Vk Knudsen

Major dietary patterns in pregnancy and fetal growth

Objectives:To investigate possible associations between maternal diet during pregnancy and fetal growth.Method:Factor analysis was used to explore dietary patterns among pregnant women. The association between maternal dietary patterns and fetal growth (in terms of small for gestational age, SGA) was investigated by logistic regression. Prospective cohort study, including information on 44u2009612 women in Denmark.Results:Two major dietary patterns were defined: the first pattern was characterized by red and processed meat, high-fat dairy, and the second pattern was characterized by intake of vegetables, fruits, poultry and fish. Women were classified into three classes according to their diet: the first class had high intake of foods of the first dietary pattern, and was classified as ‘the Western diet’, the second class preferred foods of the second pattern and was classified as the ‘Health Conscious’; and the third one had eaten foods of both patterns, and was classified as the ‘Intermediate’. The odds ratio of having a small for gestational-age infant (with a birth weight below the 2.5th percentile for gestational age and gender) was 0.74 (95% CI 0.64–0.86) for women in the Health Conscious class compared with women in the Western Diet class. The analyses were adjusted for parity, maternal smoking, age, height, pre-pregnancy weight and fathers height.Conclusions:Our results indicated that a diet in pregnancy, based on red and processed meat and high-fat diary, was associated with increased risk for SGA. Further studies are warranted to identify specific macro-, or micronutrients that may be underlying these associations.

Oral clefts and life style factors--a case-cohort study based on prospective Danish data.

This study examines the association between oral clefts and first trimester maternal lifestyle factors based on prospective data from the Danish National Birth Cohort. The cohort includes approximately 100,000 pregnancies. In total 192 mothers gave birth to child with an oral cleft during 1997–2003. Information on risk factors such as smoking, alcohol consumption, tea, coffee, cola, and food supplements was obtained during pregnancy for these and 828 randomly selected controls. We found that first trimester maternal smoking was associated with an increased risk of oral clefts (odds ratio (OR): 1.50; 95% confidence interval (CIs): 1.05, 2.14). Although not statistically significant, we also saw associations with first trimester consumption of alcohol (OR: 1.11; CIs: 0.79, 1.55), tea (OR: 1.31; CIs: 0.93, 1.86), and drinking more than 1xa0l of cola per week (OR: 1.40; CIs: 0.92, 2.12). Furthermore supplementation with ≥400xa0mcg folic acid daily during the entire first trimester (OR: 0.75; CIs: 0.46, 1.22) suggested an inverse associated with oral clefts, similar to our results on coffee drinking. No effects were found for smaller doses of folic acid, vitamin A, B6 or B12 in this study. The present study found an association between oral clefts and smoking and, although not conclusive, supports an association of oral cleft with alcohol.

Association between a Mediterranean-type diet and risk of preterm birth among Danish women: a prospective cohort study.

Background. Thus far, few factors with a causal relation to preterm birth have been identified. Many studies have focused on the womans diet, but most have been discouraging. The aim of the present study was to examine if maternal intake of a Mediterranean‐type diet (MD) is associated with reduced risk of preterm birth. Methods. The Danish National Birth Cohort assessed diet in mid‐pregnancy by food frequency questionnaires (FFQ). Women consuming MD were those who ate fish twice a week or more, used olive or rape seed oil, consumed 5+ fruits and vegetables a day, ate meat (other than poultry and fish) at most twice a week, and drank at most 2 cups of coffee a day. Results. Of 35,530 non‐smoking women, 1,137 (3.2%) fulfilled all MD criteria, and 540 (1.5%) none. Odds ratios for preterm birth and early preterm birth were 0.61 (95% Confidence Interval (CI): 0.35–1.05) and 0.28 (0.11–0.76), respectively, in MD women compared to women fulfilling none of the MD criteria. Conclusion. Shifting towards a MD during pregnancy may reduce the risk of early delivery in Danish women.

Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification?

OBJECTIVEnAs a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 microg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey.nnnDESIGNnCohort study on pregnant women in Denmark.nnnSETTINGnThe Danish National Birth Cohort (DNBC).nnnSUBJECTSnFrom November 2000 to February 2002, 22,000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrollment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy.nnnRESULTSnAn increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance.nnnCONCLUSIONSnAlternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.

Does leisure time physical activity in early pregnancy protect against pre‐eclampsia? Prospective cohort in Danish women

Objectiveu2002 To examine the association between physical activity in early pregnancy and risk of pre‐eclampsia.

Intake of vitamin C and E in pregnancy and risk of pre‐eclampsia: prospective study among 57 346 women

Objectiveu2002 It has been suggested that vitamin C, alone or in combination with vitamin E, may protect against pre‐eclampsia, whereas the safety of high‐dose vitamin E supplements has been questioned. We investigated dietary intakes of vitamins C and E to see if they correlated with the incidence of pre‐eclampsia.

Maternal dietary glycaemic load during pregnancy and gestational weight gain, birth weight and postpartum weight retention: a study within the Danish National Birth Cohort

Dietary glycaemic index and glycaemic load (GL) have been related to obesity and other health outcomes. The objective of the present study was to examine the associations between maternal dietary GL and gestational weight gain, birth weight, the risk of giving birth to a child large-for-gestational age (LGA) or small-for-gestational age and postpartum weight retention (PPWR). Data were derived from the Danish National Birth Cohort (1996-2002), including data on gestational and lifestyle factors in pregnancy and 18 months postpartum. Dietary data were collected using a validated FFQ. Information on birth outcome was obtained through registers. A total of 47,003 women were included. The associations between the GL and birth outcome, gestational weight gain, assessed between weeks 12 and 30 of gestation, and PPWR were analysed by linear and logistic regression. Birth weight increased by 36 g from the lowest to highest GL quintile (95% CI 19, 53 g), and an increased risk of LGA of 14% was detected in the highest GL quintile compared with the lowest GL quintile. Among normal-weight and overweight women, higher gestational weight gain rates were detected in the highest GL quintile (26 g/week (95% CI 19, 34) and 30 g/week (95% CI 13, 46), respectively). The association between the GL and PPWR was most pronounced among pre-pregnant obese women, with an increase in weight retention of 1·3 (95% CI 0·2, 2·8) kg from the lowest to highest GL quintile. The GL may play a role for excessive gestational weight gain and PPWR, which may be more pronounced among overweight and obese women.

General obstetrics: Fish oil in various doses or flax oil in pregnancy and timing of spontaneous delivery: a randomised controlled trial

Objectivesu2002 To test the earlier suggested hypothesis that intake of long‐chain n‐3 fatty acids from fish oil may delay the timing of spontaneous delivery and to test if alpha‐linolenic acid, provided as flax oil capsules, shows the same effect.

Iron supplement use among Danish pregnant women

OBJECTIVESnTo evaluate compliance with the national recommendation on supplemental iron to all pregnant women in Denmark and to explore differences between compliers and non-compliers with respect to dietary habits and other lifestyle factors.nnnDESIGNnIntake of supplemental iron from pure iron supplements and from multivitamin and mineral preparations was estimated in mid-pregnancy.nnnSETTINGnNationwide cohort study, the Danish National Birth Cohort (DNBC), comprising more than 100,000 women recruited in early pregnancy.nnnSUBJECTSnInformation on diet and dietary supplements was available for 54,371 women. Of these, information on lifestyle factors was available for 50,902 women.nnnRESULTSnA high compliance with the recommendation was found, as approximately 77% of the women reported use of iron supplements during pregnancy. However, many of the compliers did not obtain the recommended doses of iron, which can partly be explained by the lack of iron preparations of appropriate doses available on the Danish market. Compliance with the recommendation was associated with age above 20 years, primiparity, body mass index<30 kg m- 2, non-smoking and long education. No major differences were seen in dietary intake between compliers and non-compliers.ConclusionOverall, a high compliance rate was found among participants of the DNBC but a clarification on daily dose is needed, and more concern should be paid to vulnerable groups such as young, smoking women and women with no or short education.

Is High Consumption of Fatty Fish During Pregnancy a Risk Factor for Fetal Growth Retardation? A Study of 44,824 Danish Pregnant Women

Observational studies point to a positive association between fish consumption and both birth weight and prolonged gestation. Prolonged gestation has been associated with marine n-3 fatty acids, in particular, eicosapentaenoic acid and docosahexaenoic acid, in several-but not all-randomized controlled trials. The present study examined the relationship between fetal growth and fish consumption during pregnancy in 44,824 women from the Danish National Birth Cohort, enrolled during the years 1996-2002. The cohort included about 30% of all deliveries taking place in Denmark during this period. Consumption of total, fatty, and lean fish was estimated by a food frequency questionnaire in mid-pregnancy. Birth rates of infants who were below the 10th percentile for gender and gestational age were significantly increased for women consuming more than 60 g of fish on a daily basis compared with those taking 5 g or less. The adjusted odds ratio was 1.24 (95% confidence interval [CI], 1.03-1.49) for birth weight and 1.21 (95% CI, 1.01-1.43) for head circumference. The adjusted odds ratio for birth length was of borderline significance. Associations with total fish consumption were accounted for entirely by the consumption of fatty fish. Women who ate fatty fish at least 4 times per month were significantly more likely than others to give birth to small-for-gestational-age children. Consumption of lean fish was not associated with any adverse birth outcome. The risk of fetal growth restriction in the offspring of women who reported heavy maternal fish consumption in this large cohort study was increased approximately 24%. However, almost all this increased risk was associated with fatty fish consumption, and thus may be due to exposure to persistent organic pollutants. The investigators suggest that pregnant women be encouraged to consume moderate amounts of fatty fish.