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Boone N, Bohara B, Rohrer A, Gros M, Gregoski MJ, Lee K, Wagner CL, Chetta K. Multi-prong quality improvement approach for increasing mother's own milk use for very low birth weight infants. J Perinatol 2024; 44:671-679. [PMID: 38123800 DOI: 10.1038/s41372-023-01835-w] [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: 06/02/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Evaluate a single center quality improvement (QI) collaborative designed to increase the provision of mother's own milk (MOM) at discharge to premature infants through evidence-based practices while targeting perinatal health disparities. DESIGN This QI initiative was designed for preterm infants admitted to a single-center NICU within 24 h of life. Interventions were implemented between March 2022 and June 2022. MOM provision rates were compared between baseline (August 2021-February 2022), and after interventions (March 2022-December 2022). RESULTS The percentage of mothers who discontinued pumping during the infant hospitalization decreased from 49% to 35% (p < 0.01). Infant discharge diet with MOM improved from 36% to 58% (p < 0.001). Pump frequency at two weeks increased from 4.0 ± 2.6 to 5.1 ± 2.4 (p = 0.026). CONCLUSION Our collaborative increased the percentage of preterm infants receiving MOM at discharge and reduced the number of mothers who discontinue pumping during the NICU hospitalization.
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Affiliation(s)
- Neal Boone
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA.
| | - Beth Bohara
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Allison Rohrer
- Department of Clinical Nutrition, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Molly Gros
- Department of Lactation Services, Medical University of South Carolina, Charleston, SC, USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly Lee
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Chetta
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
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Chetta KE, Forconi M, Newton DA, Wagner CL, Baatz JE. Corrigendum to "HAMLET in human milk is resistant to digestion and carries essential free long chain polyunsaturated fatty acids and oleic acid" [Food Chem. 427 (2023) 136752]. Food Chem 2024; 438:138126. [PMID: 38061974 PMCID: PMC10842812 DOI: 10.1016/j.foodchem.2023.138126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Katherine E Chetta
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States.
| | - Marcello Forconi
- Department of Chemistry and Biochemistry, College of Charleston, Charleston, SC, United States
| | - Danforth A Newton
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
| | - Carol L Wagner
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
| | - John E Baatz
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
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Keller EP, Lawson AB, Wagner CL, Reed SG. Bayesian modeling of spatially differentiated multivariate enamel defects of the children's primary maxillary central incisor teeth. BMC Med Res Methodol 2024; 24:88. [PMID: 38622506 PMCID: PMC11017560 DOI: 10.1186/s12874-024-02211-8] [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: 09/20/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The analysis of dental caries has been a major focus of recent work on modeling dental defect data. While a dental caries focus is of major importance in dental research, the examination of developmental defects which could also contribute at an early stage of dental caries formation, is also of potential interest. This paper proposes a set of methods which address the appearance of different combinations of defects across different tooth regions. In our modeling we assess the linkages between tooth region development and both the type of defect and associations with etiological predictors of the defects which could be influential at different times during the tooth crown development. METHODS We develop different hierarchical model formulations under the Bayesian paradigm to assess exposures during primary central incisor (PMCI) tooth development and PMCI defects. We evaluate the Bayesian hierarchical models under various simulation scenarios to compare their performance with both simulated dental defect data and real data from a motivating application. RESULTS The proposed model provides inference on identifying a subset of etiological predictors of an individual defect accounting for the correlation between tooth regions and on identifying a subset of etiological predictors for the joint effect of defects. Furthermore, the model provides inference on the correlation between the regions of the teeth as well as between the joint effect of the developmental enamel defects and dental caries. Simulation results show that the proposed model consistently yields steady inferences in identifying etiological biomarkers associated with the outcome of localized developmental enamel defects and dental caries under varying simulation scenarios as deemed by small mean square error (MSE) when comparing the simulation results to real application results. CONCLUSION We evaluate the proposed model under varying simulation scenarios to develop a model for multivariate dental defects and dental caries assuming a flexible covariance structure that can handle regional and joint effects. The proposed model shed new light on methods for capturing inclusive predictors in different multivariate joint models under the same covariance structure and provides a natural extension to a nested hierarchical model.
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Affiliation(s)
- Everette P Keller
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Andrew B Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- School of Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carol L Wagner
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Susan G Reed
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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McWhorter CA, Mead MJ, Rodgers MD, Ebeling MD, Shary JR, Gregoski MJ, Newton DA, Baatz JE, Hollis BW, Hewison M, Wagner CL. Predicting comorbidities of pregnancy: A comparison between total and free 25(OH)D and their associations with parathyroid hormone. J Steroid Biochem Mol Biol 2023; 235:106420. [PMID: 37913892 DOI: 10.1016/j.jsbmb.2023.106420] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
Pregnancy is a unique time when amplified sex steroid concentrations promote an escalation in vitamin D binding protein (DBP) synthesis, associated with increased total vitamin D and metabolites, including 25-hydroxyvitamin D (25(OH)D). Free 25(OH)D concentration increases disproportionately to total 25(OH)D during pregnancy, likely an adaptation to supply the woman and fetus with readily available 25(OH)D. Highlighting the importance of the calcium metabolic stress during pregnancy, the interactional relationship between serum 25(OH)D and PTH has been evaluated. Maternal total 25(OH)D and total 25(OH)D/iPTH are measures of vitamin D status and biomarkers for potential pregnancy complications. It has been proposed that free 25(OH)D and free 25(OH)D/iPTH could be better indicators of vitamin D status and predictors of pregnancy complications such as gestational diabetes (GDM), hypertensive disorders of pregnancy, and preterm delivery. This study aims to determine if free 25(OH)D and its association with PTH are more accurate predictors of comorbidities of pregnancy than total 25(OH)D and its association with PTH. In this post hoc analysis of the Kellogg Pregnancy Study, a double-blind randomized placebo-controlled trial, participants included 297 women with singleton pregnancies: 191 participants were randomized into a group receiving a daily prenatal (400 IU vitamin D3) while 196 received a prenatal plus extra supplementation (4400 IU vitamin D3). Blood and urine samples were collected monthly. 297 participants' serum total 25(OH)D concentrations were measured using radioimmunoassay at baseline (visit 1) and 5-7 months' gestation (visit 6-7). 93 participants' serum free 25(OH)D and PTH concentrations were measured using ELISA and immunoradiometric assay, respectively, at visit 1 and 6-7; 66 participants had paired samples and were included in this analysis. Data were analyzed using SAS 9.4, Cary, N.C. or SPSS v28, IBM Corporation, Armonk, N.Y. Results were considered significant with a p < 0.05. A significant relationship exists between the ratio of total 25(OH)D/iPTH and free 25(OH)D/iPTH grouped by total 25(OH)D ≥ 30 ng/mL and < 30 ng/mL as an indicator of maternal vitamin D status. There was a statistically significant relationship between lower mean free 25(OH)D/iPTH and the development of GDM at visit 1 (p = 0.0003) and at visit 6-7 (p = 0.001) while total 25(OH)D/iPTH and GDM were significantly related only at visit 1 (p = 0.029). In this exploratory cohort, neither free 25(OH)D/iPTH nor total 25(OH)D/iPTH were significantly associated with increased incidence of preterm delivery, hypertensive disorders, or combined comorbidities of pregnancy. An univariate logistic regression evaluating the outcome of gestational diabetes while independently controlling for independent factors showed the ratio of free 25(OH)D/iPTH was more closely associated with gestational diabetes than the ratio of total 25(OH)D/iPTH, although neither were significant. This proof-of-concept analysis suggests that the ratio of free 25(OH)D/iPTH is associated with the development of gestational diabetes throughout pregnancy while total 25(OH)D/iPTH is only associated with the outcome early in pregnancy. Further investigation is warranted to explore this relationship between calcium metabolic stress during pregnancy with a larger cohort to improve validity,reproducibility, and relevance to other pregnancy comorbidities.
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Affiliation(s)
| | - Molly J Mead
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Megan D Rodgers
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Myla D Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Danforth A Newton
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - John E Baatz
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Bruce W Hollis
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Martin Hewison
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham, UK
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA.
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Chetta KE, Forconi M, Newton DA, Wagner CL, Baatz JE. HAMLET in human milk is resistant to digestion and carries essential free long chain polyunsaturated fatty acids and oleic acid. Food Chem 2023; 427:136752. [PMID: 37392621 PMCID: PMC10527475 DOI: 10.1016/j.foodchem.2023.136752] [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: 05/24/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
The oleic acid/alpha-lactalbumin complex HAMLET (human alpha-lactalbumin made lethal to tumors) is cytotoxic to various cancerous cell lines and is assembled from alpha-lactalbumin (ALA) and free oleic acid (OA). HAMLET is also cytotoxic to normal immature intestinal cells. It remains unclear if HAMLET, experimentally assembled with OA and heat, can spontaneously assemble in frozen human milk over time. To approach this issue, we used a set of timed proteolytic experiments to evaluate the digestibility of HAMLET and native ALA. The purity of HAMLET in human milk was confirmed by ultra high performance liquid chromatography coupled to tandem mass spectrometry and western blot to resolve the ALA and OA components. Timed proteolytic experiments were used to identify HAMLET in whole milk samples. Structural characterization of HAMLET was performed by Fournier transformed infrared spectroscopy and indicated a transformation of secondary structure with increased alpha-helical character of ALA upon binding to OA.
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Affiliation(s)
- Katherine E Chetta
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States.
| | - Marcello Forconi
- Department of Chemistry and Biochemistry, College of Charleston, Charleston, SC, United States
| | - Danforth A Newton
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
| | - Carol L Wagner
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
| | - John E Baatz
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
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Reed SG, Fan S, Wagner CL, Lawson AB. Predictors of Developmental Defects of Enamel in Primary Maxillary Central Incisors Using Bayesian Model Selection. Caries Res 2023; 58:30-38. [PMID: 37918363 PMCID: PMC10922907 DOI: 10.1159/000534793] [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: 11/13/2022] [Accepted: 10/22/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Localized non-inheritable developmental defects of tooth enamel (DDE) are classified as enamel hypoplasia (EH), opacity (OP), and post-eruptive breakdown (PEB) using the enamel defects index. To better understand the etiology of DDE, we assessed the linkages amongst exposome variables for these defects during the specific time duration for enamel mineralization of the human primary maxillary central incisor enamel crowns. In general, these two teeth develop between 13 and 14 weeks in utero and 3-4 weeks' postpartum of a full-term delivery, followed by tooth eruption at about 1 year of age. METHODS We utilized existing datasets for mother-child dyads that encompassed 12 weeks' gestation through birth and early infancy, and child DDE outcomes from digital images of the erupted primary maxillary central incisor teeth. We applied a Bayesian modeling paradigm to assess the important predictors of EH, OP, and PEB. RESULTS The results of Gibbs variable selection showed a key set of predictors: mother's prepregnancy body mass index (BMI); maternal serum concentrations of calcium and phosphorus at gestational week 28; child's gestational age; and both mother's and child's functional vitamin D deficiency (FVDD). In this sample of healthy mothers and children, significant predictors for OP included the child having a gestational period >36 weeks and FVDD at birth, and for PEB included a mother's prepregnancy BMI <21.5 and higher serum phosphorus concentration at week 28. CONCLUSION In conclusion, our methodology and results provide a roadmap for assessing timely biomarker measures of exposures during specific tooth development to better understand the etiology of DDE for future prevention.
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Affiliation(s)
- Susan G. Reed
- Department of Pediatrics, Darby Children’s Research
Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Sijian Fan
- Department of Statistics, University of South Carolina,
Columbia, SC, USA
| | - Carol L. Wagner
- Department of Pediatrics, Darby Children’s Research
Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of
South Carolina, Charleston, SC, USA
- Usher Institute, School of Medicine, University of
Edinburgh, Edinburg, UK
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Rodgers MD, Mead MJ, McWhorter CA, Ebeling MD, Shary JR, Newton DA, Baatz JE, Gregoski MJ, Hollis BW, Wagner CL. Vitamin D and Child Neurodevelopment-A Post Hoc Analysis. Nutrients 2023; 15:4250. [PMID: 37836534 PMCID: PMC10574578 DOI: 10.3390/nu15194250] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Vitamin D (VitD) has been shown to impact neurodevelopment. Studies have shown that higher 25-hydroxy-vitamin D (25(OH)D) concentrations (the indicator of vitD status) may be associated with better neurodevelopmental outcomes, although current data are conflicting. This study examined the relationship between total circulating 25(OH)D concentrations and neurodevelopmental outcomes in 3-5-year-old (3-5 yo) children. METHODS In this study, pregnant women were randomized to receive 400 (standard dose), 2000, or 4000 IU vitD3/day. Offspring then underwent the Brigance Screen at 3-5 yo. The 25(OH)D concentration was measured at birth and 3-5 yo. Relationships between Brigance scores and 25(OH)D and Brigance scores and vitamin D binding protein (VDBP) genotype were examined. RESULTS Higher 25(OH)D at the time of testing was associated with better overall performance on neurodevelopmental testing as measured by the Brigance quotient (B = 0.208, p = 0.049). Scores were then broken down into sub-scores. Children born to mothers in the 2000 IU/day group scored higher on the Brigance language component of the assessment versus the standard dose group (B = 4.667, p = 0.044). The group of children who had the Gc1f-1s or Gc1f-2 genotypes scored higher on the Brigance academic component (B = 9.993, p < 0.001) and lower on the Brigance language component versus the 1f1f genotype (B = -9.313, p < 0.001). Children with the Gc1s-1s, Gc1s-2, or Gc2-2 genotypes also scored lower than the Gc1f-1f genotype (B = -6.757, p = 0.003). CONCLUSION These results suggest that higher 25(OH)D concentrations early in life and higher doses of maternal vitamin D supplementation during pregnancy may have a positive association with neurodevelopmental outcomes. This study also suggests that the VDBP genotype is associated with neurodevelopment and differentially affects various fields of neurodevelopment.
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Affiliation(s)
- Megan D. Rodgers
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Molly J. Mead
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Caroline A. McWhorter
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Myla D. Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Judy R. Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Danforth A. Newton
- Darby Children’s Research Institute, Medical University of South Carolina, Charleston, SC 29425, USA
| | - John E. Baatz
- Darby Children’s Research Institute, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Mathew J. Gregoski
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Bruce W. Hollis
- Darby Children’s Research Institute, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Carol L. Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC 29425, USA
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Mead MJ, McWhorter CA, Rodgers MD, Ebeling MD, Shary JR, Gregoski MJ, Hollis BW, Hewison M, Johnson D, Caplan MJ, Wagner CL. Does maternal vitamin D status influence placental weight or vascular and inflammatory pathology? Secondary analysis from the Kellogg Pregnancy Study. J Steroid Biochem Mol Biol 2023; 233:106358. [PMID: 37414103 DOI: 10.1016/j.jsbmb.2023.106358] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Positive effects of vitamin D (vitD) supplementation on comorbidities of pregnancy (COP) have been explored; however, few studies have elucidated the pathophysiology behind the development of these COP and the potential relationship with derangements in placental development and morphology. Additionally, it is known that placentas weighing 10th-90th % for gestational age are associated with better outcomes. Therefore, the objective of this study was to assess the impact of resulting circulating serum 25(OH)D concentrations associated with intake of high or low doses of supplementary vitD on placental development and morphology in women who participated in a randomized double blind, placebo-controlled trial of vitD supplementation. We hypothesized that if maternal serum 25(OH)D concentration (vitD status marker) is insufficient/deficient, then placental weight and % for gestational age (GA) will be smaller and will correlate with increased vascular and inflammatory placental pathologic findings. METHODS The findings of the present study are a secondary analysis of data generated from a previously reported randomized controlled trial (RCT), the Kellogg Vitamin D Pregnancy Study. Pregnant women (n = 297) in this RCT (January 2013 - April 2018) were randomly assigned to 400 IU vs. 4400 IU vitD/day (10-14 weeks' gestational age) and followed to delivery. 132 placentas were analyzed by pathologists blinded to treatment, and the 2016 Amsterdam Consensus Criteria were used to categorize grouping/grading of placental pathology and weight. Total [25(OH)D] was measured using radioimmunoassay (ng/mL). Chi-square and Student's t-test were used to show the difference in maternal characteristics by treatment group and by placental weight. Chi-square analysis was used to determine differences between the percent pathology findings by treatment group. Students t-test was used to determine the differences in vitD status and the frequency of placental lesions. Association between [25(OH)D] area under the curve (AUC) and placental morphology were determined in a regression model that included maternal BMI ≥ 30 kg/m2, race/ethnicity, and vitD treatment group allocation. Data were analyzed using SAS v9.4 (Cary, NC) and statistical significance was indicated by p < 0.05. RESULTS The percent pathology findings by treatment group were not significantly different for each of the placental pathology categories as defined by the 2016 Amsterdam Consensus Criteria including placental weight. However, when using 25(OH)D as a biomarker for vitD status, linear regression model showed maternal serum [25(OH)D] AUC was significantly associated with greater placental weight (p = 0.023). Logistic regression models showed mothers with BMI ≥ 30 kg/m2 had larger placental weight (p = 0.046), and Hispanic and white/Caucasian mothers had greater placental weights than Black American mothers (p = 0.025). When placentas ≥ 90th % for GA, n = 7, were removed from the placental pool, Pearson correlation still showed a positive association between maternal serum 25(OH)D AUC and placental weight (p = 0.011). In a second linear regression model of placentas ≥ 90th % for GA (n = 7) vs. placentas < 90th % (n = 108), maternal serum 25(OH)D AUC was significantly greater in those placentas ≥ 90th % (p = 0.03); however, this was not associated with increased perinatal mortality. CONCLUSION FINDINGS: suggest increasing maternal serum [25(OH)D] via vitamin D supplementation during pregnancy did not adversely affect placental morphology; trends showed those in the treatment group had fewer placental lesions. Placental weight was found to be significantly associated with [25(OH)D] AUC, which represents maternal vitamin D status over the course of pregnancy; 7 placentas ≥ 90th % for GA were not associated with perinatal mortality.
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Affiliation(s)
- Molly J Mead
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Caroline A McWhorter
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Megan D Rodgers
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Myla D Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, United States
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, United States
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Bruce W Hollis
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, United States
| | - Martin Hewison
- Institute of Metabolism and Systems Research, Level 2, Institute of Biomedical Research, The University of Birmingham, Birmingham, UK
| | - Donna Johnson
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - Michael J Caplan
- Franklin County Ohio Office of the Coroner, Franklin County, OH, United States
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, United States.
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Huff LL, Schulz EV, Richardson CD, Ebeling MD, Shary JR, Hollis BW, Wagner CL. Oral Contraceptive Pills Increase Circulating 25-Hydroxy-Vitamin D Concentrations in Women Who Are Lactating. Am J Perinatol 2023. [PMID: 37726015 DOI: 10.1055/s-0043-1775561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE This article aims to determine the association between maternal 25-hydroxy-vitamin D [25(OH)D] status and intake of hormonal oral contraceptive pills (OCPs) in women who are lactating. STUDY DESIGN Women who were exclusively breastfeeding participated in a randomized controlled trial assessing vitamin D supplementation at 400, 2,400, or 6,400 international unit (IU)/d from 1 month through 7 months postpartum. This observational, secondary analysis assessed whether OCPs were associated with maternal 25(OH)D concentrations in women who are lactating. Multivariate regression models were used to predict 25(OH)D concentrations and create parameter estimates for each variable. RESULTS In a bivariate analysis, the use of OCPs at 4 months was associated with increased serum 25(OH)D (p = 0.02). OCPs' use at 7 months was associated with a higher trend in 25(OH)D, but this finding was not statistically significant (p = 0.1). In a multivariate regression model at 4 months, independent positive predictors of 25(OH)D concentrations were the use of OCPs (p = 0.03) and treatment with vitamin D at 6,400 IU/d (p ≤ 0.0001). Negative predictors were Black (p = 0.001) and Hispanic (p = 0.0001) race and ethnicity, and body mass index (BMI) greater than 30 (p = 0.0002). The same pattern occurred at 7 months, with more southern latitude as a positive independent predictor (p = 0.04) of 25(OH)D concentration. CONCLUSION The use of OCPs was associated with greater 25(OH)D in women who are lactating. Additionally, treatment with vitamin D at 6,400 IU/d and southern latitude was associated with greater 25(OH)D in women who are lactating. Black and Hispanic race and ethnicity, and BMI greater than 30, were independently associated with lower 25(OH)D in women who are lactating. KEY POINTS · The association of OCP with serum 25(OH)D concentrations during postpartum lactation is unknown.. · OCPs' use was associated with higher 25(OH)D concentrations in postpartum women who are lactating.. · Treatment with vitamin D and southern latitude was associated with greater 25(OH)D in women who are lactating.. · Black and Hispanic, and BMI > 30 were associated with lower 25(OH)D in women who are lactating.. · Practitioners can counsel women who are lactating on OCPs' use and the positive effects on their 25(OH)D status..
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Affiliation(s)
- Lori L Huff
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth V Schulz
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
| | - Colby D Richardson
- Department of Pediatrics, Division of Neonatology, University of Rochester Medical Center, Rochester, New York
| | - Myla D Ebeling
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Shary
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce W Hollis
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina
| | - Carol L Wagner
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina
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Steflik HJ, Wessler LA, Shugart WW, Wagner CL, Selewski DT, Twombley KE, Newman JC, Atz AM, Annibale DJ. Indomethacin patent ductus arteriosus prophylaxis in the modern era: renal implications. J Perinatol 2023; 43:1045-1046. [PMID: 37085522 DOI: 10.1038/s41372-023-01681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Heidi J Steflik
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Luke A Wessler
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - William W Shugart
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine E Twombley
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Jill C Newman
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - David J Annibale
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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11
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Davis S, Lyles E, Shary J, Ebeling M, Reed SG, Baatz JE, Hollis BW, Wagner CL. Post-hoc Analysis of NICHD Vitamin D Pregnancy Cohort and The Role of Functional Vitamin D Deficiency in Pregnancy. Am J Perinatol 2023. [PMID: 37216969 DOI: 10.1055/a-2097-2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Conduct a secondary, post-hoc analysis of NICHD vitamin D (vitD) pregnancy study by Hollis et al. (Hollis, 2011), which reported on the effect of vitD supplementation in pregnant women; and determine the potential interaction between intact parathyroid hormone (iPTH) concentrations, vitD status, and various comorbidities associated with pregnancy. HYPOTHESIS Women with low 25(OH)D concentrations and high iPTH concentrations during pregnancy, known as functional vitD deficiency (FVDD), were more likely to acquire complications also affecting their neonates. STUDY DESIGN This post-hoc analysis of data collected from a diverse group of pregnant women participating in the NICHD vitD pregnancy study, was applied to investigate the applicability of the concept of FVDD in pregnancy (Hemmingway, 2018) in identifying potential risks for certain comorbidities of pregnancy. This analysis defines FVDD as maternal serum 25(OH)D concentrations below 20 ng/mL and iPTH concentrations above 65 pg/mL creating a definitive ratio number, 0.308, to classify mothers as having FVDD prior to delivery (PTD). Statistical analyses were performed using SAS 9.4 (Cary, NC). RESULTS 281 women (85 African American, 115 Hispanic, 81 Caucasian) with 25(OH)D and iPTH concentrations measured at monthly visits were included in this analysis. No statistically significant association was found between mothers classified as having FVDD at baseline or one-month PTD and hypertensive disorders of pregnancy, infection, or admittance to the NICU. When combining all comorbidities of pregnancy in this cohort, results showed those with FVDD at baseline, 24 weeks' gestation, and one-month PTD were more likely to experience a comorbidity (p=0.001; p=0.001; p=0.004, respectively). Those with FVDD one-month PTD were 7.1 times (CI 1.71-29.81) more likely to have preterm birth (<37 weeks) than women without FVDD. CONCLUSIONS Participants were more likely to have experienced preterm birth if they met the criteria for FVDD. This study supports the importance of FVDD during pregnancy.
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Affiliation(s)
- Shellie Davis
- Pediatrics, Medical University of SC, Charleston, United States
| | - Elliott Lyles
- College of Osteopathic Medicine, Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, United States
| | - Judy Shary
- Pediatrics, Medical University of South Carolina, Charleston, United States
| | - Myla Ebeling
- Medical University of South Carolina, Charleston, United States
| | - Susan G Reed
- Pediatrics, Medical University of SC, Charleston, United States
| | - John E Baatz
- Pediatrics, Medical University of SC, Charleston, United States
| | - Bruce W Hollis
- Pediatrics, Medical University of South Carolina, Charleston, United States
| | - Carol L Wagner
- Pediatrics, Medical University of SC, Charleston, United States
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12
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Steflik HJ, Brinton DL, Corrigan C, Wagner CL, Selewski DT, Twombley KE, Atz AM. Costs associated with acute kidney injury in critically Ill neonates with patent Ductus arteriosus: pediatric health information system (PHIS) analysis. J Perinatol 2022; 42:1669-1673. [PMID: 36071104 PMCID: PMC9722647 DOI: 10.1038/s41372-022-01499-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Compare costs of hospitalization between critically-ill neonates with patent ductus arteriosus (PDA) who did and did not develop acute kidney injury (AKI). STUDY DESIGN Using the Children's Hospital Association's Pediatric Health Information System (PHIS) database, we ascertained the marginal estimated total cost of hospitalization between those who did and did not develop AKI. RESULTS Query of 49 PHIS centers yielded 14,217 neonates with PDA, 1697 with AKI and 12,520 without AKI. Predictors of cost included AKI, birth weight, ethnicity, race, length of stay (LOS), and Feudtner Complex Chronic Conditions Classification System. LOS was the strongest predictor (AKI: median 71 days [IQR 28-130]; No AKI: 28 days [10-76]; p < 0.01). Neonates with AKI had $48,416 greater costs (95% CI: $43,804-53,227) after adjusting for these predictors (AKI: $190,063, 95% CI $183,735-196,610; No AKI: $141,647, 95% CI $139,931-143,383 l; p < 0.01). CONCLUSION AKI is independently associated with increased hospital costs in critically-ill neonates with PDA.
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Affiliation(s)
- Heidi J. Steflik
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Correspondence and requests for materials should be addressed to Heidi J. Steflik.
| | - Daniel L. Brinton
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA
| | - Corinne Corrigan
- Department of Quality, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L. Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - David T. Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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13
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Steflik HJ, Brinton DL, Corrigan C, Wagner CL, Selewski DT, Twombley KE, Atz AM. Correction to: Costs associated with acute kidney injury in critically Ill neonates with patent Ductus arteriosus: pediatric health information system (PHIS) analysis. J Perinatol 2022; 42:1714. [PMID: 36329163 DOI: 10.1038/s41372-022-01548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heidi J Steflik
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Daniel L Brinton
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA
| | - Corinne Corrigan
- Department of Quality, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine E Twombley
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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14
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Chetta KE, Newton DA, Wagner CL, Baatz JE. Free Fatty Acid and α-Lactalbumin-Oleic Acid Complexes in Preterm Human Milk Are Cytotoxic to Fetal Intestinal Cells in vitro. Front Nutr 2022; 9:918872. [PMID: 35866080 PMCID: PMC9294382 DOI: 10.3389/fnut.2022.918872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Human milk, the best enteral selection for a preterm infant, becomes altered during freezing and soluble free fatty acid is generated over time. Free fatty acids may form complexes, such as the oleic acid-bound protein called HAMLET (human α-lactalbumin made lethal to tumor cells). We determined the in vitro biological activity of preterm human milk protein-oleic complexes (HAMLET-like complexes) and tested the hypothesis that laboratory-synthesized HAMLET exhibits cytotoxicity in human immature epithelial intestinal cell culture. Thirty-four milk samples from 15 mothers of hospitalized preterm infants were donated over time. Milk fractions were tested repeatedly for FHs 74 Int and HIEC-6 fetal cell cytotoxicity, using a sensitive viability assay. Protein and fatty acid identities were confirmed by Western blot, high performance liquid chromatography, and mass spectrometry. Cytotoxicity of intestinal cells exposed to milk increased respective to milk storage time (p < 0.001) and was associated with free oleic acid (p = 0.009). Synthesized HAMLET was cytotoxic in cultures of both lines. Preterm milk samples killed most cells in culture after an average 54 days in frozen storage (95% C.I. 34–72 days). After prolonged storage time, preterm milk and HAMLET showed a degree of cytotoxicity to immature intestinal cells in culture.
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15
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Andrews L, Phlegar K, Baatz JE, Ebeling MD, Shary JR, Gregoski MJ, Howard CR, Hollis BW, Wagner CL. Comparison of Infant Bone Mineral Content and Density After Infant Daily Oral Vit D 400 IU Supplementation Versus Nursing Mother Oral 6,400 IU Supplementation: A Randomized Controlled Lactation Study. Breastfeed Med 2022; 17:493-500. [PMID: 35271380 PMCID: PMC9234966 DOI: 10.1089/bfm.2021.0281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Vitamin D (vitD) plays a major role in maintenance of bone mineral homeostasis. It is unknown if bone mineral content (BMC) and bone mineral density (BMD) differ between infants who receive direct vitD supplementation and those who receive vitD indirectly via their mother's breast milk, while she received a high dose of vitD. It is hypothesized that there would be no differences in BMC or BMD by treatment group. Design/Methods: Randomized, double-blind trial to compare BMD and BMC of infants who received direct vitD (400 IU vitD3/day) in addition to their mother receiving standard dosage (400 IU vitD3/day) versus infants whose mothers were their only source of vitD and were given high-dose supplementation (6,400 IU vitD3/day). Participants were exclusively breastfeeding mothers and their infant consuming only human milk. Infant BMC and BMD were measured by dual-energy X-ray absorptiometry (DXA) scans of the infant's total body using Hologic Discovery A Densitometer and analyzed using Hologic Infant software at 1, 4, and 7 months of age. Results: Infant BMC and BMD did not differ significantly at 1, 4, or 7 months of age between direct and indirect supplementation arms. The mean difference in BMC from 1 to 7 months was 1.624 and 1.464 g for the 400 and 6,400 IU groups, respectively, (p = 0.5); the mean difference in BMD over this same period was 0.042 and 0.032 g/cm2 for the 400 and 6,400 IU groups, respectively (p = 0.2). Although some differences among races were observed, this did not reflect changes in bone growth between the treatment arms. Conclusion: High-dose vitD supplementation of mothers during lactation provided an efficacious alternative to direct supplementation of infants, as evidenced by noninferior infant BMD and BMC. Clinical Trial Registration number: NCT00412074.
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Affiliation(s)
- Laura Andrews
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristen Phlegar
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John E Baatz
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Myla D Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia R Howard
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
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16
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Engevik MA, Stripe LK, Baatz JE, Wagner CL, Chetta KE. Identifying single-strain growth patterns of human gut microbes in response to preterm human milk and formula. Food Funct 2022; 13:5571-5589. [PMID: 35481924 DOI: 10.1039/d2fo00447j] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The intestinal microbiota of the preterm neonate has become a major research focus, with evidence emerging that the microbiota influences both short and long-term health outcomes, in the neonatal intensive care unit and beyond. Similar to the term microbiome, the preterm gut microbiome is highly influenced by diet, specifically formula and human milk use. This study aims to analyze next-generation products including preterm formula, human milk-oligosaccharide term formula, and preterm breastmilk. We used a culture-based model to differentially compare the growth patterns of individual bacterial strains found in the human intestine. This model probed 24 strains of commensal bacteria and 8 pathobiont species which have previously been found to cause sepsis in preterm neonates. Remarkable differences between strain growth and culture pH were noted after comparing models of formulas and between human milk and formula. Both formula and human milk supported the growth of commensal bacteria; however, the formula products, but not human milk, supported the growth of several specific pathogenic strains. Computational analysis revealed potential connections between long-chain fatty acid and iron uptake from formula in pathobiont organisms. These findings indicate that there is a unique profile of growth in response to human milk and formula and shed light into how the infant gut microbiota could be influenced.
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Affiliation(s)
- Melinda A Engevik
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, USA.,Department of Microbiology & Immunology, Medical University of South Carolina, USA
| | - Leah K Stripe
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, USA
| | - John E Baatz
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, USA. .,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA
| | - Carol L Wagner
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, USA. .,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA
| | - Katherine E Chetta
- Department of Pediatrics, C.P. Darby Children's Research Institute, Medical University of South Carolina, USA. .,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA
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17
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Engevik MA, Stripe LA, Baatz JE, Wagner CL, Chetta KE. Profiling Growth Patterns of Human Gut Microbes in Response to Preterm Human Milk and Formula. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.0r744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mindy A. Engevik
- Regenerative Medicine & Cell BiologyMedical University of South CarolinaCharlestonSC
- Microbiology & ImmunologyMedical University of South CarolinaCharlestonSC
| | | | - John E. Baatz
- Pediatrics, Division of Neonatal‐Perinatal MedicineMedical University of South CarolinaCharlestonSC
| | - Carol L. Wagner
- Pediatrics, Division of Neonatal‐Perinatal MedicineMedical University of South CarolinaCharlestonSC
| | - Katherine E. Chetta
- Pediatrics, Division of Neonatal‐Perinatal MedicineMedical University of South CarolinaCharlestonSC
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18
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Isesele P, Enstad S, Huong P, Thomas R, Wagner CL, Sen S, Cheema SK. Breast Milk from Non-Obese Women with a High Omega-6 to Omega-3 Fatty Acid Ratio, but Not from Women with Obesity, Increases Lipogenic Gene Expression in 3T3-L1 Preadipocytes, Suggesting Adipocyte Dysfunction. Biomedicines 2022; 10:biomedicines10051129. [PMID: 35625866 PMCID: PMC9138889 DOI: 10.3390/biomedicines10051129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/10/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022] Open
Abstract
Maternal body mass index is associated with breast milk (BM) fatty acid composition. This study investigated the effects of BM omega (n)-6:n-3 polyunsaturated fatty acids (PUFAs) from non-obese women and women with obesity on the process of adipogenesis in 3T3-L1 preadipocytes. BM samples were collected from non-obese women (BMNO) and women with obesity (BMO) at one month postpartum. The fatty acid composition was measured, and BMNO and BMO groups with the lowest (Q1) and highest (Q4) quartiles of n-6:n-3 PUFA ratios were identified. 3T3-L1 preadipocytes were differentiated in the presence or absence of BM. Lipid accumulation and the expression of genes involved in lipogenesis and lipolysis were measured. Treatment with BMNO containing high (vs. low) n-6:n-3 PUFA ratios significantly increased the mRNA expression of lipogenic genes (acetyl-CoA carboxylase, fatty acid synthase, and stearoyl-CoA desaturase); however, there was no effect when cells were treated with BMO (with either low or high n-6:n-3 PUFA ratios). Treatment with BMO (high n-6:n-3 PUFA ratio) caused larger lipid droplets. Our findings demonstrated that BMNO with a high n-6:n-3 PUFA ratio was associated with a higher expression of lipogenic genes, while BMO with a high n-6:n-3 PUFA ratio showed larger lipid droplets, suggesting adipocyte dysfunction. These findings may have implications in the BM-mediated programming of childhood obesity.
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Affiliation(s)
- Peter Isesele
- Department of Biochemistry, Memorial University, St. John’s, NL A1C 5S7, Canada;
| | - Samantha Enstad
- Winnie Palmer Hospital for Women and Babies, Orlando, FL 32806, USA;
| | - Pham Huong
- School of Science/Boreal Ecosystems and Agriculture Sciences, Memorial University, Corner Brook, NL A2H 5G4, Canada; (P.H.); (R.T.)
| | - Raymond Thomas
- School of Science/Boreal Ecosystems and Agriculture Sciences, Memorial University, Corner Brook, NL A2H 5G4, Canada; (P.H.); (R.T.)
| | - Carol L. Wagner
- Department of Pediatrics, Division of Neonatology, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Sukhinder K. Cheema
- Department of Biochemistry, Memorial University, St. John’s, NL A1C 5S7, Canada;
- Correspondence: ; Tel.: +1-7-09-864-3987
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Pouch GG, Ebeling M, Shary JR, Hollis BW, Howard CR, Wagner CL. Evaluating Vitamin D Status in Infants Less than Seven Months; What Are the Preferred Biochemical Measurements? Breastfeed Med 2022; 17:422-428. [PMID: 35196139 PMCID: PMC9271327 DOI: 10.1089/bfm.2021.0237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: To ensure the safety of higher dose vitamin D supplementation in pregnant and lactating mothers, and urinary calcium/creatinine (UCa/Cr) ratios, serum calcium, and serum 25(OH)D concentrations are closely monitored. To achieve optimal maternal and infant vitamin D status, while avoiding hypercalcemia, safety measures assessing vitD supplementation must be reliable. Whether or not this holds true for infants before 7 months of age, remains unknown. Objective: Analyze the association among UCa/Cr ratio, serum calcium, intact serum parathyroid hormone (iPTH), 25(OH)D, and 25(OH)D/iPTH ratio in infants to determine whether evidence supports the use of these parameters as valuable measures of hypervitaminosis D or toxicity in infants. Methods: A series of analyses were performed on the cohort of infants who participated in the National Institute of Child Health and Human Development lactation vitD supplementation trial to determine the association among UCa/Cr ratio, serum calcium, iPTH, 25(OH)D, and 25(OH)D/iPTH ratio. Results: Upon multivariate analysis, serum calcium was significantly associated with 25(OH)D (p = 0.0441), iPTH (p = 0.0017), and 25(OH)D/iPTH ratio (p = 0.0001). Infant UCa/Cr did not associate with 25(OH)D but did associate with iPTH (p = 0.0008) and 25(OH)D/iPTH ratio (p = 0.0001). The correlation between UCa/Cr and 25(OH)D/iPTH ratios was significantly stronger than the association between UCa/Cr ratio and iPTH. Serum calcium more strongly correlated with 25(OH)D/iPTH ratio versus 25(OH)D and iPTH. Conclusion: In this healthy cohort of infants 1 to 7 months old, UCa/Cr and serum calcium are more valid indicators of 25(OH)D/iPTH ratio than either 25(OH)D or iPTH alone. Moreover, serum calcium (and not UCa/Cr) is a valid indicator of infant total circulating 25(OH)D and should be measured if vitamin D toxicity is a concern. Clinical Trial Registration number: FDA IND Number: 66,346; ClinicalTrials.gov Number: NCT00412074.
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Affiliation(s)
- Grace G Pouch
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Myla Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Cynthia R Howard
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
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20
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Newton DA, Baatz JE, Chetta KE, Walker PW, Washington RO, Shary JR, Wagner CL. Maternal Vitamin D Status Correlates to Leukocyte Antigenic Responses in Breastfeeding Infants. Nutrients 2022; 14:1266. [PMID: 35334923 PMCID: PMC8952362 DOI: 10.3390/nu14061266] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
It is unknown if vitamin D (vitD) sufficiency in breastfeeding mothers can lead to physiological outcomes for their children that are discernible from infant vitD sufficiency per se. In a 3-month, randomized vitD supplementation study of mothers and their exclusively breastfeeding infants, the effects of maternal vitD sufficiency were determined on infant plasma concentrations of 25-hydroxyvitamin D (i.e., vitD status) and 11 cytokines. An inverse correlation was seen between maternal vitD status and infant plasma TNF concentration (r = −0.27; p < 0.05). Infant whole blood was also subjected to in vitro antigenic stimulation. TNF, IFNγ, IL-4, IL-13, and TGFβ1 responses by infant leukocytes were significantly higher if mothers were vitD sufficient but were not as closely correlated to infants’ own vitD status. Conversely, IL-10 and IL-12 responses after antigenic challenge were more correlated to infant vitD status. These data are consistent with vitD-mediated changes in breast milk composition providing immunological signaling to breastfeeding infants and indicate differential physiological effects of direct-infant versus maternal vitD supplementation. Thus, consistent with many previous studies that focused on the importance of vitD sufficiency during pregnancy, maintenance of maternal sufficiency likely continues to affect the health of breastfed infants.
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Affiliation(s)
- Danforth A. Newton
- Department of Pediatrics/Neonatology, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC 29425, USA; (J.E.B.); (K.E.C.); (P.W.W.); (R.O.W.); (J.R.S.); (C.L.W.)
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21
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Abstract
The placenta plays an important role in how vitamin D is metabolized and supplied to the fetus.
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Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Shawn Jenkins Children's Hospital, Charleston, United States.,Darby Children's Research Institute, Medical University of South Carolina, Charleston, United States
| | - Bruce W Hollis
- Division of Neonatology, Shawn Jenkins Children's Hospital, Charleston, United States.,Darby Children's Research Institute, Medical University of South Carolina, Charleston, United States
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22
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McLeod C, Ebeling MD, Baatz JE, Shary JR, Mulligan JR, Wagner CL. Sociodemographic factors affecting perceived stress during pregnancy and the association with immune-mediator concentrations. J Perinat Med 2022; 50:192-199. [PMID: 34757701 DOI: 10.1515/jpm-2021-0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Determine which sociodemographic factors are most associated with increased maternal perceived stress during pregnancy. Evaluate the association between maternal stress and plasma immune-mediator concentrations (IMCs). METHODS As part of a prospective, randomized clinical trial, 247 participants completed a Perceived Stress Scale survey (PSS-10) during each trimester of pregnancy. Blood samples were collected from participants and were analyzed for 25-hydroxyvitamin D (25(OH)D) concentration and for several IMCs: interferon-gamma, interleukins (IL-) IL-2, IL-4, IL-5, IL-10, vascular endothelial growth factor, c-reactive protein, and tumor necrosis factor alpha (TNF-α) (R&D Elisa). The potential associations between PSS-10 scores, sociodemographic factors, and IMCs were assessed. RESULTS In bivariate analysis, participants who were not married and/or had high risk pregnancies were more likely to have increased PSS-10 scores (p<0.05). Increased PSS-10 scores were associated with higher serum concentrations of IL-2 and TNF-α, and decreased concentrations of IL-10 and 25(OH)D. In linear regression analysis, single marital status, high-risk pregnancy, IL-2, and TNF-α were independent predictors of PSS-10 scores. CONCLUSIONS This study identifies specific sociodemographic factors that are associated with increased perceived stress during pregnancy. This study also provides evidence that increased perceived stress is associated with physiological changes as measured by changes in circulating IL-2, TNF-α, IL-10, and 25(OH)D concentrations.
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Affiliation(s)
- Caroline McLeod
- College of Medicine, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Myla D Ebeling
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - John E Baatz
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Judy R Shary
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer R Mulligan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida-Gainesville, Gainesville, FL, USA
| | - Carol L Wagner
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
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23
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Chetta KE, Alcorn JL, Baatz JE, Wagner CL. Cytotoxic Lactalbumin-Oleic Acid Complexes in the Human Milk Diet of Preterm Infants. Nutrients 2021; 13:4336. [PMID: 34959888 PMCID: PMC8707396 DOI: 10.3390/nu13124336] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 12/13/2022] Open
Abstract
Frozen storage is necessary to preserve expressed human milk for critically ill and very preterm infants. Milk pasteurization is essential for donor milk given to this special population. Due to these storage and processing conditions, subtle changes occur in milk nutrients. These changes may have clinical implications. Potentially, bioactive complexes of unknown significance could be found in human milk given to preterm infants. One such complex, a cytotoxic α-lactalbumin-oleic acid complex named "HAMLET," (Human Alpha-Lactalbumin Made Lethal to Tumor cells) is a folding variant of alpha-lactalbumin that is bound to oleic acid. This complex, isolated from human milk casein, has specific toxicity to both carcinogenic cell lines and immature non-transformed cells. Both HAMLET and free oleic acid trigger similar apoptotic mechanisms in tissue and stimulate inflammation via the NF-κB and MAPK p38 signaling pathways. This protein-lipid complex could potentially trigger various inflammatory pathways with unknown consequences, especially in immature intestinal tissues. The very preterm population is dependent on human milk as a medicinal and broadly bioactive nutriment. Therefore, HAMLET's possible presence and bioactive role in milk should be addressed in neonatal research. Through a pediatric lens, HAMLET's discovery, formation and bioactive benefits will be reviewed.
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Affiliation(s)
- Katherine E. Chetta
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children’s Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA; (J.E.B.); (C.L.W.)
| | - Joseph L. Alcorn
- Department of Pediatrics, Division of Neonatology and Pediatric Research Center, The University of Texas Health & Science Center at Houston, 6631 Fannin Street MSB 3.252, Houston, TX 77030, USA;
| | - John E. Baatz
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children’s Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA; (J.E.B.); (C.L.W.)
| | - Carol L. Wagner
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children’s Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA; (J.E.B.); (C.L.W.)
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24
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Kazemain E, Ansari S, Davoodi SH, Patterson WB, Shakerinava P, Wagner CL, Amouzegar A. The Effect of Maternal Vitamin D Supplementation on Vitamin D Status of Exclusively Breast Feeding Mothers and Their Nursing Infants: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Adv Nutr 2021; 13:S2161-8313(22)00077-1. [PMID: 34718374 PMCID: PMC8970834 DOI: 10.1093/advances/nmab126] [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] [Indexed: 11/14/2022] Open
Abstract
The optimal vitamin D supplementation plan during lactation is unclear. We investigated the effect of maternal vitamin D supplementation on mother-infant dyads' vitamin D status during lactation. All controlled trials that compared vitamin D supplements to placebo or low doses of vitamin D in breastfeeding mothers were included. Pooled effect size and the associated 95% confidence interval (CI) for each outcome were estimated using random-effects models. A one-stage random-effect dose-response model was used to estimate the dose-response relation across different vitamin D dosages and serum 25-hydroxy vitamin D (25(OH)D) concentrations. We identified 19 clinical trials with 27 separate comparison groups (n = 3337 breastfeeding mothers). Maternal vitamin D supplement dosages were associated with circulating 25(OH)D concentrations in breastfeeding women in a non-linear fashion. Supplementation with 1000 IU of vitamin D/day increased serum 25(OH)D concentrations by 7.8 ng/mL while there was a lower increase in concentrations at vitamin D doses of >2000 IU/day (3.07 and 2.05 ng/mL increases between 2000 to 3000 and 3000 to 4000 IU/day, respectively). A linear relationship was observed between maternal vitamin D supplementation dosage and the infants' circulating 25(OH)D concentrations. Each additional 1000 IU of maternal vitamin D intake was accompanied by a 2.7 ng/mL increase in serum 25(OH)D concentration in their nursing infants. The subgroup analysis showed that maternal vitamin D supplementation was accompanied by a statistically significant increase in infants' 25(OH)D concentration in the trials with a duration of >20 weeks, vitamin D supplementation >1000 IU/day, East Indian participants, maternal BMI <25 kg/m2, and studies with an overall low risk of bias. Long-term maternal supplementation with vitamin D at a high dose (>6000 IU/day) effectively corrected vitamin D deficiency in both mothers and infants. Nevertheless, infants with 25(OH)D concentrations over 20 ng/mL may require a relatively low maternal dose to maintain vitamin D sufficiency. STATEMENT OF SIGNIFICANCE This study is the first dose-response analysis on the relation between circulating 25-hydroxy vitamin D (25(OH)D) and maternal vitamin D supplementation in mother-infant dyads. We also considered factors such as study design and population characteristics that may affect the outcomes of a given vitamin D trial that have been overlooked in previous reviews.
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Affiliation(s)
- Elham Kazemain
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Samaneh Ansari
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Hossein Davoodi
- Department of Basic Sciences and Cellular and Molecular Nutrition, Faculty of Nutrition Sciences and Food Technology and National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences,Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - William B Patterson
- Dept of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Pedram Shakerinava
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Carol L Wagner
- Address correspondence to Address correspondence to CLW (e-mail: )
| | - Atieh Amouzegar
- Address correspondence to Address correspondence to AA (e-mail: )
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25
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Enstad S, Cheema S, Thomas R, Fichorova R, Martin CR, O'Tierney-Ginn P, Wagner CL, Sen S. Response to messaging and methodological considerations when researching breastfeeding and obesity. Eur J Clin Nutr 2021; 75:1526-1527. [PMID: 33893448 DOI: 10.1038/s41430-021-00900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Samantha Enstad
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Sukhinder Cheema
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Raymond Thomas
- School of Science and the Environment/Boreal Ecosystem Research Initiative, Grenfell Campus, Memorial University of Newfoundland, Corner Brooke, NL, Canada
| | - Raina Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilia R Martin
- Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Sarbattama Sen
- Harvard Medical School, Boston, MA, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
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26
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Schulz EV, Wagner CL. Powdered to Liquid Human Milk Fortifiers in the Preterm Infant. Neoreviews 2021; 22:e360-e369. [PMID: 34074641 DOI: 10.1542/neo.22-6-e360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In preterm infants, the goal of aggressive extrauterine nutritional management is to mimic in utero growth and nutrient accretion. Over the latter half of the 20th century, nutritional optimization through the practice of fortifying human milk rose to practice with increased survival rates in preterm infants of younger gestational age. The quest for optimal preterm fortification and nutrition remains a contentious area of debate. This review aims to summarize the historical perspectives of human milk fortification as well as the current literature advocating for the use of liquid human milk fortifiers in enterally fed premature infants.
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Affiliation(s)
- Elizabeth V Schulz
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carol L Wagner
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC
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27
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Abstract
This review highlights clinical outcomes of human milk from infancy through adulthood. Human milk outcomes of both preterm and term infants, including critically ill term infants (such as infants with congenital heart disease and those requiring therapeutic hypothermia) are summarized. Several human milk diets are identified to reduce the risk of specific diseases. Emerging research of newly discovered components of human milk are also reviewed. Human milk has significant effects on the gut microbiome, somatic growth, and neurocognitive outcomes. Continued research promises to improve donor human milk and donor milk derived products to achieve better outcomes for infants who do not receive their own mother's milk. The promotion of human milk is well-founded on evidence from the previous half century.
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Affiliation(s)
- Katherine E Chetta
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States.
| | - Elizabeth V Schulz
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, United States
| | - Carol L Wagner
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, United States
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28
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Khatiwada A, Wolf BJ, Mulligan JK, Shary JR, Hewison M, Baatz JE, Newton DA, Hawrylowicz C, Hollis BW, Wagner CL. Effects of vitamin D supplementation on circulating concentrations of growth factors and immune-mediators in healthy women during pregnancy. Pediatr Res 2021; 89:554-562. [PMID: 32311700 PMCID: PMC8715366 DOI: 10.1038/s41390-020-0885-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/23/2020] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND For the second aim of the Kellogg Foundation grant, this double-blind RCT investigated the impact of plasma vitamin D metabolite 25-hydroxyvitamin D (25(OH)D) on plasma immune-mediators during pregnancy. We hypothesized that higher 25(OH)D concentrations would associate with reduced pro-inflammatory and increased tolerogenic immune-mediator concentrations. METHODS Pregnant women enrolled at 10-14 weeks gestation were randomized to 400 or 4400 IU vitamin D3/day. Data on health, safety, circulating 25(OH)D, and 9 immune-mediators were collected at each trimester. Associations between immune-mediators and 25(OH)D at baseline and at second and third trimesters were examined. RESULTS Baseline TGF-β and second and third trimesters IFN-γ and IL-2 were associated with baseline 25(OH)D. Baseline immune-mediators were associated with immune-mediators at second and third trimesters for all immune-mediators except IL-5 and IL-10. Race was associated with baseline TGF-β, VEGF and IL-10 and with IL-10 at second and third trimesters. CONCLUSIONS Both treatment groups had increased 25(OH)D at second and third trimesters, greatest in the 4400 IU group. Though associations between baseline 25(OH)D and baseline TGF-β and second and third trimester IFN-γ and IL-2 were noted, vitamin D supplementation throughout pregnancy did not impact immune-mediators at later trimesters. Supplementing with vitamin D before conception conceivably influences immune-mediator responses during pregnancy. IMPACT In this vitamin D supplementation clinical trial, baseline (first trimester) but not increasing plasma 25(OH)D concentration impacted select plasma immune-mediator profiles in pregnant women. Baseline 25(OH)D was associated with baseline TGF-β and with IFN-γ and IL-2 at second and third trimesters. Baseline IFN-γ, CRP, TGF-β, TNF-α, VEGF, IL-2, and IL-4 were associated with concentrations at second and third trimesters for respective immune-mediators; however, 25(OH)D concentration at second and third trimesters were not. Some racial differences existed in immune-mediator concentrations at baseline and at second and third trimesters. This study assesses the impact of vitamin D supplementation on multiple immune-mediators in pregnant women of different racial/ethnic groups using longitudinal data from a relatively large randomized controlled trial. This study found that race was associated with baseline TGF-β, VEGF, and IL-10 and with IL-10 at second and third trimesters, a novel finding that sheds light where relationships were less well defined. The results of this study suggest that vitamin D supplementation before conception or early in pregnancy, rather than during pregnancy, may be necessary to significantly impact immune-mediator response. This study sets premise for future clinical trials to evaluate the effect of vitamin D supplementation before conception or prior to pregnancy.
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Affiliation(s)
- Aastha Khatiwada
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425
| | - Bethany J. Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425
| | - Jennifer K. Mulligan
- Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, 29425,Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425
| | - Judy R. Shary
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Medical School, IBR Tower, Level 2, Birmingham B15 2TT, UK
| | - John E. Baatz
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425
| | - Danforth A. Newton
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425
| | - Catherine Hawrylowicz
- Division of Asthma, Allergy and Lung Biology, King’s College London, Guy’s Hospital, London, UK
| | - Bruce W. Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425
| | - Carol L. Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425,Corresponding author: Carol L. Wagner, M.D., Shawn Jenkins Children’s Hospital, Medical University of South Carolina, 165 Ashley Avenue, MSC 917, Charleston, SC 29425, Tel: (843) 792-8829, Fax: (843) 792-8801,
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29
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Ledingham L, Tatsuoka C, Minich N, Ross KR, Kerns LA, Wagner CL, Fuloria M, Groh-Wargo S, Zimmerman T, Hibbs AM. Burden of prematurity-associated recurrent wheezing: caregiver missed work in the D-Wheeze trial. J Perinatol 2021; 41:69-76. [PMID: 32694857 PMCID: PMC7855497 DOI: 10.1038/s41372-020-0729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/31/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study describes the burden of prematurity-associated wheezing in black infants with respect to caregiver missed work. STUDY DESIGN We analyzed data from the D-Wheeze trial (ClinicalTrials.gov identifier NCT01601847). Black infants between 28-0/7 to 36-6/7 weeks' gestational age at birth receiving <28 days of supplemental oxygen were enrolled. The primary outcome was missed work to care for the infant in the first year. RESULTS 147/277 (53.1%) infants had caregivers who reported time off. In an adjusted model, vitamin D supplementation (OR 0.52 [95% CI 0.30-0.89]; P = 0.018), recurrent wheeze (OR 2.26 [95% CI, 1.15-4.44]; P = 0.018), and other children in the household <5 years old (OR 0.45 [95% CI 0.26-0.78]; P = 0.004) were significantly associated with caregiver missed work. CONCLUSIONS Black premature infants had a significant burden of caregiver missed work, emphasizing the impact of prematurity-associated wheezing.
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Affiliation(s)
- Lauren Ledingham
- Case Western Reserve University, Cleveland, OH, USA. .,UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Curtis Tatsuoka
- Case Western Reserve University, Cleveland, OH,University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Nori Minich
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Kristie R. Ross
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Leigh Ann Kerns
- Case Western Reserve University, Cleveland, OH,Cleveland Clinic Foundation, Cleveland, OH
| | - Carol L. Wagner
- Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, South Carolina
| | - Mamta Fuloria
- The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Sharon Groh-Wargo
- Case Western Reserve University, Cleveland, OH,MetroHealth Medical Center, Cleveland, Ohio
| | - Teresa Zimmerman
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Anna Maria Hibbs
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
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30
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Wagner CL, Hulsey TC, Ebeling M, Shary JR, Asghari G, Howard CR, Baatz JE, Newton DA, Wahlquist AE, Reed SG, Taylor SN, Lawrence RA, Hollis BW. Safety Aspects of a Randomized Clinical Trial of Maternal and Infant Vitamin D Supplementation by Feeding Type Through 7 Months Postpartum. Breastfeed Med 2020; 15:765-775. [PMID: 32915638 PMCID: PMC7757584 DOI: 10.1089/bfm.2020.0056] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The safety of higher dose vitamin D (vitD) supplementation in women who change from exclusive or full breastfeeding to combination feeding or who continue supplementation after cessation of breastfeeding is unknown. Objective: Compare vitD supplementation safety of 6,400 to 400 IU/day and 2,400 IU/day using specific laboratory parameters in postpartum women and their infants through 7 months postpartum by feeding type. Design: In this randomized controlled trial, mothers (exclusively breastfeeding or formula-feeding) were randomized at 4-6 weeks' postpartum to 400, 2,400, or 6,400 IU vitD3 (cholecalciferol)/day for 6 months. Breastfeeding infants in 400 IU group received oral 400 IU vitD3/day; infants in 2,400 and 6,400 IU groups received placebo. Maternal safety parameters (serum vitD, 25-hydroxy-vitamin D [25(OH)D; calcidiol], calcium, phosphorus, intact PTH; urinary calcium/creatinine ratios; and feeding type/changes) were measured monthly; infant parameters were measured at months 1, 4, and 7. Sufficiency was defined as 25(OH)D >50 nmol/L. Feeding type was defined as exclusive/full, combination, or formula-feeding. Data were analyzed using SAS 9.4. Results: Four hundred nineteen mother-infant pairs were randomized into the three treatment groups and followed: 346 breastfeeding and 73 formula-feeding pairs. A dose of 6400 IU/day safely and significantly increased maternal vitD and 25(OH)D from baseline in all mothers regardless of feeding type (p < 0.0001) and was superior to the 400 and 2,400 IU groups in achieving vitD sufficiency with no other differences in safety parameters by treatment or feeding type. Infants in the 2,400 IU group were more likely vitD-deficient than the other groups; otherwise, there were no infant safety parameter differences. Conclusions: While 6,400 IU/day was more effective than 400 or 2,400 IU/day in achieving maternal vitD sufficiency in all feeding groups, the groups did not differ on other safety parameters. Similarly, infant safety parameters did not differ by treatment group or feeding status. Clinical Trial Registration: FDA IND Number: 66,346; ClinicalTrials.gov Number: NCT00412074.
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Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas C Hulsey
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
| | - Myla Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Golaleh Asghari
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA.,Nutrition and Endocrine Research Center, Research Institute of Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cynthia R Howard
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - John E Baatz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Danforth A Newton
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amy E Wahlquist
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Susan G Reed
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah N Taylor
- Divison of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ruth A Lawrence
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
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31
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Wagner CL, Hollis BW. Early-Life Effects of Vitamin D: A Focus on Pregnancy and Lactation. Ann Nutr Metab 2020; 76 Suppl 2:16-28. [PMID: 33232956 DOI: 10.1159/000508422] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/19/2022]
Abstract
Vitamin D is an endocrine regulator of calcium and bone metabolism. Yet, its effects include other systems, such as innate and adaptive immunity. Unique to pregnancy, circulating 1,25-dihydroxyvitamin D (1,25[OH]2D) increases early on to concentrations that are 2-3 times prepregnant values. At no other time during the lifecycle is the conversion of 25-hydroxyvitamin D (25[OH]D) to 1,25(OH)2D directly related and optimized at ≥100 nmol/L. Vitamin D deficiency appears to affect pregnancy outcomes, yet randomized controlled trials of vitamin D supplementation achieve mixed results depending on when supplementation is initiated during pregnancy, the dose and dosing interval, and the degree of deficiency at the onset of pregnancy. Analysis of trials on an intention-to-treat basis as opposed to the use of 25(OH)D as the intermediary biomarker of vitamin D metabolism yields differing results, with treatment effects often noted only in the most deficient women. Immediately after delivery, maternal circulating 1,25(OH)2D concentrations return to prepregnancy baseline, at a time when a breastfeeding woman has increased demands of calcium, beyond what was needed during the last trimester of pregnancy, making one question why 1,25(OH)2D increases so significantly during pregnancy. Is it to serve as an immune modulator? The vitamin D content of mother's milk is directly related to maternal vitamin D status, and if a woman was deficient during pregnancy, her milk will be deficient unless she is taking higher doses of vitamin D. Because of this relative "deficiency," there is a recommendation that all breastfed infants receive 400 IU vitamin D3/day starting a few days after birth. The alternative - maternal supplementation with 6,400 IU vitamin D3/day, effective in safely raising maternal circulating vitamin D, that of her breast milk, and effective in achieving sufficiency in her recipient breastfeeding infant - remains a viable option. Additional research is needed to understand vitamin D's influence on pregnancy health and the effect of maternal supplementation on breast milk's immune signaling.
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Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA,
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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Affiliation(s)
- Carol L Wagner
- MD, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
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Mercola J, Grant WB, Wagner CL. Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity. Nutrients 2020; 12:nu12113361. [PMID: 33142828 PMCID: PMC7692080 DOI: 10.3390/nu12113361] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [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: 10/04/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
Vitamin D deficiency co-exists in patients with COVID-19. At this time, dark skin color, increased age, the presence of pre-existing illnesses and vitamin D deficiency are features of severe COVID disease. Of these, only vitamin D deficiency is modifiable. Through its interactions with a multitude of cells, vitamin D may have several ways to reduce the risk of acute respiratory tract infections and COVID-19: reducing the survival and replication of viruses, reducing risk of inflammatory cytokine production, increasing angiotensin-converting enzyme 2 concentrations, and maintaining endothelial integrity. Fourteen observational studies offer evidence that serum 25-hydroxyvitamin D concentrations are inversely correlated with the incidence or severity of COVID-19. The evidence to date generally satisfies Hill’s criteria for causality in a biological system, namely, strength of association, consistency, temporality, biological gradient, plausibility (e.g., mechanisms), and coherence, although experimental verification is lacking. Thus, the evidence seems strong enough that people and physicians can use or recommend vitamin D supplements to prevent or treat COVID-19 in light of their safety and wide therapeutic window. In view of public health policy, however, results of large-scale vitamin D randomized controlled trials are required and are currently in progress.
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Affiliation(s)
- Joseph Mercola
- Natural Health Partners, LLC, 125 SW 3rd Place, Cape Coral, FL 33991, USA
- Correspondence: ; Tel.: +1-239-599-9529
| | - William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA;
| | - Carol L. Wagner
- Department of Pediatrics, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA;
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Awe O, Sinkway JM, Chow RP, Wagener Q, Schulz EV, Yu JY, Nietert PJ, Wagner CL, Lee KH. Differential regulation of a placental SAM68 and sFLT1 gene pathway and the relevance to maternal vitamin D sufficiency. Pregnancy Hypertens 2020; 22:196-203. [PMID: 33068876 PMCID: PMC7688503 DOI: 10.1016/j.preghy.2020.09.004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/04/2020] [Accepted: 09/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The goal of this study was to determine if an axis of placental gene expression associated with early onset and severe preeclampsia (EOSPE) was operative in term pregnancy and correlated with vitamin D sufficiency. METHODS qPCR analysis of NKX2-5, SAM68, sFLT1 and membrane bound VEGFR1/FLT1 mRNA expression was conducted in placentas from 43 subjects enrolled in a vitamin D3 pregnancy supplementation trial. Pair-wise rank order correlations between patient-specific gene expression levels were calculated, and their relationship to maternal 25(OH)D status was assessed by a two-sample Wilcoxon test. Additionally, we probed the mechanistic link between SAM68 and sFLT1 using siRNA depletion in a human trophoblast cell line model. RESULTS Positive and highly significant correlations were found between SAM68 vs. sFLT1 and SAM68 vs. FLT1 expression levels, as were significant and differential correlations between the expression of these genes and perinatal 25(OH)D status. The variability when stratified by race/ethnicity was qualitatively distinct from those previously observed in EOSPE. Mechanistic studies confirmed a functional role for SAM68 protein in the regulation of sFLT1 expression. NKX2-5 expression was not significantly correlated with sFLT1 or SAM68 expression in these samples, suggesting that its expression may be significant at earlier stages of pregnancy or be restricted to pathological settings. CONCLUSIONS These data further support our overarching hypothesis that SAM68 expression is a key determinant of VEGFR1 isoform expression in the placenta, and provide additional insights into how this gene pathway may be differentially deployed or modified in normal and pathological pregnancies.
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Affiliation(s)
- Oyindamola Awe
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - James M Sinkway
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Rebecca P Chow
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Quentell Wagener
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Elizabeth V Schulz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Jeremy Y Yu
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Kyu-Ho Lee
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States; Regenerative Medicine and Cell Biology Department, Medical University of South Carolina, Charleston, SC 29425, United States; Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Enstad S, Cheema S, Thomas R, Fichorova RN, Martin CR, O'Tierney-Ginn P, Wagner CL, Sen S. The impact of maternal obesity and breast milk inflammation on developmental programming of infant growth. Eur J Clin Nutr 2020; 75:180-188. [PMID: 32814855 PMCID: PMC7855210 DOI: 10.1038/s41430-020-00720-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 04/22/2020] [Revised: 06/22/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
Background: Little is known about how maternal obesity impacts breast milk (BM) composition and how BM composition may impact growth. We sought to determine the role of maternal body mass index (BMI) on BM inflammatory and oxidative stress markers and to delineate the role of these BM markers on infant growth. Methods: This was a secondary analysis of 40 mother-infant dyads. We first assessed the association between maternal BMI and BM marker (omega-6:omega-3 polyunsaturated fatty acid ratio (n-6:n-3 PUFA), leptin, interleukin (IL)-8, IL-6, IL-1β and malondialdehyde (MDA)) concentration at one (V1) and four (V4) months postpartum. We then examined the association between BM markers on infant growth trajectory from birth to seven months. Results: Higher maternal BMI was associated with higher BM n-6:n-3 PUFA (V1 β=0.12, 95% CI 0.01, 0.2; V4 β=0.13, 95% CI 0.01, 0.3) and leptin (V1 β=107, 95% CI 29, 184; V4 β=254, 95% CI 105, 403) concentrations. Infants exposed to high BM n-6:n-3 PUFA had higher BMI z-scores over time (p=0.01). Higher BM leptin was associated with lower infant percent fat mass at V4 (β=−9, 95% CI −17, −0.6). Infants exposed to high BM IL-8, IL-6, or IL-1β had higher weight z-scores over time (IL-8 p<0.001; IL-6 p<0.001; IL-1β p=0.02). There was no association between BM MDA and maternal BMI or infant growth. Conclusions: Higher maternal BMI is associated with higher BM n-6:n-3 PUFA and leptin concentrations. In addition, higher BM n-6:n-3 PUFA and inflammatory cytokines were associated with accelerated weight gain in infancy.
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Affiliation(s)
- Samantha Enstad
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Sukhinder Cheema
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Raymond Thomas
- School of Science and the Environment/Boreal Ecosystem Research Initiative, Grenfell Campus, Memorial University of Newfoundland, Corner Brook, NL, Canada
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilia R Martin
- Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Sarbattama Sen
- Harvard Medical School, Boston, MA, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Kiely ME, Wagner CL, Roth DE. Vitamin D in pregnancy: Where we are and where we should go. J Steroid Biochem Mol Biol 2020; 201:105669. [PMID: 32302652 DOI: 10.1016/j.jsbmb.2020.105669] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 01/06/2023]
Abstract
Vitamin D deficiency has been widely reported among pregnant women and infants around the world. Women with low sun exposure, high BMI, low vitamin D intakes and socioeconomic disadvantage with poor quality diets are at greatest risk of vitamin D deficiency, leading to very low serum concentrations of 25-hydroxyvitamin D (25(OH)D) in their offspring and an increased risk of nutritional rickets. Many observational studies, supported by compelling in vitro and in vivo data, have generated evidence suggesting that low vitamin D status in pregnancy may also contribute to the risk of adverse perinatal outcomes including hypertensive disorders (e.g., preeclampsia), fetal growth restriction, and preterm birth. However, the few large randomized controlled trials (RCTs) conducted to date have generated conflicting evidence for a role of vitamin D supplementation in improving perinatal outcomes. Vitamin D supplementation policies during pregnancy and implementation of policies vary within and between jurisdictions. Regulatory authorities have cited insufficient evidence to establish pregnancy-specific targets for serum 25(OH)D concentrations or prenatal vitamin D intake that effectively reduce the risks of adverse perinatal and infant outcomes. This paper arises from a Debate on Vitamin D Requirements during Pregnancy, held at the 22nd Vitamin D Workshop, 2019. From varied perspectives, our objectives were to evaluate the evidence for: vitamin D metabolism in pregnancy and the prevalence of gestational vitamin D deficiency worldwide; the translation of laboratory research findings to clinical studies on the role of vitamin D in perinatal health; the challenges of designing and conducting clinical trials to establish prenatal vitamin D requirements; and results to date of major large RCTs of prenatal vitamin D supplementation. Lastly, we explored potential next steps towards generating robust clinical data in this field to address both public health protection and patient care.
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Affiliation(s)
- M E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Ireland; INFANT Research Centre, University College Cork, Ireland.
| | - C L Wagner
- Division of Neonatology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - D E Roth
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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Wagner CL. Editorial for the article entitled, "Vitamin D status in preterm neonates and the effects of its supplementation on respiratory distress syndrome," Al-Biltagi, et al. Pediatr Pulmonol 2020; 55:847-849. [PMID: 32040890 DOI: 10.1002/ppul.24681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/25/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Wagner CL. Oral Maternal Vitamin D Megadoses to Prevent Vitamin Deficiency in Breastfeeding Mothers and Their Infants. Breastfeed Med 2020; 15:187-188. [PMID: 32105501 DOI: 10.1089/bfm.2020.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Carol L Wagner
- Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina
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Chen L, Wagner CL, Dong Y, Wang X, Shary JR, Huang Y, Hollis BW, Zhu H. Effects of Maternal Vitamin D3 Supplementation on Offspring Epigenetic Clock of Gestational Age at Birth: A Post-hoc Analysis of a Randomized Controlled Trial. Epigenetics 2020; 15:830-840. [PMID: 32089064 DOI: 10.1080/15592294.2020.1734148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/27/2023] Open
Abstract
Vitamin D could be beneficial for healthy ageing in humans. We previously found that vitamin D supplementation may slow down epigenetic ageing in young African American adults. We tested new epigenetic clocks developed for neonates among a multiethnic population, and tested the hypothesis that maternal vitamin D supplementation would slow down the epigenetic gestational age acceleration (GAA) in newborn babies. Ninety-two pregnant women (aged 29.6 ± 4.8 y; 21% African Americans, 28% Hispanics) were randomized to receive 4000 IU/day vitamin D3 or placebo, plus prenatal vitamins containing 400 IU vitamin D3 during pregnancy in a randomized controlled trial (RCT). Cord blood genome-wide methylation analysis was performed on the Illumina Infinium MethylationEPIC Beadchip. DNA methylation gestational age was calculated based on two calculations developed by Knight and Bohlin. DNA methylation gestational ages calculated by Knight's clock and Bohlin' clock were highly correlated with the gestational age in the placebo group (correlation coefficients = 0.88, p s< 0.001, respectively). GAA was associated with higher birth weight (p = 0.039). In the entire cohort, vitamin D3 supplementation was not associated with GAA (p > 0.05). However, vitamin D3 supplementation decreased GAA by both Knight's clock (β = -0.89, p = 0.047) and Bohlin's clock (β = -0.71, p = 0.005) in the African American participants. Maternal vitamin D3 supplementation may slow down the epigenetic gestational ageing process in African American neonates. Long-term follow-up studies are warranted to determine the role of epigenetic age acceleration in the growth and development of offspring.
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Affiliation(s)
- Li Chen
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina ,SC, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Xiaoling Wang
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Judith R Shary
- Department of Pediatrics, Medical University of South Carolina ,SC, USA
| | - Ying Huang
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA, USA
| | - Bruce W Hollis
- Department of Pediatrics, Medical University of South Carolina ,SC, USA
| | - Haidong Zhu
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA, USA
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Abstract
The evolutionary patterns of human migration and historical pre/post-industrial revolution have changed the face of bone metabolic disease through past centuries. Cultural, religious, and lifestyle practices continue to alter nutritional recommendations for this expanding diagnosis. Likewise, modern advancements in the field of neonatology and, more specifically, aggressive nutritional management of premature infants have shaped the epidemiology of neonatal bone metabolism over the past two decades. Decreased use of long-term parenteral nutrition, early fortification of enteral nutrition, and stringent American Academy of Pediatrics (AAP) practice guidelines instituting early supplementation of vitamin D have attributed to improved bone mineralization outcomes in both term and preterm infants. Nevertheless, neonatal bone mineral metabolic disorders remain prevalent. In this review, we provide an in-depth look at the diagnoses, therapeutics, and subset populations-both genetic and non-genetic-affected by neonatal bone mineral metabolic disorders.
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Affiliation(s)
- Elizabeth V Schulz
- Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 917, Charleston, SC, 29425, USA.
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 917, Charleston, SC, 29425, USA.
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Newton DA, Baatz JE, Kindy MS, Gattoni-Celli S, Shary JR, Hollis BW, Wagner CL. Insights image for vitamin D binding protein polymorphisms significantly impact vitamin D status in children. Pediatr Res 2019; 86:674. [PMID: 31234192 DOI: 10.1038/s41390-019-0476-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/14/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Danforth A Newton
- Department of Pediatrics/Div. Neonatology, Medical University of South Carolina, Charleston, SC, USA.
| | - John E Baatz
- Department of Pediatrics/Div. Neonatology, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S Kindy
- Department of Pharmaceutical Sciences, University of South Florida, Florida, USA.,James A. Haley VA Medical Center, Tampa, FL, USA
| | | | - Judy R Shary
- Department of Pediatrics/Div. Neonatology, Medical University of South Carolina, Charleston, SC, USA
| | - Bruce W Hollis
- Department of Pediatrics/Div. Neonatology, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L Wagner
- Department of Pediatrics/Div. Neonatology, Medical University of South Carolina, Charleston, SC, USA
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Reed SG, Miller CS, Wagner CL, Hollis BW, Lawson AB. Toward Preventing Enamel Hypoplasia: Modeling Maternal and Neonatal Biomarkers of Human Calcium Homeostasis. Caries Res 2019; 54:55-67. [PMID: 31665727 PMCID: PMC7299520 DOI: 10.1159/000502793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/20/2018] [Accepted: 08/15/2019] [Indexed: 01/01/2023] Open
Abstract
AIM The aim of this study was to assess biomarkers of calcium homeostasis and tooth development, in mothers during pregnancy and their children at birth, for enamel hypoplasia (EH) in the primary maxillary central incisor teeth. METHODS Bayesian methodology was used for secondary data analyses from a randomized, controlled trial of prenatal vitamin D3 supplementation in healthy mothers (N = 350) and a follow-up study of a subset of the children. The biomarkers were serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), total circulating 25-dihydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH)2D). The maternal biomarkers were assayed monthly during pregnancy, and the child's biomarkers were derived from cord blood. Digital images of the child's 2 teeth were scored for EH using Enamel Defects Index criteria for each of the incisal, middle, and cervical regions for an EH extent score. RESULTS The child EH prevalence was 41% (60/145), with most defects present in the incisal and middle tooth regions. Cord blood iPTH and 1,25(OH)2D levels were significantly associated with EH extent after controlling for maternal factors. For every 1 pg/mL increase in cord blood iPTH, the EH extent decreased by approximately 6%. For every 10 pg/mL increase in cord blood 1,25(OH)2D, the EH extent increased by almost 30% (holding all other terms constant and adjusting for subject-level heterogeneity). The relationship between maternal 25(OH)D and maternal mean iPTH varied significantly by EH extent. CONCLUSION The results suggest possible modifiable relationships of maternal and neonatal factors of calcium homeostasis during pregnancy and at birth for EH, contributing to the frontier of knowledge regarding sound tooth development for dental caries prevention.
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Affiliation(s)
- Susan G Reed
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA,
| | - Cameron S Miller
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bruce W Hollis
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew B Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Woo J, Giurgescu C, Wagner CL. Evidence of an Association Between Vitamin D Deficiency and Preterm Birth and Preeclampsia: A Critical Review. J Midwifery Womens Health 2019; 64:613-629. [PMID: 31411387 DOI: 10.1111/jmwh.13014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/13/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/30/2023]
Abstract
Vitamin D deficiency has been associated with adverse pregnancy and birth outcomes such as increased risk for preterm birth and preeclampsia. This state of the science review analyzed recently published meta-analyses and relevant studies that have evaluated the association between vitamin D deficiency and preeclampsia or preterm birth. The results suggest that a positive association between vitamin D deficiency and preterm birth exists. However, the findings of the relationship between vitamin D deficiency and preeclampsia were inconclusive, possibly because of the need for supplementation to occur prior to placentation. This may be because of a lack of studies with ethnic minority populations, who are more likely to experience vitamin D deficiency, and inadequate supplementation doses used for treatment of vitamin D deficiency. Health care providers should screen pregnant women at risk for vitamin D deficiency and supplement women accordingly based on their vitamin D status. Lastly, well-designed and standardized clinical trials need to include large cohorts of minority pregnant women to establish the impact of vitamin D supplementation on improving preterm birth and preeclampsia risk in pregnancy.
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Affiliation(s)
- Jennifer Woo
- Texas Woman's University, Denton, Texas.,Parkland Memorial Hospital, Dallas, Texas
| | | | - Carol L Wagner
- Medical University of South Carolina, Charleston, South Carolina
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Abstract
BACKGROUND International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. RESEARCH AIM To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC's role. METHODS The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008-2019. Qualitative and quantitative studies were reviewed. RESULTS Twelve (N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC's role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. CONCLUSION In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.
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Affiliation(s)
- Barbara Haase
- 1 Medical University Of South Carolina, Department of Women's and Children's Services, Charleston, SC 29425, USA
| | - Emily Brennan
- 2 Medical University of South Carolina (MUSC) Library, Charleston, SC, USA
| | - Carol L Wagner
- 3 Medical University of South Carolina, Department of Pediatrics, Charleston, SC, USA
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Affiliation(s)
- Carol L Wagner
- Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina.
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Wagner CL. The Impact of Technological Advances on our Understanding of the Dynamic Nature of Human Milk Cells: A Commentary About "Characterization of Stem Cells and Immune Cells in Preterm and Term Mother's Milk" (Li et al., 2019). J Hum Lact 2019; 35:535-537. [PMID: 31211645 PMCID: PMC6948717 DOI: 10.1177/0890334419851489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carol L. Wagner
- Department of Pediatrics, Division of Neonatology, Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC, USA
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Powell AM, Shary JR, Louden C, Ramakrishnan V, Eckard AR, Wagner CL. Association of Bacterial Vaginosis with Vitamin D in Pregnancy: Secondary Analysis from the Kellogg Pregnancy Study. AJP Rep 2019; 9:e226-e234. [PMID: 31304052 PMCID: PMC6624108 DOI: 10.1055/s-0039-1693163] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/26/2019] [Indexed: 11/16/2022] Open
Abstract
Objective Bacterial vaginosis (BV) is associated with vitamin D deficiency and poor pregnancy outcomes. We studied a nested cohort from a randomized controlled trial to investigate the association between BV and vitamin D concentration in pregnancy. Study Design Subjects with randomly assigned 400 versus 4,400 IU of daily cholecalciferol (vitamin D 3 ) had vaginal swabs collected for Gram staining and Nugent score calculation, as well as plasma 25-hydroxyvitamin D (25(OH)D) measurement at three pregnancy time points. Results Fifty-two (21.2%) of the 245 women included in the analysis were diagnosed with BV at study entry. Women with BV were also more likely to be African American ( p < 0.0001) and have lower 25(OH)D concentrations at 22 to 24 weeks' gestation ( p = 0.03). There were no differences in pregnancy outcomes of interest within this group compared with the remaining study subjects. In mixed regression modeling, while race ( p = 0.001) and age ( p = 0.03) were significant predictors of BV prevalence independently, 25(OH)D concentration ( p = 0.81), gestational age ( p = 0.06), and body mass index ( p = 0.87) were not. Conclusion Neither vitamin D deficiency in early pregnancy nor supplementation decreased BV incidence during pregnancy. Pregnancy outcomes (preterm birth and hypertensive disorders of pregnancy) were similar among women with and without BV.
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Affiliation(s)
- Anna Maya Powell
- Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Judy R. Shary
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Allison Ross Eckard
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Carol L. Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Jefferson KK, Parikh HI, Garcia EM, Edwards DJ, Serrano MG, Hewison M, Shary JR, Powell AM, Hollis BW, Fettweis JM, Strauss Iii JF, Buck GA, Wagner CL. Relationship between vitamin D status and the vaginal microbiome during pregnancy. J Perinatol 2019; 39:824-836. [PMID: 30858609 PMCID: PMC6535112 DOI: 10.1038/s41372-019-0343-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/22/2019] [Accepted: 01/30/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Evidence supports an inverse association between vitamin D and bacterial vaginosis (BV) during pregnancy. Furthermore, both the vaginal microbiome and vitamin D status correlate with pregnancy outcome. Women of African ancestry are more likely to experience BV, to be vitamin D deficient, and to have certain pregnancy complications. We investigated the association between vitamin D status and the vaginal microbiome. STUDY DESIGN Subjects were assigned to a treatment (4400 IU) or a control group (400 IU vitamin D daily), sampled three times during pregnancy, and vaginal 16S rRNA gene taxonomic profiles and plasma 25-hydroxyvitamin D [25(OH)D] concentrations were examined. RESULT Gestational age and ethnicity were significantly associated with the microbiome. Megasphaera correlated negatively (p = 0.0187) with 25(OH)D among women of African ancestry. Among controls, women of European ancestry exhibited a positive correlation between plasma 25(OH)D and L. crispatus abundance. CONCLUSION Certain vaginal bacteria are associated with plasma 25(OH)D concentration.
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Affiliation(s)
- Kimberly K Jefferson
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA
| | - Hardik I Parikh
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA
- Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA
| | - Erin M Garcia
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA
| | - David J Edwards
- Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA
- Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Myrna G Serrano
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Judith R Shary
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - Anna M Powell
- Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD, USA
| | - Bruce W Hollis
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - Jennifer M Fettweis
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jerome F Strauss Iii
- Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gregory A Buck
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Carol L Wagner
- Division of Neonatology, Shawn Jenkins Children's Hospital, Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
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Wagner CL, Boan AD, Marzolf A, Finch CW, Morella K, Guille C, Gardner Z, Marriott BP. The Safety of Mother's Milk® Tea: Results of a Randomized Double-Blind, Controlled Study in Fully Breastfeeding Mothers and Their Infants. J Hum Lact 2019; 35:248-260. [PMID: 30005170 DOI: 10.1177/0890334418787474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Various natural products are reported to improve maternal milk supply yet are not necessarily safe for infants. Researchers have not systematically studied galactagogue teas for safety. RESEARCH AIM This study evaluates the safety of a galactagogue tea in breastfeeding women and their infants, assessing short- and long-term adverse effects. METHODS Healthy, exclusively/fully breastfeeding women ( N = 60) with no milk insufficiency were randomized into (1) an all-natural tea containing fruits of bitter fennel, anise, and coriander; fenugreek seed; and other herbs (Mother's Milk® herbal tea; test) group or (2) a lemon verbena leaf (placebo) group. Maternal diaries captured self-reported maternal and infant adverse effects, tea consumed, and perceived infant satisfaction. Maternal quality of life and psychological state were assessed at baseline and 2 and 4 weeks. Poststudy calls assessed adverse effects through the infants' age of 12 months. RESULTS No adverse effects attributable to the interventions were reported at any time point. No differences were found between test and placebo groups in sociodemographic characteristics, maternal or infant adverse symptoms, quality of life, breastfeeding self-efficacy, maternal psychological measures, infant growth, and infant satisfaction (all p >.05). CONCLUSIONS This double-blind, randomized controlled trial (RCT) of an herbal galactagogue versus placebo among healthy, exclusively/fully breastfeeding mothers and infants found no adverse events associated with the test tea across the 30-day study or the first year of their infant's life. This composite tea appears to present no safety risk for mothers or their young babies.
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Affiliation(s)
- Carol L Wagner
- 1 Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea D Boan
- 1 Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Alicia Marzolf
- 2 Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Carolyn W Finch
- 1 Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Kristen Morella
- 3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Connie Guille
- 4 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Zoe Gardner
- 5 Traditional Medicinals, Sebastopol, CA, USA
| | - Bernadette P Marriott
- 2 Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.,4 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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50
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Rothenberg SE, Wagner CL, Hamidi B, Alekseyenko AV, Andrea Azcarate-Peril M. Longitudinal changes during pregnancy in gut microbiota and methylmercury biomarkers, and reversal of microbe-exposure correlations. Environ Res 2019; 172:700-712. [PMID: 30903970 PMCID: PMC6675619 DOI: 10.1016/j.envres.2019.01.014] [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] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Gut microorganisms contribute to the metabolism of environmental toxicants, including methylmercury (MeHg). Our main objective was to investigate whether associations between biomarkers for prenatal MeHg exposure and maternal gut microbiota differed between early and late gestation. METHODS Maternal blood and stool samples were collected during early (8.3-17 weeks, n=28) and late (27-36 weeks, n=24) gestation. Total mercury and MeHg concentrations were quantified in biomarkers, and inorganic mercury was estimated by subtraction. The diversity and structure of the gut microbiota were investigated using 16S rRNA gene profiling (n = 52). Biomarkers were dichotomized, and diversity patterns were compared between high/low mercury concentrations. Spearman's correlation was used to assess bivariate associations between MeHg biomarkers (stool, blood, and meconium), and 23 gut microbial taxa (genus or family level, >1% average relative abundance). RESULTS Within-person and between-person diversity patterns in gut microbiota differed between early/late gestation. The overall composition of the microbiome differed between high/low MeHg concentrations (in blood and stool) during early gestation, but not late gestation. Ten (of 23) taxa were significantly correlated with MeHg biomarkers (increasing or decreasing); however, associations differed, depending on whether the sample was collected during early or late gestation. A total of 43% of associations (69/161) reversed the direction of correlation between early/late gestation. CONCLUSIONS The time point at which a maternal fecal sample is collected may yield different associations between gut microorganisms and MeHg biomarkers, which may be due in part to remodeling of maternal microbiota during pregnancy. Our results suggest the effectiveness of dietary interventions to reduce prenatal MeHg exposure may differ between early and late gestation.
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Affiliation(s)
- Sarah E Rothenberg
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA.
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Bashir Hamidi
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander V Alekseyenko
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - M Andrea Azcarate-Peril
- Division of Gastroenterology and Hepatology and Microbiome Core Facility, University of North Carolina, Chapel Hill, NC, USA
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