Monday, December 23, 2013

Pregnant women need not avoid peanuts, evidence shows

Peanut and tree nut allergy incidence lower among children whose mothers ate them during pregnancy

Women need not fear that eating peanuts during pregnancy could cause their child to develop a peanut allergy, according to a new study from Boston Children's Hospital published online Dec. 23 in JAMA Pediatrics.

"Our study showed increased peanut consumption by pregnant mothers who weren't nut allergic was associated with lower risk of peanut allergy in their offspring," says the study's senior author Michael Young, MD, of Boston Children's Division of Allergy and Immunology. "Assuming she isn't allergic to peanuts, there's no reason for a woman to avoid peanuts during pregnancy."

Previously, women had been advised to avoid highly allergenic foods such as peanuts and tree nuts during pregnancy and while nursing, and that their children should avoid peanuts until 3 years of age. The goal of these recommendations, despite a lack of supporting research, was to minimize early allergen exposure and sensitization, thereby reducing the risk of developing childhood peanut allergy. The American Academy of Pediatrics (AAP) endorsed these recommendations in 2000. However, from 1997 to 2007, the number of peanut allergy cases in the U.S. tripled, leading the medical community to reexamine its recommendations. Based on the lack of evidence supporting early dietary avoidance, the AAP rescinded the recommendation in 2008.

"No one can say for sure if the avoidance recommendation for peanuts was related to the rising number of peanut allergies seen in the late 1990s and early 2000s, but one thing is certain: it did not stop the increase," Young says. "It was clear that a new approach was needed, opening the door for new research."

To further define the relationship between maternal diet and the development of food allergy in offspring, Young and his team analyzed large amounts of data provided by the Growing Up Today Study (GUTS). Examining the records of 8,205 children, the researchers positively identified 140 cases of peanut or tree nut allergies. They then examined the diets of each child's mother—specifically, peanut and nut consumption—during the peri-pregnancy period and compared them with the dietary habits of pregnant women whose children did not develop a peanut allergy.

Young and team found that the rate of peanut allergy was significantly lower among children in the study whose mothers ate peanuts during the peri-pregnancy period. Although this is a substantial finding, the data demonstrate only an association between maternal diet and the risk of peanut allergy in children.

"The data are not strong enough to prove a cause-and-effect relationship. Therefore, we can't say with certainty that eating more peanuts during pregnancy will prevent peanut allergy in children. But we can say that peanut consumption during pregnancy doesn't cause peanut allergy in children," Young says. "By linking maternal peanut consumption to reduced allergy risk we are providing new data to support the hypothesis that early allergen exposure increases tolerance and reduces risk of childhood food allergy."


Thursday, December 19, 2013

Inadequate pregnancy weight gain a risk factor for infant mortality

One-quarter of US women gain an inadequate amount of weight during pregnancy, University of Maryland School of Public Health study shows

Women who do not gain enough weight during pregnancy are at increased risk of losing their baby in its first year of life, according to a new study by researchers in the University of Maryland School of Public Health (UMD SPH). This study examined the relationship between gestational weight gain, mothers' body mass index (BMI) before and during pregnancy, and infant mortality rates. One-quarter of the more than 159,000 women in the study gained too little weight during pregnancy, and these mothers were more likely to give birth to babies who died in infancy than the women who gained a normal or even excessive amount of weight during pregnancy. The study is published in the American Journal of Public Health. It was conducted by Dr. Regina Davis, associate executive director of the American Public Health Association, Dr. Sandra Hofferth, professor, and Dr. Edmond Shenassa, associate professor. All three are affiliated with the UMD SPH Maternal and Child Health Program, Department of Family Science, and Hofferth and Shenassa are faculty associates of the Maryland Population Research Center.

"Our study showed that gaining too little weight during pregnancy is a risk factor for infant mortality for all but the heaviest women," explained Dr. Davis. Gaining more weight than recommended was not a risk factor for infant mortality but may be related to subsequent maternal health problems. "It is important that childbearing women have pregnancy weight gain goals that are specific to their individual BMI," added Dr. Hofferth, the study's senior author.

According to guidelines published by the Institute of Medicine (IOM), underweight women should gain between 28 and 40 pounds during pregnancy, while normal weight women are expected to gain 25-35 pounds, overweight women 15-25 pounds, and obese women 11-20 pounds. Results from this study showed that only about a third of women gained an amount of weight that was within the recommended guidelines for their body size. Nearly 25% of the women in the study gained an inadequate amount of weight, while another 41% gained too much.

Davis, Hofferth, and Shenassa analyzed data collected from 159,244 mothers who gave birth to live, single babies between 2004 and 2008 in order to determine whether there was a link between gestational weight gain (GWG), mothers' body mass index (BMI), and infant mortality. The women in the study responded to telephone or written questionnaires within nine months after their babies' birth, and their information was recorded in the Pregnancy Risk Assessment Monitoring System (PRAMS) for use by future researchers. The study team analyzed the PRAMS data to learn whether mothers' BMI before and during pregnancy might alter the influence of GWG on infant mortality.

Infant mortality risks in the study sample were 3.9% among infants of mothers who gained an inadequate amount of weight during pregnancy, 1.2% among infants of mothers who gained an adequate amount of weight, and .7% among mothers who gained more than the recommended amount. Mothers' pre-pregnancy BMI was also a key factor in infant survival. Mothers who were underweight before pregnancy and gained too little weight during pregnancy had six times the normal rate of infant mortality. Even among overweight women, inadequate weight gain was associated with a two-fold elevation in the risk of mortality. Only children born to obese women were protected from the effects of inadequate weight gain. In contrast, gaining more than the recommended amount of weight was not associated with risk to the infant among mothers in any weight category. Obese mothers who gained an excessive amount of weight actually had a 49% reduced likelihood of infant death.

This study confirms that only about a third of women in the US gain weight during pregnancy that is within the recommended range. In order to improve the likelihood of healthy outcomes for mothers and infants, healthcare providers should provide childbearing women with gestational weight gain goals that are specific to their individual BMI. Pregnant women can help ensure the health of their infants by monitoring their weight gain, eating an appropriate amount of healthy foods, and engaging in reasonable physical activity.

Tuesday, December 17, 2013

Effects of prenatal exposure to paracetamol

Paracetamol (acetaminophen) is the most commonly used medicine in pregnancy, yet there are very few studies that have investigated the possible long-term consequences for the child. A new study from the Norwegian Institute of Public Health suggests that long-term use of paracetamol during pregnancy may increase the risk of adverse effects on child development.

The study uses data from the Norwegian Mother and Child Cohort Study to investigate the effect of paracetamol during pregnancy on psychomotor development, behaviour and temperament at 3 years of age. Almost 3000 sibling pairs were included in the study.

The study is a collaboration between the University of Oslo, the Norwegian Institute of Public Health and the Hospital for Sick Children in Toronto, Canada, and was published in the International Journal of Epidemiology 25th October 2013.


By comparing children who were exposed to paracetamol during pregnancy with unexposed siblings of the same sex, researchers could control for a variety of genetic and environmental factors, in addition to other important factors such as infections, fever, use of other medications, alcohol intake and smoking.

• The study shows that children who had been exposed to paracetamol for more than 28 days of pregnancy had poorer gross motor skills, poor communication skills and more behavioural problems compared with unexposed siblings.
• The same trend was seen with paracetamol taken for less than 28 days, but this was weaker.
• To investigate whether the underlying illness could be the cause of the effect on the children, and not paracetamol itself, the researchers examined a different type of analgesic with another type of mechanism of action (ibuprofen). The researchers did not find any similar long-term effects after use of ibuprofen.

Monday, December 16, 2013

Elective Early-Term Deliveries Increase Complications for Baby and Mom,

Enduring the last few weeks of pregnancy can be physically and emotionally challenging for some women. The aches and pains, the swelling of the limbs and the anxiety of when labor may start are part of the natural gestation process, but they also can seem unbearable. It may seem easier to relieve symptoms associated with late pregnancy by electing to deliver early, but Mayo Clinic researchers caution that there can be an increased risk of complications to the mother and the newborn associated with early-term deliveries.

Mayo researchers recently published a review article on this topic in the journal Mayo Clinic Proceedings.

Historically, a full-term pregnancy is calculated as 40 weeks after the last menstrual period. A term pregnancy occurs at 37 weeks or beyond, and an early-term pregnancy is considered to be 37 weeks to 38 weeks and six days. According to the researchers, approximately 10 to 15 percent of all deliveries in the United States are performed before 39 completed weeks of gestation without a true medical indication for early delivery.

"Morbidity and mortality rates have increased in mothers and their babies that are born in the early-term period compared to babies born at 39 weeks or later," says Jani Jensen, M.D., obstetrician and lead author of the study. "There is a need to improve awareness about the risks associated with this."

The increased risks for newborns include morbidity, such as respiratory (breathing) difficulties, feeding difficulties and problems such as cerebral palsy although the overall risk is low. These morbidities can also lead to higher rates of admission to the neonatal intensive care unit (NICU).

An elective early-term delivery requires a pregnant woman to be induced, which involves medication or procedures to help start labor. This can lead to a prolonged labor requiring deliveries with instruments such as forceps or a vacuum and may cause infection or hemorrhaging. There is also an increased risk of needing to have a cesarean delivery, and long term there could be more surgical complications for the mother. "It's not an entirely benign procedure that we are talking about," says Dr. Jensen.

Dr. Jensen sees a huge need to increase patient awareness and the public's perception about term pregnancy and when it is safe to deliver a baby. One research study that was reviewed included 650 women who recently delivered a baby. Half of the respondents believed that a full-term pregnancy occurred at 37 to 38 weeks of gestation and 25 percent thought it was safe to deliver a baby at 34 to 36 weeks.

Tobacco, Drug Use May Raise Risk of Stillbirth

Smoking tobacco or marijuana, taking prescription painkillers, or using illegal drugs during pregnancy may increase the risk of stillbirth, according to a new study.

Stillbirth occurs when a fetus dies at or after 20 weeks of gestation. While the U.S. stillbirth rate decreased from 18 per 1,000 births in 1950 to 6 per 1,000 births in 2006, it still remains higher than many other developed countries and affects almost 26,000 U.S. newborns each year.

To learn more about the causes and prevention of stillbirth, NIH created the Stillbirth Collaborative Research Network. With support from NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the network enrolled more than 600 women who delivered stillbirths at 59 participating hospitals. For comparison, the scientists also enrolled almost 2,000 women who gave birth to a live infant.

The researchers took umbilical cord and blood samples at delivery from the 2 groups of women. They tested the women’s blood for cotinine, a derivative of nicotine. They tested the umbilical cords for evidence of the stimulants cocaine and amphetamine; prescription painkillers, such as morphine and codeine; and marijuana. They also asked the women to self-report smoking and drug use during pregnancy. The results appeared online on December 6, 2013, in Obstetrics & Gynecology.

Among the women who experienced a stillbirth, about 19% showed traces of cotinine and about 7% tested positive for other drugs. In comparison, among women who gave birth to a live infant, about 9% tested positive for cotinine and 4% for other drugs.

Based on blood test results and the women’s responses, the researchers estimated that tobacco use increased the risk of stillbirth by 1.8 to 2.8 times, with the highest risk found among those with the highest cotinine levels. Women who reported they didn’t smoke but tested positive for cotinine (and so were presumably exposed to second-hand smoke) had roughly double the risk of stillbirth.

Women with stillbirth were twice as likely as those with a live birth to report having been addicted to an illicit drug. A positive test for any drug in the umbilical cord was also associated with about double the risk for stillbirth. However, the researchers couldn’t entirely separate the effects of smoking tobacco from those of smoking marijuana. In addition, the number of women who tested positive for stimulant or prescription painkiller use was small. Further study will be needed to understand the effects of these drugs on stillbirth.

With the legalization of marijuana in some states and the continued widespread use of other drugs, these findings highlight the need for preventing drug and tobacco use during pregnancy.

“Smoking is a known risk factor for stillbirth, but this analysis gives us a much clearer picture of the risks than before,” says senior author Dr. Uma M. Reddy of NICHD. “Additionally, results from the latest findings also showed that likely exposure to secondhand smoke can elevate the risk of stillbirth.”

Thursday, December 12, 2013

Red meat = higher rate of gestational diabetes in pregnant women,

Pregnant women and women planning to become pregnant can make use of the holiday season to adjust their diets and reduce the risk of gestational diabetes, according to researchers at the University of Adelaide's Robinson Institute.

The recommendation comes at a time when there is increasing evidence to suggest that red meat is linked with a higher rate of gestational diabetes in pregnant women, which poses risks to the health of both the mother and the baby.

In a commentary published in this month's journal Evidence-Based Nursing, author Philippa Middleton says the latest international research shows that women who eat a lot of red and processed meats even before they become pregnant have a significant risk of developing gestational diabetes.

"There have been several reports linking red meat with increased risk of type 2 diabetes, and now the work of a number of research teams worldwide is showing this link for diabetes during pregnancy," says Ms Middleton, who is one of the Robinson Institute's research leaders.

"While this news is alarming, there are also some positives. The latest research from the United States has shown that eating fish and poultry does not increase the risk of gestational diabetes, and consuming more vegetable and non-meat protein is associated with a reduction in risk.

"For example, just over half a serving of nuts per day can reduce the risk of gestational diabetes by 40%."

Ms Middleton says although the link between red meat and diabetes is strengthening, scientists still don't understand the underlying mechanisms that cause it.

"More research is needed to better understand why this is happening and how to adapt women's diets and other lifestyle behaviors to prevent both gestational and type 2 diabetes," she says.

"Based on current evidence, pregnant women or women planning to become pregnant should consider eating more vegetable protein, and nuts, and replacing some red meat with fish and poultry.

"Midwives, dieticians and others involved in pregnancy care can help women to make these dietary changes in the hope of reducing poor outcomes for the mother and the baby," Ms Middleton says.

Friday, November 29, 2013

Exercise During Pregnancy Gives Newborn Brain Development Head Start

As little as 20 minutes of moderate exercise three times per week during pregnancy enhances the newborn child's brain development, according to researchers at the University of Montreal and its affiliated CHU Sainte-Justine children's hospital. This head-start could have an impact on the child's entire life.

"Our research indicates that exercise during pregnancy enhances the newborn child's brain development," explained Professor Dave Ellemberg, who led the study. "While animal studies have shown similar results, this is the first randomized controlled trial in humans to objectively measure the impact of exercise during pregnancy directly on the newborn's brain. We hope these results will guide public health interventions and research on brain plasticity. Most of all, we are optimistic that this will encourage women to change their health habits, given that the simple act of exercising during pregnancy could make a difference for their child's future." Ellemberg and his colleagues Professor Daniel Curnier and PhD candidate Élise Labonté-LeMoyne presented their findings today at the Neuroscience 2013 congress in San Diego.

Not so long ago, obstetricians would tell women to take it easy and rest during their pregnancy. Recently, the tides have turned and it is now commonly accepted that inactivity is actually a health concern. "While being sedentary increases the risks of suffering complications during pregnancy, being active can ease post-partum recovery, make pregnancy more comfortable and reduce the risk of obesity in the children," Curier explained. "Given that exercise has been demonstrated to be beneficial for the adult's brain, we hypothesized that it could also be beneficial for the unborn child through the mother's actions."

To verify this, starting at the beginning of their second trimester, women were randomly assigned to an exercise group or a sedentary group. Women in the exercise group had to perform at least 20 minutes of cardiovascular exercise three times per week at a moderate intensity, which should lead to at least a slight shortness of breath. Women in the sedentary group did not exercise. The brain activity of the newborns was assessed between the ages of 8 to 12 days, by means of electroencephalography, which enables the recording of the electrical activity of the brain. "We used 124 soft electrodes placed on the infant's head and waited for the child to fall asleep on his or her mother's lap. We then measured auditory memory by means of the brain's unconscious response to repeated and novel sounds," Labonté-LeMoyne said. "Our results show that the babies born from the mothers who were physically active have a more mature cerebral activation, suggesting that their brains developed more rapidly."

The researchers are now in the process of evaluating the children's cognitive, motor and language development at age 1 to verify if these differences are maintained.

Thursday, October 31, 2013

Low vitamin D levels raise anemia risk in children, Hopkins-led study shows

Low levels of the "sunshine" vitamin D appear to increase a child's risk of anemia, according to new research led by investigators at the Johns Hopkins Children's Center. The study, published online Oct. 10 in the Journal of Pediatrics, is believed to be the first one to extensively explore the link between the two conditions in children.

The researchers caution that their results are not proof of cause and effect, but rather evidence of a complex interplay between low vitamin D levels and hemoglobin, the oxygen-binding protein in red blood cells. The investigators say several mechanisms could account for the link between vitamin D and anemia, including vitamin D's effects on red blood cell production in the bone marrow, as well as its ability to regulate immune inflammation, a known catalyst of anemia.

To capture the interaction between the two conditions, researchers studied blood samples from more than 10,400 children, tracking levels of vitamin D and hemoglobin. Vitamin D levels were consistently lower in children with low hemoglobin levels compared with their non-anemic counterparts, the researchers found. The sharpest spike in anemia risk occurred with mild vitamin D deficiency, defined as vitamin D levels below 30 nanograms per milliliter (ng/ml). Children with levels below 30 ng/ml had nearly twice the anemia risk of those with normal vitamin D levels. Severe vitamin D deficiency is defined as vitamin D levels at or below 20 ng/ml. Both mild and severe deficiency requires treatment with supplements.

When investigators looked at anemia and vitamin D by race, an interesting difference emerged. Black children had higher rates of anemia compared with white children (14 percent vs. 2 percent) and considerably lower vitamin D levels overall, but their anemia risk didn't rise until their vitamin D levels dropped far lower than those of white children. The racial difference in vitamin D levels and anemia suggests that current therapeutic targets for preventing or treating these conditions may warrant a further look, the researchers say.

"The clear racial variance we saw in our study should serve as a reminder that what we may consider a pathologically low level in some may be perfectly adequate in others, which raises some interesting questions about our current one-size-fits-all approach to treatment and supplementation," says lead investigator Meredith Atkinson, M.D., M.H.S., a pediatric kidney specialist at the Johns Hopkins Children's Center.

Untreated, chronic anemia and vitamin D deficiency can have wide-ranging health consequences, including organ damage, skeletal deformities and frequent fractures, and lead to premature osteoporosis in later life.

Long known for its role in bone development, vitamin D has recently been implicated in a wide range of disorders. Emerging evidence suggests that low vitamin D levels may play a role in the development of certain cancers and heart disease and lead to suppressed immunity, the researchers note.

Anemia, which occurs when the body doesn't have enough oxygen-carrying red blood cells, is believed to affect one in five children at some point in their lives, experts say. Several large-scale studies have found severe vitamin D deficiency in about a tenth of U.S. children, while nearly 70 percent have suboptimal levels.

Friday, September 13, 2013

Expectant mothers' periodontal health vital to health of her baby

When a woman becomes pregnant, she knows it is important to maintain a healthy lifestyle to ensure both the health of herself and the health of her baby. New clinical recommendations from the American Academy of Periodontology (AAP) and the Eurpean Federation of Periodontology (EFP) urge pregnant women to maintain periodontal health as well. Research has indicated that women with periodontal disease may be at risk of adverse pregnancy outcomes, such giving birth to a pre-term or low-birth weight baby, reports the AAP and EFP.

Periodontal disease is a chronic, bacteria-induced, inflammatory condition that attacks the gum tissue and in more severe cases, the bone supporting the teeth. If left untreated, periodontal disease, also known as gum disease, can lead to tooth loss and has been associated with other systemic diseases, such as diabetes and cardiovascular disease.

"Tenderness, redness, or swollen gums are a few indications of periodontonal disease," warns Dr. Nancy L. Newhouse, DDS, MS, President of the AAP and a practicing periodontist in Independence, Missouri. "Other symptoms include gums that bleed with toothbrushing or eating, gums that are pulling away from the teeth, bad breath, and loose teeth. These signs, especially during pregnancy, should not be ignored and may require treatment from a dental professional."

Several research studies have suggested that women with periodontal disease may be more likely to deliver babies prematurely or with low-birth weight than mothers with healthy gums. According to the Center for Disease Control and Prevention (CDC), babies with a birth weight of less than 5.5 pounds may be at risk of long-term health problems such as delayed motor skills, social growth, or learning disabilities. Similar complications are true for babies born at least three weeks earlier than its due date. Other issues associated with pre-term birth include respiratory problems, vision and hearing loss, or feeding and digestive problems.

The medical and dental communities concur that maintaining periodontal health is an important part of a healthy pregnancy. The clinical recommendations released by the AAP and the EFP state that non-surgical periodontal therapy is safe for pregnant women, and can result in improved periodontal health. Published concurrently in the Journal of Periodontology and Journal of Clinical Periodontology, the report provides guidelines for both dental and medical professionals to use in diagnosing and treating periodontal disease in pregnant women. In addition, the American College of Obstetricians and Gynecologists recently released a statement encouraging pregnant women to sustain their oral health and recommended regular dental cleanings during pregnancy.

"Routine brushing and flossing, and seeing a periodontist, dentist, or dental hygienist for a comprehensive periodontal evaluation during pregnancy may decrease the chance of adverse pregnancy complications," says Dr. Newhouse. "It is important for expectant mothers to monitor their periodontal health and to have a conversation with their periodontist or dentist about the most appropriate care. By maintaining your periodontal health, you are not only supporting your overall health, but also helping to ensure a safe pregnancy and a healthy baby," says Dr. Newhouse.

Diets Low in Polyunsaturated Fatty Acids May Be a Problem for Youngsters

In the first study to closely examine the polyunsaturated fatty acid (PUFA) intake among U.S. children under the age of 5, Sarah Keim, PhD, principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children’s Hospital, has found what might be a troubling deficit in the diet of many youngsters. The study, published online today by Maternal and Child Nutrition, used data on nearly 2500 children age 12 to 60 months from the U.S. National Health and Nutrition Examination Survey.

PUFAs are essential to human health. A proper ratio of omega-6 to omega-3 PUFAs plays an important role in cell function, inflammation, eye development and neural functioning. However, the ideal dietary intake of PUFAs for young children is unclear. Knowing that infants often receive significant amounts of key PUFAs through breast milk and infant formula during the first year of life, Dr. Keim and her colleague, Amy Branum, PhD, MSPH, of the Centers for Disease Control and Prevention, decided to estimate the average intake of PUFAs in the diet for children between infancy and kindergarten.

“The ratio of omega-6 to omega-3 intake was high—about 10. Some experts use this as an indicator of diet quality, with a high ratio being less healthy,” says Dr. Keim. “In addition, intake of a key fatty acid known as DHA in children 12 to 60 months of age was low—lower than what infants generally consume—and it did not increase with age.”

Dr. Keim’s study was also the first to examine the primary dietary sources of PUFA intake among children under the age of 5 and to examine age, race and ethnicity in relation to fish intake in this age group. Fish are an excellent source of fatty acids, such as DHA and EPA, and were shown to be the richest sources of PUFAs in children’s diets.

“Only about 54 percent of children ate fish at least once in the previous month. Non-Hispanic black children were more likely than non-Hispanic white children to have eaten fish,” says Dr. Keim. “Because diet can be an important contributor to many diseases, it’s important to understand how such disparities might contribute to disease risk.”

The swift physical and neurological development during this period of childhood may mean that variations in PUFA intake could have important implications for growth, she adds.

“This work could help inform dietary recommendations for children, and may be particularly important for the preterm population,” Dr. Keim says. “We are currently carrying out a clinical trial to see if DHA supplementation when children are 1 year of age can help cognitive development in those born preterm.”

At present, there is no official dietary recommendation in the U.S. for DHA and EPA intake or supplementation among children, although the Institute of Medicine has issued what they call a “reasonable intake” level of two 3-oz servings of fish per week for children. “According to our research, however, children are clearly not consuming this much fish,” says Dr. Keim. In addition, the researchers found that overall intake of key fatty acids, such as DHA and EPA, among U.S. children is only a fraction of what is regularly consumed by young children in certain other countries, including Canada. Other studies suggest that similarly low intakes exist in kids age 5 and older. By incorporating key omega-3 PUFAs into a child’s diet at a very early age, Dr. Keim says, it may be more likely to become part of a lifelong diet.

Dr. Keim hopes her work will contribute to a more detailed understanding of the diets of young children in the U.S. and will motivate health professionals to start considering the specific nutritional needs of children for healthy growth and development. “We’d like to continue our work examining dietary patterns in very young children, since they are often excluded from dietary studies,” she says.

Ideally, Dr. Keim says she would like to see families expose their children to a variety of fresh foods as soon as they are old enough to eat solids. “Dietary habits can form very early, so starting with a balanced diet may have long-lasting effects for children’s health.” According to Dr. Keim, this balanced diet should include fish and other good sources of healthy fatty acids.

Diet during pregnancy and early life affects children’s behaviour and intelligence

The statement “you are what you eat” is significant for the development of optimum mental performance in children as evidence is accumulating to show that nutrition pre-birth and in early life “programmes” long term health, well being, brain development and mental performance and that certain nutrients are important to this process.

Researchers from the NUTRIMENTHE project have addressed this in a five-year study involving hundreds of European families with young children. Researchers looked at the effect of, B-vitamins, folic acid, breast milk versus formula milk, iron, iodine and omega-3 fatty acids, on the cognitive, emotional and behavioural development of children from before birth to age nine.

The study has found that folic acid, which is recommended in some European countries, to be taken by women during the first three months of pregnancy, can reduce the likelihood of behavioural problems during early childhood. Eating oily fish is also very beneficial, not only for the omega-3 fatty acids they which are ‘building blocks’ for brain cells, but also for the iodine content which has a positive effect on reading ability in children when measured at age nine.

A long-term study was needed as explained by Professor Cristina Campoy, who led the project “Short term studies seem unable to detect the real influence of nutrition in early life”, explained Prof Cristina Campoy, “NUTRIMENTHE was designed to be a long-term study, as the brain takes a long time to mature, and early deficiencies may have far-reaching effects. So, early nutrition is most important.”

Many other factors can affect mental performance in children including; the parent’s educational level, socio-economic status of the parents, age of the parents and, as discovered by NUTRIMENTHE, the genetic background of the mother and child. This can influence how certain nutrients are processed and transferred during pregnancy and breastfeeding and in turn, affect mental performance.

In giving advice to parents, Cristina Campoy explained, “it is important to try to have good nutrition during pregnancy and in the early life of the child and to include breastfeeding if possible, as such ‘good nutrition’ can have a positive effect on mental performance later in childhood.” She went on to explain, “however, in the case of genetics, future studies should include research on genetic variation in mothers and children so that the optimum advice can be given. This area is relatively new and will be challenging!”

Thursday, August 8, 2013

Diets of Pregnant Women Contain Harmful, Hidden Toxins

Pregnant women regularly consume food and beverages containing toxins believed to pose potential risks to developing fetuses, according to researchers at the University of California in Riverside and San Diego, suggesting that health care providers must do more to counsel their patients about the dangers of hidden toxins in the food supply.

In a peer-reviewed study published in the July issue of Nutrition Journal -- "Consumption habits of pregnant women and implications for developmental biology: a survey of predominantly Hispanic women in California" -- a team of psychologists from UC Riverside and UC San Diego found that the diets of pregnant Hispanic women included tuna, salmon, canned foods, tap water, caffeine, alcohol and over-the-counter medications that contain substances known to cause birth defects.

The study is unique in that it highlights the unseen dangers of consuming toxins in food and beverages that are not typically thought of as unhealthy for a fetus, said Sarah Santiago, a Ph.D. student in psychology at UCR and the paper's lead author. It also contributes to the body of literature aimed at assessing dietary habits of both Hispanic and non-Hispanic pregnant women.

"Unlike alcohol and nicotine, which carry a certain stigma along with surgeon general warnings on the packaging, tuna, canned foods, caffeine, and a handful of other foods and beverages with associated developmental effects are not typically thought of as unsafe," Santiago explained. "Hopefully, this study will encourage health care providers to keep pregnant women well informed as to the possible dangers of unhealthy consumption habits."

The research team -- Santiago; Kelly Huffman, assistant professor of psychology at UC Riverside; and UCSD undergraduate student Grace Park -- surveyed 200 pregnant or recently pregnant women at a private medical group in Downey, Calif., between December 2011 and December 2012. The women ranged in age from 18 to about 40, with Hispanic women accounting for 87 percent of the group. Nearly all had a high school degree, and about one-fourth had a college or post-graduate degree. More than two-thirds had an annual income of $50,000 or less.

Using a food questionnaire, participants reported how often and when during their pregnancy they ate certain foods, drank certain beverages, and ingested prescription and over-the-counter medications. Nearly all of the women reported eating meat while pregnant, with about three-quarters of them eating fish, typically tuna, tilapia and salmon. All reported eating fresh fruit, but fewer than one-third ate the recommended amount of more than one serving a day. Three-fourths ate canned goods, particularly fruits, vegetables and soup. Most reported drinking water, with 12 percent consuming tap water. Eighty percent consumed caffeinated beverages, and about 6 percent reported drinking alcohol sometime during their pregnancy. Most reported taking prenatal vitamins. Nearly half reported taking an over-the-counter medication -- primarily acetaminophen -- at least once and most reported taking prescription medications at least once.

The results are concerning, the researchers said.

"Consumption of tuna, salmon, canned goods, sugary desserts, fast foods, and drinking of tap water, caffeinated beverages, and alcoholic beverages during pregnancy have been deemed unhealthy due to the appearance of environmental toxins found to have harmful effects in the developing offspring," the researchers wrote.

Tuna contains methylmercury, and prenatal exposure has been associated with numerous developmental deficits involving attention, verbal learning, motor function and delayed performance. "Staggering" levels of polychlorinated biphenyls (PCBs) have been found in farmed salmon. Prenatal exposure to PCBs has been linked to lower birth weights, smaller head circumferences, and abnormal reflex abilities in newborns and to mental impairment in older children. Metal food cans are lined with a plastic that contains Bisphenol A (BPA), which leaches from the lining in cans into the food. Prenatal exposure to BPA has been associated in animal studies with hyperactivity, aggression and reproductive problems.

"This study has found that income is inversely correlated with canned food consumption, suggesting that women of low socio-economic status in particular may be especially at risk," the UC Riverside psychologists found.

Tap water also contains prenatal toxins. In Downey, eight pollutants found in drinking water exceed the health guidelines set by federal and state agencies. Some of those contaminants are known to result in central nervous system defects, oral cleft defects, neural tube defects, low birth weight and risk of fetal death, the researchers said. Pregnant women should be encouraged to drink filtered or bottled water in areas where contamination levels are high, they advised.

Also problematic was the level of caffeine consumption, the research team found. Caffeine consumed during pregnancy is associated with fetal mortality, birth defects and decreased birth weights. Animal studies have found developmental delays, abnormal neuromotor activity, and neurochemical disruptions.

A handful of women in the study -- 5.8 percent -- reported drinking alcohol at some time during their pregnancy, less than the national estimate of 7.6 percent. Maternal drinking rates are highest among white women ages 35 to 44.

"We do not know whether this is something unique to Hispanic women, or ubiquitous among women of multiple ethnicities," the researchers wrote. "The implications of this research are twofold: Women of childbearing age hoping to conceive should be advised to eliminate all alcohol consumption, as effects of maternal drinking have dire consequences in the first trimester when the mother may not know she is pregnant. … It is also clear that prenatal medical professionals should discourage the consumption of dangerous foods, beverages and medications that women commonly report consuming during pregnancy."

Not enough research has been conducted on certain substances to merit fail-proof labels of teratogenicity -- that is, whether a substance causes developmental malformations, Santiago said.

"Because regulation of prenatal consumption demands a very high level of evidence of teratogenicity, little-researched substances often go unregulated and health care professionals assume they are healthy," she explained. "The problem could also lie in reduced access to health care, or time constraints in prenatal consultations. Perhaps health care providers are informed, but fail to pass the information on to their clients for lack of time or because they assume the clients are already informed."

Teratogenic substances often have subtle, though serious, effects that manifest later in development, Santiago added. "Research suggesting that a given substance does not cause physical abnormalities at birth may be misinterpreted as a green light for consumption -- a grave mistake, considering that other research may exist demonstrating the long-term neural or behavioral abnormalities that result from consuming that substance during pregnancy."

Santiago said the research team continues to collect data on beliefs and attitudes about consumption of these substances during pregnancy. "Hopefully we will uncover some clues as to why women continue to eat these substances, and where in the system interventions would be most appropriate."