3 ratio were positively associated with at least one anthropometric parameter, whereas IGFBP-1 was negatively associated with birth anthropometry. In conclusion, prenatal vitamin D supplementation does not alter or enhance fetal IGF pathways.
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Affiliation(s)
- Monika Bilic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Huma Qamar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Akpevwe Onoyovwi
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Jill Korsiak
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Eszter Papp
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Rosanna Weksberg
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada
- Molecular and Medical Genetics, University of Toronto, Toronto, Canada
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Daniel E Roth
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
- Correspondence should be addressed to D E Roth:
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34
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Bourassa MW, Osendarp SJM, Adu-Afarwuah S, Ahmed S, Ajello C, Bergeron G, Black R, Christian P, Cousens S, de Pee S, Dewey KG, Arifeen SE, Engle-Stone R, Fleet A, Gernand AD, Hoddinott J, Klemm R, Kraemer K, Kupka R, McLean E, Moore SE, Neufeld LM, Persson LÅ, Rasmussen KM, Shankar AH, Smith E, Sudfeld CR, Udomkesmalee E, Vosti SA. Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries. Ann N Y Acad Sci 2019; 1444:6-21. [PMID: 31134643 PMCID: PMC6852202 DOI: 10.1111/nyas.14121] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.
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Affiliation(s)
| | - Saskia J M Osendarp
- Osendarp Nutrition, Berkel & Rodenrijs, the Netherlands.,Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Saima Ahmed
- The New York Academy of Sciences, New York, New York
| | - Clayton Ajello
- The Vitamin Angels Alliance, Inc., Santa Barbara, California
| | | | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.,UN World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, California
| | | | | | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Rolf Klemm
- The Vitamin Angels Alliance, Inc., Santa Barbara, California.,Helen Keller International, Baltimore, Maryland
| | | | | | | | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | | | - Lars-Åke Persson
- London School of Hygiene and Tropical Medicine, Addis Ababa, Ethiopia
| | | | - Anuraj H Shankar
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Summit Institute of Development, Mataram, Indonesia
| | - Emily Smith
- Bill & Melinda Gates Foundation, Seattle, Washington.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Stephen A Vosti
- Department of Nutrition, University of California, Davis, Davis, California
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35
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Abstract
Plasma volume (PV) can be an important marker of health status and may affect the interpretation of plasma biomarkers, but is rarely measured due to the complexity and time required. Indocyanine green (ICG) is a water-soluble tricarbocyanine dye with a circulatory half-life of 2–3 min, allowing for quick clearance and repeated use. It is used extensively in medical diagnostic tests including ophthalmologic imaging, liver function, and cardiac output, particularly in critical care. ICG has been validated for measuring PV in humans, however previous work has provided minimal published details or has focused on a single aspect of the method. We aimed to develop a detailed, optimal protocol for the use of ICG to measure PV in women of reproductive age. We combined best practices from other studies and optimized the protocol for efficiency. This method reduces the time from blood collection to PV determination to ˜2 h and the amount of plasma required to estimate PV to 2.5 mL (1.5 mL before ICG injection and 1.0 mL post-injection). Participant inconvenience is reduced by inserting an intravenous (IV) catheter in only one arm, not both arms. Five post-injection plasma samples (2–5 min after ICG bolus) are enough to accurately develop the decay curve for plasma ICG concentration and estimate PV by extrapolation.
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Affiliation(s)
- Sixtus Aguree
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, United States
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, United States
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Gernand AD. The upper level: examining the risk of excess micronutrient intake in pregnancy from antenatal supplements. Ann N Y Acad Sci 2019; 1444:22-34. [PMID: 31094004 PMCID: PMC6618111 DOI: 10.1111/nyas.14103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022]
Abstract
Micronutrient deficiencies are prevalent and co-occurring among pregnant women in low- and middle-income countries (LMIC). To prevent and treat deficiencies, antenatal vitamin and mineral supplements are the most common interventions during gestation. With most micronutrients, there can be health risks when intake regularly exceeds a high amount, and an upper threshold value set by the United States and Canada, the World Health Organization, and other groups is commonly called an upper intake level (UL). This review summarizes what is known about risks in pregnancy when ULs are exceeded and assesses the potential risk of exceeding the UL if a pregnant woman is taking a multiple micronutrient supplement. Overall, there is limited information on pregnancy-specific risks from excess intake. When assuming high dietary intake plus the amount in a standard multiple micronutrient supplement (with 30 mg of iron), only niacin and iron would be expected to slightly exceed the UL. Known risks for this level intake for each nutrient are transient and mild.
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Affiliation(s)
- Alison D. Gernand
- Department of Nutritional Sciencesthe Pennsylvania State UniversityUniversity ParkPennsylvania
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Savage JS, Hohman EE, McNitt KM, Pauley AM, Leonard KS, Turner T, Pauli JM, Gernand AD, Rivera DE, Symons Downs D. Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial. Nutrients 2019; 11:E899. [PMID: 31010102 PMCID: PMC6520673 DOI: 10.3390/nu11040899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022] Open
Abstract
Excess maternal weight gain during pregnancy elevates infants' risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6-13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14-34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Emily E Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Katherine M McNitt
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Tricia Turner
- Diagnostic Medical Sonography, South Hills School of Business and Technology, State College, PA 16801, USA.
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA 17033, USA.
- Department of Maternal & Fetal Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Daniel E Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287, USA.
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA 17033, USA.
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Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, Rasmussen KM, Siega-Riz AM, Stang J, Casavale KO, Spahn JM, Stoody EE. Dietary patterns before and during pregnancy and maternal outcomes: a systematic review. Am J Clin Nutr 2019; 109:705S-728S. [PMID: 30982868 DOI: 10.1093/ajcn/nqy216] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children. OBJECTIVE Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM. METHODS A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded. RESULTS Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM. CONCLUSIONS Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.
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Affiliation(s)
| | | | | | | | - Barbara Abrams
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | | | - Anna Maria Siega-Riz
- Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - Jamie Stang
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kellie O Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | | | - Eve E Stoody
- Food and Nutrition Service, USDA, Alexandria, VA
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Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, Rasmussen KM, Siega-Riz AM, Stang J, Casavale KO, Spahn JM, Stoody EE. Dietary patterns before and during pregnancy and birth outcomes: a systematic review. Am J Clin Nutr 2019; 109:729S-756S. [PMID: 30982873 DOI: 10.1093/ajcn/nqy353] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Maternal diet before and during pregnancy could influence fetal growth and birth outcomes. OBJECTIVE Two systematic reviews aimed to assess the relationships between dietary patterns before and during pregnancy and 1) gestational age at birth and 2) gestational age- and sex-specific birth weight. METHODS Literature was searched from January, 1980 to January, 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using predetermined inclusion and exclusion criteria. Data were extracted from included articles and risk of bias was assessed. Data were synthesized qualitatively, a conclusion statement was drafted for each question, and evidence supporting each conclusion was graded. RESULTS Of the 9103 studies identified, 11 [representing 7 cohorts and 1 randomized controlled trial (RCT)] were included for gestational age and 21 (representing 19 cohorts and 2 RCTs) were included for birth weight. Limited but consistent evidence suggests that certain dietary patterns during pregnancy are associated with a lower risk of preterm birth and spontaneous preterm birth. These protective dietary patterns are higher in vegetables; fruits; whole grains; nuts, legumes, and seeds; and seafood (preterm birth, only), and lower in red and processed meats, and fried foods. Most of the research was conducted in healthy Caucasian women with access to health care. No conclusion can be drawn on the association between dietary patterns during pregnancy and birth weight outcomes. Although research is available, the ability to draw a conclusion is restricted by inconsistency in study findings, inadequate adjustment of birth weight for gestational age and sex, and variation in study design, dietary assessment methodology, and adjustment for key confounding factors. Insufficient evidence exists regarding dietary patterns before pregnancy for both outcomes. CONCLUSIONS Maternal dietary patterns may be associated with a lower preterm and spontaneous preterm birth risk. The association is unclear for birth weight outcomes.
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Affiliation(s)
| | | | | | | | - Barbara Abrams
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | | | - Anna Maria Siega-Riz
- Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - Jamie Stang
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kellie O Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | | | - Eve E Stoody
- Food and Nutrition Service, USDA, Alexandria, VA
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Subramanian A, Gernand AD. Vitamin D metabolites across the menstrual cycle: a systematic review. BMC Womens Health 2019; 19:19. [PMID: 30691458 PMCID: PMC6348668 DOI: 10.1186/s12905-019-0721-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/18/2019] [Indexed: 01/28/2023]
Abstract
Background Accurate estimation of vitamin D status is important for health research and can impact prevention and treatment of deficiency in women of reproductive age. We aimed to assess if blood concentrations of 25-hydroxyvitamin D [25(OH)D] or 1,25-dihydroxyvitamin D [1,25(OH)2D] change across the menstrual cycle. Methods We conducted a systematic search in PubMed, Web of Science, CAB and BIOSIS of literature published until December 2018 which reported concentrations of vitamin D metabolites at two or more identified points among women with regular menstrual cycles. Results Ten longitudinal studies met the inclusion criteria; nine studies measured 1,25(OH)2D and five studies measured 25(OH)D. Study size ranged from 5 to 47 subjects, with an age range of 18–47 years. One study found a decrease in concentration of 25(OH)D in the periovulatory and luteal phase. Four studies found no changes in concentrations of 25(OH)D. Two studies found a rise in 1,25(OH)2D within the follicular phase, including a 128% increase from day 1 to 15 and a 56% increase from day 0 to 12. Two studies found rises in 1,25(OH)2D concentrations from the follicular to luteal phase of 13 and 26%. Five studies did not find any changes in concentrations of 1,25(OH)2D. Conclusions No conclusion can be drawn on the pattern of 1,25(OH)2D concentrations across the normal menstrual cycle due to inconsistencies in study findings. Evidence is currently insufficient to assess 25(OH)D concentrations across the cycle. Future studies should aim to measure 1,25(OH)2D and 25(OH)D longitudinally, to understand relationships with other hormones and the potential impact on estimates of vitamin D deficiency.
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Affiliation(s)
- Anita Subramanian
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA.
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Affiliation(s)
| | | | - Abdullah Al Mahmud
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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Freigoun MT, Rivera DE, Guo P, Hohman EE, Gernand AD, Downs DS, Savage JS. A Dynamical Systems Model of Intrauterine Fetal Growth. Math Comput Model Dyn Syst 2018; 24:661-687. [PMID: 30498392 PMCID: PMC6258009 DOI: 10.1080/13873954.2018.1524387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 09/12/2018] [Indexed: 06/09/2023]
Abstract
The underlying mechanisms for how maternal perinatal obesity and intrauterine environment influence fetal development are not well understood and thus require further understanding. In this paper, energy balance concepts are used to develop a comprehensive dynamical systems model for fetal growth that illustrates how maternal factors (energy intake and physical activity) influence fetal weight and related components (fat mass, fat-free mass, and placental volume) over time. The model is estimated from intensive measurements of fetal weight and placental volume obtained as part of Healthy Mom Zone (HMZ), a novel intervention for managing gestational weight gain in obese/overweight women. The overall result of the modeling procedure is a parsimonious system of equations that reliably predicts fetal weight gain and birth weight based on a sensible number of assessments. This model can inform clinical care recommendations as well as how adaptive interventions, such as HMZ, can influence fetal growth and birth outcomes.
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Affiliation(s)
- Mohammad T. Freigoun
- Control Systems Engineering Laboratory, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA
| | - Daniel E. Rivera
- Control Systems Engineering Laboratory, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA
| | - Penghong Guo
- Control Systems Engineering Laboratory, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA
| | - Emily E. Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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Assibey-Mensah V, Parks WT, Gernand AD, Catov JM. Race and risk of maternal vascular malperfusion lesions in the placenta. Placenta 2018; 69:102-108. [DOI: 10.1016/j.placenta.2018.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/11/2018] [Accepted: 07/30/2018] [Indexed: 11/26/2022]
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Roth DE, Morris SK, Zlotkin S, Gernand AD, Ahmed T, Shanta SS, Papp E, Korsiak J, Shi J, Islam MM, Jahan I, Keya FK, Willan AR, Weksberg R, Mohsin M, Rahman QS, Shah PS, Murphy KE, Stimec J, Pell LG, Qamar H, Al Mahmud A. Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth. N Engl J Med 2018; 379:535-546. [PMID: 30089075 PMCID: PMC6004541 DOI: 10.1056/nejmoa1800927] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is unclear whether maternal vitamin D supplementation during pregnancy and lactation improves fetal and infant growth in regions where vitamin D deficiency is common. METHODS We conducted a randomized, double-blind, placebo-controlled trial in Bangladesh to assess the effects of weekly prenatal vitamin D supplementation (from 17 to 24 weeks of gestation until birth) and postpartum vitamin D supplementation on the primary outcome of infants' length-for-age z scores at 1 year according to World Health Organization (WHO) child growth standards. One group received neither prenatal nor postpartum vitamin D (placebo group). Three groups received prenatal supplementation only, in doses of 4200 IU (prenatal 4200 group), 16,800 IU (prenatal 16,800 group), and 28,000 IU (prenatal 28,000 group). The fifth group received prenatal supplementation as well as 26 weeks of postpartum supplementation in the amount of 28,000 IU (prenatal and postpartum 28,000 group). RESULTS Among 1164 infants assessed at 1 year of age (89.5% of 1300 pregnancies), there were no significant differences across groups in the mean (±SD) length-for-age z scores. Scores were as follows: placebo, -0.93±1.05; prenatal 4200, -1.11±1.12; prenatal 16,800, -0.97±0.97; prenatal 28,000, -1.06±1.07; and prenatal and postpartum 28,000, -0.94±1.00 (P=0.23 for a global test of differences across groups). Other anthropometric measures, birth outcomes, and morbidity did not differ significantly across groups. Vitamin D supplementation had expected effects on maternal and infant serum 25-hydroxyvitamin D and calcium concentrations, maternal urinary calcium excretion, and maternal parathyroid hormone concentrations. There were no significant differences in the frequencies of adverse events across groups, with the exception of a higher rate of possible hypercalciuria among the women receiving the highest dose. CONCLUSIONS In a population with widespread prenatal vitamin D deficiency and fetal and infant growth restriction, maternal vitamin D supplementation from midpregnancy until birth or until 6 months post partum did not improve fetal or infant growth. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT01924013 .).
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Affiliation(s)
- Daniel E Roth
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Shaun K Morris
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Stanley Zlotkin
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Alison D Gernand
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Shaila S Shanta
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Eszter Papp
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Jill Korsiak
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Joy Shi
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - M Munirul Islam
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Ishrat Jahan
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Farhana K Keya
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Andrew R Willan
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Rosanna Weksberg
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Minhazul Mohsin
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Qazi S Rahman
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Prakesh S Shah
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Kellie E Murphy
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Jennifer Stimec
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Lisa G Pell
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Huma Qamar
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
| | - Abdullah Al Mahmud
- From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh
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Gernand AD, Simhan HN, Baca KM, Caritis S, Bodnar LM. Vitamin D, pre-eclampsia, and preterm birth among pregnancies at high risk for pre-eclampsia: an analysis of data from a low-dose aspirin trial. BJOG 2017; 124:1874-1882. [PMID: 27704679 PMCID: PMC7845451 DOI: 10.1111/1471-0528.14372] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. DESIGN Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin. SETTING Thirteen sites across the USA. POPULATION Women at high risk for pre-eclampsia. METHODS We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12-26 weeks' gestation (n = 822). We used mixed effects models to examine the association between 25(OH)D and risk of pre-eclampsia and preterm birth, controlling for confounders including prepregnancy BMI and race. MAIN OUTCOME MEASURES Pre-eclampsia and preterm birth. RESULTS Twelve percent of women were vitamin D deficient [25(OH)D <30 nmol/l]. Women with 25(OH)D <30 versus ≥75 nmol/l had a 2.4-fold (95% CI 1.0-5.6) higher risk of early-onset pre-eclampsia (<35 weeks' gestation) after confounder adjustment. Women with 25(OH)D <50 nmol/l had a 1.8-fold (95% CI 1.0-3.2) increased risk of preterm birth at <35 weeks compared with women who had 25(OH)D ≥75 nmol/l, which was driven by indicated preterm births at <35 weeks' gestation [25(OH)D <50 versus ≥75 nmol/l adjusted RR 2.5 (95% CI 1.1-5.8)]. There was no association between vitamin D status and pre-eclampsia or preterm birth at <37 weeks. CONCLUSION Maternal vitamin D status in the second trimester was inversely associated with risk of early-onset pre-eclampsia and preterm birth at <35 weeks in women at high risk for pre-eclampsia. TWEETABLE ABSTRACT Vitamin D is inversely related to risk of pre-eclampsia and preterm birth at <35 weeks in high-risk pregnancies.
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Affiliation(s)
- AD Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - HN Simhan
- Division of Maternal-Fetal Medicine, Magee-Women’s Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - KM Baca
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - S Caritis
- Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - LM Bodnar
- Departments of Epidemiology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, PA, USA
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Gernand AD, Paul RR, Ullah B, Taher MA, Witter FR, Wu L, Labrique AB, West KP, Christian P. A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study. J Health Popul Nutr 2016; 35:34. [PMID: 27769295 PMCID: PMC5073953 DOI: 10.1186/s41043-016-0072-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. METHODS As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. RESULTS LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. CONCLUSIONS Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. TRIAL REGISTRATION ClinicalTrials.gov NCT00860470.
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Affiliation(s)
- Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA 16802 USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Rina Rani Paul
- The JiVitA Maternal and Child Health and Nutrition Research Project, Godown Road, Gaibandha, Bangladesh
| | - Barkat Ullah
- The JiVitA Maternal and Child Health and Nutrition Research Project, Godown Road, Gaibandha, Bangladesh
| | - Muhammad A. Taher
- Centre for Nuclear Medicine & Ultrasound, Rangpur Medical College Hospital Campus, G.P.O. Box No. 16, Rangpur, Bangladesh
| | - Frank R. Witter
- Division of Maternal-Fetal Medicine, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Lee Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Alain B. Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Keith P. West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Abstract
Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences for the fetus. Examples of efficacious single micronutrient interventions include folic acid to prevent neural tube defects, iodine to prevent cretinism, zinc to reduce risk of preterm birth, and iron to reduce the risk of low birth weight. Folic acid and vitamin D might also increase birth weight. While extensive mechanistic and association research links multiple antenatal micronutrients with plausible materno-fetal health advantages, hypothesized benefits have often been absent, minimal or unexpected in trials. These findings suggest a role for population context in determining health responses and filling extensive gaps in knowledge. Multiple micronutrient supplements reduce the risks of being born with low birth weight, small for gestational age or stillborn in undernourished settings, and justify micronutrient interventions with antenatal care. Measurable health effects of gestational micronutrient exposure might persist into childhood but few data exists on potential long-term benefits. In this Review, we discuss micronutrient intake recommendations, risks and consequences of deficiencies, and the effects of interventions with a particular emphasis on offspring.
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Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, Pennsylvania 16802, USA
| | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, Maryland 21205, USA
| | - Christine P Stewart
- Department of Nutrition, One Shields Avenue, University of California, Davis, California 95616, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, Maryland 21205, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, Maryland 21205, USA
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Gernand AD, Schulze KJ, Nanayakkara-Bind A, Arguello M, Shamim AA, Ali H, Wu L, West KP, Christian P. Effects of Prenatal Multiple Micronutrient Supplementation on Fetal Growth Factors: A Cluster-Randomized, Controlled Trial in Rural Bangladesh. PLoS One 2015; 10:e0137269. [PMID: 26431336 PMCID: PMC4591978 DOI: 10.1371/journal.pone.0137269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022] Open
Abstract
Prenatal multiple micronutrient (MM) supplementation improves birth weight through increased fetal growth and gestational age, but whether maternal or fetal growth factors are involved is unclear. Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh. In a double-blind, cluster-randomized, controlled trial of MM vs. iron and folic acid (IFA) supplementation, we measured placental growth hormone (PGH) at 10 weeks and PGH and human placental lactogen (hPL) at 32 weeks gestation in maternal plasma (n = 396) and insulin, insulin-like growth factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) in cord plasma (n = 325). Birth size and gestational age were also assessed. Early pregnancy mean (SD) BMI was 19.5 (2.4) kg/m2 and birth weight was 2.68 (0.41) kg. There was no effect of MM on concentrations of maternal hPL or PGH, or cord insulin, IGF-1, or IGFBP-1. However, among pregnancies of female offspring, hPL concentration was higher by 1.1 mg/L in the third trimester (95% CI: 0.2, 2.0 mg/L; p = 0.09 for interaction); and among women with height <145 cm, insulin was higher by 59% (95% CI: 3, 115%; p = 0.05 for interaction) in the MM vs. IFA group. Maternal hPL and cord blood insulin and IGF-1 were positively, and IGFBP-1 was negatively, associated with birth weight z score and other measures of birth size (all p<0.05). IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth. Prenatal MM supplementation had no overall impact on intrauterine growth factors. MM supplementation altered some growth factors differentially by maternal early pregnancy nutritional status and sex of the offspring, but this should be examined in other studies.
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Affiliation(s)
- Alison D. Gernand
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States of America
| | - Kerry J. Schulze
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Ashika Nanayakkara-Bind
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Margia Arguello
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | - Lee Wu
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Keith P. West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
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Roth DE, Gernand AD, Morris SK, Pezzack B, Islam MM, Dimitris MC, Shanta SS, Zlotkin SH, Willan AR, Ahmed T, Shah PS, Murphy KE, Weksberg R, Choufani S, Shah R, Al Mahmud A. Maternal vitamin D supplementation during pregnancy and lactation to promote infant growth in Dhaka, Bangladesh (MDIG trial): study protocol for a randomized controlled trial. Trials 2015; 16:300. [PMID: 26169781 PMCID: PMC4499946 DOI: 10.1186/s13063-015-0825-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/26/2015] [Indexed: 12/27/2022] Open
Abstract
Background Vitamin D regulates bone mineral metabolism and skeletal development. Some observational studies have suggested that prenatal vitamin D deficiency increases the risk of adverse pregnancy and/or birth outcomes; however, there is scant evidence from controlled trials, leading the World Health Organization to advise against routine vitamin D supplementation in pregnancy. Importantly, little is known about the effect of maternal vitamin D status on infant linear growth in communities in South Asia where stunting is highly prevalent and maternal-infant vitamin D status is commonly suboptimal. Methods/Design The Maternal Vitamin D for Infant Growth study is a randomized, placebo-controlled, dose-ranging trial of maternal vitamin D supplementation during pregnancy and lactation in Dhaka, Bangladesh. The primary aims are to estimate (1) the effect of maternal prenatal oral vitamin D3 supplementation (4200 IU/wk, 16,800 IU/wk, or 28,000 IU/wk, administered as weekly doses) versus placebo on infant length at 1 year of age and (2) the effect of maternal postpartum oral vitamin D3 supplementation (28,000 IU/wk) versus placebo on length at 1 year of age among infants born to women who received vitamin D 28,000 IU/wk during pregnancy. Generally healthy pregnant women (n = 1300) in the second trimester (17–24 weeks of gestation) are randomized to one of five parallel arms: placebo 4200 IU/wk, 16,800 IU/wk, or 28,000 IU/wk in the prenatal period and placebo in the postpartum period or 28,000 IU/wk in the prenatal period and 28,000 IU/wk in the postpartum period. Household- and clinic-based follow-up of mother-infant pairs is conducted weekly by trained personnel until 26 weeks postpartum and every 3 months thereafter. The primary trial outcome measure is length for age z-score at 1 year of age. Anthropometric measurements, clinical information, and biological specimens collected at scheduled intervals will enable the assessment of a range of maternal, perinatal, and infant outcomes. Discussion The role of vitamin D in maternal and infant health remains unresolved. This trial is expected to contribute unique insights into the effects of improving maternal-infant vitamin D status in a low-income setting where stunting and adverse perinatal outcomes represent significant public health burdens. Trial registration ClinicalTrials.gov identifier: NCT01924013. Registered on 13 August 2013 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0825-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel E Roth
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Alison D Gernand
- Department of Nutritional Sciences, Penn State University, 110 Chandlee Laboratory, University Park, PA, USA.
| | - Shaun K Morris
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Brendon Pezzack
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Michelle C Dimitris
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Shaila S Shanta
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Stanley H Zlotkin
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Andrew R Willan
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Prakesh S Shah
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Division of Neonatology, Mt. Sinai Hospital, 600 University Avenue, Toronto, ON, Canada.
| | - Kellie E Murphy
- Department of Obstetrics and Gynecology, University of Toronto and Mt. Sinai Hospital, 600 University Avenue, Toronto, ON, Canada.
| | - Rosanna Weksberg
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Genetics and Genome Biology, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Sanaa Choufani
- Genetics and Genome Biology, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Rashed Shah
- Department of Health and Nutrition, Save the Children USA, 2000 L Street NW, Suite 500, Washington, DC, USA.
| | - Abdullah Al Mahmud
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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50
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Gernand AD, Klebanoff MA, Simhan HN, Bodnar LM. Maternal vitamin D status, prolonged labor, cesarean delivery and instrumental delivery in an era with a low cesarean rate. J Perinatol 2015; 35:23-8. [PMID: 25102320 PMCID: PMC4281279 DOI: 10.1038/jp.2014.139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/15/2014] [Accepted: 06/23/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association between maternal 25-hydroxyvitamin D (25(OH)D) and adverse labor and delivery outcomes. STUDY DESIGN We measured serum 25(OH)D at ⩽ 26 weeks gestation in a random subsample of vertex, singleton pregnancies in women who labored (n=2798) from the 12-site Collaborative Perinatal Project (1959 to 1966). We used labor and delivery data to classify cases of adverse outcomes. RESULT Twenty-four percent of women were vitamin D deficient (25(OH)D <30 nmol l(-1)), and 4.5, 3.3, 1.9 and 7.5% of women had prolonged stage 1 labor, prolonged stage 2 labor, primary cesarean delivery or indicated instrumental delivery, respectively. After adjustment for prepregnancy body mass index, race and study site, 25(OH)D concentrations were not associated with risk of prolonged stage 1 or 2, cesarean delivery or instrumental delivery. CONCLUSION Maternal vitamin D status at ⩽ 26 weeks was not associated with risk of prolonged labor or operative delivery in an era with a low cesarean rate.
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Affiliation(s)
- Alison D. Gernand
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA and Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Mark A. Klebanoff
- Departments of Pediatrics and of Obstetrics and Gynecology, Ohio State University College of Medicine and The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh and Division of Maternal-Fetal Medicine, Magee-Womens Hospital, Pittsburgh, PA
| | - Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health and Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh, Pittsburgh, PA Pittsburgh, PA
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