Friday, September 13, 2013
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.
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.
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!”