Roslyn Tarrant

Factors Associated With Duration of Breastfeeding in Ireland Potential Areas for Improvement

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

Maternal health behaviours during pregnancy in an Irish obstetric population and their associations with socio-demographic and infant characteristics

Background/Objectives:To examine the prevalence and combined occurrence of peri-conceptional folic acid (FA) supplement use, smoking and alcohol consumption during pregnancy in a sample of women in Dublin, and determine the factors associated with these health behaviours.Subjects/Methods:A prospective observational study (2004–2006) involving the recruitment of 491 pregnant women from antenatal clinics in a Dublin maternity hospital, with postpartum follow-up of 450 eligible mothers. Data on FA use, maternal smoking and alcohol consumption patterns during pregnancy were collected from the antenatal patient-administered questionnaire, which was completed by participants, and returned to the investigator on the day of recruitment.Results:The median gestational age of women at recruitment was 36 weeks. A combined 24.2% of mothers commenced FA at the recommended time, avoided alcohol consumption and smoking during pregnancy. In all, 35.3% of mothers reported to consuming alcohol, 20.9% smoked during pregnancy and 44.4% commenced FA at the recommended time. Mothers <25 years were more likely to have not taken FA at the recommended time (adjusted odds ratio (aOR): 4.0, 95% confidence interval (CI): 1.64–9.77) and were more likely to have smoked during pregnancy (aOR: 3.56, 95% CI: 1.32–9.57). Irish nationality positively predicted both alcohol consumption (aOR: 4.37, 95% CI: 1.88–10.15) and smoking (aOR: 10.92, 95% CI: 1.35–87.98) during pregnancy.Conclusions:Educational efforts are still necessary to convince women of Irish nationality, in particular, of the adverse effects of smoking and alcohol consumption on fetal outcome. Women <25 years should be specifically targeted in smoking cessation and FA promotional campaigns.

Low body mass index in adolescent idiopathic scoliosis: relationship with pre- and postsurgical factors.

Study Design. Retrospective cohort study. Objective. To determine the association between low preoperative body mass index (BMI) and outcome of spinal fusion in adolescent idiopathic scoliosis (AIS). Summary of Background Data. Several studies report a lower weight and BMI in untreated subjects with AIS than nonscoliotic age-matched controls. However, very little is known about the clinical impact of low BMI on pre- or postsurgical parameters in this patient group. Methods. Seventy-seven eligible patients with AIS who underwent 1-stage posterior spinal fusion and correction at 2 tertiary centers (January 2010–April 2012) were included. Preoperative weight, corrected height, and BMI values were converted to z scores using the British 1990 growth reference data. Relationships between anthropometric indices and comorbidities, laboratory blood data, radiographical outcomes, length of hospital stay, and perioperative complications were examined, and the independent factors associated with low BMI (z score < −1) evaluated using binary logistic regression analysis. Results. In this AIS cohort (mean age, 15.04 yr; n = 72 females), 21 subjects (27.3%) had a low preoperative BMI; of these, 5 cases (6.5%) were considered severely thin. Lower BMI and weight z scores correlated with a greater percent correction of thoracic curves (rs = −0.287 and rs = −0.257, respectively, P < 0.05). In both the univariate and multivariate regression analysis, low BMI was significantly associated with preoperative asthma incidence (adjusted odds ratio 5.33, P = 0.023) and prolonged prothrombin time (adjusted odds ratio 4.53, P = 0.027), in addition to postoperative ileus development (adjusted odds ratio 11.96, P = 0.019). Preoperative Cobb angle, estimated intraoperative blood loss and length of hospital stay did not significantly differ between the BMI groups. Conclusion. Significantly increased preoperative coagulation abnormality and asthma incidence as well as a greater percent correction of thoracic curves were associated with low BMI in this series. It was also found that postoperative ileus was independently associated with low BMI. Level of Evidence: 3

Maternal and infant nutritional supplementation practices in Ireland: implications for clinicians and policymakers.

This prospective Irish observational study examined maternal and infant nutritional supplement use. From an initial sample of 539 mothers recruited from the Coombe Women and Infants University Hospital in Dublin (during 2004-2006), 450 eligible mothers were followed up at 6 weeks and 6 months postpartum. Only 200 women (44.4%) complied with peri-conceptional folic acid at the recommended time with strong social patterning associated with its uptake. Almost 10% of the sample (n = 44) consumed a combined multivitamin and mineral supplement during pregnancy. A vitamin D-containing supplement was provided to only 5 (1.1%) and 15 (3.3%) infants at 6 weeks and 6 months, respectively. A national guideline that advises on adequate and safe use of both vitamin and multivitamin supplements during pregnancy with particular reference to vitamin A and D is warranted. Given the re-emergence of rickets in Ireland, and the reported morbidities associated with vitamin D insufficiency, promoting and monitoring compliance with 200 IU [5 microg] daily vitamin D supplements to all infants particularly those from higher risk groups from birth to 1 year, should be a public health priority.

Prevalence and impact of low body mass index on outcomes in patients with adolescent idiopathic scoliosis: a systematic review

Comparatively lower body mass index (BMI) has been reported in patients with adolescent idiopathic scoliosis (AIS)—a feature which may be an unrecognised symptom, or an organic consequence of the condition. The primary aim of this systematic review is to investigate the relationship between low BMI and AIS. A secondary aim is to investigate the effect of low BMI on outcomes of postsurgical correction in this patient group. The Cochrane Library, PubMed, SCOPUS, Web of Science and Ovid MEDLINE databases were searched up to December 2016 for relevant studies that reported prevalence of low preoperative BMI in patients with AIS and/or compared BMI between patients with AIS and healthy controls, as well as those that examined the relationship between low BMI and postoperative outcomes. Forty-five eligible studies were identified from the search strategy. Mean differences (MDs) were used with 95% confidence intervals (CI) in a random effects model to compare BMI in patients with AIS and controls in a pooled analysis of data from nine eligible studies (n = 3747 patients). In the meta-analysis, BMI of patients in the AIS group was significantly lower than those in the control group (MD −1.19, 95% CI −1.78 to −0.60). Low BMI in AIS can impact postoperative outcomes, including increased risk of ileus. This review demonstrates that patients with AIS are significantly more likely to have a low BMI compared to the general population. We advocate that closer attention be paid to AIS patients with low BMI both pre- and postsurgical correction.

Early formula feeding practices and their potential contribution to later obesity risk

Background and Aims Early feeding practices, including early introduction to solid foods and overfeeding, are known risk factors for childhood obesity. This study aimed to assess maternal formula feeding practices and infant formula feeding patterns, factors that are known to potentially contribute to later obesity risk. Methods This Irish prospective observational study involved the recruitment and follow-up of 450 eligible mother-infant pairs to 6 weeks postpartum. Data related to formula milk consumption patterns, formula type/brand changing, additions of solids to bottle feeds were examined, and available infant 6 week weight measurements recorded. Results In total, 368 (81.8%) mothers provided any formula milk to their infants at 6 weeks; of these, 14 (3.8%) reported to adding solid foods to their infant’s bottle feeds. Almost 50% of formula feeding mothers (n = 181) reported to changing their infant’s formula type/brand at least once during the first 6 weeks, mainly due to increased hunger and feeding frequency (2–3 hourly) (54.8%). Where 6 week infant weight measurements were available (n = 184), a mean of 205ml (SD 45ml) of formula milk/kilogram body weight/day was consumed by these infants. Conclusion Several formula feeding practices with potential implications for later obesity risk were identified in this study including premature introduction to solids (≤ 6 weeks) and consumption of excessive formula milk volumes at 6 weeks relative to infant feeding guidelines. Early provision of recommended feeding guidelines including specific advice on age-appropriate milk volumes to parents who formula feed should be considered in obesity prevention programmes.