Maternal Mental Health in Late Pregnancy and Longitudinal Changes in Postpartum Serum Vitamin B-12, Homocysteine, and Milk B-12 Concentration Among Brazilian Women.

Background: Little is known regarding the association between mental health distress during pregnancy and postpartum maternal serum biomarkers of vitamin B-12 status and milk B-12 concentration. Objective: To evaluate the association between depressive and anxiety symptoms in the third trimester of pregnancy and changes in postpartum serum B-12, homocysteine, and B-12 milk concentration. Methods: A total of 101 women (18-40 years) were studied in a prospective cohort with data at the third trimester of pregnancy (baseline) and three postpartum time-points (TPs): 2-8 days (TP1), 28-50 days (TP2), and 88-119 days (TP3) postpartum. B-12 concentrations in milk were measured by competitive chemiluminescent enzyme immunoassay at TP1, TP2, and TP3. Serum B-12 and homocysteine concentrations were evaluated at baseline, TP1, TP2, and TP3 by chemiluminescent immunoassays. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory at baseline. Spearman's correlation test and multiple linear mixed-effect models were performed. Results: The prevalence of depressive and anxiety state symptoms was 35.6 and 39.6% at baseline. High prevalence of low milk B-12 concentration (<310 pmol/L) were observed at TP1 (53.2%), TP2 (71.4%), and TP3 (71.1%). Women with anxiety symptoms at baseline presented higher median concentrations of serum homocysteine at TP1 and lower concentrations of serum and milk B-12 at TP2 compared with women without anxiety symptoms [8 (7; 9) vs. 6 (5; 8) and 266 (188; 369) vs. 332 (272; 413)]. Milk B-12 concentrations were positively and significantly correlated with maternal serum B-12 concentrations at different TP. Women with anxiety symptoms at baseline exhibited a decrease in daily postpartum homocysteine concentrations compared to women without anxiety symptoms (ß = -0.002, SE = 0.001, p = 0.024). Conclusion: Anxiety symptoms at the end of pregnancy were associated with longitudinal changes in maternal serum homocysteine concentrations during the first 3 months postpartum.

Associations Between Human Milk Oligosaccharides at 1 Month and Infant Development Throughout the First Year of Life in a Brazilian Cohort.

BACKGROUND: Human milk oligosaccharides (HMOs) are unconjugated glycans associated with infant health and development. OBJECTIVES: To investigate the associations between HMO concentrations at 1 month and infant development throughout the first year of life. METHODS: A prospective cohort of Brazilian women between 18-40 years of age and their infants was studied from baseline (between 28-35 gestational weeks) and followed at 1 (n = 73), 6 (n = 51), and 12 months (n = 45). A total of 19 HMOs were quantified by HPLC with fluorescence detection. Infant development was evaluated by the Brazilian Ages and Stages Questionnaire. A directed acyclic graph was used to define the minimally sufficient adjustment (gestational age at birth, gestational weight gain, prepregnancy BMI, maternal age, parity, and the mode of breastfeeding at 1 month). Cox regression models with HRs and Benjamini-Hochberg multiple corrections were performed to estimate associations of HMOs with the cumulative risk of inadequate development for 5 developmental domains or for ≥2 developmental domains in all women and in the subset of secretor women (defined as the presence or near absence of 2'-fucosyllactose and lacto-N-fucopentaose I). RESULTS: The multivariate models with multiple corrections revealed an inverse association between lacto-N-tetrose (LNT) and the risk of inadequate development for personal-social skills (0.06; 95% CI: 0.01-0.76) and for ≥2 developmental domains (0.06; 95% CI: 0.01-0.59). The secretor mothers analysis also showed inverse associations with slightly different results for personal-social skills (0.09; 95% CI: 0.02-0.84) and ≥2 developmental domains (0.05; 95% CI: 0.01-0.70). CONCLUSIONS: Higher concentrations of LNT HMOs in Brazilian women are associated with their infants being less likely to be at risk of inadequate development for personal-social skills or for ≥2 developmental domains during the first year of life.

Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk.

BACKGROUND: Little is known regarding the associations between maternal factors and B-vitamin and choline concentrations in early milk and the trajectories of these vitamins during lactation. OBJECTIVES: In this hypothesis-generating study, we modeled the association between maternal and offspring factors and longitudinal changes in milk B-vitamin and choline concentrations throughout lactation. METHODS: A hundred women were studied in a prospective birth cohort and milk samples from 52 women were collected at 2-8 d, 76 women at 28-50 d, and 42 women at 88-119 d postpartum. Maternal dietary intake during pregnancy and lactation was assessed by an FFQ. Linear mixed-effects models with interaction terms were used to evaluate changes in milk B-vitamin and choline concentrations over time based on maternal factors and the early postpartum concentrations of these micronutrients. RESULTS: The women with higher early postpartum milk concentrations of niacin (ßinteraction = -0.02; SE = 0.00; P < 0.001), pantothenic acid (ßinteraction = -0.10; SE = 2.56; P < 0.001), vitamin B-12 (ßinteraction= -0.10; SE = 0.03; P < 0.001), and choline (ßinteraction= -0.90; SE = 0.18; P < 0.001) exhibited a decrease in their concentrations throughout lactation. The participants with overweight and obesity prepregnancy experienced an increase in milk vitamin B-12 concentrations over time (ßinteraction = 0.04; SE = 0.02; P = 0.06). In contrast, a decrease in vitamin B-12 concentration was observed among women with vitamin B-12 intake below the RDA during pregnancy (ßinteraction= -0.08; SE = 0.05; P = 0.07). The women with niacin intake below the RDA during lactation experienced an increase in milk concentrations over time (ßinteraction = 0.01; SE = 0.01; P = 0.03). A gestational age at birth >40 wk was associated with an increase in milk choline concentration throughout lactation (ßinteraction = 0.54; SE = 0.16; P< 0.01). CONCLUSIONS: Changes in B-vitamin and choline concentrations in human milk over time may be associated with the early concentrations of these micronutrients in milk, maternal prepregnancy BMI, dietary intake, and gestational age at delivery.

Maternal mental health and gestational weight gain in a Brazilian Cohort.

Depression and anxiety are common during pregnancy, but little is known about the influence of these disorders on gestational weight gain (GWG). Data from a prospective cohort of pregnant women followed in a public healthcare center in Rio de Janeiro, Brazil, were used to evaluate the association of depression, anxiety, and suicide risk with GWG. GWG was evaluated at 5-13, 20-26, 30-36, and 37-42 weeks, and GWG adequacy was determined. Statistical analyses included linear mixed-effect models and Poisson regression. We evaluated 206 women, in which 15% (n = 31) presented major depressive disorder, 19.4% (n = 34) suicide risk and 10% (n = 21) generalized anxiety disorder at baseline. Women with depression at the first trimester, persistent depressive symptoms, and anxiety symptoms at the second trimester presented significantly lower rates of GWG per week compared to those without depression or anxiety, respectively. Persistent depressive symptoms represented a 2.40 (95% CI 1.20; 4.81; p = 0.013) increase in the risk of insufficient GWG. There was no significant association between generalized anxiety disorder or suicide risk with GWG. The presence of depression, depressive symptoms, and anxiety during pregnancy were associated with lower GWG rates. Persistent depressive symptoms during pregnancy were directly associated with insufficient GWG.