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.

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.

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!”

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."

Pregnant Women Consuming Choline - Nutrient in Eggs and Meat A Key To Healthy Children

Just as women are advised to get plenty of folic acid around the time of conception and throughout early pregnancy, new research suggests another very similar nutrient may one day deserve a spot on the obstetrician’s list of recommendations.

Consuming greater amounts of choline – a nutrient found in eggs and meat – during pregnancy may lower an infant’s vulnerability to stress-related illnesses, such as mental health disturbances, and chronic conditions, like hypertension, later in life.

In an early study in The FASEB Journal, nutrition scientists and obstetricians at Cornell University and the University of Rochester Medical Center found that higher-than-normal amounts of choline in the diet during pregnancy changed epigenetic markers – modifications on our DNA that tell our genes to switch on or off, to go gangbusters or keep a low profile – in the fetus. While epigenetic markers don’t change our genes, they make a permanent imprint by dictating their fate: If a gene is not expressed – turned on – it’s as if it didn’t exist.


The finding became particularly exciting when researchers discovered that the affected markers were those that regulated the hypothalamic-pituitary-adrenal or HPA axis, which controls virtually all hormone activity in the body, including the production of the hormone cortisol that reflects our response to stress and regulates our metabolism, among other things.

More choline in the mother’s diet led to a more stable HPA axis and consequently less cortisol in the fetus. As with many aspects of our health, stability is a very good thing: Past research has shown that early exposure to high levels of cortisol, often a result of a mother’s anxiety or depression, can increase a baby’s lifelong risk of stress-related and metabolic disorders.


Eva K. Pressman, M.D.
“The study is important because it shows that a relatively simple nutrient can have significant effects in prenatal life, and that these effects likely continue to have a long-lasting influence on adult life,” said Eva K. Pressman, M.D., study author and director of the high-risk pregnancy program at the University of Rochester Medical Center. “While our results won’t change practice at this point, the idea that maternal choline intake could essentially change fetal genetic expression into adulthood is quite novel.”

Pressman, who advises pregnant women every day, says choline isn’t something people think a lot about because it is already present in many things we eat and there is usually no concern of choline deficiency. Though much more research has focused on folate – functionally very similar to choline and used to decrease the risk of neural tube defects like spina bifida – a few very compelling studies sparked her interest, including animal studies on the role of choline in mitigating fetal alcohol syndrome and changing outcomes in Down syndrome.

A long-time collaborator with researchers at Cornell, Pressman joined a team led by Marie Caudill, Ph.D., R.D., professor in the Division of Nutritional Sciences at Cornell, in studying 26 pregnant women in their third trimester who were assigned to take 480 mg of choline per day, an amount slightly above the standard recommendation of 450 mg per day, or about double that amount, 930 mg per day. The choline was derived from the diet and from supplements and was consumed up until delivery.

The team found that higher maternal choline intake led to a greater amount of DNA methylation, a process in which methyl groups – one carbon atom linked to three hydrogen atoms – are added to our DNA. Choline is one of a handful of nutrients that provides methyl groups for this process. The addition of a single methyl group is all it takes to change an individual’s epigenome.

Measurements of cord blood and samples from the placenta showed that increased choline, via the addition of methyl groups, altered epigenetic markers that govern cortisol-regulating genes. Higher choline lessened the expression of these genes, leading to 33 percent lower cortisol in the blood of babies whose mom’s consumed 930 mg per day.

Study authors say the findings raise the exciting possibility that choline may be used therapeutically in cases where excess maternal stress from anxiety, depression or other prenatal conditions might make the fetal HPA axis more reactive and more likely to release greater-than-expected amounts of cortisol.

While more research is needed, Caudill says that her message to pregnant women would be to consume a diet that includes choline rich foods such as eggs, lean meat, beans and cruciferous vegetables like broccoli. For women who limit their consumption of animal products, which are richer sources of choline than plant foods, she adds that supplemental choline may be warranted as choline is generally absent in prenatal vitamin supplements.

“One day we might prescribe choline in the same way we prescribe folate to all pregnant women,” notes Pressman, the James R. Woods Professor in the Department of Obstetrics and Gynecology. “It is cheap and has virtually no side effects at the doses provided in this study. In the future, we could use choline to do even more good than we are doing right now.”