Laura Mullaney

A review of European guidelines on periconceptional folic acid supplementation.

Strong evidence that folic acid (FA) prevents the majority of cases of neural tube defects (NTDs) has led to national organisations developing guidelines for women concerning periconceptional supplementation. In Europe, there is evidence of national variations in the incidence of NTDs, with a recent Irish study reporting an increase in the rate. This review compares the periconceptional FA supplementation guidelines between the different countries in Europe. An online search of country-specific guidelines produced before 2015 concerning periconceptional FA supplementation was conducted. If an English version was not available directly, the EUROCAT register was searched for the English version of the recommendations. We identified national guidelines from 20 European countries. Over half recommended that FA supplements be taken by women planning a pregnancy, but three recommended that they should be taken by all women of child-bearing age. Four guidelines recommended starting FA at least 4 weeks preconceptionally, but no country recommended starting FA at least 12 weeks preconceptionally as suggested by recently published studies. There is a need for further consideration of the duration of preconceptional FA supplementation specifically. The latest scientific evidence in this area should inform the development of European guidelines on FA, as there is wide variation in current recommendations. Overall, the wide variation in national guidelines concerning periconceptional FA supplementation may in part explain the differences in national rates of NTDs reported by EUROCAT. National guidelines on FA supplementation should be standardised across European countries.

The relationship between gestational weight gain and fetal growth: time to take stock?

Abstract The aim of this article is to review the current evidence on gestational weight gain (GWG). Maternal obesity has emerged as one of the great challenges in modern obstetrics as it is becoming increasingly common and is associated with increased maternal and fetal complications. There has been an upsurge of interest in GWG with an emphasis on the relationship between excessive GWG and increased fetal growth. Recent recommendations from the Institute of Medicine in the USA have revised downwards the weight gain recommendations in pregnancy for obese mothers. We believe that it is time to take stock again about the advice that pregnant women are given about GWG and their lifestyle before, during, and after pregnancy. The epidemiological links between excessive GWG and aberrant fetal growth are weak, particularly in obese women. There is little evidence that intervention studies decrease excessive GWG or improve intrauterine fetal growth. Indeed, there is a potential risk that inappropriate interventions during the course of pregnancy may lead to fetal malnutrition that may have adverse clinical consequences, both in the short- and long-term. It may be more appropriate to shift the focus of attention from monitoring maternal weight to increasing physical activity levels and improving nutritional intakes.

An analysis of folic acid supplementation in women presenting for antenatal care.

BACKGROUND Neural tube defects (NTDs) are major congenital malformations that are potentially preventable if the woman takes periconceptional folic acid (FA) supplements. A recent report found that NTD incidence had increased in Ireland. This study examined the usage of FA supplementation in women presenting for antenatal care in a maternity hospital. METHODS Women were recruited at their convenience in the first trimester. Their clinical and sociodemographic details were computerized. Maternal weight and height were measured before calculating body mass index. Detailed FA questionnaires were completed under supervision of a trained researcher. RESULTS While 96.1% (n = 564) out of 587 reported that they took FA after they became pregnant, only 24.7% (n = 145) took it for >12 weeks preconceptionally as recommended. Only 5.7% (n = 6) of obese women took high-dose FA as recommended. On univariate analysis, the strongest predictors of preconceptional FA usage were higher maternal age, higher education and income, being married, being nulliparous, not smoking, infertility treatment and planned pregnancy. On multivariate analysis, both planned pregnancy and nulliparity were the most important predictors of preconceptional FA use. CONCLUSIONS Our study shows that current recommendations to prevent NTDs by FA supplementation pre-pregnancy are not being fully implemented in Ireland. We recommend a review of current public health policies on FA supplementation.

An estimation of periconceptional under-reporting of dietary energy intake

BACKGROUND The purpose of this cross-sectional study was to examine periconceptional misreporting of energy intake (EI) using the Willet food frequency questionnaire (WFFQ). METHODS Women were recruited in the first trimester. Women completed a semi-quantitative WFFQ. Maternal body composition was measured using eight-electrode bioelectrical impedance analysis. Under-reporters were those whose ratio of EI to their calculated basal metabolic rate fell below the calculated plausible threshold for their physical activity category. RESULTS The mean age was 30.1 ± 5.3 years (n = 524). The mean body mass index (BMI) was 25.4 ± 5.6 kg/m(2), and 16.6% were obese (BMI ≥ 30.0 kg/m(2)). Under-reported EI was observed in 122 women (23.3%) with no over-reporters in the sample. Under-reporters were younger (P < 0.001), less likely to have a normal BMI (P = 0.002) and more likely to be obese (P < 0.001) than plausible reporters. Under-reporters had higher percentage of body-fat and lower percentage of body fat-free mass (P < 0.001), were more likely to be at risk of relative deprivation (P = 0.001) and reported a higher percentage of EI from carbohydrate (P = 0.02) than plausible reporters. CONCLUSIONS Observed differences between under-reporters and plausible reporters suggest that the exclusion of these under-reporters represents an important potential source of bias in obesity research among women in the periconceptional period.

Knowledge about folic acid supplementation in women presenting for antenatal care

Background/Objectives:The incidence of neural tube defects (NTDs) in Ireland has increased in recent years. This study examines knowledge about folic acid (FA) supplementation for the prevention of NTDs among women presenting for antenatal care.Subjects/Methods:Women were recruited at their convenience in the first trimester after sonographic confirmation of an ongoing singleton pregnancy. A detailed questionnaire was completed under the supervision of a research dietitian. Clinical and socio-demographic details were collected.Results:Of the 587 women studied, 96% took FA during early pregnancy. Of these, 56.4% cited brain/spinal development or the prevention of brain/spinal defects, spina bifida or NTDs as the reason for taking FA. Multivariate analysis showed that women who were experiencing material deprivation or who were living in Ireland <5 years were least likely to be knowledgeable about the benefits of FA supplementation (P<0.05 for both). Over half (57.1%) of the women did not take FA preconceptionally. The main reason reported for not supplementing preconceptionally was that the woman did not expect to get pregnant (76.4%). Over one-third of women (35%), however, reported that they did not know they needed to take FA before becoming pregnant.Conclusions:These results highlight the need for a renewed public health campaign in Ireland about the importance of FA. As well as focusing on women who have recently come to live in Ireland, this campaign needs focus on women living in deprivation, as these are the women most at risk of having inadequate knowledge about the importance of FA in improving pregnancy outcomes.

Duration of periconceptional folic acid supplementation in women booking for antenatal care

OBJECTIVE To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices. DESIGN Cross-sectional observational study. Womens clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher. SETTING A large university maternity hospital, Republic of Ireland, January 2014-April 2016. SUBJECTS Women (n 856) recruited at their convenience in the first trimester. RESULTS While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed. CONCLUSIONS As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.

How do women feel about being weighed during pregnancy? A qualitative exploration of the opinions and experiences of postnatal women

OBJECTIVE to explore routine weighing in antenatal care and weight management in pregnancy with women who have been weighed during pregnancy. DESIGN a qualitative study utilising semi-structured telephone interviews, and thematic analysis. SETTING participants resided in Dublin, Ireland and had been weighed during pregnancy. PARTICIPANTS individual telephone interviews conducted with ten postpartum women (nine months postpartum). FINDINGS experiences of routine weighing were positive, and participants believed it should be part of standard antenatal care. Several benefits to routine weighing were cited, including providing reassurance and minimising postpartum weight retention. It was felt that there was a lack of information provided on gestational weight gain and healthy lifestyle in pregnancy, and that healthcare professionals are ideally placed to provide this advice. Increased information provision was seen as a method to improve healthy lifestyle behaviours in pregnancy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE these findings contribute to the current debate about the re-introduction of routine weighing throughout pregnancy (Allen-Walker et al., 2016). Women stated that they expected to be weighed during pregnancy and, contrary to previous claims, there was no evidence that routine weighing during antenatal care caused anxiety. From discussions it was clear that women desired more information on gestational weight gain and a healthy lifestyle, and felt that health professionals should provide this.

Relationship between fasting plasma glucose levels and maternal food group and macronutrient intakes in pregnancy

Aim Increased maternal body mass index (BMI) has been consistently associated with elevated blood glucose levels during pregnancy. Studies to date investigating the relationship between maternal blood glucose levels and dietary intake have shown mixed results. We investigated the association between maternal fasting plasma glucose (FPG) levels and food group and macronutrient intakes in the first trimester of pregnancy, after adjustment for maternal bodyweight. Methods Women were recruited after sonographic confirmation of an ongoing singleton pregnancy in the first trimester. Dietary information was collected using the validated Willett Food Frequency Questionnaire. Maternal height and weight were measured and BMI calculated. Body composition was measured using advanced bioelectrical impedance analysis. FPG levels were obtained for women who were selectively screened with a 75 g oral glucose tolerance test. Results No associations were observed between maternal FPG levels and food group or macronutrient intakes but higher energy and starch intakes were found in obese subjects (P = 0.009 and P = 0.03 respectively). On univariate analysis, higher FPG levels were associated positively with higher maternal bodyweight, BMI, body fat, fat free mass and visceral fat (all P 29.9 kg/m2 (OR 7.4, P = 0.01). Conclusions Our findings indicate that maternal BMI is the key determinant of maternal glycaemia. Interventions which focus on overall energy restriction and especially the limitation of dietary starch to optimise prepregnancy maternal bodyweight are likely to be useful in improving glycaemic control in higher risk pregnancies.

PS-273 The Relationship Between Infant Birth Weight And Neonatal Body Composition

Background and aims Birth weight has been used as a marker of adiposity in neonates. Ponderal index incorporates infant length and is used in place of body mass index (BMI) in infants. Skinfold thickness and anthropometric measurements can be unreliable in the first few days of life. Infant body composition can be measured using air displacement plethysmography. Our aim was to explore the relationship between birth weight and neonatal body composition. Methods Infant birth weight and anthropometry were recorded. Infant body composition was measured within 3 days of delivery using air displacement plethysmography (PEA POD, Cosmed, Rome, Italy). Term infants born between 37–42 weeks were included in analysis. Data were analysed using SPSS Statistics 19. Results Measurements were performed on 467 (227 (49%) male and 240 (51%) female) term neonates (37–42 weeks) within the first 72 h of life. Mean birth weight and percentage body fat was 3.58 kg and 9.7% in males and 3.42 kg and 11.3% in females. Infants in the top quartiles of birth weight had higher body fat percentage. A multiple regression was run to predict body fat percentage from birth weight, gestation and gender. 35.7% of variance could be explained by these variables. Conclusions Birth weight, gestation and gender only have a moderate effect size on infant body fat percentage at birth, therefore birth weight is not a reliable marker of infant adiposity.

The relationship between socioeconomic status and nutritional knowledge in women during pregnancy

Epidemiological data have shown that socioeconomic status affects nutritional knowledge and dietary quality (1) . Irish national food surveys have also suggested that socioeconomic differences in food group, nutrient intakes, dietary attitudes and health behaviours exist (2,3) . It is known that pregnancy can enhance a women’s nutritional awareness (4) . The aim of the present study was to assess whether nutritional knowledge in pregnant women in Ireland is affected by socioeconomic status. One hundred and sixteen pregnant women aged 16–41 years (mean age of 29.5 years) were recruited at their initial antenatal booking visit (10–15 weeks gestation) at a large Dublin maternity hospital. Formal education and material deprivation were used to assess the socioeconomic status of respondents. The women were classified into three educational categories: no formal education to lower secondary education, upper secondary education and third level education. Deprivation status was assessed by determining the number of basic necessities (5) respondents had had to forego in the previous year due to lack of money, with respondents categorised into three groupings: low(none), medium(1–2) and high (3 + ). The women’s level of nutritional knowledge was assessed using a self-administered questionnaire of 12 multiple choice questions. The questions were formulated from the Best Practice for Infant Feeding in Ireland guidelines published by the Food Safety Authority of Ireland in 2012 (6) . The questionnaire assessed respondents’ knowledge regarding essential food groups and nutrients in pregnancy as well as lifestyle factors such as smoking and exercise. Each respondent received a score out of 12 on their nutritional knowledge questionnaire (max. = 11, min. = 1), with participants then categorised as having high (score P7) or low (score O6) nutritional knowledge based on these scores.