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Addressing the gaps in nutritional care before and during pregnancy
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- Sarah Louise Killeen, Aisling A. Geraghty, Eileen C. O'Brien, Sharleen L. O'Reilly, Cara A. Yelverton, Fionnuala M. McAuliffe
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- Journal:
- Proceedings of the Nutrition Society / Volume 81 / Issue 1 / March 2022
- Published online by Cambridge University Press:
- 27 October 2021, pp. 87-98
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The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the ‘patient voice’. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.
A protocol for the development of a Core Outcome Set for PREgnancy Nutrition (PRENCOS)
- Sarah Louise Killeen, Eilleen C. O'Brien, Aisling A. Geraghty, Fionnuala M. McAuliffe
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E539
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Introduction:
Maternal nutrition during pregnancy is a modifiable risk factor for health. Heterogeneity in outcome reporting in studies evaluating nutrition in pregnancy limits their comparability and is a barrier for high quality evidence synthesis. A core outcome set (COS) is set of outcomes, which are agreed by consensus, to be a minimum standard to report within an area of research. The CoRe Outcomes in Women's and Newborn health (CROWN) initiative is an international initiative which supports the development of COSs for Women and Newborn health research. To date, there is no COS which specifically addresses the issues with outcome reporting in research on nutrition in pregnancy. Therefore, we present a study protocol for the development of a COS for maternal nutrition research in pregnancy.
Methods:The COS is registered with the Core Outcomes for Measurement of Effectiveness Trials (COMET) registry. A systematic review will be conducted following PRISMA guidelines to identify studies evaluating maternal nutrition during pregnancy. Outcomes will be extracted from eligible studies and cataloged using the taxonomy of the COMET initiative. We will make efforts to supplement our findings with outcomes from other sources, including qualitative interviews with mothers. Secondly, a modified Delphi survey will be conducted with international stakeholders including healthcare professionals, researchers and mothers. Participants will be presented with the list of outcomes from step one and invited to rank the importance of including each outcome in the final COS using a 9-point Likert scale. We will complete descriptive statistics and in a second round of the survey, participants will receive feedback on their individual scores from round one, along with the average score each stakeholder group provided for each outcome. Based on this, participants will have the opportunity to change their scoring and will be encouraged to give a rationale for their final choice. Lastly, a face-face consensus meeting will be held with representatives from all stakeholder groups to finalise the COS.
Results:We will identify the outcomes reported in maternal nutrition research. We will also determine the outcomes which are important to pregnant women and if these are missing from the literature. A final COS for nutrition research in pregnancy will be developed.
Discussion:This COS will support the harmonisation of outcome selection and reporting in maternal nutrition research which is necessary for high quality evidence synthesis to support clinical practice and the nutritional care of pregnant women.
The importance of well-being and education for the initiation and duration of breastfeeding in Ireland; Findings from the ROLO study
- Cara Yelverton, Aisling Geraghty, Eileen O'Brien, Sarah Louise Killeen, Fionnuala McAulliffe
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E540
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Introduction:
Breastfeeding is well-established as optimal for both mother and baby, with a number of benefits including a quicker return to pre-pregnancy weight for the mother and the reduced risk of non-communicable diseases, including obesity, for the infant. The current global recommendation is to breastfeed exclusively for 6 months postpartum, yet in Ireland initiation and duration of breastfeeding is extremely low. Low education level is considered a barrier to breastfeeding, however, there is currently a paucity of research on the influence of maternal well-being on breastfeeding habits in Ireland.
Aim:To explore the relationship between education levels and well-being in early pregnancy on breastfeeding habits in Irish women.
Methods:This was a secondary analysis of the randomised control trial, the ROLO study in the National Maternity Hospital, Dublin, Ireland. 610 healthy, pregnant women on their 2nd pregnancy were included. Well-being was measured using the WHO-5 item well-being index at the end of the 1st trimester. Education level and breastfeeding initiation information were both obtained from hospital records. Women were stratified into two groups of education level; those that had achieved 3rd level education (n = 341), and those with less than 3rd level (n = 269). Within these two groups, the relationship between well-being scores and breastfeeding habits was explored using Pearson correlations, chi-square tests, and multiple regression modelling for confounders.
Results:In Women with high education, those with high well-being (n = 269) were significantly more likely to initiate breastfeeding than those low well-being (n = 72; 69.5% vs 56.9%, p < 0.05). This association remained after controlling for maternal age, BMI, and intervention group (B = 0.57, p < 0.05). Well-being was not associated with breastfeeding duration in women with 3rd level education (26.63 weeks vs 25.64 weeks, p = 0.87). In women with low education levels, there was no association of well-being and breastfeeding initiation (37.4% vs 35.9%, p = 0.84) or well-being and breastfeeding duration (6.75 weeks vs 5.70 weeks, p = 0.65).
Discussion:While education level is a strong indication of women's likelihood to breastfeed, it is important to recognise other influencing factors. Among highly educated women well-being was also important as a determinant of initiating breastfeeding. This is important for healthcare professionals working in maternity care in Ireland and highlights the potential of improving well-being and there-by increasing Irish breastfeeding rates.
A systematic review of probiotic use to improve metabolic health in women
- David F. Byrne, Aisling A. Geraghty, Sarah Louise Killeen, Fionnuala M. McAuliffe
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E656
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Introduction
There is a substantial body of literature on the use of probiotics in humans. Mostly, this literature examines the use of specific probiotics for treating various acute and chronic health conditions and diseases, (gastrointestinal conditions, respiratory illnesses, metabolic disorders, and atopic diseases) in both adults and children. The sex of the populations in these studies tends to be mixed, while studies that focus on female participants are largely restricted to pregnant populations. It is well established that pre-pregnancy is an important time-point over the life-course, where improvements to the health of the woman may also benefit potential future pregnancies. Furthermore, the route of delivering the probiotic intervention may differ across studies. These modes of delivery include capsules, powdered sachets, yoghurt foods, and fermented milk drinks. There is uncertainty as to the confounding effect of this variability. The objective of this review is to identify the evidence for the effects of probiotic interventions, administered as capsules, on metabolic and immune markers in healthy women of reproductive age.
Materials and MethodsThe data sources selected were PubMed, MEDLINE, EMBASE, CINAHL, and Web of Science. A grey literature search using controlled vocabulary was performed. PRISMA guidelines were followed, and the Cochrane risk of bias tool was used. Publications were considered for inclusion if they were in English and reported the results of a randomised-controlled trial.
ResultsFour papers were identified with review relevant outcomes. The reported findings from the included studies did not provide conclusive evidence for the effect of probiotic capsule supplementation in healthy, non-pregnant women.
DiscussionSources of variability are multifaceted in this area. Functional differences occur at the strain level, lowering the specificity of the effects of various bacterial strains across different studies. These factors may reduce the external validity of results across such studies. It is imperative that an evidence base be established in this cohort. This can be achieved with prospectively registered, randomised-controlled trials of sufficient sample size and statistical power.