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High Pregnancy, Cord Blood, and Infant Vitamin D Concentrations May Predict Slower Infant Growth.
Hauta-Alus, HH, Kajantie, E, Holmlund-Suila, EM, Rosendahl, J, Valkama, SM, Enlund-Cerullo, M, Helve, OM, Hytinantti, TK, Viljakainen, H, Andersson, S, et al
The Journal of clinical endocrinology and metabolism. 2019;(2):397-407
Abstract
CONTEXT The relationship of maternal and infant 25-hydroxyvitamin D concentration [25(OH)D] with infant growth is unclear. OBJECTIVE Our objective was to explore whether 25(OH)D in pregnancy, umbilical cord blood (UCB), or in infancy was associated with infant growth. DESIGN This study involved 798 healthy infants and their mothers in Finland. We assessed 25(OH)D during pregnancy, from UCB at birth, and from the infant at the age of 12 months. MAIN OUTCOME MEASURES Infant length, weight, length-adjusted weight, and head circumference at 6 and 12 months and midupper-arm circumference at 12 months. RESULTS Of the mothers and infants, 96% and 99% were vitamin D sufficient [25(OH)D ≥50 nmol/L], respectively. Mothers with pregnancy 25(OH)D >125 nmol/L had the shortest, lightest (in weight), and thinnest (in length-adjusted weight) infants at 6 months (P for all < 0.05). For each 10 nmol/L higher UCB 25(OH)D, the infants were 0.03 SD score (SDS) shorter at 6 months (95% CI -0.05 to -0.01), adjusted for birth size, infant 25(OH)D, and parental height. Higher UCB 25(OH)D associated with smaller head circumference at 6 and 12 months (P for all <0.05) but attenuated after adjustments. Mothers with pregnancy 25(OH)D >125 nmol/L had the thinnest infants at 12 months (P = 0.021). For each 10 nmol/L higher infant 25(OH)D, the infants were 0.03 SDS lighter (-0.05 to -0.01) and 0.03 SDS thinner (-0.05 to 0.00) at 12 months. CONCLUSIONS Our results suggest that high pregnancy, cord blood, and infant vitamin D concentration may have disadvantageous effects on infant growth.
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[Which medications are safe while breastfeeding? : A synopsis for the anesthetist, obstetrician and pediatrician].
Fischer, A, Ortner, C, Hartmann, T, Jochberger, S, Klein, KU
Wiener medizinische Wochenschrift (1946). 2019;(3-4):45-55
Abstract
Pharmacokinetic data on drug administration during lactation are often inconsistent or missing. For legal reasons medicinal drug product information generally advises to interrupt breastfeeding for 24 h after medication intake. However this is not standard of care in clinical practice as the mother should be instructed to initiate breastfeeding as soon as possible after giving birth. At the same time the medication exposure over the breast milk for the newborn should be minimized. Aim of this article is to summarize pharmacokinetic data and to give important clinical information on medications frequently administered during the lactation period. As a general rule a mother can start breastfeeding following anesthesia as soon as she is able to get her baby latched on her breast.
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Maternal risk factors and newborn infant vitamin D status: a scoping literature review.
Sotunde, OF, Laliberte, A, Weiler, HA
Nutrition research (New York, N.Y.). 2019;:1-20
Abstract
Low vitamin D (VitD) status is common among newborn infants, more so in temperate latitudes with evidence that maternal VitD deficiency is a major risk factor given that the neonate relies solely on maternal-fetal transfer of VitD. This scoping review was conducted to provide an overview of the latest evidence from studies regarding the impact of maternal risk factors on infant 25-hydryoxyvitamin D [25(OH)D] concentrations with a focus on studies in Canada and the United States. Several maternal risk factors that contribute to low maternal-fetal 25(OH)D concentrations have been reported over many decades, but no clear pattern has been established for multiethnic populations. For example, darker skin pigmentation and ethnicity are common risk factors for low VitD status. Studies in predominantly white women showed that supplementation of VitD during pregnancy causes significant increases in maternal serum 25(OH)D which often improves cord serum 25(OH)D values. In addition, VitD recommendations by health care professionals and adherence to supplementation by pregnant women appear to positively influence maternal and infant 25(OH)D concentrations. Conversely, winter season, obesity, lower socioeconomic status including lifestyle factors (smoking), and use of medication pose risk for lower maternal-fetal transfer of VitD. However, there is still a dearth of pertinent data on the relationship between some of the maternal risk factors and newborn 25(OH)D concentrations, for instance, relationships between gestational diabetes and neonatal VitD status. Additional research is required to determine if the same target for 25(OH)D concentrations applies for pregnant women, neonates, and infants.
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Systematic Review of Expected Weight Changes After Birth for Full-Term, Breastfed Newborns.
DiTomasso, D, Cloud, M
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN. 2019;(6):593-603
Abstract
OBJECTIVE To summarize the findings of recent studies on neonatal weight changes that occur in the early weeks of life among full-term, breastfed newborns. DATA SOURCES Using the keywords breastfeeding, newborn, infant, weight, weight loss, and growth, we searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, and MEDLINE for primary studies and secondary analyses. We also reviewed the reference lists of retrieved articles. STUDY SELECTION Quantitative studies published in the English language from 2015 through 2019 that focused on newborn weight changes. From a total of 827 records initially screened, we included 11 studies in this analysis. DATA EXTRACTION Two authors independently reviewed the selected articles with the use of the Johns Hopkins Nursing Evidence-Based Practice Synthesis and Recommendations Tool. To determine evidence levels and quality ratings, we evaluated the consistency and generalizability of study results, sample sizes, study designs, adequacy of controls, and definitive nature of the conclusions. DATA SYNTHESIS By 2 days after birth, mean weight loss among neonates was 6% to 7% of birth weight, and by Day 3, mean weight loss was usually 7% to 8%. The nadir of lost birth weight occurred on Days 2, 3, or 4 after birth. At times, breastfed newborns lost 10% or more of their birth weight. By 10 to 14 days, most newborns regained their birth weight. Rates of exclusive breastfeeding decreased when newborns lost greater amounts of weight. Compared with past studies, more sample groups in this review included exclusively breastfed newborns and weight assessments beyond birth hospitalization. CONCLUSION Weight loss is commonly 7% to 8% of birth weight or greater by the third day after birth among healthy, full-term, breastfed newborns.
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Effects of infant formula composition on long-term metabolic health.
Lemaire, M, Le Huërou-Luron, I, Blat, S
Journal of developmental origins of health and disease. 2018;(6):573-589
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Abstract
Early nutrition may have long-lasting metabolic impacts in adulthood. Even though breast milk is the gold standard, most infants are at least partly formula-fed. Despite obvious improvements, infant formulas remain perfectible to reduce the gap between breastfed and formula-fed infants. Improvements such as reducing the protein content, modulating the lipid matrix and adding prebiotics, probiotics and synbiotics, are discussed regarding metabolic health. Numerous questions remain to be answered on how impacting the infant formula composition may modulate the host metabolism and exert long-term benefits. Interactions between early nutrition (composition of human milk and infant formula) and the gut microbiota profile, as well as mechanisms connecting gut microbiota to metabolic health, are highlighted. Gut microbiota stands as a key actor in the nutritional programming but additional well-designed longitudinal human studies are needed.
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Anthropometry and Body Composition of Preterm Neonates in the Light of Metabolic Programming.
Parlapani, E, Agakidis, C, Karagiozoglou-Lampoudi, T
Journal of the American College of Nutrition. 2018;(4):350-359
Abstract
The improved survival of preterm infants has led to increased interest regarding their health as adults. In the context of metabolic programming, the connection between perinatal and early postnatal nutrition and growth with health in later life has brought to the fore the role of catch-up growth during the first months of preterm infants' lives and its association with body fat and obesity in childhood or puberty. A state-of-the art review was conducted in order to assess the way catch-up is evaluated, in terms of timing and rate. Adequate growth is of major importance for neurodevelopment; however, it may compete with adiposity or metabolic health. Studies based on body composition assessment have given conflicting results as regards the effect of early versus late and rapid versus slow catch-up growth on later health, mainly attributed to the lack of established criteria and definitions. Given that adequate early nutrition is crucial for the neurodevelopment of preterm infants, further studies are needed on the role of catch-up growth in long-term outcome, using generally accepted qualitative and quantitative criteria.
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Near-infrared spectroscopy is a promising noninvasive technique for monitoring the effects of feeding regimens on the cerebral and splanchnic regions.
Grometto, A, Pizzo, B, Strozzi, MC, Gazzolo, F, Gazzolo, D
Acta paediatrica (Oslo, Norway : 1992). 2018;(2):234-239
Abstract
AIM: The effects of different milk and, or, administration regimens on cerebro-splanchnic perfusion are still a matter of debate. We investigated the effects of the bolus administration of breast milk or formula on cerebro-splanchnic oximetry, function and perfusion, assessed by near-infrared spectroscopy (NIRS). METHODS This observational study of 30 infants fed with breast (n = 15) or formula (n = 15) milk, and matched for gestational age and birth weight, was carried out in the neonatal intensive care unit of the C Arrigo Children's Hospital, Alessandria, Italy, a tertiary-level referral centre, from October 2015 to December 2016. NIRS monitoring parameters, such as cerebral and splanchnic oximetry, fraction of tissue oxygen extraction and the cerebral-splanchnic ratio, were recorded before, during and after feeding. RESULTS Breast milk led to a significant increase in cerebro-splanchnic oximetry and tissue oxygen extraction (p < 0.001) during and after feeding, and the cerebro-splanchnic perfusion ratio was significantly higher (p < 0.001) in the breast than formula group. CONCLUSION Our study results suggest that breast milk was better tolerated than formula, requiring lower energy expenditure and lower cerebro-splanchnic haemodynamic redistribution. The findings could prompt investigations using NIRS as a promising noninvasive tool for cerebral and splanchnic longitudinal monitoring during neonatal feeding.
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Maternal epigenetics and fetal and neonatal growth.
Kitsiou-Tzeli, S, Tzetis, M
Current opinion in endocrinology, diabetes, and obesity. 2017;(1):43-46
Abstract
PURPOSE OF REVIEW The article provides an update on new insights of factors altering inherited maternal epigenome that ultimately affect fetal and neonatal growth. RECENT FINDINGS A number of new publications have identified mechanisms through which maternal nutrition, environmental exposures such as stress and toxic substances altering expression of imprinted genes during pregnancy can influence fetal and neonatal phenotype and susceptibility to disease development later in life. The possible causes of metabolic syndrome by in-utero epigenetic alterations of genes involved in energy metabolism (PPARγ and PPARα), microRNAs, arginine methyltransferases, lysine demethylases, and histone deacetylaces have been elucidated. Moreover associations between methylation of key genes (NRC31, HSD11β1/2, GFI1) involved in the hypothalamic-pituitary-adrenal axis have been identified. Alcohol exposure during pregnancy was found to alter methylation patterns of several imprinted genes (H19, SLC22A18, SLC6A3, DRD4). Finally alterations in vulnerable epigenetic marks of imprinted genes such as H19/IGF2, during early stages of embryonic development result in intrauterine growth restriction. SUMMARY All these investigations continue to provide new insights for improved clinical management of in-utero development.
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Vitamin B12 status in pregnant women and their infants in South India.
Finkelstein, JL, Kurpad, AV, Thomas, T, Srinivasan, K, Duggan, C
European journal of clinical nutrition. 2017;(9):1046-1053
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Abstract
BACKGROUND/OBJECTIVES Vitamin B12 deficiency during pregnancy has been associated with increased risk of adverse perinatal outcomes. However, few studies have investigated the burden and determinants of vitamin B12 status in young infants. This study was conducted to determine the associations between maternal and infant vitamin B12 status. SUBJECTS/METHODS Pregnant women participating in a vitamin B12 supplementation trial in Bangalore, India, were randomized to receive vitamin B12 (50 μg) or placebo supplementation daily during pregnancy through 6 weeks postpartum. All women received 60 mg of iron and 500 μg of folic acid daily during pregnancy, as per standard of care. This prospective analysis was conducted to determine the associations between maternal vitamin B12 biomarkers (that is, plasma vitamin B12, methylmalonic acid (MMA) and tHcy) during each trimester with infant vitamin B12 status (n=77) at 6 weeks of age. RESULTS At baseline (⩽14 weeks of gestation), 51% of mothers were vitamin B12 deficient (vitamin B12<150 pmol/l) and 43% had impaired vitamin B12 status (vitamin B12<150 pmol/l and MMA>0.26 μmol/l); 44% of infants were vitamin B12 deficient at 6 weeks of age. After adjusting for vitamin B12 supplementation, higher vitamin B12 concentrations in each trimester were associated with increased infant vitamin B12 concentrations and lower risk of vitamin B12 deficiency in infants (P<0.05). After adjusting for vitamin B12 supplementation, infants born to women with vitamin B12 deficiency had a twofold greater risk of vitamin B12 deficiency (P<0.01). Higher maternal folate concentrations also predicted lower risk of vitamin B12 deficiency in infants (P<0.05). Impaired maternal vitamin B12 status, which combined both circulating and functional biomarkers, was the single best predictor of infant vitamin B12 status. CONCLUSIONS Impaired maternal vitamin B12 status throughout pregnancy predicted higher risk of vitamin B12 deficiency in infants, after adjusting for vitamin B12 supplementation. Future interventions are needed to improve vitamin B12 status periconceptionally, and to ensure optimal vitamin B12 status and health outcomes in pregnant women and their children.
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Imprinting, latchment and displacement: a mini review of early instinctual behaviour in newborn infants influencing breastfeeding success.
Mobbs, EJ, Mobbs, GA, Mobbs, AE
Acta paediatrica (Oslo, Norway : 1992). 2016;(1):24-30
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Abstract
UNLABELLED Instinctive behaviours have evolved favouring the mother-infant dyad based on fundamental processes of neurological development, including oral tactile imprinting and latchment. Latchment is the first stage of emotional development based on the successful achievement of biological imprinting. The mechanisms underpinning imprinting are identified and the evolutionary benefits discussed. CONCLUSION It is proposed that the oral tactile imprint to the breast is a keystone for optimal latchment and breastfeeding, promoting evolutionary success.