Paediatric and perinatal epidemiology
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Paediatr Perinat Epidemiol · Jul 2012
Review Meta AnalysisVitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis.
Vitamin D has well-defined classical functions related to calcium metabolism and bone health but also has non-classical effects that may influence other aspects of health. There has been considerable recent interest in the role of vitamin D on outcomes related to pregnancy and young child health but few efforts have been made to systematically consolidate this evidence to inform the research and policy agenda for low-income countries. A systematic review was undertaken to identify intervention and observational studies of vitamin D supplementation, intake or status (25-hydroxy-vitamin D) during pregnancy on perinatal and infant health outcomes. ⋯ Little evidence from trials exists to evaluate the effect of vitamin D supplementation during pregnancy on maternal, perinatal or infant health outcomes. Based on both trials and observational studies, we recommend that future research explore small-for-gestational age, preterm delivery, pre-eclampsia, and maternal and childhood infections, as outcomes of interest. Trials should focus on populations with a high prevalence of vitamin D deficiency, explore the relevance of timing of supplementation, and the dosage used in such trials should be sufficient to correct deficiency.
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Paediatr Perinat Epidemiol · Jul 2012
ReviewAntihelminthics in pregnancy and maternal, newborn and child health.
Soil-transmitted helminths (STHs), primarily Ascaris, Trichuris and hookworm, inflict a substantial morbidity burden on poor populations living in tropical and subtropical regions. Chronic STH infections can cause intestinal blood loss and nutrient loss and/or malabsorption, which can result in or exacerbate iron deficiency, anaemia and other nutritional deficiencies. More than 1 billion people are infected with at least one STH, and at least 44 million pregnant women are infected with hookworm alone. ⋯ Three observational studies showed that antihelminthics in pregnancy improved maternal iron status, two studies reported beneficial effects on birthweight, and two studies found a beneficial effect on infant survival. Although few RCTs to date have failed to collectively demonstrate a clear beneficial impact of antihelminthics in pregnancy on maternal, newborn and child health outcomes, findings from observational studies suggest a potential benefit on maternal anaemia, birthweight and infant mortality. This meta-analysis was limited by a dearth of evidence from RCTs, and further trials examining the effect of antihelminthics starting in the second trimester of pregnancy in poor, STH-endemic regions with high rates of anaemia are needed.
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Paediatr Perinat Epidemiol · Jul 2012
Review Meta AnalysisInterventions with vitamins B6, B12 and C in pregnancy.
The water-soluble vitamins B6, B12 and C play important roles in maternal health as well as fetal development and physiology during gestation. This systematic review evaluates the risks and benefits of interventions with vitamins B6, B12 and C during pregnancy on maternal, neonatal and child health and nutrition outcomes. Relevant publications were identified by searching PubMed, Popline and Web of Science databases. ⋯ In conclusion, existing evidence does not justify vitamin C supplementation during pregnancy. Additional studies are needed to confirm positive effects of vitamin B6 supplementation on infant birthweight and other outcomes. While vitamin B12 supplementation may reduce the incidence of neural tube defects in the offspring based on theoretical considerations, research is needed to support this hypothesis.
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Paediatr Perinat Epidemiol · Jul 2012
ReviewIntergenerational influences on child growth and undernutrition.
Intergenerational effects on linear growth are well documented. Several generations are necessary in animal models to 'wash out' effects of undernutrition, consistent with the unfolding of the secular trend in height in Europe and North America. Birthweight is correlated across generations and short maternal stature, which reflects intrauterine and infant growth failure, is associated with low birthweight, child stunting, delivery complications and increased child mortality, even after adjusting for socio-economic status. ⋯ Failure to prevent linear growth failure in developing countries has serious consequences for short- and long-term health as well as for the formation of human capital. The nutrition transition has created a double burden by adding obesity and related chronic diseases to the public health agenda of countries still struggling with the 'old' problems of maternal and child undernutrition. The challenge ahead is to increase efforts to prevent linear growth failure while keeping child overweight at bay.
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Paediatr Perinat Epidemiol · Jul 2012
ReviewGlobal policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?
Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. ⋯ All member states are being encouraged by the World Health Assembly to scale-up efforts to improve maternal infant and young child nutrition. Hopefully Ministries of Health in countries most affected by maternal and child undernutrition will take leadership in the development of such plans, and ensure that the control of anaemia during pregnancy is given a great priority among these actions, as well as building programme experience with improved nutrition during pregnancy and lactation. For this to happen it is essential that donor support is assured, even if only to spearhead a few flagship countries.