Public and patient involvement (PPI) describes how researchers collaborate and engage with the public in order to make research more relevant to them. The ROLO Family Advisory Committee is a self-selected group of parents who are involved in the longitudinal follow-up of the ROLO Study. It was established in 2017 and the goal is to achieve a partnership between ROLO families and researchers, leading to improved research quality, relevance and outcomes. The aim of engaging with parents from the ROLO study is to understand key outcomes of importance for parents relating to their own health and their children's health and to gain insights into how the research agenda can be more relevant to parent and child needs.

All parents involved with ROLO study were invited to join the ROLO Family Advisory Committee in 2017. Parents who had expressed interest in joining the committee were invited to attend annual ROLO Families Advisory Committee Meetings in 2018 and 2019. Parents were asked to discuss their opinions about current research projects and potential future projects. This was followed by an open discussion about relevant health questions. These meetings were either transcribed on the day or recorded with audio recordings transcribed verbatim and broad themes identified.

Mothers had greater concern for outcomes relating to their children than themselves. Parents were very interested in understanding the relationship between diet in pregnancy and child health and welcomed research regarding blood tests that could be predictors of future health. Parents had great concern for the effect social media has on child mental health and also wanted more studies conducted in the areas of fussy eating and how to ensure children consume a wide range of healthy foods. It was consistently highlighted that children and teenagers should understand healthy eating principles and ways to promote their physical and mental health.

Through the two focus groups, valuable insights were gained regarding what research parents consider relevant and future research questions. The ROLO agenda has certainly been enriched by PPI. We are seeking opportunities to enable research to be carried out in the areas discussed at the meetings.

339 mother and child pairs were followed up from the ROLO Kids study in the National Maternity Hospital, Dublin, Ireland. Height and weight of the mother and the child were measured, and BMI was calculated. Demographic details were collected and questionnaires asked mothers to assign their child to a weight category and to give the reason they put their child in this particular category. KAPPA analysis and student t tests were used to analyse the data.

In this cohort over 75% of the children were normal weight, 14.7% were in the overweight category, and 8.5% in the obese category. The KAPPA score for maternal-perceived category and actual weight status was 0.037 which is a low level of agreement. Mothers were more likely to underestimate their child's weight, with 28.5% underestimating the appropriate weight category for their child compared with 2.4% who overestimated. Maternal age, education, and child sex did not influence accurate weight assessments; however, mothers with a higher BMI were more likely to inaccurately assess their child's weight (P < 0.05).

Maternal perception of their child's weight status is not an accurate indication of child weight, particularly for mothers with a raised BMI. This research highlights the important role of health care providers in assessing child weight status, rather than relying on parental reports alone, in order to appropriately intervene to reduce the incidence of childhood obesity.

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.

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.

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.

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.

Breastfeeding can improve health outcomes for mothers and babies and is an important factor in the reduction of obesity. However, breastfeeding rates in Ireland are amongst the lowest internationally, with rates of 59.9% in 2016.

The objective of this study was to assess intention to breastfeed at booking, feeding status at hospital discharge, one and three months postnatal and influencing factors.

Secondary data from 124 healthy pregnant women participating in an RCT in the National Maternity Hospital who recorded their intention to breastfeed at booking were included. Observational data including demographic and lifestyle data was collected from participants.

Of the 124 women, 80.7% were Irish, 86.2% had achieved third level education, and 43.5% (n = 54) were multiparous. Mean age was 32.7years and mean BMI 24.9kg/m2. 91.1% (n = 113) reported intending to breastfeed at booking. Upon hospital discharge, 91% of those intending to breastfeed had initiated breastfeeding (n = 101/111). 78.6% (n = 77/98) and 66.7% (n = 58/87) of those who had intended to breastfeed remained breastfeeding at one and three months postnatal respectively. Intention to breastfeed in early pregnancy was significantly higher amongst women with third level education (p < 0.001). Intention to breastfeed did not differ significantly with maternal age, ethnicity, BMI, or parity, however, women who had breastfed previously were more likely to intend to breastfeed for future infants (p < 0.001). Women with higher education were more likely to breastfeed at discharge, one and three months postnatal (p < 0.05). Although maternal BMI was not associated with intention to breastfeed, women who did not initiate breastfeeding at hospital discharge had a significantly higher BMI (M = 27.22kg/m2, SD = 4.53, p = 0.018) compared to women who initiated breastfeeding (M = 24.68kg/m2, SD = 3.05). Similarly, of those intending to breastfeed, women who were not breastfeeding at three months postnatal had a significantly higher BMI (M = 26.33kg/m2, SD = 3.99, p = 0.01) than those continuing breastfeeding (M = 24.08kg/m2, SD = 2.61). There were no significant differences regarding feeding status with maternal ethnicity, age, or parity at discharge and one month postnatal (p > 0.05). However, primiparous women intending to breastfeed were significantly more likely to continue breastfeeding at three months compared to multiparous women (p < 0.05).

Many factors are shown to influence breastfeeding intention and duration including parity, education and BMI. It is important to identify these potentially inhibiting factors during pregnancy to develop support measures to encourage initiation and continuation of breastfeeding.

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.

To explore the relationship between education levels and well-being in early pregnancy on breastfeeding habits in Irish women.

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.

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).

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.

The foetal programming hypothesis posits that optimising early life factors e.g. maternal diets can help avert the burden of adverse childhood outcomes e.g. childhood obesity. To improve applicability to public health messaging, we investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity in a large consortium.

We harmonized and pooled individual participant data from up to 8,769 mother-child pairs in 7 European mother-offspring cohorts. Maternal early-, late-, and whole-pregnancy dietary quality and inflammatory potential were assessed with Dietary Approaches to Stop Hypertension (DASH) and energy-adjusted Dietary Inflammatory Index (E-DII), respectively. Primary outcome was childhood overweight and obesity (OWOB), defined as age- and sex-specific body-mass-index-z score (BMIz) > 85th percentile based on WHO growth standard. Secondary outcomes were sum-of-skinfold-thickness (SST), fat-mass-index (FMI) and fat-free-mass-index (FFMI) in available cohorts. Outcomes were assessed in early- [mean (SD) age: 2.8 (0.3) y], mid- [6.2 (0.6) y], and late-childhood [10.6 (1.2) y]. We used multivariable regression analyses to assess the associations of maternal E-DII and DASH with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Analyses were adjusted for maternal age, pre-pregnancy BMI, parity, lifestyle factors, energy intake, educational attainment, offspring age and sex.

A more pro-inflammatory maternal diet, indicated by higher E-DII, was associated with a higher risk of offspring late-childhood OWOB [pooled-OR (95% CI) comparing highest vs. lowest E-DII quartiles: 1.22 (1.01,1.47) for whole-pregnancy and 1.38 (1.05,1.83) for early-pregnancy; both P < 0.05]. Moreover, higher late-pregnancy E-DII was associated with higher mid-childhood FMI [pooled-β (95% CI): 0.11 (0.003,0.22) kg/m2; P < 0.05]; trending association was observed for whole-pregnancy E-DII [0.12 (-0.01,0.25) kg/m2; P = 0.07]. A higher maternal dietary quality, indicated by higher DASH score, showed a trending inverse association with late-childhood OWOB (pooled-OR (95% CI) comparing highest vs. lowest DASH quartiles: 0.58 (0.32,1.02; P = 0.06). Higher early-pregnancy DASH was associated with lower late-childhood SST [pooled-β (95% CI): -1.9 (-3.6,-0.1) cm; P < 0.05] and tended to be associated with lower late-childhood FMI [-0.34 (-0.71,0.04) kg/m2; P = 0.08]. Higher whole-pregnancy DASH tended to associate with lower early-childhood SST [-0.33 (-0.72,0.06) cm; P = 0.10]. Results were similar when modelling DASH and E-DII continuously.

Analysis of pooled data suggests that pro-inflammatory, low-quality maternal antenatal diets may influence offspring body composition and obesity risk, especially during mid- or late-childhood. Due to variation of data availability at each timepoint, our results should be interpreted with caution. Because most associations were observed at mid-childhood or later, future studies will benefit from a longer follow-up.

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.

The 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.

Four 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.

Sources 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.

The early fetal environment during pregnancy is extremely important and research indicates that weight at birth can have crucial impacts for the individual's health later in life. With rates of childhood obesity estimated to be as high as 21% in some European countries, it is vital that early risk factors are identified so that interventions can be developed. We aimed to investigate if children born macrosomic (birth weight > 4kg) remained larger than normal birth weight babies up to 5 years of age.

This is a longitudinal follow-up of 387 five-year-old children (53% born with macrosomia, 47% normal birth weight) born into the ROLO randomised control trial in the National Maternity Hospital, Dublin (ISRCTN54392969). Birth weight was previously recorded then at 6 months, 2 years, and 5 years of age child height, weight, anthropometric and skinfold measurements were collected. Body Mass Index (kg/m2) and centiles were calculated. Student t-tests and Mann-Whitney U tests were used to compare the two groups with multiple linear regression modelling to control for confounders.

Children with a birth weight > 4 kg had consistently higher weights, lengths, and BMI centiles, along with increased head and chest circumferences, compared to normal birth weight children from 6 months up to 5 years of age (p < 0.05). After controlling for child sex, intervention group, smoking during pregnancy, maternal education status, and maternal BMI, children with macrosomia were 0.61 kg heavier than non-macrosomic infants at 5 years of age (95% CI: 0.04–1.18, p < 0.05).

Children born with a high birth weight remain heavier and larger into childhood. These individuals are at a higher risk of obesity which highlights the need for monitoring and potential interventions, both during pregnancy and in infancy, to curb the current childhood obesity crisis.

To determine if response to a low glycaemic index (GI) dietary intervention, measured by changes in dietary intake and gestational weight gain, differed across women of varying socio-economic status (SES).

Secondary data analysis of the ROLO randomised control trial. The intervention consisted of a two-hour low-GI dietary education session in early pregnancy. Change in GI was measured using 3 d food diaries pre- and post-intervention. Gestational weight gain was categorised as per the 2009 Institute of Medicine guidelines. SES was measured using education and neighbourhood deprivation.

The National Maternity Hospital, Dublin, Ireland.

Women (n 625) recruited to the ROLO randomised control trial.

The intervention significantly reduced GI and excess gestational weight gain (EGWG) among women with third level education residing in both disadvantaged (GI, mean (sd), intervention v. control: −3·30 (5·15) v. −0·32 (4·22), P=0·024; EGWG, n (%), intervention v. control: 7 (33·6) v. 22 (67·9); P=0·022) and advantaged areas (GI: −1·13 (3·88) v. 0·06 (3·75), P=0·020; EGWG: 41 (34·1) v. 58 (52·6); P=0·006). Neither GI nor gestational weight gain differed between the intervention and control group among women with less than third level education, regardless of neighbourhood deprivation.

A single dietary education session was not effective in reducing GI or gestational weight gain among less educated women. Multifaceted, appropriate and practical approaches are required in pregnancy interventions to improve pregnancy outcomes for less educated women.