Which mothers take folic acid and folate containing foods?

This study documented the prevalence (proportion) of mothers taking folic as supplements or as fortified foods and explored the factors that determined whether folic acid was taken. A cross sectional analysis of the baseline data of mothers who participated in the Perth Infant Feeding Study was performed. A total of 587 mothers who delivered at the two hospitals in the study completed baseline questionnaires. The factors associated with the decision to take folic acid supplements or fortified foods were investigated using multivariate logistic regression. Main outcome measures were the percentage of mothers taking folic acid or folic acid fortified foods. A total of 455 (78%) mothers stated that they took folic acid supplements before or during the first three months of their pregnancy. Of the 132 who did not take folate supplements only 35 (6% of all participating mothers) claimed to have taken folate fortified food or beverages. In the highest income group, 87% of mothers took folic acid supplements compared to 64% in the poorest group. The significant factors independently associated with not taking folic acid supplements or fortified food were " years of education " (OR ' 10 years or less' 0.45 (0.23-0.88)), " family income " (OR < $ 25000 0.40(0.20-0.80)), and for taking folic acid "the timing of the pregnancy. "(OR'actively trying'2.01 (0.1.04-0.3.87)). There was a significant proportion of mothers who did not take folic acid periconceptually. The mothers who were not taking folic were less educated, from lower socio-economic groups and were not actively trying to fall pregnant at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory fortification of foods with folic acid should be required.     

Residential mobility in the UK during pregnancy and infancy: Are pregnant women,new mothers and infants ‘unhealthy migrants’?

People that move home within developed countries report, on average, better health than non-movers. Pregnant women, new mothers and infants are particularly mobile, but the limited evidence regarding the relationship between their mobility and health suggests they may not conform to the ‘healthy migrant’ effect. This paper examines the relationship between mobility and health among these groups in the UK, using logistic regression to analyse cross-sectional data for 18,197 families in the Millennium Cohort Study wave one. It compares health status variables among mobile and non-mobile families; describes mobile families’ socio-demographic characteristics; explores associations between health outcomes, reasons for residential moves, and experiences of homelessness; and assesses the association between mobility and health care utilisation, social support and residential satisfaction.     

Does vitamin D during pregnancy impact offspring growth and bone?

During pregnancy, maternal and fetal Ca demands are met through increased intestinal Ca absorption. Increased Ca absorption may be more dependent on oestrogen's up-regulation of Ca transport genes than on vitamin D status. Numerous studies, however, have found that severe vitamin D deficiency with secondary hyperparathyroidism during pregnancy leads to abnormal Ca homoeostasis in the neonate. Some, but not all, studies of maternal vitamin D supplementation during pregnancy find a greater birth weight among infants of mothers with adequate vitamin D status. Observational studies find a higher incidence of small-for-gestational age (SGA) infants among mothers who are vitamin D deficient, but this effect may be modified by genetics. In addition, the effect of vitamin D status on SGA may not be linear, with increased occurrence of SGA at high maternal 25-hydroxyvitamin D (25-OHD) concentrations. Some studies, but not all, also have found that maternal vitamin D status is associated with growth trajectory during the first year of life, although the findings are contradictory. There are recent studies that suggest maternal 25-OHD, or surrogates of vitamin D status, are associated with growth and bone mass later in childhood. These results are not consistent, and blinded randomised trials of vitamin D supplementation during pregnancy with long-term follow-up are needed to determine the benefits, and possible risks, of maternal vitamin D status on offspring growth and bone development. The possibility of adverse outcomes with higher maternal 25-OHD concentrations should be considered and investigated in all ongoing and future studies.     

Is praziquantel therapy safe during pregnancy?

Schistosomiasis control programmes are generally based on mass distribution of praziquantel (PZQ). This approach has been further strengthened by studies that demonstrated reduction in schistosomiasis-related morbidity following regular use of PZQ. Many women were excluded from this therapy when pregnant. Since a high degree of parity is achieved in many schistosomiasis-endemic regions, excluded women often miss treatment and consequently the beneficial effect of this therapy. This study investigated the effect of PZQ therapy on pregnancy in the Gezira region of Sudan. As part of the Blue Nile Health Project, more than 320 000 individuals received annual treatment with PZQ from 1980 to1990. The present study reviewed the treatment records of all women between 1990 and 1995 in four villages. Eighty-eight of 637 women interviewed had received PZQ during their pregnancy. The outcome and the effect of PZQ therapy on their offspring were compared with a group of 549 women who had not received the drug during pregnancy. There were no significant differences between the two groups in the rate of abortion or preterm deliveries. No congenital abnormalities were noted by clinical examination in any of the babies born to either group. This retrospective study suggested that PZQ therapy is safe during pregnancy.     

Are fewer women smoking during pregnancy?

OBJECTIVE: To determine whether pregnancy-smoking rates have changed in last decade. METHODS: Retrospective cohort study of 67,395 pregnancies in Kansas City over 2 epochs, 1993-1997 and 1998-2002, using computer files of birth certificates. RESULTS: Overall pregnancy-smoking rates decreased from 18.1% (95% CI=17.7-18.5%) to 14.2% (13.8-14.5%). Among smokers, there was a distribution shift toward light smoking; light [39% (38.9-40.3%) vs 49% (47.6-50.4%)], moderate [36.8% (34.8%-38.8%) vs 34.4% (32.1-36.7%)], and heavy [23.1% (21.9-26.3%) vs 16.6% (14-19.1%)]. CONCLUSIONS: The results suggest decreasing heavier smoking. However, the trend toward light smoking suggests decreasing self-reporting. These findings highlight the dilemma in using self-reports for public health policy and emphasize the importance of antismoking socialization for all pregnancies.     

Mental and social health during and after acute emergencies: emerging consensus?

Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. This affirmation of emerging agreement is important and should give clear messages to health planners.     

Pneumococcal disease manifestation in children before and after vaccination: what's new?

Pneumococcal infections remain a relevant cause of morbidity and mortality in children, especially in countries where vaccination has not been introduced. In contrast to the common belief by many pediatricians, the most important pneumococcal infections are of the respiratory tract and not invasive diseases. The recent pandemic of the H1N1 virus prompted studies to better understand the interaction between the influenza virus, Streptococcus pneumoniae, and pneumonia outcomes. Radiological findings of bacteremic pneumonia have been well investigated and besides the typical alveolar consolidation, a broad spectrum of atypical patterns has been reported. Molecular techniques, such as real-time polymerase chain reaction (PCR), can improve the detection of S. pneumoniae in sterile fluids, mainly in regions where previous antibiotic therapy is a common practice. In the post vaccination era, new manifestations of pneumococcal invasive disease, such as hemolytic uremic syndrome, have increased in association with parapneumonic empyema. Moreover, serotypes not included in PCV7, particularly serotypes 1, 3, 5, 7F, and 19A, have been among the most common isolates in pneumococcal disease. In Latin America, pneumococcal primary peritonitis has been described as an important clinical syndrome in a growing proportion of patients, mainly in girls. The development of newer and more specific diagnostic markers to distinguish bacterial and viral pneumonia are urgently sought, and will be especially pertinent after the introduction of pneumococcal conjugate vaccines with expanded serotypes. Such markers would minimize inappropriate diagnosis of false positive cases and treatment with antibacterial agents, while increasing positive predictive values for diagnosis of bacterial pneumonia. The extension of serotype coverage with the new conjugate vaccines is promising for pneumococcal infections and coverage against antibiotic-resistant strains.     

Does maternal smoking during pregnancy cause childhood overweight?

The objective of this study was to examine a possible association between maternal smoking in pregnancy and childhood overweight. From a population-based cohort of 5722 women from Trondheim, Bergen (Norway) and Uppsala (Sweden) enrolled in early pregnancy during 1986-92, a random sample of 482 women was selected for participation. They were followed up throughout pregnancy, and their children from birth until 5 years of age. Data on maternal smoking and diet, socio-economic determinants and breast feeding were recorded prospectively. During pregnancy and childhood, anthropometric measures were also recorded. Maternal smoking status was based on reported number of cigarettes smoked in week 17 of pregnancy. Child overweight was defined by body mass index (BMI) and sum of skinfold thickness (SFT) >or= 85th percentile at 5 years of age. Children of mothers who smoked in pregnancy had increased risk of overweight at 5 years of age (RR 2.5, 95% CI 1.5, 4.2 for BMI; and RR 1.8, 95% CI 1.1, 3.0 for SFT). Adjusting for maternal diet, breast feeding, maternal obesity and socio-economic status did not suggest confounding. However, adjustment for birthweight increased the observed risk. A linear increase in BMI and SFT was observed with increasing number of cigarettes smoked. In conclusion, smoking during pregnancy may be a risk factor for development of childhood overweight. This study may support the hypothesis of 'fetal origin of adult disease', but the risk of overweight associated with smoking during pregnancy was independent of intrauterine growth retardation, and may thus be attributed to specific effects of cigarette smoke.     

Maternal smoking during pregnancy and children's cognitive and physical development: a causal risk factor?

There remains considerable debate regarding the effects of maternal smoking during pregnancy on children's growth and development. Evidence that exposure to maternal smoking during pregnancy is associated with numerous adverse outcomes is contradicted by research suggesting that these associations are spurious. The authors investigated the relation between maternal smoking during pregnancy and 14 developmental outcomes of children from birth through age 7 years, using data from the Collaborative Perinatal Project (1959-1974; n = 52,919). In addition to adjusting for potential confounders measured contemporaneously with maternal smoking, the authors fitted conditional fixed-effects models among siblings that controlled for unmeasured confounders. Results from the conditional analyses indicated a birth weight difference of -85.63 g associated with smoking of >or=20 cigarettes daily during pregnancy (95% confidence interval: -131.91, -39.34) and 2.73 times' higher odds of being overweight at age 7 years (95% confidence interval: 1.30, 5.71). However, the associations between maternal smoking and 12 other outcomes studied (including Apgar score, intelligence, academic achievement, conduct problems, and asthma) were entirely eliminated after adjustment for measured and unmeasured confounders. The authors conclude that the hypothesized effects of maternal smoking during pregnancy on these outcomes either are not present or are not distinguishable from a broader range of familial factors associated with maternal smoking.