Developing a Prenatal Nutrition Tool: A Process of Evidence, Collaboration, and Consultation

The Prenatal Nutrition Tool was created for care providers that work with pregnant clients and aims to support focused conversations on nutrition topics that influence maternal and infant health outcomes. A systematic 9-step product development process that combined findings from the literature with perspectives of nutrition experts and care providers was used to develop the tool. The results of a literature review and a modified Delphi Process (to obtain expert opinion) laid the foundation for the tool content. The final tool incorporated client feedback. More specifically, client feedback helped to refine tool questions. The tool consists of 2 parts: a questionnaire (written survey) and a conversation guide. The questionnaire covers 4 key themes (pregnancy weight gain, multivitamins, life circumstances, overall food intake) in 13 questions. The conversation guide utilizes public health nutrition guidance documents to lead care providers in focused discussions with clients. The tool is not intended to be a screening tool for medical conditions or replace an in-depth prenatal nutrition assessment. The tool can be accessed by any care provider in Canada on the Alberta Health Services website at Prenatal Nutrition Tool | Alberta Health Services .

Characteristics of vulnerable women and their association with participation in a Canada Prenatal Nutrition Program site in Toronto, Canada

Introduction The Canada Prenatal Nutrition Program (CPNP) supports community organizations to provide maternal–infant health services for socially/economically vulnerable women. As part of our research program exploring opportunities to provide postnatal breastfeeding support through the CPNP, we investigated the sociodemographic and psychosocial characteristics of clients enrolled in a Toronto CPNP site and explored associations with participation. Methods Data were collected retrospectively from the charts of 339 women registered in one southwest Toronto CPNP site from 2013 to 2016. Multivariable regression analyses were used to assess associations between 10 maternal characteristics and three dimensions of prenatal program participation: initiation (gestational age at enrolment in weeks), intensity (number of times one-on-one supports were received) and duration (number of visits). Results The mean (SD) age of clients was 31 (5.7) years; 80% were born outside of Canada; 29% were single; and 65% had household incomes below the Statistics Canada family size-adjusted low-income cut-offs. Income was the only characteristic associated with all dimensions of participation. Compared to clients living above the low-income cut-off, those living below the low-income cut-off enrolled in the program 2.85 weeks earlier (95% CI: −5.55 to −0.16), had 1.29 times higher number of one-on-one supports (95% CI: 1.03 to 1.61) and had 1.29 times higher number of program visits (95% CI: 1.02 to 1.63). Conclusion Our findings show that this CPNP site serves vulnerable women, with few differences in participation based on maternal characteristics. This evidence can guide service provision and monitoring decisions at this program site. Further research is needed to explore new program delivery models to enhance perinatal services for vulnerable women.

Pre-natal nutrition education: Health care providers’ knowledge and quality of services in primary health care centres in Lagos, Nigeria

Introduction A healthy and balanced diet is very important during pregnancy. By enhancing maternal nutritional status, healthcare providers can lower the risks of pregnancy complications and adverse birth outcomes. Objectives To assess the pre-natal nutrition knowledge and services rendered by healthcare providers in antenatal clinics at Primary Health care Centres in Lagos, Nigeria. Methodology This was a cross-sectional study carried out in June—September 2019. Self-administered questionnaires were used to collect data on nutritional knowledge from 391 nurses and midwives who provided pre-natal nutrition education. Direct observation with checklist was used to assess the nutrition education services at the ANC clinics and covered: adequacy of the venue, availability/use of nutrition education resources, education content and teaching strategies. EPi-Info version 3.5 was used for data analysis. Inferential statistics such as chi square and multiple logistic regression were used to determine associated factors and predictors of nutrition knowledge. The level of significance was set at 5% (p<0.05). Results The mean age of respondents was 41.71±10.33years, all were females; 44.8% were Registered Nurses, 12.0% were Registered Midwives, and 23.8% had a B.Sc. in Nursing. Majority (81.3%) had taken a nutrition course in nursing training program, 62.1% as elective classes. Majority (81.1%) had good knowledge of prenatal nutrition. Respondents who were older (51-60years) (p<0.001), single (p<0.001) and Christian (p = 0.001) had significantly better knowledge. Nurses who had University degrees (p<0.001), of higher cadre (p<0.001), more years of practice (p<0.001) and involved in treating severely malnourished children (p = 0.013) were also significantly more knowledgeable. Respondents below 40 years (OR 0.104, CI 0.049–0.218) and those with 10 years or less of practice (OR 0.189, CI 0.092–0.387) had less odds of having good nutrition knowledge. Being single (OR 8.791, CI 3.125–24.731), and Christian (OR = 5.810, CI: 3.321–10.164) predict good nutrition knowledge. In 39% of the 41 PHCs observed, quality of nutrition education services was inadequate. Gaps were mainly in availability of certain nutrition education facilities/resources and teaching strategies. Conclusion The majority of the respondents had good knowledge of pre-natal nutrition. Overall, however, nutrition education services provided by two-fifths of the facilities were inadequate. Interventions to improve prenatal nutrition knowledge of nurses/midwives should be focused more on those who are younger and have less work experience. All necessary equipment required for health service providers to execute their roles as nutrition counselors and educators should also be provided by the government.

Exploring Biological Impacts of Prenatal Nutrition and Selection for Residual Feed Intake on Beef Cattle Using Omics Technologies: A Review

Approximately 70% of the cost of beef production is impacted by dietary intake. Maximizing production efficiency of beef cattle requires not only genetic selection to maximize feed efficiency (i.e., residual feed intake (RFI)), but also adequate nutrition throughout all stages of growth and development to maximize efficiency of growth and reproductive capacity, even during gestation. RFI as a measure of feed efficiency in cattle has been recently accepted and used in the beef industry, but the effect of selection for RFI upon the dynamics of gestation has not been extensively studied, especially in the context of fluctuating energy supply to the dam and fetus. Nutrient restriction during gestation has been shown to negatively affect postnatal growth and development as well as fertility of beef cattle offspring. This, when combined with the genetic potential for RFI, may significantly affect energy partitioning in the offspring and subsequently important performance traits. In this review, we discuss: 1) the importance of RFI as a measure of feed efficiency and how it can affect other economic traits in beef cattle; 2) the influence of prenatal nutrition on physiological phenotypes in calves; 3) the benefits of investigating the interaction of genetic selection for RFI and prenatal nutrition; 4) how metabolomics, transcriptomics, and epigenomics have been employed to investigate the underlying biology associated with prenatal nutrition, RFI, or their interactions in beef cattle; and 5) how the integration of omics information is adding a level of deeper understanding of the genetic architecture of phenotypic traits in cattle.

Prenatal Vitamins and the Risk of Offspring Autism Spectrum Disorder: Systematic Review and Meta-Analysis

Prenatal nutrition is associated with offspring autism spectrum disorder (herein referred to as autism), yet, it remains unknown if the association is causal. Triangulation may improve causal inference by integrating the results of conventional multivariate regression with several alternative approaches that have unrelated sources of bias. We systematically reviewed the literature on the relationship between prenatal multivitamin supplements and offspring autism, and evidence for the causal approaches applied. Six databases were searched up to 8 June 2020, by which time we had screened 1309 titles/abstracts, and retained 12 articles. Quality assessment was guided using Newcastle–Ottawa in individual studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for the body of evidence. The effect estimates from multivariate regression were meta-analysed in a random effects model and causal approaches were narratively synthesised. The meta-analysis of prenatal multivitamin supplements involved 904,947 children (8159 cases), and in the overall analysis showed no robust association with offspring autism; however, a reduced risk was observed in the subgroup of high-quality observational studies (RR 0.77, 95% CI (0.62, 0.96), I2 = 62.4%), early pregnancy (RR 0.76, 95% CI (0.58; 0.99), I2 = 79.8%) and prospective studies (RR 0.69, 95% CI (0.48, 1.00), I2 = 95.9%). The quality of evidence was very low, and triangulation was of limited utility because alternative methods were used infrequently and often not robustly applied.

Midwives’ Experiences with and Perspectives on Online (Nutritional) Counselling and mHealth Applications for Pregnant Women; an Explorative Qualitative Study

Prenatal nutrition is a key predictor of early-life development. However, despite mass campaigns to stimulate healthy nutrition during pregnancy, the diet of Dutch pregnant women is often suboptimal. Innovative technologies offer an opportunity to develop tailored tools, which resulted in the release of various apps on healthy nutrition during pregnancy. As midwives act as primary contact for Dutch pregnant women, the goal was to explore the experiences and perspectives of midwives on (1) nutritional counselling during pregnancy, and (2) nutritional mHealth apps to support midwifery care. Analyses of eleven in-depth interviews indicated that nutritional counselling involved the referral to websites, a brochure, and an app developed by the Dutch Nutrition Centre. Midwives were aware of the existence of other nutritional mHealth apps but felt uncertain about their trustworthiness. Nevertheless, midwives were open towards the implementation of new tools providing that these are trustworthy, accessible, user-friendly, personalised, scientifically sound, and contain easy-digestible information. Midwives stressed the need for guidelines for professionals on the implementation of new tools. Involving midwives early-on in the development of future nutritional mHealth apps may facilitate better alignment with the needs and preferences of end-users and professionals, and thus increase the likelihood of successful implementation in midwifery practice.

Parenting Gizi Berbasis WhatsApp untuk Meningkatkan Pengetahuan Ibu dalam Mengoptimalkan 1000 Hari Pertama Kehidupan

Maternal prenatal nutrition and a child's nutrition in the first two years of life (First 1000 Days of Life) are important factors in children's neurodevelopment and quality of life for children in the future. Unfortunately, not all mothers have sufficient knowledge to optimize this vital period of growth. This community service program aimed to increase maternal knowledge in optimizing the first 1000 days of life in the PKK group of Perum Tlanakan Indah, Pamekasan Regency. Nutrition parenting activities were carried out through WhatsApp group-based counseling. The results of data analysis using gain score showed an increase in maternal knowledge by 82,22% or the moderate category. The result of this program was expected to be a recommendation for the authority to provide education in their working area and support the optimization of 1000 HPK.ABSTRAKNutrisi prenatal ibu dan nutrisi anak dalam 2 tahun pertama kehidupan (1000 Hari Pertama Kehidupan) merupakan faktor penting dalam perkembangan saraf anak dan kualitas hidup anak di masa depan. Sayangnya, tidak semua ibu memiliki pengetahuan yang mencukupi untuk mengoptimalkan periode penting pertumbuhan. Program pengabdian kepada masyarakat ini bertujuan untuk meningkatkan pengetahuan ibu dalam kelompok PKK Perum Tlanakan Indah Kabupaten Pamekasan dalam mengoptimalkan 1000 Hari Pertama Kehidupan (HPK). Kegiatan parenting gizi dilaksanakan melalui penyuluhan berbasis WhatssApp group. Hasil analisis data melalui gain score menunjukkan bahwa terdapat peningkatan pengetahuan ibu sebesar 82,22% atau dalam kategori sedang. Dengan demikian, hasil kegiatan ini diharapkan bisa menjadi rekomendasi bagi pihak terkait untuk memberikan edukasi di wilayah kerjanya guna mendukung optimalisasi 1000 HPK.

Use of Expressed Breastmilk at Two Weeks Postpartum Is Associated With Early Cessation and Non-exclusive Breastmilk Feeding for Six Months in a Cohort of Vulnerable Women

Objectives Pumping and feeding expressed breastmilk (EBM) in the early postpartum period are common but may not support longer-term breastfeeding outcomes. Our objectives were to examine in a cohort of vulnerable mothers of term-born infants: i) the prevalence of EBM feeding; and ii) associations between EBM use at two weeks and any and exclusive breastmilk feeding over the first six months postpartum. Methods We pooled data from two studies conducted with participants (n = 316) at three Toronto sites implementing the Canada Prenatal Nutrition Program, an initiative targeting vulnerable families. Socio-demographic data were collected prenatally or at two weeks postpartum. Household food insecurity was assessed at six months using the Canadian Community Health Survey module. A standardized questionnaire was administered prospectively at two weeks and two, four and six months postpartum to collect data on infant feeding practices in the previous two weeks. Descriptive statistics and logistic regression analyses were performed. Results The mean age of participants was 32 years, 91% were born outside Canada and 38% had lived in Canada less than three years. Nearly half (44%) reported household food insecurity. All participants initiated breastfeeding and 34% reported EBM use at two weeks postpartum. This declined to 24% at two months, 14% at four months and 8% at six months postpartum. Over the six-month follow-up period, 20% discontinued any breastmilk feeding and only 16% practiced exclusive breastmilk feeding. In adjusted models, EBM use at two weeks was associated with breastmilk feeding cessation (OR 2.75; 95% CI: 1.4–5.2) and non-exclusive breastmilk feeding for six months postpartum (OR 4.32; 95% CI 1.8–10.5). Conclusions EBM use in the first two weeks was a predictor of early cessation and non-exclusive breastmilk feeding for six months postpartum in our cohort of vulnerable women living in an urban Canadian context and accessing prenatal nutrition programs. Further research is needed to determine whether early EBM use is a marker for breastfeeding difficulties or undermines longer-term breastfeeding outcomes. Funding Sources Canadian Institutes of Health Research; The Sprott Foundation: Joannah and Brian Lawson Centre for Child Nutrition.