Iron-deficiency anemia is common during pregnancy and can lead to serious health consequences for mothers and babies. Antenatal iron supplementation has been associated with lower anemia prevalence and improved pregnancy outcomes and is recommended by WHO to all pregnant women via daily oral iron (30-60 mg) and folic acid (0.4 mg) supplements. Nevertheless, data on uptake and adherence to iron supplementation among pregnant women in many countries tends to be outdated and fragmented, with few studies having comprehensively summarized barriers and facilitators to supplementation. We conducted a secondary analysis of demographic and health surveys from 69 low- and middle-income countries, to determine uptake and adherence to iron-containing supplements among pregnant women and explore associations between socio-demographic characteristics and antenatal care and supplements consumption. Results show that 86% of all respondents reported receiving iron supplements during pregnancy, and that, among those receiving the supplements, 46.1% reported consuming 90 or more supplements, while 23.3% reported 120 or more, and 7.1% 180 or more. Higher education, wealth, and access to media were strongly associated with higher odds of initiating iron supplementation (OR: 1.32; 95%CI: 1.25-1.38; OR: 1.29; 95%CI: 1.20-1.38; OR: 1.15; 95%CI: 1.05-1.26 respectively) and adhering to the regimen (OR: 1.16; 95%CI: 1.12-1.21; OR: 1.21; 95%CI: 1.13-1.30; OR: 1.14; 95%CI: 1.08-1.20 respectively). Finally, attending antenatal care, and especially attending earlier during the pregnancy, was associated with higher odds of consuming the supplements. Country-specific antenatal care guidelines are needed to provide clear guidance on the timing and frequency of antenatal care attendance and supplementation.

Providing physiologic support to a brain-dead pregnant decedent poses complex ethical, legal, and clinical challenges. Understanding these considerations is necessary to navigate complex discussion and provide appropriate medical care. We use a theoretical case to examine these considerations and outline a path forward.

Gestational weight gain (GWG) can be defined as the total weight gained throughout pregnancy and is required for healthy fetal growth; however, gaining excessive weight during pregnancy has been linked with several adverse effects. This review aims to consider the evidence on weight management during pregnancy, with a focus on the key challenges surrounding GWG and the practical considerations related to assessing weight changes. It is estimated that nearly 50% of women gain excessive weight during pregnancy; nevertheless, this can be difficult to quantify due to the lack of global consensus on recommended GWG guidelines. Currently, there are no GWG guidelines in the UK and Ireland, as reiterated in the recent National Institute for Health and Care Excellence guidelines, due to the lack of evidence about what the optimal total weight change in pregnancy should be. This is further complicated by the conflicting results of interventions aimed at preventing excessive GWG and their resultant inconsistent effects on adverse pregnancy outcomes. Accurate calculation of GWG requires measurement of pre-pregnancy weight and weight prior to the onset of labour. However, several practical considerations are associated with obtaining these weights, as in practice, estimated or self-recalled weights are often used as an alternate, thereby introducing variability into the measurement of GWG and the potential for inaccuracies in analysis. These limitations highlight the need for a more uniform approach in assessing GWG. The WHO is in the process of developing global GWG standards, and this could potentially establish a uniform gold standard for assessing GWG and reintroduce routine weighing.

Fasting during pregnancy is a widespread practice in Muslim communities, yet its health implications remain poorly understood. A lack of conceptual frameworks and limited understanding of the characteristics of women who fast during pregnancy have hindered research in this area. This study examines the differences in several nutritional biomarkers between women who fasted and those who did not and identifies factors associated with fasting behaviour. We analysed data from the Kuwait Birth Cohort in which information on fasting, sociodemographic characteristics and health behaviours was collected via structured interviews between 2017 and 2021. Clinical and laboratory data were extracted from medical records. Predictors of fasting were identified using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 5-fold cross-validation, followed by Poisson regression with robust standard errors. Among 1087 women with available data, 581 (53·4 %; 95 % CI 50·4 %, 56·4 %) reported fasting during pregnancy (19·5 % in the first trimester, 25·1 % in the second and 10·1 % in the third). Women who fasted had significantly lower levels of ferritin (P = 0·048), vitamin B12 (P = 0·001), erythrocytes folate (P < 0·001), 25-hydroxyvitamin D (P = 0·002) and vitamin D binding protein (P = 0·011), but higher parathyroid hormone (P = 0·011). Predictive models based on sociodemographic and clinical factors showed limited predictive ability. This study indicates that fasting during pregnancy is a common practice among women in Kuwait and is associated with lower levels of key nutrients such as vitamin D, RBC folate and vitamin B12. Fasting during pregnancy appears to be driven more by personal, religious and cultural influences than by identifiable clinical or sociodemographic characteristics.

This study examined the impact of maternal undernutrition during gestation and/or lactation on neonatal immune indices. From day 10 of gestation to term, pregnant rats received either ad libitum (AdLib) feeding or 50% food restriction (FR). After birth, pups were either nursed by their own dams or cross-fostered, resulting in three groups (n = 6 per group): a control group with AdLib feeding throughout (AdLib/AdLib), a group with FR only during gestation (FR/AdLib), and a group with FR during both gestation and lactation (FR/FR). At day of life 1 and at three weeks of age, spleen and thymus weights, as well as basal and lipopolysaccharide (LPS)-stimulated TNF levels and white blood cell indices, were measured in male offspring. At day of life 1, immunological indices were similar among groups. By three weeks, monocyte percentage was significantly decreased in FR/FR compared with AdLib/AdLib (1.6 ± 0.5% vs. 3.1 ± 0.4%). Relative spleen weight (adjusted for body weight) was also significantly lower in FR/FR compared with both AdLib/AdLib and FR/AdLib. Following LPS administration, TNF-α levels were reduced in FR/FR compared with FR/AdLib and AdLib/AdLib (206 ± 28 vs. 511 ± 91 and 484 ± 59 pg/ml, respectively; P < 0.05). Moreover, in FR/FR offspring, monocyte (5.4 ± 1.1% vs. 2.0 ± 0.6% and 2.0 ± 0.7%) and neutrophil (50.6 ± 5.5% vs. 17.2 ± 2.4% and 20.0 ± 4.2%) percentages were significantly increased, while lymphocyte percentage (43.2 ± 5.9% vs. 80.0 ± 2.4% and 77.2 ± 4.4%) was decreased compared with FR/AdLib and AdLib/AdLib. These findings suggest that undernutrition during both prenatal and postnatal periods can attenuate neonatal immunity by decreasing basal monocyte counts and impairing cytokine responses.

The planetary health diet (PHD) is a mostly plant-based diet that aims to optimise human health while minimising the environmental impact of food production. Limited data exist on whether the PHD fulfils key nutritional requirements during pregnancy. This research aimed to examine the PHD in early pregnancy and how it aligns with daily nutrient intake and European Food Safety Authority (EFSA) dietary guidelines. Pregnant women (n 678) from two Irish cohorts (ROLO and MicrobeMom) were analysed, and PHD index (PHDI) scores were assigned based on data from 3-d food diaries. Women were dichotomised by the median score to create a ‘High PHDI’ (> 88·99) and a ‘Low PHDI’ group (≤ 88·99). Differences in nutrient intakes and adherence to dietary guidelines between ‘High’ and ‘Low’ PHDI groups were explored. Compared with those with a ‘Low’ score, those with a ‘High’ PHDI score reported higher intakes of dietary fibre (g/d) (17·32 (13·39, 21·08) v. 21·74 (18·28, 25·88), P < 0·001), Fe (mg/d) (10·48 (8·48, 12·82) v. 12·06 (9·48, 14·60), P < 0·001), folate (µg dietary folate equivalent per d) (250·73 (193·88, 312·45) v. 279·57 (219·43, 356·81), P < 0·001) and Ca (mg/d) (837·75 (695·36, 1056·72) v. 956·57 (751·84, 1155·03), P < 0·001). A greater proportion of women in the ‘High PHDI’ group met EFSA recommendations for dietary fibre intake (10·3 % v. 28·9 %, P < 0·001). The PHD may support maternal nutritional adequacy in pregnancy while promoting environmental sustainability. Our findings provide valuable insights that can inform future dietary recommendations for pregnancy, contributing to both maternal health and planetary well-being.

Iodine is a component of thyroid hormones and essential for neurological development. To evaluate the iodine nutritional status of pregnant women residing in Veneto and the possible role of thyroglobulin (Tg) as a proxy. 528 pregnant women in the third trimester of pregnancy were consecutively enrolled in this cross-sectional study and were asked to provide an early-morning spot urine sample (for UI/Creat) and a blood sample (for thyroid function and Tg). They also completed a questionnaire. Infant anthropometric data at birth were obtained. Median UI/Creat was 112·8 μg/g. 34·1 % of women had a UI/Creat ≥ 150 μg/g. Iodised salt (IS) was used by 76·9 % of women, iodine-containing supplements (ICS) by 74·2 % and cow’s milk was regularly consumed by 46·0 %. At multivariable analysis, consumption of regular cow’s milk and ICS were significant predictors of UI/Creat ≥ 150 μg/g (OR 1·57, 95 % CI: 1·06, 2·32 and OR: 2·83, 95 % CI: 1·66, 4·82, respectively). The median Tg value was lower among the iodine-sufficient than among the iodine-deficient women (P = 0·005). At multiple linear regression analysis, Tg was among the factors associated with weight (β = –81·83, P < 0·001) and length (β = –0·3, P < 0·01) at birth, although weakly. Tg was a factor associated with pre-term delivery (OR: 1·52, 95 % CI: 1·20, 1·92). Regular use of cow’s milk and ICS is a factor associated with UI/Creat ≥ 150 μg/g. Tg was associated with iodine status and pregnancy outcomes, although it had only a modest discriminative ability for sufficiency.

Micro- and nanoplastics (MNPs) pollution has become a global environmental concern due to its widespread presence and diverse sources. These tiny plastic particles, originating from industrial processes, plastic waste degradation, and consumer products, have infiltrated various ecosystems, food chains, and even human tissues. Recent studies indicate that MNPs are not only pervasive in air, water, and soil but also accumulate in the human body through ingestion, inhalation, and dermal exposure. However, the implications of MNPs exposure, particularly during pregnancy, remain poorly understood. Of critical concern is the potential transfer of MNPs and their associated chemical additives across the placental barrier, posing risks to fetal development. In this review, we comprehensively analyze mainstream technologies used for detecting and characterizing MNPs, including spectroscopy- and microscopy-based approaches, as well as emerging detection methods. We also examine recent findings on the toxicity of MNP-associated chemicals, such as endocrine-disrupting compounds and heavy metals, which may have long-term effects on human health. Particular emphasis is placed on how maternal exposure to MNPs could impact offspring development, potentially leading to neurodevelopmental disorders, metabolic disturbances, and immune system dysregulation. Despite growing concerns, research gaps persist regarding the precise mechanisms through which MNPs influence maternal and fetal health. The findings recommend for further multidisciplinary research to assess the long-term consequences of prenatal MNPs exposure. Addressing these uncertainties is crucial for informing public health policies, mitigating risks, and ensuring the well-being of pregnant women and future generations.

Maternal depressive symptoms during pregnancy have consequences for offspring brain development, likely mediated via biological signals. However, gestational biological correlates of maternal depression may differ depending on childhood maltreatment (CM) history. We investigated the association of maternal depressive symptoms in pregnancy and CM history with newborn global white matter microstructure. In a sample of N = 90 mother–infant dyads from two cohorts, maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale. CM was assessed with the Childhood Trauma Questionnaire or the Adverse Childhood Experiences scale. Diffusion-weighted imaging was performed in the infants within 90 days of birth. Fiber profiles of fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were determined, and a global mean for each metric was computed. In adjusted models, there was a significant interaction effect of maternal depression and CM on newborn global FA (β = −0.523, p = .029) and RD (β = 0.590, p = .014) but not AD (β = 0.367, p = .120). In infants of women with CM history, maternal depressive symptoms were correlated negatively with FA and positively with RD. In contrast, infants of women without CM exhibited the reverse pattern of associations between depressive symptoms and diffusion metrics. These findings suggest that the impact of prenatal exposures, such as maternal depressive symptoms, on offspring brain development may be conditional on the presence or absence of maltreatment history. These findings highlight the importance of assessing trauma history and monitoring psychosocial well-being during pregnancy.