This week, we see the publication of the first papers in PLOS Medicine's special issue on nutrition in maternal and child health, advised by Guest Editors Dr. Lars Åke Persson of the London School of Hygiene & Tropical Medicine and based at the Ethiopian Public Health Institute, Addis Ababa; Dr. Kathleen M. Rasmussen of the Division of Nutritional Sciences at Cornell University, Ithaca, New York; and Dr. Huixia Yang of Peking University First Hospital and the Chinese Association of Obstetricians and Gynecologists.
In many parts of the world maternal and child health outcomes are increasingly impacted by indirect causes, many of which are related to nutrition. Women with diabetes, anemia or who are overweight are at a higher risk of childbirth-related complications. Their newborns, in turn, are also at a higher risk of experiencing adverse health outcomes later in life. With nearly one in three persons in the world suffering from at least one form of malnutrition - from undernutrition to obesity via diet-related non-communicable diseases - and infant nutrition being crucial particularly in the first 1,000 days of life, this Special Issue will focus on these topics with impactful research content.
In a Research article, Jane L Tarry-Adkins and colleagues reveal that babies born to mothers with gestational diabetes who are treated with metformin are likely to be of a lower birthweight than babies whose mothers are treated with insulin. Significantly, the children exposed to metformin are heavier than the insulin-exposed children at 18-24 months. Knowing that there is an increased risk of CVD and diabetes for children who undergo 'catch up' growth, it will be important to understand if these risks apply to children exposed to metformin.
Sophie E Moore and colleagues present the results of their trial to test whether nutritional supplements for pregnant women in a rural region of The Gambia improve a child's immune response. 875 women were randomised to receive one of 4 supplements: standard care of iron and folic acid (FeFol); FeFol plus multiple micronutrients; FeFol plus protein-energy; or FeFol plus protein-energy and micronutrients. Infants were vaccinated at 8, 12 and 16 weeks of age with the diphtheria-tetanus-pertussis vaccine and those whose mothers had received the combined FeFol, micronutrient and protein-energy supplement showed improved vaccine responses. This is a striking example of how a mother's nutritional status can impact a child beyond pregnancy and any immediate birth outcomes.
With much focus recently on complications occurring from obesity during pregnancy such as gestational diabetes - and the subsequent increased risk of developing type 2 diabetes - as well as increased risk of adiposity in children, there is increased awareness of the need for a healthy BMI at the start of pregnancy. Zainab Akhter and colleagues, in their systematic review and meta-analysis, reveal the increased risk of having a smaller size for gestational age baby and increased risk of preterm birth for mothers who have bariatric surgery prior to pregnancy. These findings indicate the need for additional nutritional support before conception and during pregnancy, and increased monitoring throughout pregnancy.
The issue will continue over the coming weeks with further research papers - to view the papers, visit our Special Issue Collection.
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Research Article - Tarry-Adkins et al
Funding:
JLA and SEO are funded by the British Heart Foundation (https://www.bhf.org.uk/) (RG/17/12/33167) and the Medical Research Council (MC_ UU_12012/4) (https://mrc.ukri.org/). CEA is supported by a grant from the Addenbrooke's Charitable Trust (ACT) (https://www.act4addenbrookes.org.uk/) and by an Isaac Newton Trust/Wellcome Trust ISSF/University of Cambridge Joint Research Grant (https://www.newtontrust.cam.ac.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Tarry-Adkins JL, Aiken CE, Ozanne SE (2019) Neonatal, infant, and childhood growth following metformin versus insulin treatment for gestational diabetes: A systematic review and meta-analysis. PLoS Med 16(8): e1002848. https://doi.org/10.1371/journal.pmed.1002848
Image Credit: Skitterphoto, Pixabay
Author Affiliations:
Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
Department of Obstetrics and Gynaecology, Rosie Hospital and NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002848
Research Article - Moore et al
Funding:
This research was jointly funded by the UK Medical Research Council (http://www.mrc.ac.uk) and the Department for International Development (DFID) under the MRC/DFID Concordat agreement (MRC Programme MC-A760-5QX00, awarded to AMP). The sponsors of the study had no role in the study design, collection, analysis and interpretation of the data, and writing of the manuscript.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Okala SG, Darboe MK, Sosseh F, Sonko B, Faye-Joof T, Prentice AM, et al. (2019) Impact of nutritional supplementation during pregnancy on antibody responses to diphtheria-tetanus-pertussis vaccination in infants: A randomised trial in The Gambia. PLoS Med 16(8): e1002854. https://doi.org/10.1371/journal.pmed.1002854
Author Affiliations:
Kings' College London, Department of Women and Children's Health, St Thomas' Hospital, London, United Kingdom
MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002854
Research Article - Akhter et al.
Funding:
This study was conducted as part of a Newcastle University Research Excellence Academy PhD Studentship received by ZA (https://www.ncl.ac.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Akhter Z, Rankin J, Ceulemans D, Ngongalah L, Ackroyd R, Devlieger R, et al. (2019) Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis. PLoS Med 16(8): e1002866. https://doi.org/10.1371/journal.pmed.1002866
Author Affiliations:
Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
Department of Surgery, Sheffield Teaching Hospitals, Sheffield, United Kingdom
Institute of Health Sciences Research, University of Aberdeen, Aberdeen, United Kingdom
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002866
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