Pregnancy weight gain standards are charts describing percentiles of weight gain among participants with no risk factors that could adversely affect weight gain. This detailed information is burdensome to collect. We investigated the extent to which exclusion of various pre-pregnancy, pregnancy and postpartum factors impacted the values of pregnancy weight gain percentiles. We examined pregnancy weight gain (kg) among 3178 participants of the US nuMoM2b-Heart Health Study (HHS). We identified five groups of potential exclusion criteria for pregnancy weight gain standards: socio-economic characteristics (group 1), maternal morbidities (group 2), lifestyle/behaviour factors (group 3), adverse neonatal outcomes (group 4) and longer-term adverse outcomes (group 5). We established the impact of different exclusion criteria by comparing the median, 25th and 75th percentiles of weight gain in the full cohort with the values after applying each of the five exclusion criteria groups. Differences > 0·75 kg were considered meaningful. Excluding participants with group 1, 2, 3 or 4 exclusion criteria had no impact on the 25th, median or 75th percentiles of pregnancy weight gain. Percentiles were only meaningfully different after excluding participants in group 5 (longer-term adverse outcomes), which shifted the upper end of the weight gain distribution to lower values (e.g. 75th percentile decreased from 19·6 kg to 17·8 kg). This shift was due to exclusion of participants with excess postpartum weight retention > 5 kg or > 10 kg. Except for excess postpartum weight retention, most potential exclusion criteria for pregnancy weight gain standards did not meaningfully impact chart percentiles.

Maternal diet may modulate human milk microbiota, but the effects of nutritional supplements are unknown. We examined the associations of prenatal diet and supplement use with milk microbiota composition. Mothers reported prenatal diet intake and supplement use using self-administered food frequency and standardised questionnaires, respectively. The milk microbiota was profiled using 16S rRNA gene sequencing. Associations of prenatal diet quality, dietary patterns, and supplement use with milk microbiota diversity and taxonomic structure were examined using Wilcoxon signed-rank tests and multivariable models adjusting for relevant confounders. A subset of 645 mothers participating in the CHILD Cohort Study (originally known as the Canadian Healthy Infant Longitudinal Development Study) provided one milk sample between 2 and 6 months postpartum and used prenatal multivitamin supplements ≥4 times a week. After adjusting for confounders, vitamin C supplement use was positively associated with milk bacterial Shannon diversity (β = 0.18, 95% CI = 0.05, 0.31) and Veillonella and Granulicatella relative abundance (β = 0.54; 95% CI = 0.05, 1.03 and β = 0.44; 95% CI = 0.04, 0.84, respectively), and negatively associated with Finegoldia relative abundance (β = –0.31; 95% CI = –0.63, –0.01). Fish oil supplement use was positively associated with Streptococcus relative abundance (β = 0.26; 95% CI = 0.03, 0.50). Prenatal diet quality and dietary patterns were not associated with milk microbiota composition. Prenatal vitamin C and fish oil supplement use were associated with differences in the milk microbiota composition. Future studies are needed to confirm our findings and elucidate mechanisms linking maternal supplement use to milk microbiota and child health.

Folate, vitamin B12, vitamin B6 and riboflavin interact by functioning as cofactors within one-carbon metabolism (OCM), a network of interrelated cellular pathways essential for numerous biological processes, including the biosynthesis of DNA, amino acid interconversions and methylation reactions. The pathways of OCM are influenced by endocrine signals and genetic polymorphisms and are particularly responsive to relevant B-vitamin intakes. Physiological changes in healthy pregnancy, leading to a steady decline in B-vitamin status, add another layer of complexity to the regulation of OCM. Although significant advances have been made to improve our understanding of these pregnancy-related changes, no specific reference ranges yet exist for B-vitamin biomarkers in pregnancy to support normal fetal growth without depleting maternal stores. The lack of pregnancy-related criteria for adequacy of B-vitamin status is in turn a major limitation in identifying pregnant women most at risk of B-vitamin deficiency. Another challenge is that the evidence is very limited to provide a basis for establishing pregnancy-specific dietary recommendations for B-vitamins to support successful pregnancy outcomes. In terms of preventing adverse outcomes, periconceptional folic acid supplementation has a proven role, established more than 30 years ago, in protecting against neural tube defect-affected pregnancies and this has been the major focus of public health policy worldwide. This review evaluates the emerging evidence for the less well recognised role of B-vitamins in preventing hypertensive disorders in pregnancy and the intergenerational effects of B-vitamins on offspring neurodevelopment and cognitive performance during childhood. We also consider the underlying biological mechanisms.

Early nutritional and growth experiences can impact development, metabolic function, and reproductive outcomes in adulthood, influencing health trajectories in the next generation. The insulin-like growth factor (IGF) axis regulates growth, metabolism, and energetic investment, but whether it plays a role in the pathway linking maternal experience with offspring prenatal development is unclear. To test this, we investigated patterns of maternal developmental weight gain (a proxy of early nutrition), young adult energy stores, age, and parity as predictors of biomarkers of the pregnancy IGF axis (n = 36) using data from the Cebu Longitudinal Health and Nutrition Survey in Metro Cebu, Philippines. We analyzed maternal conditional weight measures at 2, 8, and 22 years of age and leptin at age 22 (a marker of body fat/energy stores) in relation to free IGF-1 and IGFBP-3 in mid/late pregnancy (mean age = 27). Maternal IGF axis measures were also assessed as predictors of offspring fetal growth. Maternal age, parity, and age 22 leptin were associated with pregnancy free IGF-1, offspring birth weight, and offspring skinfold thickness. We find that free IGF-1 levels in pregnancy are more closely related to nutritional status in early adulthood than to preadult developmental nutrition and demonstrate significant effects of young adult leptin on offspring fetal fat mass deposition. We suggest that the previously documented finding that maternal developmental nutrition predicts offspring birth size likely operates through pathways other than the maternal IGF axis, which reflects more recent energy status.

Coffee is one of the most popular beverages worldwide, and there is an increasing concern of the health risk of coffee consumption in pregnancy. Preeclampsia (PE) is a serious pregnancy disease that causes elevated blood pressure and proteinuria in pregnant women and growth restriction of fetuses due to poorly developed placental vasculature. The aim of our study is to investigate the possible effect of coffee intake during pregnancy in rats with potential underlying vasculature conditions. The endothelial nitric oxide synthase inhibitor N(gamma)-nitro-L-arginine methyl ester (L-NAME) at a high dose (125 mg/kg/d) was used to induce PE in pregnant rats, which were used as the positive control group. In addition, low-dose L-NAME (10 mg/kg/d) was used to simulate the compromised placental vasculature function in pregnant rats. Coffee was given together with low-dose L-NAME to the pregnant rats from gestational day 10.5–18.5. Our results show that the pregnant rats treated with low-dose L-NAME + coffee, but not low-dose L-NAME alone, developed PE symptoms such as prominent fetal growth restriction, hypertension, and proteinuria. Therefore, our findings suggest that coffee intake during pregnancy may cause an increased risk of PE in susceptible women.

The association between the frequency of eating ready-made meals (RMM) or eating out (EO) during pregnancy and postpartum depression remains unclear. We aimed to explore the association between the frequency of RMM or EO use during pregnancy and the incidence of postpartum depression. This study included 639 community-dwelling pregnant women who were recruited between 2019 and 2022. Data on the frequency of RMM and EO use, as well as sociodemographic, economic and lifestyle factors, were obtained using self-administered questionnaires. Data on dietary intake were obtained using a validated brief self-administered diet history questionnaire. Postpartum depression was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). The incidence of postpartum depression (EPDS score of ≥9) based on the frequency of RMM or EO use was analysed using multiple logistic regression analysis. After adjusting for potential confounders, there was limited evidence suggesting an association between consuming RMM 3 times/week or more and the likelihood of experiencing postpartum depression, with an adjusted OR (aOR) and 95 % CI (95 % CI) of 4·16 and 1·68–10·27 (Pfor trend = 0·017) compared with consuming RMM less than 1 time/week. There was no evidence for an association between consuming EO 3 times/week or more and postpartum depression (aOR: 1·20, 95 % CI: 0·14, 10·04 and Pfor trend = 0·283). Accordingly, the present study presented weak evidence of an association between RMM and postpartum depression. Further studies with large and diverse samples are needed to overcome any potential selection bias.

The 7th edition of the Canadian Stroke Best Practice Recommendations (CSBPR) is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners, and intended to drive healthcare excellence, improved outcomes and more integrated health systems. This edition includes a new module on the management of cerebral venous thrombosis (CVT). Cerebral venous thrombosis is defined as thrombosis of the veins of the brain, including the dural venous sinuses and/or cortical or deep veins. Cerebral venous thrombosis is a rare but potentially life-threatening type of stroke, representing 0.5–1.0% of all stroke admissions. The reported rates of CVT are approximately 10–20 per million and appear to be increasing over time. The risk of CVT is higher in women and often associated with oral contraceptive use and with pregnancy and the puerperium. This guideline addresses care for adult individuals who present to the healthcare system with current or recent symptoms of CVT. The recommendations cover the continuum of care from diagnosis and initial clinical assessment of symptomatic CVT, to acute treatment of symptomatic CVT, post-acute management, person-centered care, special considerations in the long-term management of CVT, including pregnancy and considerations related to CVT in special circumstances such as trauma and vaccination. This module also includes supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

According to the modified World Health Organization classification, pregnant women with unrepaired aortic coarctation are at very high risk for both maternal and fetal complications and should, therefore, be counselled against pregnancy. The most frequent maternal complications include systemic hypertension, renal failure, preeclampsia, and aortic dissection. Herein, we describe a successful pregnancy in an adult patient with unrepaired aortic coarctation.

Emerging evidence has indicated that perinatal exposure to low-calorie sweeteners (LCSs) might be associated with adverse pregnancy outcomes and offspring health(1). The aim of the study was to examine the patterns and predictors of LCS consumption among pregnant women in Australia. A web-based survey was conducted among 422 pregnant women aged 18-50 years between September and October 2022. Participants were recruited by a reputable consumer panel provider, Qualtrics. Sociodemographic, lifestyle, dietary intake (including LCS consumption), pregnancy-related characteristics, and participants’ awareness regarding the potential health effects of LCS were assessed. We assessed LCS consumption from twelve food groups that are common sources of LCS(2). To identify LCS consumption patterns and predictors of the patterns, a latent class analysis and hierarchical multinomial logistic regression was employed, respectively. The women’s mean (SD) age was 30 (4.6) years. Overall, 95% of the women reported consuming any LCS in the current pregnancy. Three different LCS consumption patterns were identified. Infrequent or non-consumers, representing 50% of the women, included those who rarely or never consumed LCS-containing foods and beverages (with a probability of less than 10%). The second pattern, moderate consumption, which encompassed 40% of the women, indicated low to moderate consumption of LCSs (for instance, the likelihood of consuming LCS-containing drinks ranged from 18% to 50%). The third pattern highlighted habitual consumption. These individuals (10%) had a high likelihood (ranging from 75% to 95%) of consuming foods from all food groups that contained LCS. The majority of women (71%) were unaware of the potential adverse effects of LCS, and only 25% expressed concerns about the potential impacts of LCS on their health and the health of their offspring. Moreover, women who frequently consumed sugar-sweetened beverages (SSBs) (≥2 times/week) or had gestational diabetes were over three times more likely to adopt a habitual LCS consumption pattern compared to those who consumed SSBs less often [adjusted relative risk ratio (aRRR) = 3.17, 95% CI: 1.39-7.21] and those without gestational diabetes [aRRR = 3.53, 95% CI: 1.03-12.10]. Additionally, having a medical condition was linked to a 55% lower chance of moderate LCS consumption compared to infrequent or non-consumption. These findings indicate LCS consumption is widespread, but awareness of its potential adverse health effect is low among pregnant women in Australia. Public health interventions to increase the awareness of potential adverse effect of LCS consumption, particularly among pregnant women with moderate and habitual consumption are warranted.

Vegan diet consumption is gaining popularity globally and in New Zealand. However, plant foods provide absent or limited quantities of important micronutrients such as vitamin B12, iron, zinc, and omega-three fatty acids(1). A restrictive and unplanned vegan diet may thus increase risks of nutrient deficiencies especially during pregnancy and early life if the nutrient demands are not fulfilled. Health professionals who provide primary support for pregnant women and their children are important figures in monitoring the nutritional statuses during the antenatal and postnatal periods(2). (Being knowledgeable about the nutritional risks of poorly-planned vegan diets, and having access to appropriate educational resources would support vegan mothers and children to achieve a well-balanced diet. Currently, there are insufficient studies investigating the perspectives of New Zealand’s health professionals within the realm of vegan diets during pregnancy and early life. The aim of the research is to utilise a mixed-methods approach to explore these concerns, attitudes, and experiences. Healthcare professionals, including dietitians, nurses, general practitioners and midwives were invited to participate in the study. Knowledge and attitude scores were collected with an online questionnaire and scores were recorded as a proportion of the participants. Subsequently, descriptions of experiences, concerns, and perspectives about the adoption of vegan diets during pregnancy and early life were collected with semi-structured interviews. A total of 14 health professionals completed the study. All health professionals showed positive attitudes towards the adoption of vegan diets during pregnancy but some exhibited greater concern about their restrictive nature especially in early childhood. Achieving intake adequacy and subjecting young children to intensive assessments for nutrient adequacy were among the concerns raised. More than 90% of health professionals were concerned about iron and vitamin B12 deficiencies while less than 50% were concerned about deficiencies in protein, omega-three fatty acids, iodine, zinc and vitamin D. Less than 50% of participants were aware that plant foods do not provide sufficient vitamin B12. More than 50% disagreed that sufficient information about vegan diets during pregnancy and early life is available. Insufficient evidence-based consensus and government guidelines, and limited access and referrals to dietitians for guidance on vegan diets were highlighted as challenges that reduce the overall knowledge and confidence. Hence, continual professional education and updated evidence-based resources would be important steps to support health professionals in providing guidance to individuals on vegan diets.

Prenatal stress has a significant, but small, negative effect on children’s executive function (EF) in middle and high socioeconomic status (SES) households. Importantly, rates and severity of prenatal stress are higher and protective factors are reduced in lower SES households, suggesting prenatal stress may be particularly detrimental for children’s EF in this population. This study examined whether prenatal stress was linked to 5-year-old’s EF in a predominantly low SES sample and child sex moderated this association, as males may be more vulnerable to adverse prenatal experiences. Participants were 132 mother-child dyads drawn from a prospective prenatal cohort. Mothers reported on their depression symptoms, trait anxiety, perceived stress, everyday discrimination, and sleep quality at enrollment and once each trimester, to form a composite prenatal stress measure. Children’s EF was assessed at age 5 years using the parent-report Behavior Rating Inventory of Executive Function - Preschool (BRIEF-P) Global Executive Composite subscale and neuropsychological tasks completed by the children. Mixed models revealed higher prenatal stress was associated with lower BRIEF-P scores, indicating better EF, for females only. Higher prenatal stress was associated with lower performance on neuropsychological EF measures for both males and females. Results add to the limited evidence about prenatal stress effects on children’s EF in low SES households.