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OBJECTIVE This study aimed to describe the overall quantity and type of supplements and medications used during pregnancy in a low-risk cohort and to examine any racial/ethnic differences in intake. STUDY DESIGN We used data from 2,164 racially/ethnically diverse, nonobese, and low-risk pregnant women participating without pre-pregnancy chronic conditions in a prospective cohort study at 12 sites across the United States. Medication data were self-reported as free text in enrollment, follow-up visit questionnaires, and abstracted from medical records at delivery. Supplements and medications data were mapped to their active ingredients and categorized into corresponding classes using the Slone Drug Dictionary. The total number and classes of supplements and medications consumed during pregnancy were calculated. Modified Poisson regression models were used to estimate the racial/ethnic differences in supplements and medications intake. All models were adjusted for maternal sociodemographic factors and study site. RESULTS 98% of women took at least one supplement during pregnancy, with prenatal vitamins/multivitamins being most common. While only 31% reported taking no medications during pregnancy, 23% took one, 18% took two, and 28% took three or more. The percentage of women taking at least one medication during pregnancy was highest among non-Hispanic white women and lowest among Asians (84 vs. 55%, p

Background: Vitamin D deficiency was associated with an increased risk of coronavirus disease 2019 (COVID-19) infection. Vitamin D deficient mothers are more likely to have infants with vitamin D deficiency, affecting their immunity and protection against infection. This study aimed at comparing the concentrations of vitamin D3 and T cell-related cytokines in milk between mothers with confirmed COVID-19 polymerase chain reaction (PCR) test, mothers with viral infections suggestive of COVID-19, and mothers without infection. Materials and Methods: Concentrations of vitamin D3 and T cell-related cytokines in milk samples were determined by ELISA from 10 mothers who had a positive COVID-19 PCR test, 10 mothers with viral symptoms suggestive of COVID-19, and 20 mothers without infection. Results: Vitamin D3 concentration in human milk was higher in women without infection than in women with viral symptoms or COVID-19 PCR. Interleukin-2 level in milk was higher in the no-infection group than the COVID-19 PCR group but it did not differ with the viral symptoms group. Vitamin D3 did not correlate with any cytokines in human milk. Prenatal vitamin intake did not affect the vitamin D3 in human milk. The percentage of milk from mothers with

Background. The composition of preparations, intended for pregnant women is an important issue of proper dietary supplementation. The range of such products on the market is very wide and their composition is not regulated by law. Objectives. To evaluate the composition of preparations for pregnant women in the context of 2014 Polish Gynecological Society (PTG) recommendation and the 2020 recommendation of the Polish Society of Gynecologists and Obstetricians (PTGiP). Materials and methods. A range of preparations was collected in pharmacies and e-pharmacies in 2019. The nutrient content was determined based on the information on the unit packaging or the pharmacy's website. The content of folic acid, vitamin D, iodine, DHA, and iron was assessed. Results. There were 33 vitamin-mineral preparations (VMPs) on offer on the analyzed market. All preparations contained folic acid, of which 55% contained precisely the dose recommended by the PTG, and 45% of the preparations is compliant in this respect with the recommendation of the PTGiP. Ninety seven percent of VMPs contained vitamin D. Fifty percent of them did not contain this vitamin at the dose recommended by the PTG, and half of the preparations do not meet the PTGiP recommendation either. Ninety seven percent of VMPs contained iodine. Out of them 44% contained a too low dose of iodine, by the PTG standards, but only 9% of preparations do not meet the PTGiP recommendation in this respect. DHA was a component contained in 73% of VMPs. Among them, 33% contained the dose recommended by the PTG for women who eat little fish and 88% of the preparations are in line with the new recommendation PTGiP. Eighty two percent of preparations contained iron, which in the light of the PTGiP recommendation is debatable. Conclusions. The composition of many VMPs did not reflect experts' recommendations regarding the type and amounts of particular nutrients.

We examined maternal prenatal vitamin use or supplemental folic acid intake during month one of pregnancy for association with autism spectrum disorder (ASD) in the Early Autism Risk Longitudinal Investigation, an enriched-risk pregnancy cohort. Total folic acid intake was calculated from monthly prenatal vitamins, multivitamins, and other supplement reports. Clinical assessments through age 3 years classified children as ASD (n = 38) or non-ASD (n = 153). In pregnancy month one, prenatal vitamin use (59.7%) was not significantly associated with odds of ASD (OR = 0.70, 95%CI 0.32, 1.53). Sample size was limited and residual confounding was possible. Given the estimated effect sizes in this and previous work, prenatal vitamin intake during early pregnancy could be a clinically useful preventative measure for ASD.

Summary Background & aims Maternal gestational infection is a well-characterized risk factor for offsprings’ development of mental disorders including schizophrenia, autism, and attention deficit disorder. The inflammatory response elicited by the infection is partly directed against the placenta and fetus and is the putative pathogenic mechanism for fetal brain developmental abnormalities. Fetal brain abnormalities are generally irreversible after birth and increase risk for later mental disorders. Maternal immune activation in animals models this pathophysiology. SARS-CoV-2 produces maternal inflammatory responses during pregnancy similar to previously studied common respiratory viruses. Method Choline, folic acid, Vitamin D, and n-3 polyunsaturated fatty acids are among the nutrients that have been studied as possible mitigating factors for effects of maternal infection and inflammation on fetal development. Clinical and animal studies relevant to their use in pregnant women who have been infected are reviewed. Results Higher maternal choline levels have positive effects on the development of brain function for infants of mothers who experienced viral infections in early pregnancy. No other nutrient has been studied in the context of viral inflammation. Vitamin D reduces pro-inflammatory cytokines in some, but not all, studies. Active folic acid metabolites decrease anti-inflammatory cytokines. N-3 polyunsaturated fatty acids have no effect. Conclusions Vitamin D and folic acid are already supplemented in food additives and in prenatal vitamins. Despite recommendations by several public health agencies and medical societies, choline intake is often inadequate in early gestation when the brain is forming. A public health initiative for choline supplements during the pandemic could be helpful for women planning or already pregnant who also become exposed or infected with SARS-CoV-2.

BackgroundPrenatal vitamin use is recommended before and during pregnancies for normal fetal development. Prenatal vitamins do not have a standard formulation, but many contain calcium, folic acid, iodine, iron, omega-3 fatty acids, zinc, and vitamins A, B6, B12, and D, and usually they contain higher concentrations of folic acid and iron than regular multivitamins in the US Nutrient levels can impact epigenetic factors such as DNA methylation, but relationships between maternal prenatal vitamin use and DNA methylation have been relatively understudied. We examined use of prenatal vitamins in the first month of pregnancy in relation to cord blood and placenta DNA methylation in two prospective pregnancy cohorts: the Early Autism Risk Longitudinal Investigation (EARLI) and Markers of Autism Risk Learning Early Signs (MARBLES) studies.ResultsIn placenta, prenatal vitamin intake was marginally associated with −0.52% (95% CI −1.04, 0.01) lower mean array-wide DNA methylation in EARLI, and associated with −0.60% (−1.08, −0.13) lower mean array-wide DNA methylation in MARBLES. There was little consistency in the associations between prenatal vitamin intake and single DNA methylation site effect estimates across cohorts and tissues, with only a few overlapping sites with correlated effect estimates. However, the single DNA methylation sites withp-value nCpGs = 4068, EARLI placentanCpGs = 3647, MARBLES cordnCpGs = 4068, MARBLES placentanCpGs = 9563) were consistently enriched in neuronal developmental pathways.ConclusionsTogether, our findings suggest that prenatal vitamin intake in the first month of pregnancy may be related to lower placental global DNA methylation and related to DNA methylation in brain-related pathways in both placenta and cord blood.

Objectives Certain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes. Methods The study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied. Results Of the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days’ threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins. Conclusion The use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists’ management of this critical clinical issue.

Underserved subgroups are less likely to have optimal health prior to pregnancy. We describe preconception health indicators (behavior, pregnancy intention, and obesity) among pregnant Latina women with and without chronic stress in metro Atlanta. We surveyed 110 pregnant Latina women enrolled in prenatal care at three clinics in Atlanta. The survey assessed chronic stress, pregnancy intention, preconception behavior changes (taking folic acid or prenatal vitamins, seeking healthcare advice, any reduction in smoking or drinking), and previous trauma. Specific behaviors to improve health prior to pregnancy were uncommon (e.g., taking vitamins (25.5%) or improving nutrition (20.9%)). Just under half of women were experiencing a chronic stressor at the time of conception (49.5%). Chronically stressed women were more likely to be obese (aOR: 3.0 (1.2, 7.4)), less likely to intend their pregnancy (aOR: 0.3 (0.1, 0.7)), and possibly less likely to report any PHB (45.5% vs. 57.4%; aOR: 0.5 (0.2–1.1)). Chronically stress women were less likely to enter prenatal care with optimal health. However, preconception behaviors were uncommon overall.

Maternal depression, which includes depression in the prenatal and postpartum periods, is estimated to affect between 10 and 20% of women globally but the rate is higher in the Middle East. Research focused on maternal depression in Iraq is limited to one study focused on postpartum depression. This paper identifies the prevalence and factors associated with antenatal depression among pregnant Iraqi women. Women seeking maternal health services at primary health centers were invited to participate. Data were collected by trained midwifery students in Erbil, Iraq. Responses to the PHQ-2 PRIME-MD depression questions were used to identify depressive symptoms. Chi-square and logistic regression analyses were used to analyze findings. Of the 179 participants, 86 (48%) reported depressive symptoms. In bivariate analysis, antenatal depression was associated with gestational age (p = 0.03), first prenatal visit in the second trimester (p = 0.003), loss of appetite (p = 0.003), not having help at home (p = 0.03), and use of prenatal vitamins (p = 0.002). Gravida approached significance (p = 0.07). In adjusted analysis, women reporting loss of appetite were more likely to report depressive symptoms (OR = 3.09, 95% CI: 1.47–6.51). Consistent with other research from the region, nearly half the women reported depressive symptoms. Because lack of appetite is associated with depressive symptoms, women reporting loss of appetite should be prioritized for depression screening in time-constrained settings.

Prenatal vitamin D (VitD) deficiency influences children’s health in later life. We aimed to test the associations between maternal VitD status in each of the three trimesters of pregnancy and cord blood 25(OH)D concentrations in newborns. Participants were pregnant women recruited from the Shanghai Birth Cohort (SBC) (n = 1100). Of all the participants, 946 completed the collection of venous blood at early (

Objective Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. Design Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection Setting A multidisciplinary antenatal clinic in Australia Method Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder Main outcome measures Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions Results Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women’s main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin

* Abbreviations: ETT: : endotracheal tube EXIT: : ex utero intrapartum treatment POPS: : procedure on placental support A 36-year-old gravida 3, para 2-0-0-2 pregnant woman was referred to our fetal care center at 20 5/7 weeks’ gestation because of fetal micrognathia, lagging femur length, and a single umbilical artery. Her pertinent medical and surgical histories included asthma and a prior cesarean section. The pregnancy was the product of in vitro fertilization. Preimplantation genetic screening demonstrated an embryo with a normal karyotype. Her medications included fluticasone propionate/salmeterol, montelukast, lansoprazole, and prenatal vitamins. Family history revealed 2 paternal female first cousins once removed with Smith-Lemli-Opitz syndrome and seizure disorder related to sodium channelopathy. Her standard prenatal screening results were unremarkable. Evaluation at our fetal care center included the following: Figure 1. Fetal magnetic resonance imaging scan obtained at 20 weeks’ gestation. A. The abnormal facial profile with severe micrognathia. B. Facial profile; white arrow indicates glossoptosis. The conglomeration of these fetal findings is consistent with a diagnosis of Pierre Robin sequence. Pierre Robin sequence occurs …

Background: Depression is a common complication of pregnancy and vitamin D deficiency is one biological risk factor for postpartum depression (PPD). Materials and Methods: We evaluated the ratio of 24,25(OH)(2)D and 25(OH)D serum concentrations referred to as the Vitamin D Metabolite Ratio (VMR), a new candidate biomarker during pregnancyand its relationship with PPD. Women were enrolled in the first trimester of pregnancy and followed through four timepoints. Results: A total of 89 women had complete depression, biomarker and demographic data and 34% were at risk for PPD (CES-D≥16). Stepwise multiple logistic regression models for PPD risk were carried out with eight predictors. Results showed that only lower VMR, OR = 1.43, 95% CI 1.10–1.86, p = 0.007, and Hispanic/Latina identification, OR = 3.83, 95% CI 1.44–10.92, p = 0.007 were significantly associated with higher PPD risk. Conclusion: Routine prenatal screening for vitamin D metabolites, particularly in Hispanic/Latina women, may identify women at risk for PPD.

Increasing vitamin D deficiency and evidence for vitamin D's role in brain and immune function have recently led to studies of neurodevelopment; however, few are specific to autism spectrum disorder (ASD) and vitamin D in pregnancy, a likely susceptibility period. We examined this in a case–control study of 2000–2003 Southern Californian births; ASD and intellectual disability (ID) were identified through the Department of Developmental Services and controls from birth certificates (N = 534, 181, and 421, respectively, in this analysis). Total 25-Hydroxyvitamin D (25(OH)D) was measured in mid-pregnancy serum, categorized as deficient (

Prenatal maternal diet is a critical factor in offspring neurodevelopment. Emerging evidence suggests that prenatal diet may also play a role in the etiology autism spectrum disorder (ASD). This review summarizes studies published in English that examined prenatal nutrients or maternal diet in association with ASD from PubMed as of July 2020. Thiry-six studies from nine countries were included in this systematic review; these focused on multivitamin (n = 5), prenatal vitamin (n = 3), folic acid (FA; n = 14), Vitamin D (n = 11), polyunsaturated fatty acid or fish/supplement intake (n = 7), iron (n = 3), Vitamin B12 (n = 1), calcium (n = 1), magnesium (n = 1), and broad maternal dietary habits (n = 3). Overall, higher or moderate intake of prenatal/multivitamin, FA, and Vitamin D was associated with reductions in odds of ASD, though results have not been uniform and there is a need to clarify differences in findings based on biomarkers versus reported intake. Evidence was inconclusive or insufficient for other nutrients. Differences in the timing and measurement of these dietary factors, as well as potential residual confounding, may contribute to existing discrepancies. Key areas for future research to better understand the role of maternal diet in ASD include the need to address potential critical windows, examine the combined effect of multiple nutrients, and consider interactions with genetic or environmental factors. LAY SUMMARY: Maternal diet during pregnancy is important for child neurodevelopment. We reviewed 36 studies examining maternal diet and autism spectrum disorder (ASD) and found that prenatal vitamin/multivitamin use and adequate intake of folic acid and Vitamin D were each associated with lower likelihood of having a child with ASD. Future studies on these and other dietary factors are needed to better understand the role of maternal diet in the development of ASD. Autism Res 2020, 13: 1634-1658. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

* Abbreviations: CPAP: : continuous positive airway pressure MRI: : magnetic resonance imaging TLV: : total lung volume A 32-year-old gravida 4, para 2-1-0-3 woman was referred to the Cincinnati Fetal Center at 20 5/7 weeks’ gestation for a diagnosis of fetal bladder outlet obstruction and anhydramnios. Her obstetric history was significant for 3 cesarean deliveries. Her medical history was noncontributory, and her only medication was prenatal vitamins. Family history included a paternal male cousin with a “partially blocked urethra” as a teenager, and a paternal female cousin with an unknown kidney issue requiring hospitalization; however, the family was unable to provide further information. Prenatal laboratory testing was unremarkable except for rubella-nonimmune status. Fetal imaging at the referring obstetrician’s office at 19 1/7 weeks’ gestation showed anhydramnios, suspected bladder outlet obstruction, absent left kidney, echogenic right kidney, and a pericardial effusion. An amniocentesis had not been performed, and noninvasive prenatal genetic screening result was consistent with a male fetus with low risk for trisomy 13, 18, and 21, monosomy X, and triploidy. A multidisciplinary team reviewed her records and imaging at 21 6/7 weeks’ gestation, and proceeded with the following evaluations

Asthma is a chronic inflammatory respiratory disease. Nutritional conditions effects on allergic diseases such as asthma. The aim of this study is to find relation of maternal vitamin E and progression of children asthma. This is a review article searched in data base include Google, PubMed, SID, Irandoc, Scopus and up-to-date. Key words for search include maternal vitamin e, asthma, children and pediatric. There was not limitation time for search. A few articles found in our search. Some of them were cohort studies. A few researches were about vitamin e only and a few of them evaluated vitamin e with other vitamins in clinical trial studies. Because the articles were heterogenic, we could not do a meta-analysis. Often articles showed the vitamin e improved clinical manifestations of asthma and or lung function in spirometry tests. A few articles revealed no any effect of prenatal vitamin e during pregnancy on children wheezing or asthma. Vitamin e has not any serious side effects. Vitamin e supplement during pregnancy has different effects on wheezing or asthma prevalence in children.

BACKGROUND: We previously reported the results of a trial of prenatal vitamin D supplementation to prevent asthma and recurrent wheeze in young children, which suggested that supplementation provided a protective effect at the age of 3 years. We followed the children through the age of 6 years to determine the course of asthma and recurrent wheeze. METHODS: In this follow-up study, investigators and participants remained unaware of the treatment assignments through the children’s sixth birthday. We aimed to determine whether, when maternal levels of 25-hydroxyvitamin D were taken into account, children born to mothers who had received 4400 IU of vitamin D(3) per day during pregnancy (vitamin D group) would have a lower incidence of asthma and recurrent wheeze at the age of 6 years than would those born to mothers who had received 400 IU of vitamin D(3) per day (control group). Time-to-event methods were used to compare the treatment groups with respect to time to the onset of asthma or recurrent wheeze. Multivariate methods were used to compare longitudinal measures of lung function between the treatment groups. RESULTS: There was no effect of maternal vitamin D supplementation on asthma and recurrent wheeze in either an intention-to-treat analysis or an analysis with stratification according to the maternal 25-hydroxyvitamin D level during pregnancy. There was no effect of prenatal vitamin D supplementation on most of the prespecified secondary outcomes. We found no effects of prenatal supplementation on spirometric indexes. Although there was a very small effect on airway resistance as measured by impulse oscillometry, this finding was of uncertain significance. CONCLUSIONS: Vitamin D supplementation during the prenatal period alone did not influence the 6-year incidence of asthma and recurrent wheeze among children who were at risk for asthma. (Funded by the National Heart, Lung, and Blood Institute; VDAART ClinicalTrials.gov number, NCT00920621.)

Background Zinc and vitamin A supplementation have both been shown to affect iron status, hemoglobin (Hb) concentration, and anemia in animal and human studies. However, evidence on their combined use in pregnancy, in the context of iron-folic acid (IFA) supplementation, remains limited. Objective This study determined the effects of prenatal zinc, vitamin A, and iron supplementation on maternal hematologic and micronutrient status at delivery in Tanzania. Methods We analyzed 2 large randomized controlled trials, using generalized estimating equations, and examined the effect of daily zinc (25 mg) and vitamin A (2500 IU) supplementation starting in the first trimester of pregnancy compared with placebo (n = 2500), and separately evaluated the safety and efficacy of daily iron (60 mg) supplementation among iron-replete pregnant women (n = 1500). Blood samples from baseline and delivery were tested for Hb, serum ferritin, soluble transferrin receptor, plasma zinc, and zinc protoporphyrin. Results Zinc and vitamin A supplementation were associated with lower Hb concentrations at delivery of -0.26 g/dL (95% CI: -0.50, -0.02 g/dL) and -0.25 g/dL (95% CI: -0.49, -0.01 g/dL), respectively. Vitamin A increased mean ferritin concentrations at delivery (14.3 μg/L, 95% CI: 1.84, 29.11 μg/L), but was associated with increased risk of severe anemia (RR: 1.41; 95% CI: 1.06, 1.88). Among women who were iron replete at baseline, iron supplementation reduced the risk of iron depletion at delivery by 47% (RR: 0.53; 95% CI: 0.43, 0.65). There was no effect of zinc or iron supplements on plasma zinc concentrations. Conclusions Our findings support existing WHO guidelines on prenatal iron, vitamin A, and zinc supplementation among pregnant women. In this setting, scaling uptake of prenatal iron supplements is warranted, but prenatal zinc and vitamin A supplementation did not benefit maternal hematologic status at delivery. In settings where vitamin A deficiency is endemic, the efficacy and safety of the WHO recommended prenatal vitamin A supplementation require further evaluation.

Purpose Adequate calcium intake during pregnancy is of major importance for the health of both mother and fetus. Up to date, evidence on the prevalence of inadequate calcium intake among pregnant women is sparse for Western countries, and it is unknown to what extent inadequate dietary calcium intake is adequately balanced by supplement use. The objective of this study was to estimate calcium intake from diet and supplement use during the early pregnancy in The Netherlands. Methods As part of the Expect cohort study, 2477 pregnant women (8-16 weeks of gestation) completed an online questionnaire including questions on baseline characteristics, the use of calcium containing supplements, and a short food-frequency questionnaire (FFQ). Intake data were used to calculate median calcium intakes from diet, from supplements, and combined, and to compare these values with currently accepted requirement levels. Results Forty-two percent of the pregnant women had a total calcium intake below the estimated average requirement of 800 mg/day. Median (interquartile range) calcium intake was 886 (611-1213) mg/day. Calcium or multivitamin supplements were used by 64.8% of the women at 8 weeks of gestation, with a median calcium content of 120.0 (60.0-200.0) mg/day. Prenatal vitamins were the most often used supplements (60.6%). Conclusions Forty-two percent of Dutch pregnant women have an inadequate calcium intake. Supplements are frequently used, but most do not contain sufficient amounts to correct this inadequate intake.

Background: Preeclampsia (PE), a pregnancy complication, is characterized by abnormal placental angiogenesis. The current study examines the effect of vitamin D deficiency/supplementation on pregnancy outcome and placental angiogenesis using an animal model of PE. Methods: Pregnant Wistar rats were divided into four groups: Control; PE; Vitamin D deficient with PE (VDD-PE) and Vitamin D supplemented with PE (VDS-PE). PE was induced by administering L-nitroarginine methyl ester (L-NAME) at the dose of 50 mg per kg body weight per day from day 14 to day 19 gestation in all the 4 groups. During the pre-pregnancy and pregnancy period, the rats from the Control and PE groups were fed a control diet, the VDD-PE group received a vitamin D deficient diet and the VDS-PE group received a vitamin D supplemented diet. Dams were sacrificed at d20 of gestation. Results: L-NAME administration increased systolic as well as diastolic blood pressure in both PE and VDD-PE groups as compared to the control (p < 0.01). Vitamin D supplementation was beneficial in reducing the blood pressure. Vitamin D deficiency also lowered the placental protein levels of pro-angiogenic proteins VEGF and Flt-1 (p < 0.05 and p < 0.01, respectively), while the levels of these proteins in the VDS-PE group were similar to those in the control group. Vitamin D status did not influence the levels of PlGF and Hif1α. Conclusion: A low dose vitamin D supplementation given from pre-pregnancy and throughout pregnancy was beneficial in reducing the blood pressure and normalizing the placental levels of VEGF and Flt-1. This has implications for reducing the severity of preeclampsia.

BackgroundMaternal inflammation in early pregnancy has been identified epidemiologically as a prenatal pathogenic factor for the offspring's later mental illness. Early newborn manifestations of the effects of maternal inflammation on human fetal brain development are largely unknown.MethodsMaternal infection, depression, obesity, and other factors associated with inflammation were assessed at 16 weeks gestation, along with maternal C-reactive protein (CRP), cytokines, and serum choline. Cerebral inhibition was assessed by inhibitory P50 sensory gating at 1 month of age, and infant behavior was assessed by maternal ratings at 3 months of age.ResultsMaternal CRP diminished the development of cerebral inhibition in newborn males but paradoxically increased inhibition in females. Similar sex-dependent effects were seen in mothers' assessment of their infant's self-regulatory behaviors at 3 months of age. Higher maternal choline levels partly mitigated the effect of CRP in male offspring.ConclusionsThe male fetal-placental unit appears to be more sensitive to maternal inflammation than females. Effects are particularly marked on cerebral inhibition. Deficits in cerebral inhibition 1 month after birth, similar to those observed in several mental illnesses, including schizophrenia, indicate fetal developmental pathways that may lead to later mental illness. Deficits in early infant behavior follow. Early intervention before birth, including prenatal vitamins, folate, and choline supplements, may help prevent fetal development of pathophysiological deficits that can have life-long consequences for mental health.

Maternal choline supplementation (MCS) has emerged as a promising therapy to lessen the cognitive and affective dysfunction associated with Down syndrome (DS). Choline is an essential nutrient, especially important during pregnancy due to its wide-ranging ontogenetic roles. Using the Ts65Dn mouse model of DS, our group has demonstrated that supplementing the maternal diet with additional choline (4-5 × standard levels) during pregnancy and lactation improves spatial cognition, attention, and emotion regulation in the adult offspring. The behavioral benefits were associated with a rescue of septohippocampal circuit atrophy. These results have been replicated across a series of independent studies, although the magnitude of the cognitive benefit has varied. We hypothesized that this was due, at least in part, to differences in the age of the subjects at the time of testing. Here, we present new data that compares the effects of MCS on the attentional function of adult Ts65Dn offspring, which began testing at two different ages (6 vs. 12 months of age). These data replicate and extend the results of our previous reports, showing a clear pattern indicating that MCS has beneficial effects in Ts65Dn offspring throughout life, but that the magnitude of the benefit (relative to non-supplemented offspring) diminishes with aging, possibly because of the onset of Alzheimer's disease-like neuropathology. In light of growing evidence that increased maternal choline intake during pregnancy is beneficial to the cognitive and affective functioning of all offspring (e.g., neurotypical and DS), the addition of this nutrient to a prenatal vitamin regimen would be predicted to have population-wide benefits and provide early intervention for fetuses with DS, notably including babies born to mothers unaware that they are carrying a fetus with DS.

Maternal vitamin D status during pregnancy and lactation is a modifiable factor that may influence offspring musculoskeletal outcomes. However, few randomized trials have tested the effects of prenatal or postpartum vitamin D supplementation on offspring bone and muscle development.The aim was to examine hypothesized effects of improvements in early-life vitamin D status on childhood musculoskeletal health in Dhaka, Bangladesh.In a previously completed, double-blind, dose-ranging trial, healthy pregnant women (n = 1300) were recruited at 17-24 weeks' gestation and randomly assigned to a prenatal/postpartum regimen of 0/0, 4200/0, 16,800/0, 28,000/0, or 28,000/28,000 IU cholecalciferol (vitamin D3)/wk until 26 wk postpartum. In this new report, we describe additional follow-up at 4 y of age (n = 642) for longer-term outcomes. Bone mineral content (BMC) and areal bone mineral density (aBMD) were measured by DXA. Grip strength was tested using a hand-held dynamometer. The primary comparison was children of women assigned to 28,000 IU/wk prenatally compared with placebo. Differences are expressed as means and 95% CIs.Total-body-less-head (TBLH) BMC, TBLH aBMD, and grip strength were similar in the combined high-dose prenatal (28,000/0 and 28,000/28,000 IU/wk) compared with placebo groups (mean difference [95% CI] = 0.61 g [-10.90, 12.13], 0.0004 g/cm2 [-0.0089, 0.0097], and 0.02 kg [-0.26, 0.31], respectively). In dose-ranging analyses, TBLH BMC and aBMD, whole-body BMC and aBMD, and grip strength in each of the prenatal vitamin D groups were not significantly different from placebo (P 0.05 for all comparisons). Only head aBMD was greater in children of women assigned to the 28,000/28,000-IU regimen compared with placebo (mean difference [95% CI] = 0.024 g/cm2 [0.0009, 0.047], P = 0.042); the effect was attenuated upon adjustment for child height, weight, and sex (P = 0.11).Maternal prenatal, with or without postpartum, vitamin D supplementation does not improve child BMC, aBMD, or grip strength at 4 y of age. The MDIG trial and present follow-up study were registered prospectively at www.clinicaltrials.gov as NCT01924013 and NCT03537443, respectively.

OBJECTIVES: Health Canada recommends supplementation with 16–20 mg iron during pregnancy to maintain adequate iron stores and reduce the prevalence of iron deficiency. Most prenatal vitamins contain 27 mg iron (the recommended dietary allowance). In the case of diagnosed iron deficiency (typically defined as a ferritin concentration

Aim: The aim of this study was to assess biomarkers of calcium homeostasis and tooth development, in mothers during pregnancy and their children at birth, for enamel hypoplasia (EH) in the primary maxillary central incisor teeth. Methods: Bayesian methodology was used for secondary data analyses from a randomized, controlled trial of prenatal vitamin D3 supplementation in healthy mothers (N = 350) and a follow-up study of a subset of the children. The biomarkers were serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), total circulating 25-dihydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH)2D). The maternal biomarkers were assayed monthly during pregnancy, and the child’s biomarkers were derived from cord blood. Digital images of the child’s 2 teeth were scored for EH using Enamel Defects Index criteria for each of the incisal, middle, and cervical regions for an EH extent score. Results: The child EH prevalence was 41% (60/145), with most defects present in the incisal and middle tooth regions. Cord blood iPTH and 1,25(OH)2D levels were significantly associated with EH extent after controlling for maternal factors. For every 1 pg/mL increase in cord blood iPTH, the EH extent decreased by approximately 6%. For every 10 pg/mL increase in cord blood 1,25(OH)2D, the EH extent increased by almost 30% (holding all other terms constant and adjusting for subject-level heterogeneity). The relationship between maternal 25(OH)D and maternal mean iPTH varied significantly by EH extent. Conclusion: The results suggest possible modifiable relationships of maternal and neonatal factors of calcium homeostasis during pregnancy and at birth for EH, contributing to the frontier of knowledge regarding sound tooth development for dental caries prevention.

Fetal growth restriction is linked to adverse health outcomes and is prevalent in low- and middle-income countries; however, determinants of fetal growth are still poorly understood. The objectives were to determine the effect of prenatal vitamin D supplementation on the insulin-like growth factor (IGF) axis at birth, to compare the concentrations of IGF-I in newborns in Bangladesh to a European reference population and to estimate the associations between IGF protein concentrations and birth size. In a randomized controlled trial in Dhaka, Bangladesh, pregnant women enrolled at 17–24 weeks of gestation were assigned to weekly oral vitamin D3 supplementation from enrolment to delivery at doses of 4200 IU/week, 16,800 IU/week, 28,000 IU/week or placebo. In this sub-study, 559 woman–infant pairs were included for analysis and cord blood IGF protein concentrations were quantified at birth. There were no significant effects of vitamin D supplementation on cord blood concentrations of IGF-I (P = 0.398), IGF-II (P = 0.525), binding proteins (BPs) IGFBP-1 (P = 0.170), IGFBP-3 (P = 0.203) or the molar ratio of IGF-I/IGFBP-3 (P = 0.941). In comparison to a European reference population, 6% of girls and 23% of boys had IGF-I concentrations below the 2.5th percentile of the reference population. IGF-I, IGF-II, IGFBP-3 and the IGF-I/IGFBP-3 ratio were positively associated with at least one anthropometric parameter, whereas IGFBP-1 was negatively associated with birth anthropometry. In conclusion, prenatal vitamin D supplementation does not alter or enhance fetal IGF pathways.

Diverse studies have investigated the impact of prenatal exposure to vitamin D levels on brain development; however, evidence in humans has never been systematically reviewed. This article summarized evidence of the association between 25-hydroxyvitamin D [25(OH)D] levels in maternal blood in pregnancy or newborn blood at birth and neurodevelopmental outcomes, including cognition, psychomotor performance, language development, behavioral difficulties, attention deficit and hyperactivity disorder (ADHD), and autistic traits. PubMed, Web of Science and SCOPUS databases were systematically searched for epidemiologic studies published through May 2018 using keywords. Random-effects meta-analyses were conducted. Of 260 identified articles, 25 were included in the present review. Comparing the highest vs. the lowest category of prenatal 25(OH)D levels, the pooled beta coefficients were 0.95 (95% CI −0.03, 1.93; p = 0.05) for cognition, and 0.88 (95% CI −0.18, 1.93; p = 0.10) for psychomotor development. The pooled relative risk for ADHD was 0.72 (95% CI, 0.59, 0.89; p = 0.002), and the pooled odds ratio for autism-related traits was 0.42 (95% CI, 0.25, 0.71; p = 0.001). There was little evidence for protective effects of high prenatal 25(OH)D for language development and behavior difficulties. This meta-analysis provides supporting evidence that increased prenatal exposure to 25(OH)D levels is associated with improved cognitive development and reduced risk of ADHD and autism-related traits later in life. Associations represent a potentially high public health burden given the current prevalence of vitamin D deficiency and insufficiency among childbearing aging and pregnant women.

BACKGROUND OR OBJECTIVES: Pregnant women experience a lot of changes, which often reflect in their hematological indices. The study examines the differences in the hematological profile of pregnant and nonpregnant women in Port Harcourt, in the Niger Delta region of Nigeria. METHODS: The subjects were systematically sampled, comprising of 90 pregnant and 90 non-pregnant women, with ages ranging 16 to 45 years. Five milliliters of whole blood was collected from each subject at ambient temperature using standard venepuncture techniques and three milliliters was dispensed in EDTA bottle. T-test was used to compare the mean of the parameters among the pregnant and nonpregnant women. Analysis of variance was used to compare the means for the parameters within the three trimesters. Tukey’s Post Hoc test was used to identify the trimester pairs that had significant mean difference, Hematological parameters were analyzed using Abacus380 hematological analyzer. The data obtained were coded and analysed using SPSS version 20 and data were considered significant at p≤0.05. RESULTS: Comparison of pregnant women with controls showed that Total White Blood Count TWBC), monocytes, neutrophils, Mean Cell Volume (MCV), and Mean Cell Hemoglobin (MCH) were significantly increased in pregnancy (p

OBJECTIVES This study explored the association of children's salivary characteristics, past caries experience, birth weight, and reported maternal prenatal vitamin and mineral supplementation with the dental untreated decay of the child. METHODS This cross-sectional study, a sub-study of Griffith University Environments for Healthy Living birth cohort study, was conducted on 174 mother-child dyads. Mother's prenatal usage of vitamin and mineral supplements; child's birthweight; salivary pH, buffering capacity, and levels of salivary MS and LB were explored as risk indicators. Dental caries experience was assessed using International Caries Detection and Assessment System criteria. Path analysis was conducted to evaluate the association of risk indicators with children's current and past dental caries experience. RESULTS Children's past caries experience (β = 0.332, p = 0.018), and salivary MS counts (β = 0.215, p = 0.032) were positively associated with untreated decay at time of examination. With a trend towards significance, children whose mothers had reported taking iron supplements during pregnancy experienced lower levels of past caries (β = -0.137, p = 0.068) and untreated dental caries (β = -0.046, p = 0.051). CONCLUSIONS This study confirms that a child's levels of untreated decay is positively associated with their past caries, and that it correlates with current levels of salivary MS. Children of mothers who reported to have taken iron supplements during pregnancy experienced less caries throughout their lives. These observations confirm the importance to offspring of monitoring maternal health throughout pregnancy and of early monitoring of children's oral health in preventing future dental disease.

Background As pharmacists assume a larger role in prenatal and preconception care, providing an evidence-based recommendation for a prenatal vitamin is essential. Objectives To identify the prenatal vitamins that community pharmacists are recommending to patients and compare the contents with national and international standards. The secondary objectives were to compare responses between the type of pharmacy (chain, grocery, or independent) and region of Michigan. Methods A female student pharmacist posing as a patient anonymously interviewed 60 community pharmacists distributed across 5 different regions of Michigan through telephone to determine prenatal vitamin recommendations for preconception use. The regions of Michigan were included to determine if sociodemographic factors were associated with varying responses or recommendations. Results Of the pharmacists interviewed, 97% recommended a prenatal vitamin, with 81% recommending an over-the-counter (OTC) prenatal vitamin. Only 33% of the pharmacists provided a specific brand name. Folic acid was the most common ingredient that the pharmacists identified to look for in a prenatal vitamin, followed by docosahexaenoic acid and iron. No difference was detected in the pharmacist responses across type of pharmacy (chain, grocery store chain, or independent). A difference was found between regions of Michigan and recommendations for a specific prenatal vitamin brand (P = 0.017). Conclusion Most of the community pharmacists recommended an OTC prenatal vitamin with an adequate amount of folic acid. Considering the broad range of prenatal vitamins on the market, a clear recommendation from a pharmacist about a specific prenatal vitamin that contains adequate nutrients is paramount. Expanding the knowledge and understanding of key prenatal vitamin ingredients and availability may strengthen future recommendations.

A decade ago identified as bone-building mineral improving calcium absorption, today new research opens potentials of Vitamin D in spectrum of diseases from diabetes, hypertension to cancer including special population like pregnancy & lactation. Vitamin D deficiency is recognized as the most untreated nutritional deficiency currently in the world. As calcium demands increase during pregnancy, Vitamin D status becomes crucial for optimal maternal & fetal outcomes. Adverse health outcomes such as preeclampsia, low birth weight, neonatal hypocalcemia, bone fragility & increased incidence of autoimmune diseases have been linked to low Vitamin D levels during pregnancy & infancy. Vitamin D deficiency is common during pregnancy & lactation despite wide-spread use of prenatal vitamins, because these are inadequate to maintain normal Vitamin D levels. The widespread Vitamin D deficiency in pregnant women and lactating mother’s calls for a view to define optimum level of Vitamin D and the adequate amount of Vitamin D intake required to maintain optimum levels in these populations. The current IOM (US) as well as ICMR (India) recommendations for Vitamin D supplementation is not sufficient to maintain the optimal levels of serum 25(OH) D above 30 ng/ml required during pregnancy. It may therefore be judicious to include screening of all pregnant women for Vitamin D levels as a part of routine antenatal care and supplementation should be considered if deficiency persists. Till date interventional trials in special population suggest that administration of Vitamin D during pregnancy & lactation is safe & beneficial for optimal maternal & fetal outcomes. When Vitamin D deficiency is identified during pregnancy, most experts agree that up to 2000 IU/day of Vitamin D is safe. This review elaborates Vitamin D deficiency in Indian scenario and the need for Vitamin D supplementation, expounds and exercises the facts for implementation of Vitamin D supplementation to be advised when planning for pregnancy, current recommendations and implications of Vitamin D deficiency during pregnancy and lactation.

Background Lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ), collectively called the macular pigment (MP), are dietary carotenoids that preferentially localize in the macula of the human eye. MP protects the macula from photo-oxidative damage and enhances visual function. Inadequate maternal intake of carotenoids, coupled with the placental transfer of maternal carotenoids to support fetal brain and retina development, potentially put mothers at risk of depletion systemically and in their ocular tissues. Presently, maternal carotenoid status throughout pregnancy remains poorly characterized, and no prospective randomized controlled trial of L and Z supplementation via prenatal vitamins has assessed maternal and infants’ systemic and ocular carotenoid status during pregnancy. We hypothesize that prenatal maternal carotenoid supplementation will counteract maternal carotenoid depletion during pregnancy and will improve biomarkers of carotenoid status of both mothers and infants. Methods Lutein and Zeaxanthin in Pregnancy (L-ZIP) is a phase 2, single-center, prospective, double-masked, randomized active-controlled clinical trial conducted at the John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. Participants consume a daily standard prenatal multivitamin with no added carotenoids and are randomized (1:1 allocation) to receive either a capsule containing 10 mg L and 2 mg Z in safflower oil (Carotenoid group) or a capsule containing only safflower oil with no added carotenoids (Control group) for a period of 6 to 8 months. Skin, serum, and ocular carotenoids are measured at every study visit (i.e., within the first trimester [baseline], second trimester, third trimester, and 0–2 weeks postpartum). Skin carotenoid assessment is by resonance Raman spectroscopy (RRS); serum carotenoid status is quantified using high-performance liquid chromatography (HPLC); and MP is measured with the dual-wavelength autofluorescence. Infants’ MP and foveal anatomy are assessed using RetCam retinal camera and Bioptigen SD-OCT, respectively. The primary outcomes are changes in maternal systemic and ocular carotenoid status during pregnancy. Discussion L-ZIP is the first prospective RCT to investigate maternal carotenoid status throughout pregnancy and to determine whether prenatal maternal carotenoid supplementation will offset maternal carotenoid depletion and improve biomarkers of maternal and infant’s carotenoid status. Findings from L-ZIP will strengthen recommendations regarding prenatal carotenoid supplementation and consequently inform policy decisions. Trial registration ClinicalTrials.gov NCT03750968. Registered on November 23, 2018

Background Variability in the 25-hydroxyvitamin D [25(OH)D] response to prenatal and postpartum vitamin D supplementation is an important consideration for establishing vitamin D deficiency prevention regimens. Objectives We aimed to examine interindividual variation in maternal and infant 25(OH)D following maternal vitamin D supplementation. Methods In a randomized trial of maternal vitamin D supplementation (Maternal Vitamin D for Infant Growth Trial), healthy pregnant women (n = 1300) received a prenatal cholecalciferol (vitamin D-3) dose of 0, 4200, 16,800, or 28,000 IU/wk from 17 to 24 wk of gestation followed by placebo to 6 mo postpartum. A fifth group received 28,000 IU cholecalciferol/wk both prenatally and postpartum. In a subset of participants, associations of 25(OH)D with hypothesized explanatory factors were estimated in women at delivery (n = 655) and 6 mo postpartum (n = 566), and in their infants at birth (n = 502) and 6 mo of age (n = 215). Base models included initial 25(OH)D and supplemental vitamin D dose. Multivariable models were extended to include other individual characteristics and specimen-related factors. The model coefficient of determination (R2) was used to express the percentage of total variance explained. Results Supplemental vitamin D intake and initial 25(OH)D accounted for the majority of variance in maternal 25(OH)D at delivery and postpartum (R2 = 70% and 79%, respectively). Additional characteristics, including BMI, contributed negligibly to remaining variance (

Deficiencies of many nutrients in pregnancy have adverse effects on fetal brain development with consequent impaired cognitive function in childhood. However, it is unclear whether deficiencies of vitamin B12 prenatally are harmful to the developing fetus. We therefore used the Avon Longitudinal Study of Parents and Children to test the hypothesis that cognitive outcomes in childhood are reduced if their mothers consumed a diet low in vitamin B12 during pregnancy. A detailed exposome analysis was used to identify 9 factors independently associated with low vitamin B12 intake. These were taken into account in each of 26 outcome analyses. Results showed that the children of women with the lowest 10% intake of B12 were at increased risk of poor vocabulary at 24 months, reduced ability at combining words at 38 months, poor speech intelligibility at 6 years, poor mathematics comprehension at school years 4 and 6 (ages 8-9 and 10-11 years), and poor results on the national mathematics tests (age 13). There were no such significant adjusted associations for reading or spelling abilities, or for verbal or full-scale IQ (Intelligence Quotient) at 8 or at 15. Thus, we have confirmed that there are adverse effects on the child's development if the pregnant woman has a low intake of vitamin B12, and we have shown that these are specific to certain speech and mathematical abilities.

Objective: To examine general adherence to pregnancy health behaviours among HIV-negative and HIV-positive pregnant women.

A 22-year-old, gravida 1, para 0 at 33 weeks’ gestation presented to the endoscopy suite for repeat esophageal dilation. Because of long-standing achalasia and dysphagia, she had undergone esophagectomy with gastric pull-up 5 years previously but was having ongoing issues with an anastomotic stricture requiring repeated esophageal dilations, including earlier during this pregnancy. Given the severity of her dysphagia, her gastroenterologist felt that postponing the current esophageal dilation until after delivery was not advisable. She was otherwise healthy and took no medications other than prenatal vitamins and a proton-pump inhibitor. She had an allergy to latex and tree nuts.

Background We examined the effect of maternal vitamin D supplementation during pregnancy and lactation on risk of acute respiratory infection (ARI) in infants up to 6 months of age in Bangladesh. Methods This study was nested in a randomized, double-blind, placebo-controlled, 5-arm dose-ranging trial of prenatal and postpartum vitamin D supplementation. One group of women received 0 IU vitamin D per week during pregnancy and for 26 weeks post delivery (“placebo” group), one group received high-dose prenatal vitamin D supplementation of 28 000 IU per week and 26 weeks post delivery, and there were 3 additional dose-ranging groups receiving vitamin D supplementation during pregnancy only (4200, 16 800, and 28 000 IU per week, respectively). Episodes of ARI were identified by active and passive surveillance. The primary outcome was microbiologically confirmed ARI, and the primary analysis compared the high-dose prenatal plus postpartum vitamin D vs placebo groups. Results In total, 1174 mother-infant pairs were included. Among infants born to mothers in the placebo group, 98% had a venous umbilical cord 25(OH)D level below 30 nmol/L compared with none in the high-dose prenatal plus postdelivery vitamin D group. Incidence of microbiologically confirmed ARI in the high-dose prenatal plus postpartum vitamin D (1.21 episodes per 6 person-months; N = 235) and placebo groups (1.07 episodes per 6 person-months; N = 234) was not significantly different (hazard ratio of 1.12 [95% confidence intervals: 0.90-1.40]). There were no differences in the incidence of microbiologically confirmed or clinical ARI, upper, lower, or hospitalized lower respiratory tract infection between high-dose prenatal plus postpartum vitamin D and placebo groups. Conclusions Despite a high prevalence of maternal baseline vitamin D deficiency and significant effects of maternal vitamin D supplementation on infant vitamin D status, the intervention did not reduce the risk of microbiologically confirmed ARI in infants up to 6 months of age.

Background Systematic review and meta-analyses of observational studies on maternal vitamin D status and risk of respiratory allergic conditions indicated that mothers who had supplementation during pregnancy could decrease the risk of recurrent wheeze or asthma in their offspring. Objectives We conducted this meta-analysis of Randomized Controlled Trials with the primary intention of detecting the effect of prenatal vitamin D supplementation on the offspring's asthma. Secondary outcomes under respiratory health include eczema, lower respiratory tract infections, Immunoglobulin E positive test, upper respiratory tract infections, and allergic rhinitis. Methods A comprehensive search of PubMed, ScienceDirect, Google Scholar, and Cochrane Library databases was performed to retrieve randomized controlled trials. Risk Ratio with 95% confidence intervals was computed from dichotomous data using a random-effects model, with I2 >50% representing notable heterogeneity. Results Six clinical trials met the inclusion criteria, involving a total of 2898 subjects (1461 experimental group and 1437 control group). There was non-significant inverse relationship between vitamin D intake during pregnancy and the occurrence of asthma in offspring (pooled RR = 0.89, 95% CI = 0.69–1.15, I2 = 46% and Z-static = 0.90, P-value = 0.37). There is no significant difference in the risk of assessed childhood respiratory problems due to maternal supplementation of vitamin D during pregnancy. Conclusion and implications Currently, there is no fertile evidence to promote vitamin D supplementation in pregnancy for childhood respiratory health. Future clinical trials should emphasize early initiation of vitamin D supplementation, consider 6 weeks to 6 months postnatal critical window for vitamin D deficiency for offspring, lower risk dose of vitamin D, and identify different phenotypes of asthma and response to vitamin D supplementation.

OBJECTIVE: Iodine deficiency is a worldwide public health problem and a preventable cause of neuro-developmental delay in children. There are no data regarding iodine sufficiency and knowledge on iodine nutrition among pregnant women in Puerto Rico. The objective of this study was to assess iodine status, potential factors influencing iodine status, and knowledge regarding iodine nutrition among Puerto Rican pregnant women. METHODS: This was a cross-sectional study of 125 pregnant women recruited from an ambulatory high-risk obstetric clinic in San Juan, Puerto Rico. The participants completed a survey and provided spot urine samples. We excluded women on thyroid medications or those who had undergone iodinated contrast studies in the last 6 months. Spot urine iodine concentrations (UICs) were measured spectrophotometrically. RESULTS: The median UIC was 182 μg/L. Only 3 (2%) of the participants were aware that pregnant women need increased iodine intake, and 78% reported taking prenatal vitamins, 77% of which were prescription products. The participants who reported taking prescription prenatal vitamins had a median (range) UIC of 148.6 (15.3–1188.6) μg/L compared to those who were not taking prescription prenatal vitamins, who had a median UIC of 249.7 (47.8–2179.0) μg/L (P = .05). The iodine content of the prenatal vitamins was unknown. CONCLUSIONS: The World Health Organization has defined iodine deficiency as a median UIC of

OBJECTIVES\ud The purpose of this study was to parameterize mid-trimester drop in blood pressure (BP) trajectory during pregnancy and to evaluate its utility for predicting preeclampsia.\ud METHODS\ud To develop parametric models for BP trajectory during pregnancy, we used data from 7923 Chinese pregnant women with 24 810 routine antenatal care visits. Then, we evaluated the utility of BP trajectory parameters for predicting clinician-diagnosed preeclampsia in a separate sample of 3524 pregnant women from a randomized controlled trial of prenatal vitamin supplementation conducted in the same area. We focused on parameters related to the mid-trimester BP drop, including the gestational age and BP value at the nadir (lowest point), change in BP, velocity, and area under curve during two periods (from 12 weeks of gestation to the nadir and from the nadir to 33 weeks of gestation).\ud RESULTS\ud All participants in our analysis had a mid-pregnancy drop in their SBP, DBP, and mean arterial pressure (MAP) trajectories. There were high correlations (|r| > 0.90) among trajectory parameters of the same BP measure. The final prediction model included selective parameters of SBP, DBP, and MAP trajectories, prepregnancy BMI and gestational age at the first antenatal care visit. The area under the receiver-operating curve for predicting preeclampsia was 0.886 (95% confidence interval 0.846--0.926) in the training dataset and 0.802 (0.708--0.895) in the validation dataset.\ud CONCLUSION\ud Our novel BP trajectory parameters are informative and can predict preeclampsia at a clinically acceptable level.

OBJECTIVES: Vitamin D may have an adjunctive role in the prevention and treatment of iron deficiency (ID) through its proposed role in the regulation of erythropoiesis and circulating hepcidin concentrations. Observational studies have shown associations between low vitamin D and iron status; however, there are few data from intervention trials. In participants of the Maternal Vitamin D for Infant Growth Trial (MDIG; NCT01924013), among whom the baseline prevalence of vitamin D deficiency was 64%, we examined the effect of prenatal vitamin D supplementation on iron status during pregnancy by testing the effect of vitamin D supplementation on serum ferritin concentrations. METHODS: In this double-blind, dose-response, randomized trial in Dhaka, Bangladesh, women were recruited at 17–24 weeks’ gestation and randomly assigned to receive a prenatal vitamin D(3) dose of 4200, 16,800, 28,000 IU/week or placebo. Serum ferritin was quantified using an electro-chemiluminescence immunoassay. Plasma C-reactive protein (CRP) was analysed by enzyme-linked immunoassay. Linear regression was used to test the hypothesized effect of vitamin D supplementation on serum ferritin (n = 1011 of 1300 enrolled). In a sensitivity analysis, we adjusted for concurrent CRP to correct for inflammation (n = 920). Regression correction was used to generate an inflammation-corrected estimate of the prevalence of ID (n = 920). RESULTS: Prevalence of ID (serum ferritin

Background We assessed the relationships between prenatal pyrethroid pesticide exposure and autism spectrum disorders (ASD) or non-typical development (non-TD) at 3 years. Methods Participants were mother-child pairs (n = 201) in the MARBLES (Markers of Autism Risk in Babies-Learning Early Signs) cohort. Because familial recurrence risk is high, MARBLES enrolls pregnant women with a family history of ASD. Children from these pregnancies were clinically assessed at 3 years of age and classified into 3 outcome categories: ASD, typically developing (TD), or non-TD (neither TD or ASD). Repeated maternal second and third trimester urine samples were analyzed for pyrethroid metabolite 3-phenoxybenzoic acid (3-PBA). Multinomial logistic regression was used to obtain relative risk ratios (RRR) linking 3-PBA concentrations averaged across each trimester and over pregnancy with child's outcome: ASD or non-TD vs. TD. Models were adjusted for specific gravity, maternal pre-pregnancy BMI, prenatal vitamin use, birth year, home-ownership, and pregnancy concentrations of TCPy (3,5,6-trichloro-2-pyridinol, a metabolite of chlorpyrifos). Results The median specific gravity corrected 3-PBA concentration of all samples was 1.46 ng/mL. Greater second trimester 3-PBA concentrations were associated with a relative risk ratio (RRR) for ASD of (RRR: 1.50 (95% CI 0.89 to 2.51), p = 0.12). There were no differences between non-TD and TD. Conclusions This study found no evidence for differences in 3-PBA comparing non-TD with TD. A modestly elevated RRR was found comparing second trimester urinary 3-PBA concentrations for ASD versus TD; however, the confidence interval was wide and hence, these findings cannot be considered definitive.

BACKGROUND: In animal models, it is possible to induce different alcohol-related dysmorphic abnormalities based on the timing of prenatal alcohol exposure (PAE). Our objective was to assess whether patterns of PAE differentially predict alcohol-related dysmorphic features in 415 infants. METHODS: We analyzed a prospective pregnancy cohort in western Ukraine enrolled between 2008–2014. Five distinct trajectories were previously identified to summarize prenatal alcohol exposure: (A) minimal/no PAE (n=253), (B) low/moderate PAE with reduction early in gestation (n=78), (C) low/moderate sustained PAE (n=20), (D) moderate/high PAE with reduction early in gestation (n=45), and (E) high sustained PAE (n=19). A dysmorphology exam of body size, 3 cardinal and 15 non-cardinal dysmorphic features was performed at approximately 6–12 months of age. A modified dysmorphology score was created based on previously published weights. Univariate comparisons were made between each dysmorphic feature and trajectory group. Features that differed by trajectory group were assessed in multivariable analyses. Models were adjusted for maternal age, prenatal vitamin use, socioeconomic status, smoking, and child’s age at dysmorphology exam, with censoring weights for losses to follow-up. RESULTS: The three highest trajectories predicted total dysmorphology score, with larger effects in sustained exposure groups. Cardinal features: the three highest trajectories were each associated with a 2–3-fold increased risk of having 2+ cardinal facial features. When assessed individually, there were no consistent associations between the individual trajectories and each cardinal feature. Non-cardinal features: The three highest trajectories were associated with increased risk of hypotelorism. Only the highest trajectory was associated with heart murmur. The highest trajectory predicted