Michelle P. Judge

Dietary intake of essential and long-chain polyunsaturated fatty acids in pregnancy

The dietary intake of EFA and long-chain PUFA (LCPUFA) by women with (n=14) and without (n=31) gestational diabetes mellitus (GDM) was determined by repeated 24-h recalls. Women with GDM consumed significantly more energy as fat compared with women who had uncomplicated pregnancies; absolute dietary fat did not differ. Dietary n−3 LCPUFA was substantially lower than the current recommendation for pregnancy, whereas intake of saturated FA (SFA) exceeded it. We conclude that replacing dietary sources of SFA with those of EFA and LCPUFA, especially n−3 LCPUFA, would benefit the dietary fat profiles of all pregnant women.

Maternal consumption of a DHA-containing functional food benefits infant sleep patterning: An early neurodevelopmental measure

BACKGROUND Docosahexaenoic acid (DHA; 22:6n-3) is highly important during pregnancy for optimal development and functioning of fetal neural tissue. Infant ability to organize sleep and wake states following parturition is highly associated with later developmental outcomes. The impact of maternal DHA intake on sleep organization has not been previously investigated. AIMS To examine the effect of a DHA-containing functional food consumed during pregnancy on early neurobehavioral development as assessed by infant sleep patterning in the first 48 postnatal hours. STUDY DESIGN A longitudinal, randomized, double-blinded, placebo-controlled design was used. SUBJECTS Women (18-35 y) with no pregnancy complications consumed a cereal-based functional food (92 kcal) containing 300 mg DHA an average of 5 d/week or placebo bars (n=27 DHA, n=21 Placebo). The intervention began at 24 weeks gestation and continued until delivery (38-40 weeks). OUTCOME MEASURES Infant sleep/wake states were measured on postnatal days 1 (D1) and 2 (D2) using a pressure sensitive mattress recording respiration and body movements. RESULTS Using ANCOVA and controlling for ethnic variation, there were significant group differences in arousals in quiet sleep on D1 (P=0.006) and D2 (P=0.011) with fewer arousals in the DHA intervention group compared to the placebo group. Similarly, arousals in active sleep on D1 were significantly lower in the DHA-intervention group (P=0.012) compared to the placebo group. CONCLUSIONS We conclude that increased prenatal supply of dietary DHA has a beneficial impact on infant sleep organization.

Influence of Feeding Type on Gut Microbiome Development in Hospitalized Preterm Infants

Background Premature infants have a high risk for dysbiosis of the gut microbiome. Mother’s own milk (MOM) has been found to favorably alter gut microbiome composition in infants born at term. Evidence about the influence of feeding type on gut microbial colonization of preterm infants is limited. Objective The purpose of this study was to explore the effect of feeding types on gut microbial colonization of preterm infants in the neonatal intensive care unit. Methods Thirty-three stable preterm infants were recruited at birth and followed up for the first 30 days of life. Daily feeding information was used to classify infants into six groups (MOM, human donor milk [HDM], Formula, MOM + HDM, MOM + Formula, and HDM + Formula) during postnatal days 0–10, 11–20, and 21–30. Stool samples were collected daily. DNA extracted from stool was used to sequence the 16S rRNA gene. Exploratory data analysis was conducted with a focus on temporal changes of microbial patterns and diversities among infants from different feeding cohorts. Prediction of gut microbial diversity from feeding type was estimated using linear mixed models. Results Preterm infants fed MOM (at least 70% of the total diet) had highest abundance of Clostridiales, Lactobacillales, and Bacillales compared to infants in other feeding groups, whereas infants fed primarily HDM or formula had a high abundance of Enterobacteriales compared to infants fed MOM. After controlling for gender, postnatal age, weight, and birth gestational age, the diversity of gut microbiome increased over time and was constantly higher in infants fed MOM relative to infants with other feeding types (p < .01). Discussion MOM benefits gut microbiome development of preterm infants, including balanced microbial community pattern and increased microbial diversity in early life.

Plasma or red blood cell phospholipids can be used to assess docosahexaenoic acid status in women during pregnancy.

The suitability of using plasma phopholipids (PLs) to assess docosahexaenoic acid (DHA) status during pregnancy is well accepted. Recent discussions have centered around whether red blood cells (RBCs) can be used to indicate DHA status. We tested the hypothesis that in pregnant women participating in an intervention study when fed a functional food containing DHA, maternal plasma PL DHA would be positively associated with maternal RBC PL and umbilical cord blood RBC PL DHA. Maternal and umbilical cord blood samples were obtained at delivery from women whose mean dietary intake was 187 mg/d (including the amount consumed from the DHA-functional food). Maternal plasma and RBCs and cord blood RBC lipids were extracted and PLs separated by thin-layer chromatography. Phopholipid lipids were methylated, and fatty acids were identified using gas chromatography. Fifty-nine maternal samples and 30 cord blood samples were analyzed. There were moderate to strong correlations between DHA in all compartments (maternal plasma vs maternal RBC PL DHA weight percent [wt%], r = 0.633, P < or = .001; maternal plasma vs cord blood RBC PL DHA wt%, r = 0.458, P < or = .01; maternal RBCs vs cord blood RBC PL DHA wt%, r = 0.376, P < or = .01). These results support the practice of using either plasma PLs or RBC PLs to assess maternal and infant DHA status.

Reduced DHA transfer in diabetic pregnancies: mechanistic basis and long-term neurodevelopmental implications

Infants born to diabetic mothers have a higher frequency of impaired neurodevelopment. The omega-3 or n-3 fatty acid docosahexaenoic acid (DHA) is an important structural component of neural tissue and is critical for fetal brain development. Maternal DHA supplementation during pregnancy is linked to better infant neurodevelopment; however, maternal-fetal transfer of DHA is reduced in women with diabetes. Evidence of mechanisms explaining altered maternal-fetal DHA transfer in this population is limited. This review explores existing evidence underpinning reduced maternal-fetal DHA transfer in maternal fuel metabolism in this population. Further research is necessary to evaluate the role of peroxisome proliferator-activated receptors in modulating placental fatty acid binding and maternal-fetal DHA transfer. Considerations for clinical practice include a diet high in DHA and/or provision of supplemental DHA to obstetric diabetic patients within minimum guidelines.

Effect of Maternal Body Mass Index on Infant Breastfeeding Behaviors and Exclusive Direct Breastfeeding

OBJECTIVE To describe the effect of maternal body mass index (BMI) on infant breastfeeding behaviors (poor, steady, vigorous) and the transition of the mother-infant dyad to exclusive, direct breastfeeding during the first month of life. DESIGN Longitudinal descriptive investigation. SETTING Tertiary-level southeastern medical center and follow-up telephone calls. PARTICIPANTS One hundred sixteen healthy, racially diverse, breastfeeding mother-infant dyads (77 full-term and 39 late-preterm infants). MAIN OUTCOME MEASURE(S) Breastfeeding outcomes were classified as exclusive direct or partially breastfed. The effect of maternal BMI was compared to results from weekly mothers reports of infant breastfeeding behaviors. RESULTS Significant breastfeeding differences were observed based on maternal BMI and infant gestational age. Mothers with BMIs greater than 25 who described their infants as a vigorous breastfeeders were less likely to exclusively direct breastfeed (p < .002). Only 40% of mother-infant dyads had exclusive direct breastfeeding at any time point or gestational age with no significant increase at any time point after discharge. The BMIs of the woman made no difference in exclusive direct breastfeeding full-term infants compared to late-preterm infants. CONCLUSION Maternal BMI had limited negative influence on exclusive direct breastfeeding during the first 4 weeks after discharge. Mothers should be educated that many infants need 3 to 4 weeks after discharge to learn how to breastfeed, infant feeding demands change during this time, and this time is important to the infants neurologic and overall development.

Postpartum Depression and the Role of Nutritional Factors

Postpartum depression is the number one complication of childbirth [1], and healthcare providers need to have a keen understanding of the disorder in order to provide support and advice. In the first portion of this chapter, the prevalence and onset of postpartum depression is discussed, with a consideration for risk factors that have been associated with the disorder. Within this context, there is a discussion of how postpartum depression affects the mother, the mother–infant relationship, and infant development. Detection of postpartum depression is key to treatment, making repeated screening throughout the first year postpartum highly important.

Omega-3 Consumption During Pregnancy to Support Optimal Outcomes

&NA; Long‐chain omega‐3 polyunsaturated fatty acids (n‐3 LCPUFA), including docosahexaenoic acid, are components of cellular membranes that affect biological functioning. Most pregnant women consume inadequate amounts of n‐3 LCPUFA and inadequately convert linolenic acid into docosahexaenoic acid. The purpose of this article is to educate nursing professionals on the importance of n‐3 LCPUFA consumption during pregnancy and highlight the critical role of nursing professionals in supporting optimal consumption for improved metabolic, antioxidant, and anti‐inflammatory potential.

Evidence of developmental continuity from birth to 1 year: sleep, temperament, problem solving, and recognition memory.

Background:Research evidence is limited regarding developmentally appropriate care. Variations exits with respect to test procedure type, infant age at testing, and test relatedness. Purpose:To assess developmental continuity using multiple developmental measures from birth to 12 months in a single cohort of term infants. Methods:A secondary analysis, longitudinal, correlational design was used to assess developmental continuity in a single cohort of infants (n 27). Measures included: sleep, using the Motility Monitoring System (first 48 hours of life); temperament, using the Infant Characteristics Questionnaire (ICQ, 6 months) and the Revised Infant Temperament Questionnaire (RITQ, 12 months); problem-solving, using the Willatts Infant Planning Test (PS, 9 and 12 months); and the Fagan Test of Infant Intelligence (FTII, 6 and 9 months). Results:Using Spearmen correlation, significant correlations included: (1) Sleep and ICQ: transitional sleep and “unpredictable” (r 0.455, P .017), “unadaptable” (r 0.420, P .026), and “dull” (r 0.416, P .028); (2) ICQ and FTII 6 months (r −0.512, P .008); (3) RITQ “approachability” and quiet sleep (r 0.662, P .005); (4) arousals in active sleep and PS at 9 months (r −0.528, P .016). Implications for Practice:Given our reported continuity between early sleep and later developmental measures, sleep-wake state should be considered in caregiving and environmental control to support sleep. Parental education on facilitating sleep-wake regulation in the home environment is essential. Implications for Research:These data support the existence of continuity between early sleep and later developmental milestones warranting a larger-scale investigation. Specific focus on development of care strategies for facilitating sleep immediately following birth is warranted.

The Effects of Omega-3 Polyunsaturated Fatty Acids on Maternal and Child Mental Health

The burden of mental health disorders in women, children, and adolescents has become a public health problem in the U.S. (Kessler, 2003). Essential omega-3 fatty acids, particularly docosahexaenoic acid (DHA, 22:6, n-3), play critical roles in building and maintaining a healthy central nervous system, affecting cognition and mood regulation. Given these roles, omega-3 fatty acids are being investigated as a complementary or alternative approach in the treatment of mental health disorders including postpartum depression, attention-deficit hyperactivity disorder (ADHD), childhood depression, and autistic spectrum disorder. The present chapter reflects the current state of scientific knowledge regarding the link between omega-3 fatty acids and general health and related psychopathologies affecting maternal, infant, and child health. Efforts are necessary to expand our current knowledge of the impact of omega-3 fatty acids on mental health disorders. Given the poor general intake of omega-3 in the general population of women and children, increased efforts are necessary to ensure intake is improved.