Sarah A. Keim

DHA supplementation: current implications in pregnancy and childhood.

Dietary supplementation with ω-3 long chain fatty acids including docosahexaenoic acid (DHA) has increased in popularity in recent years and adequate DHA supplementation during pregnancy and early childhood is of clinical importance. Some evidence has been built for the neuro-cognitive benefits of supplementation with long chain polyunsaturated fatty acids (LCPUFA) such as DHA during pregnancy; however, recent data indicate that the anti-inflammatory properties may be of at least equal significance. Adequate DHA availability in the fetus/infant optimizes brain and retinal maturation in part by influencing neurotransmitter pathways. The anti-inflammatory properties of LCPUFA are largely mediated through modulation of signaling either directly through binding to receptors or through changes in lipid raft formation and receptor presentation. Our goal is to review the current findings on DHA supplementation, specifically in pregnancy and infant neurodevelopment, as a pharmacologic agent with both preventative and therapeutic value. Given the overall benefits of DHA, maternal and infant supplementation may improve neurological outcomes especially in vulernable populations. However, optimal composition of the supplement and dosing and treatment strategies still need to be determined to lend support for routine supplementation.

Epidemiology: The Changing Face of Preterm Birth

Preterm birth, defined as a pregnancy ending at less than 37 completed weeks of gestation, is the leading cause of infant mortality in the United States. The occurrence of preterm births rose steadily from 9.4% of all pregnancies in the United States in 1981 to 12.8% in 2006, before declining to 12.7% in 2007 and 12.3% in 2008. Most of the increase was attributable to increases in multiple gestations. Recent research has sought to understand this condition by evaluating its familial occurrence and both clinical and pathologic information to derive an etiologically homogeneous categorization.

Trends and factors associated with self-reported receipt of preconception care: PRAMS, 2004-2010.

BACKGROUND Preconception care (PCC) is a form of primary prevention for promoting health, assessing risk, and intervening to modify risk factors to try to improve maternal and infant outcomes. Clinical provision of preconception care before and after the release of recommendations has not been evaluated. Our objective was to determine trends in self-reported receipt of PCC from 2004 to 2010, and factors associated with self-reported receipt of PCC. METHODS Pregnancy Risk Assessment Monitoring System (PRAMS) data from 12 states were used to determine trends in PCC. Weighted multivariable logistic regression was used to identify factors associated with self-reported receipt of PCC. RESULTS The sample consisted of n = 64,084 women, with 30.8 percent reporting receipt of PCC. PCC increased from 30.3 percent in 2004 to 32.6 percent in 2010 (p = 0.08 for trend). Women who were younger, with lower household income, or with a preterm birth were less likely to report PCC. Women with lower levels of education, who were non-Hispanic black, intending pregnancy, without previous children, or with prepregnancy government insurance were more likely to report PCC. CONCLUSIONS Only one-third of women with a recent live birth report receipt of any PCC. There is a need to increase PCC receipt, especially among populations that demonstrate lower levels.

Should Obese Women Gain Less Weight in Pregnancy Than Recommended

BACKGROUND Previous research on inadequate gestational weight gain among obese women and adverse outcomes has been mixed. The objective of this study was to examine associations between inadequate gain among obese women and antepartum, intrapartum, and infant outcomes. METHODS Obese women from the U.S. Collaborative Perinatal Project were divided into obesity classes I (30.0-34.9 kg/m(2)) and II/III (> 35.0 kg/m(2)) and three weight gain categories (inadequate: < 5 kg, adequate: 5-9 kg, excessive: > 9 kg) as defined by the U.S. Institute of Medicine. Associations between 1-kg increments of inadequate gain (< 5 kg) and outcomes were examined. Women with inadequate gain were also compared with women gaining normal (5-9 kg) and excessive (> 9 kg) weight. RESULTS Each fewer 1-kg of weight gain increased small-for-gestational age (SGA) risk and reduced large-for-gestational age (LGA) risk by similar magnitude. Compared with excessive gain, inadequate gain reduced the odds of preeclampsia (OR: 0.56, CI: 0.37, 0.84), gestational hypertension (OR: 0.66, CI: 0.47, 0.92), and LGA (OR: 0.48, CI: 0.38, 060) and increased the odds of SGA (OR: 2.26, CI: 1.52, 3.35). Inadequate gain offered fewer advantages over adequate weight gain: lower odds of LGA (OR: 0.75, CI: 0.57, 0.99); increased odds of SGA (OR: 1.86, CI: 1.18, 2.91). Most associations applied to obesity class I but not class II/III women. CONCLUSIONS Inadequate weight gain poses benefits and risks to mothers and infants, but is preferable to excessive gain. The risks and benefits apply differently to class I versus class II/III obese women, indicating the need for weight gain recommendations by obesity class.

Parent–Child Interaction, Self-Regulation, and Obesity Prevention in Early Childhood

This paper describes the epidemiologic evidence linking parent–child relationships, self-regulation, and weight status with a focus on early childhood. The emotional quality of parent–child interactions may influence children’s risk for obesity through multiple pathways. Prospective studies linking observer ratings of young children’s self-regulation, particularly inhibitory control, to future weight status are discussed. Although findings are preliminary, promoting positive relationships between parents/caregivers and young children holds promise as a component of efforts to prevent childhood obesity. Multi-disciplinary collaborations between researchers with training in developmental science and child health should be encouraged.

Dietary intake of polyunsaturated fatty acids and fish among US children 12–60 months of age

UNLABELLED This study aimed to estimate intake of individual polyunsaturated fatty acids (PUFAs), identify major dietary sources of PUFAs and estimate the proportion of individuals consuming fish among US children 12-60 months of age, by age and race and ethnicity. The study employed a cross-sectional design using US National Health and Nutrition Examination Survey data. Representative sample of US population based on selected counties. SUBJECTS 2496 US children aged 12-60 months. Mean daily intake of n-6 PUFAs and eicosapentaenoic acid (EPA) varied by age, with children 12-24 months of age having lower average intakes (mg or g day(-1) ) than children 49-60 months of age and the lowest n6 : n3 ratio, upon adjustment for energy intake. Docosahexaenoic acid (DHA) intake was low (20 mg day(-1) ) compared to typical infant intake and did not change with age. Compared to non-Hispanic white children, Mexican American children had higher DHA and arachidonic acid (AA) intake. In the previous 30 days, 53.7% of children ever consumed fish. Non-Hispanic black children were more likely than non-Hispanic white children to have consumed fish (64.0% vs. 53.0%). Results indicate low prevalence of fish intake and key n-3 PUFAs, relative to n-6 fatty acids, which suggests room for improvement in the diets of US children. More research is needed to determine how increasing dietary intakes of n-3 PUFAs like DHA could benefit child health.

Early Lactation and Infant Feeding Practices Differ by Maternal Gestational Diabetes History.

Background: Detailed data on lactation practices by gestational diabetes mellitus (GDM) history are lacking, precluding potential explanations and targets for interventions to improve lactation intensity and duration and, ultimately, long-term maternal and child health. Objective: This study aimed to examine breastfeeding practices through 12 months postpartum by GDM history. Methods: Women who delivered a singleton, liveborn infant at The Ohio State University Wexner Medical Center (Columbus, OH), in 2011 completed a postal questionnaire to assess lactation and infant feeding practices and difficulties. Bivariate and multivariate associations between GDM history and lactation and infant feeding practices were examined. Results: The sample included 432 women (62% response rate), including 7.9% who had GDM during the index pregnancy. Women with GDM initiated breastfeeding (at-the-breast or pumping) as often as women without any diabetes but were more likely to report introduction of formula within the first 2 days of life (79.4% vs 53.8%, P < .01; adjusted odds ratio: 3.48; 95% confidence interval, 1.47-8.26). Women with GDM initiated pumping 4 days earlier than women without diabetes (P < .05), which was confirmed in adjusted analyses. There was no difference in the proportion of women reporting breastfeeding difficulty (odds ratio: 2.08; 95% confidence interval, 0.78-5.52). However, there was a trend toward women with GDM reporting more formula feeding and less at-the-breast feeding as strategies to address difficulty compared with women without diabetes. Conclusion: Additional research is needed to understand why women with GDM engage in different early lactation and infant feeding practices, and how best to promote and sustain breastfeeding among these women.

Provision of specific preconception care messages and associated maternal health behaviors before and during pregnancy

OBJECTIVE The purpose of this study was to examine the associations between receipt of specific preconception care messages before pregnancy and maternal behaviors before and during pregnancy. STUDY DESIGN Data were from the Pregnancy Risk Assessment Monitoring System 2009-2010. Only women who reported receiving general preconception care were asked questions about specific health messages that they received before pregnancy (32.2% of the total sample; N = 10,267). Preconception care messages that were received and corresponding behaviors that were examined included taking vitamins with folic acid before pregnancy, dieting to lose weight or exercising before pregnancy (for women who were overweight or obese before pregnancy), and smoking and drinking alcohol during pregnancy (for women who reported smoking or alcohol use in the past 2 years). Separate weighted multivariable logistic regression models were used to assess the association between receipt of specific preconception care messages and maternal behaviors before and during pregnancy. RESULTS Women who reported receiving the message about taking vitamins with folic acid before pregnancy reported taking vitamins more often in the month before pregnancy compared with women who did not receive the message (77% vs 40%; P < .01; adjusted odds ratio [aOR], 2.99; 95% confidence interval [CI], 2.24-4.00). Among overweight and obese women, there was no difference in dieting or exercising between those who received the message about maintaining a healthy weight before pregnancy and those who did not (dieting: 41% vs 39% [P = .58; aOR, 1.06; 95% CI, 0.77-1.47]; exercising: 43% vs 40% [P = .42; aOR, 1.10; 95% CI, 0.81-1.51]). Among smokers, women who received the message regarding smoking during pregnancy smoked more often during the last 3 months of pregnancy than women who did not receive the message (47% vs 27%; P < .01; aOR, 2.22; 95% CI, 1.21-4.09). Among drinkers, the same percentage of women who did and did not receive the message about alcohol use during pregnancy drank in the last 3 months of pregnancy (13% vs 13%; P = .86; aOR, 0.95; 95% CI, 0.65-1.38). CONCLUSION Our study found that counseling on folic acid was associated with greater vitamin use, although counseling on dieting, exercising, drinking, and smoking among women who were at high risk was not associated with behaviors before or during pregnancy.

How Research on Charitable Giving Can Inform Strategies to Promote Human Milk Donations to Milk Banks.

Many hospitalized preterm infants do not exclusively receive mother’s own milk, so milk from another mother may be sought. Previous research indicated that just 1% of US women who express breast milk actually donate it for another family. Therefore, strategies to boost donation rates should be identified. We draw upon the experimental literature on charitable giving of monetary donations to offer 6 strategies to promote breast milk donations to milk banks in North America. These strategies include (1) highlighting a potential identifiable recipient of donated breast milk as opposed to highlighting groups of potential recipients; (2) emphasizing similarities between the potential donor and potential beneficiaries; (3) emphasizing similarities between the potential donor and previous donors; (4) using negative arousal to promote donations; (5) emphasizing the self-interest of those asking for breast milk donations; and (6) highlighting the specific effect of breast milk donations. Potential limitations of these strategies are discussed.

Associations Between Breast Milk Feeding, Introduction of Solid Foods, and Weight Gain in the First 12 Months of Life:

Background and Objectives. Breast milk feeding and solid food introduction can influence infant growth, but are rarely examined together. The objectives were to describe relationships between feeding practices, feeding practices and weight gain, and how the relationship of breast milk feeding and growth may change when breastfed infants start solid foods before 6 months. Methods. Data were analyzed on 438 infants from the Moms2Moms Study (2011-2012, Ohio), using multivariable linear and logistic regression models to explore each of the relationships. Results. For each additional month of breast milk feeding, solid food introduction was delayed by 1.32 days (95% CI 0.11 to 2.53) and average weight gain per month decreased by 5.05 g (95% CI 7.39 to 2.17). There was no association between solid food introduction and growth. Conclusions. Longer breastfeeding duration was associated with slower growth regardless of solid food introduction. Age at solid food introduction was not associated with growth.