RESUMEN
BACKGROUND: Successfully recruiting male participants to complete a healthcare related study is important for healthcare study completion and to advance our clinical knowledgebase. To date, most research studies have examined the barriers and facilitators of female participants in longitudinal healthcare-related studies with limited information available about the needs of males in longitudinal research. This systematic review examines the unique barriers and facilitators to male recruitment across longitudinal healthcare-related research studies. METHODS: Following PRIMSA guidelines, MEDLINE, Embase, CINAHL and Web of Science databases were systematically searched using the terms recruitment and/or retention, facilitators and/or barriers and longitudinal studies from 1900 to 2023 which contained separate data on males aged 17-59 years. Health studies or interventions were defined longitudinal if they were greater than or equal to 12 weeks in duration with 3 separate data collection visits. RESULTS: Twenty-four articles published from 1976-2023 met the criteria. One-third of the studies had a predominantly male sample and four studies recruited only male participants. Males appear disinterested towards participation in health research, however this lack of enthusiasm can be overcome by clear, non-directive communication, and studies that support the participants interests. Facilitating factors are diverse and may require substantial time from research teams. CONCLUSIONS: Future research should focus on the specific impact of these factors across the spectrum of longitudinal health-related studies. Based on the findings of this systematic review, researchers from longitudinal health-related clinical trials are encouraged to consider male-specific recruitment strategies to ensure successful recruitment and retention in their studies. REGISTRATION: This systemic review is registered with the PROSPERO database (CRD42021254696).
Asunto(s)
Selección de Paciente , Humanos , Masculino , Estudios Longitudinales , Adulto , Adolescente , Persona de Mediana Edad , Adulto Joven , Investigación sobre Servicios de Salud/estadística & datos numéricosRESUMEN
Antenatal depression (AND) affects 1 in 10 fathers, potentially negatively impacting maternal mental health and well-being during and after the transition to parenthood. However, few studies have assessed the social predictors of paternal AND or their possible associations with maternal mental health. We analysed data from 180 couples participating in the Queensland Family Cohort longitudinal study. Both parents completed surveys measuring mental health, relationship quality, social support, and sleep quality at 24 weeks of pregnancy. Mothers also completed the same surveys 6 weeks' postpartum. Antenatal depression, stress, and anxiety were highest among fathers reporting lower social support and higher sleep impairment. Maternal AND, stress, and anxiety were higher among mothers reporting higher physical pain and poor sleep quality. Postnatally, mothers reporting lower social support also reported higher depression, anxiety, stress, and psycho-social well-being. While there were no significant associations between AND among fathers and maternal antenatal or postnatal depression, an exploratory analysis revealed that mothers whose partners reported lower antenatal social support also reported lower postnatal social support and higher postnatal depression. Our findings highlight the importance of including data among fathers to achieve a whole family approach to well-being during the transition to parenthood.
Asunto(s)
Depresión Posparto , Salud Mental , Masculino , Femenino , Humanos , Embarazo , Estudios Longitudinales , Estudios Prospectivos , Depresión Posparto/epidemiología , Depresión Posparto/psicología , Queensland/epidemiología , Padre/psicología , Madres/psicología , Depresión/epidemiología , Depresión/psicologíaRESUMEN
BACKGROUND: There are very few developed countries where physical isolation and low community transmission has been reported for COVID-19 but this has been the experience of Australia. The impact of physical isolation combined with low disease transmission on the mental health of pregnant women is currently unknown and there have been no studies examining the psychological experience for partners of pregnant women during lockdown. The aim of the current study was to examine the impact of the first COVID-19 lockdown in March 2020 and post lockdown from August 2020 on the mental health of pregnant women or postpartum women and their partners. METHODS: Pregnant women and their partners were prospectively recruited to the study before 24 weeks gestation and completed various questionnaires related to mental health and general wellbeing at 24 weeks gestation and then again at 6 weeks postpartum. The Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) were used as outcome measures for the assessment of mental health in women and DASS-21 was administered to their partners. This analysis encompasses 3 time points where families were recruited; before the pandemic (Aug 2018-Feb 2020), during lockdown (Mar-Aug 2020) and after the first lockdown was over (Sept-Dec 2020). RESULTS: There was no significant effect of COVID-19 lockdown and post lockdown on depression or postnatal depression in women when compared to a pre-COVID-19 subgroup. The odds of pregnant women or postpartum women experiencing severe anxiety was more than halved in women during lockdown relative to women in the pre-COVID-19 period (OR = 0.47; 95%CI: 0.27-0.81; P = 0.006). Following lockdown severe anxiety was comparable to the pre-COVID-19 women. Lockdown did not have any substantial effects on stress scores for pregnant and postpartum women. However, a substantial decrease of over 70% in the odds of severe stress was observed post-lockdown relative to pre-COVID-19 levels. Partner's depression, anxiety and stress did not change significantly with lockdown or post lockdown. CONCLUSION: A reproductive age population appear to be able to manage the impact of lockdown and the pandemic with some benefits related to reduced anxiety.
Asunto(s)
COVID-19 , Ansiedad/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles , Depresión/epidemiología , Femenino , Humanos , Salud Mental , Periodo Posparto/psicología , Embarazo , Mujeres Embarazadas/psicología , Estudios Prospectivos , Queensland/epidemiología , SARS-CoV-2RESUMEN
BACKGROUND: The Australian population has an unmet need for contraception. However, evidence suggests contraceptive patterns of Aboriginal and Torres Strait Islander populations are unique. To tailor contraceptive services and meet the contraceptive needs of Aboriginal and Torres Strait Islander people, it is important to understand the contributing factors to contraceptive use and non-use. METHODS: This study aimed to systematically review and narratively synthesise the evidence exploring the factors influencing contraceptive use among Aboriginal and Torres Strait Islander people. A systematic literature search was initially run in September 2016 and was updated again in April and August of 2018. A qualitative narrative synthesis was conducted from 2018 to 2019. Factors influencing contraceptive use or non-use were explored using a Social Ecological Model. RESULTS: The review identified 17 studies meeting the inclusion criteria published between 1972 and 2018. Most of the included studies were qualitative (n = 11), with the remaining studies being mixed methods (n = 3) or quantitative (n = 3). The majority focused on either a localised geographic area or specific Aboriginal or Torres Strait Islander community (n = 11). One study specifically focused on factors influencing contraceptive use, albeit among postpartum women. The remaining studies discussed factors influencing contraceptive use within the context of risky behaviour, sexual transmitted infections, or contraceptive practices more generally. Factors unique to individual communities included community attitudes (e.g. importance of not being too young to have a baby), specific cultural norms (e.g. subincising the penis as part of transition to manhood), and access to culturally appropriate health services. Other factors, including contraceptive characteristics (e.g. discomfort of condoms) and reproductive coercion (e.g. partner wants a baby), were similar to those found in the broader population of Australia and internationally. Most studies were lacking in quality, warranting more methodologically sound studies in the future to further assess the factors contributing to contraceptive use or non-use among Aboriginal and Torres Strait Islander people. CONCLUSIONS: Identifying community specific facilitators, as well as understanding the more broadly applicable factors contributing to contraceptive use or non-use, is essential if wanting to offer appropriate contraceptive services within an Aboriginal or Torres Strait Islander community.
Asunto(s)
Conducta Anticonceptiva/etnología , Anticonceptivos/uso terapéutico , Servicios de Planificación Familiar , Servicios de Salud del Indígena , Nativos de Hawái y Otras Islas del Pacífico , Australia/epidemiología , Conducta Anticonceptiva/estadística & datos numéricos , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: To describe the current contraception usage patterns from a cohort of Australian Indigenous women, including their ideal family size and spacing between children. DESIGN: Cross-sectional analysis of data (2012-2019). SETTING: Data are from a longitudinal study, the Gomeroi gaaynggal (babies from Gomeroi lands) program, based in rural and remote Gomeroi lands in New South Wales. PARTICIPANTS: Women carrying an Indigenous baby who enrolled during pregnancy were eligible for the study. The mother and child are then followed for up to 10 years. MAIN OUTCOME MEASURES: Contraception usage in the postnatal period was recorded, as well as whether they were sexually active, whether they wanted more children and their preferred spacing between children. Medical, social and demographic information was also collected. These measures were self-reported via an online tool (Survey Monkey® ) at their first visit to the study following the birth of their child. RESULTS: Ninety-nine women were included in the analysis. Most women reported that they were sexually active at the time they were questioned about their contraceptive usage. The most popular contraception choices were condoms, the oral contraceptive pill and implant rods. Those answering that they did not want more children had a median of three children already. Those who wanted more children had a median of one child. The majority of the women stated that 2-3 years between babies was ideal. CONCLUSION: The sampled women had clear beliefs about their ideal family size, in which contraceptive usage played an important part.
Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Composición Familiar , Nativos de Hawái y Otras Islas del Pacífico/psicología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Adulto , Anticoncepción/psicología , Conducta Anticonceptiva/psicología , Estudios Transversales , Femenino , Fertilidad , Humanos , Estudios Longitudinales , Nueva Gales del Sur , Población Rural/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
Maternal undernutrition during pregnancy is prevalent across the globe, and the origins of many chronic diseases can be traced back to in utero conditions. This systematic review considers the current evidence in animal models regarding the relationship between maternal global nutrient restriction during pregnancy and offspring kidney structure and function. CINAHL, Cochrane, EMBASE, MEDLINE, and Scopus were searched to November 2017. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles were screened by two independent reviewers. Twenty-eight studies met the inclusion criteria: 16 studies were on rats, 9 on sheep, 2 on baboons, and 1 on goats. The majority of the rat studies had maternal global nutrient restriction during pregnancy at 50% of ad libitum while restriction for sheep and baboon studies ranged from 50% to 75%. Because of the heterogeneity of outcome measures and the large variation in the age of offspring at followup, no meta-analysis was possible. Common outcome measures included kidney weight, nephron number, glomerular size, glomerular filtration rate, and creatinine clearance. To date, there have been no studies assessing kidney function in large animal models. Most studies were rated as having a high or unknown risk of bias. The current body of evidence in animals suggests that exposure to maternal global nutrient restriction during pregnancy has detrimental effects on offspring kidney structure and function, such as lower kidney weight, lower nephron endowment, larger glomerular size, and lower glomerular filtration rate. Further long-term followup of studies in large animal models investigating kidney function through to adulthood are warranted.
Asunto(s)
Fenómenos Fisiológicos Nutricionales de los Animales , Enfermedades Renales/etiología , Riñón , Desnutrición/fisiopatología , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Complicaciones del Embarazo/fisiopatología , Efectos Tardíos de la Exposición Prenatal , Animales , Modelos Animales de Enfermedad , Femenino , Tasa de Filtración Glomerular , Riñón/patología , Riñón/fisiopatología , Enfermedades Renales/patología , Enfermedades Renales/fisiopatología , Tamaño de los Órganos , Embarazo , Especificidad de la EspecieRESUMEN
BACKGROUND: Pregnancy can be a stressful time for many women. There is ample evidence of numerous physical and mental health inequities for Indigenous Australians. For those Indigenous women who are pregnant, it is established that there is a higher incidence of poor physical perinatal outcomes when compared with non-Indigenous Australians. However, little evidence exists that examines stressful events and post-traumatic stress disorder (PTSD) symptoms in pregnant women who are members of this community. AIMS: To quantify the rates of stressful events and PTSD symptoms in pregnant Indigenous women. METHODS: One hundred and fifty rural and remote Indigenous women were invited to complete a survey during each trimester of their pregnancy. The survey measures were the stressful life events and the Impact of Events Scale. RESULTS: Extremely high rates of PTSD symptoms were reported by participants. Approximately 40% of this group exhibited PTSD symptoms during their pregnancy with mean score 33.38 (SD = 14.37) significantly higher than a study of European victims of crisis, including terrorism attacks (20.6, SD = 18.5). CONCLUSIONS: The extreme levels of PTSD symptoms found in the women participating in this study are likely to result in negative implications for both mother and infant. An urgent response must be mounted at government, health, community development and research levels to address these findings. Immediate attention needs to focus on the development of interventions to address the high levels of PTSD symptoms that pregnant Australian Indigenous women experience.
Asunto(s)
Nativos de Hawái y Otras Islas del Pacífico/psicología , Complicaciones del Embarazo/epidemiología , Población Rural/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Estrés Psicológico/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Acontecimientos que Cambian la Vida , Nueva Gales del Sur/epidemiología , Embarazo , Estudios Prospectivos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Background. Previous research has shown that delivery mode can shape infant gut microbiome composition. However, mothers delivering by caesarean section routinely receive prophylactic antibiotics prior to delivery, resulting in antibiotic exposure to the infant via the placenta. Previously, only a small number of studies have examined the effect of delivery mode versus antibiotic exposure on the infant gut microbiome with mixed findings.Objective. We aimed to determine the effect of delivery mode compared to antibiotic use during labour and delivery on the infant and maternal gut microbiome at 6 weeks post-partum.Methodology. Twenty-five mother-infant dyads were selected from the longitudinal Queensland Family Cohort Study. The selected dyads comprised nine vaginally delivered infants without antibiotics, seven vaginally delivered infants exposed to antibiotics and nine infants born by caesarean section with routine maternal prophylactic antibiotics. Shotgun-metagenomic sequencing of DNA from stool samples collected at 6 weeks post-partum from mother and infant was used to assess microbiome composition.Results. Caesarean section infants exhibited decreases in Bacteroidetes (ANCOM-BC q<0.0001, MaAsLin 2 q=0.041), changes to several functional pathways and altered beta diversity (R 2=0.056, P=0.029), while minimal differences due to antibiotic exposure were detected. For mothers, caesarean delivery (P=0.0007) and antibiotic use (P=0.016) decreased the evenness of the gut microbiome at 6 weeks post-partum without changing beta diversity. Several taxa in the maternal microbiome were altered in association with antibiotic use, with few differentially abundant taxa associated with delivery mode.Conclusion. For infants, delivery mode appears to have a larger effect on gut microbiome composition at 6 weeks post-partum than intrapartum antibiotic exposure. For mothers, both delivery mode and intrapartum antibiotic use have a small effect on gut microbiome composition at 6 weeks post-partum.
Asunto(s)
Antibacterianos , Cesárea , Parto Obstétrico , Heces , Microbioma Gastrointestinal , Humanos , Microbioma Gastrointestinal/efectos de los fármacos , Microbioma Gastrointestinal/genética , Femenino , Antibacterianos/administración & dosificación , Embarazo , Adulto , Lactante , Heces/microbiología , Periodo Periparto , Recién Nacido , Masculino , Profilaxis Antibiótica , Estudios LongitudinalesRESUMEN
Background: Mental health conditions prior to or during pregnancy that are not addressed can have adverse consequences for pregnancy and birth outcomes. This study aimed to determine the extent to which women's mental health-related hospitalisation (MHrH) prior to or during pregnancy was associated with a risk of adverse birth outcomes. Methods: We linked the perinatal data register for all births in the Northern Territory, Australia, from the year 1999 to 2017, to hospital admissions records to create a cohort of births to women aged 15-44 years with and without MHrH prior to or during pregnancy. We used Modified Poisson Regression and Latent Class Analysis to assess the association between maternal MHrH and adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight, and short birth length). We explored a mediation effect of covariates on theoretical causal paths. We calculated the adjusted Population Attributable Fraction (PAF) and Preventive Fractions for the Population (PFP) for valid associations. Findings: From 72,518 births, 70,425 births (36.4% for Aboriginal women) were included in the analysis. The Latent Class Analys identified two classes: high (membership probability of 10.5%) and low adverse birth outcomes. Births to Aboriginal women with MHrH were around two times more likely to be in the class of high adverse birth outcomes. MHrH prior to or during pregnancy increased the risk of all adverse birth outcomes in both populations with risk ranging from 1.19 (95% CI: 1.05, 1.35) to 7.89 (1.17, 53.37). Eight or more antenatal care visits and intrauterine growth restriction mostly played a significant mediation role between maternal MHrH and adverse birth outcomes with mediation effects ranging from 1.04 (1.01, 1.08) to 1.39 (1.14, 1.69). MHrH had a low to high population impact with a PAF ranging from 16.1% (5.1%, 25.7%) to 87.3% (14.3%, 98.1%). Eight or above antenatal care visits avert extra adverse birth outcomes that range from 723 (332-765) stillbirths to 3003 (1972-4434) preterm births. Interpretation: Maternal MHrH is a modifiable risk factor that explained a low to moderate risk of adverse birth outcomes in the Northern Territory. The knowledge highlights the need for the development and implementation of preconception mental health care into routine health services. Funding: The Child and Youth Development Research Partnership (CYDRP) data repository is supported by a grant from the Northern Territory Government.
RESUMEN
The stillbirth rate among Aboriginal and Torres Strait Islander women and communities in Australia is around double that of non-Indigenous women. While the development of effective prevention strategies during pregnancy and improving care following stillbirth for women and families in communities has become a national priority, there has been limited progress in stillbirth disparities. With community permission, this study aimed to gain a better understanding of community experiences, perceptions, and priorities around stillbirth. We undertook an Indigenous researcher-led, qualitative study, with community consultations guided by a cultural protection protocol and within an unstructured research framework. A total of 18 communities were consulted face-to-face through yarning interviews, focus groups and workshops. This included 54 community member and 159 health professional participants across remote, regional, and urban areas of Queensland, Western Australia, Victoria, South Australia, and Northern Territory. Thematic analysis of consultation data identified common themes across five focus/priority areas to address stillbirth: Stillbirth or Sorry Business Baby care needs to be family-centered; using Indigenous "ways of knowing, being, and doing" to ensure cultural safety; application of Birthing on Country principles to maternal and perinatal care; and yarning approaches to improve communication and learning or education. The results underscore the critical need to co-design evidence-based, culturally appropriate, and community-acceptable resources to help reduce existing disparities in stillbirth rates.
Asunto(s)
Grupos Focales , Investigación Cualitativa , Mortinato , Adulto , Femenino , Humanos , Masculino , Embarazo , Australia , Aborigenas Australianos e Isleños del Estrecho de Torres , Entrevistas como Asunto , Mortinato/psicologíaRESUMEN
BACKGROUND: In Australia, Aboriginal and Torres Strait Islander (Indigenous) families have strong, cohesive, and nurturing cultural practices that contribute to effective family functioning and child rearing. These practices can lead to positive effects on children and communities, and include kinship relations, traditional knowledge systems, collective community focus, respect for Elders contributions, and spirituality. However, poor health and wellbeing outcomes exist across the lifespan for Indigenous Australians. Health programs, services and research that support Indigenous women, babies and their families are a critical investment to improve birthing and health outcomes and impact the life trajectories of Indigenous Australians. AIM: The Indigenous Health Research Priorities study aims to identify the research priorities for families during the perinatal and early childhood period through a co-designed and collaborative process. This has been led by communities to determine the priorities identified with and for local Indigenous families in Queensland. This paper aims to report on engagement and involvement with Indigenous communities to identity health research priorities for families and presents preliminary findings of the research process including participants' demographic information and feedback on the yarning sessions, as part of the study protocol. METHODS: The study protocol showcases the Participatory Action Research approach, yarning sessions with clients and staff of three community-controlled health services to date, and Delphi workshop methods to prioritise the health issues identified during the yarns with corresponding communities. The study will undertake qualitative data collection and analysis to identify and report on community and health service research priorities for Indigenous families in Queensland. A short survey was conducted to collect participants' demographic information. A feedback form with five open-ended questions was also administered to collect data on participants' views and satisfaction with the research process. PRELIMINARY RESULTS: This protocol paper reports on the participant demographic information and feedback on the research process and reactions to participating in the yarning sessions. There have been 12 yarning sessions in Far North Queensland to date. The qualitative analysis of these will be reported on in future, with South East Queensland and further sites to follow. Feedback from 61 community members and health professionals has highlighted they valued sharing stories, being heard, and feeling hopeful. Preliminary findings will be reported. DISCUSSION: Identification of health research priorities will allow each organisation and region of Queensland to develop research initiatives and the translational outcomes that are a focus for their community members.
Health programs and services designed to support Aboriginal and Torres Strait Islander (herein Indigenous) women, babies and their families are a critical investment to improve birthing and health outcomes, and potentially impact the life course of Indigenous Australians. The Indigenous Health Research Priorities study aims to identify research priorities for families during pregnancy, birthing, and early childhood through a collaborative consultation process. We engaged with community members, both clients and health care staff of three community-controlled health services in Far North Queensland. Yarning sessions were held to identify health research priorities with and for local Indigenous families. Feedback forms were collected to gauge engagement and satisfaction with the research process. Twelve yarning sessions with 61 participants highlighted they valued sharing stories, being heard, having a voice, and feeling hopeful. Identifying health research priorities will allow each organisation and region of Queensland to develop health programs and services and research initiatives that are important for their community members.Once the yarning group data is analysed, we will return to discuss, prioritise, and reach consensus on those health issues identified during the yarns with communities, using a Delphi study. The Delphi will run as an interactive workshop using playing cards and group discussions, where participants will rank the importance of the health issues for their community. Prioritising the top 10 health issues will help to ensure research is designed better for and with communities, so that future research directions meet the needs identified and self-determined by Indigenous communities.
RESUMEN
Breastmilk is thought to influence the infant gut by supplying prebiotics in the form of human milk oligosaccharides and potentially seeding the gut with breastmilk microbes. However, the presence of a breastmilk microbiota and origins of these microbes are still debated. As a pilot study, we assessed the microbes present in expressed breastmilk at six-weeks postpartum using shotgun metagenomic sequencing in a heterogenous cohort of women who delivered by vaginal (n = 8) and caesarean delivery (n = 8). In addition, we estimated the microbial load of breastmilk at six-weeks post-partum with quantitative PCR targeting the 16S rRNA gene. Breastmilk at six-weeks postpartum had a low microbial mass, comparable with PCR no-template and extraction controls. Microbes identified through metagenomic sequencing were largely consistent with skin and oral microbes, with four samples returning no identifiable bacterial sequences. Our results do not provide convincing evidence for the existence of a breastmilk microbiota at six-weeks postpartum. It is more likely that microbes present in breastmilk are sourced by ejection from the infant's mouth and from surrounding skin, as well as contamination during sampling and processing.
Asunto(s)
Microbiota , Leche Humana , Lactante , Embarazo , Humanos , Femenino , Leche Humana/microbiología , Proyectos Piloto , ARN Ribosómico 16S/genética , Lagunas en las Evidencias , Microbiota/genética , Periodo Posparto , BocaRESUMEN
Higher dietary intakes of Omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) have been linked to lower rates of preterm birth and preeclampsia. The aim of this analysis was to describe dietary intake and fractions of red blood cell (RBC) membrane LC-PUFAs during pregnancy in a cohort of Indigenous Australian women. Maternal dietary intake was assessed using two validated dietary assessment tools and quantified using the AUSNUT (Australian Food and Nutrient) 2011-2013 database. Analysis from a 3-month food frequency questionnaire indicated that 83% of this cohort met national n-3 LC-PUFA recommendations, with 59% meeting alpha-linolenic acid (ALA) recommendations. No nutritional supplements used by the women contained n-3 LC-PUFAs. Over 90% of women had no detectable level of ALA in their RBC membranes, and the median Omega-3 Index was 5.5%. This analysis appears to illustrate a decline in concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) across gestation in women who had preterm birth. However, there was no visible trend in LC-PUFA fractions in women who experienced hypertension during pregnancy. Further research is needed to better understand the link between dietary intake of n-3 LC-PUFA-rich foods and the role of fatty acids in preterm birth and preeclampsia.
Asunto(s)
Ácidos Grasos Omega-3 , Preeclampsia , Nacimiento Prematuro , Embarazo , Humanos , Recién Nacido , Femenino , Aborigenas Australianos e Isleños del Estrecho de Torres , Dieta , Australia , Ácido Eicosapentaenoico , Ácidos Docosahexaenoicos , Ácidos Grasos Insaturados , Ácidos GrasosRESUMEN
AIM: The nutritional quality of foods consumed by infants and young children to complement breastfeeding or formula feeding influences growth and development. The aim of this study was to identify the dietary intake of Indigenous infants and young children in the Gomeroi gaaynggal cohort, and evaluate the nutritional adequacy of their intake compared with Australian recommendations. METHODS: Dietary intake was assessed using diet recalls at approximately 9-, 12- and 24-month visits. Nutrient values of foods were obtained from AUSNUT 2011-13 and nutrient intake compared to the Australian Nutrient Reference Values. Foods were categorised into food groups and intakes compared to the Australian Guide to Healthy Eating. RESULTS: A total of 206 infants and young children were included in the study. Of these, 95 individual children had dietary data collected between 7.6 and 24.7 months. Infant formula and breastfeeding rates were highest among infants (70% and 20%, respectively). Cow's milk intake was highest among young children (75%). Infants and young children in the cohort met most macro- and micronutrient intake recommendations. Few young children met recommendation for iron (42%), no infant met recommendation for omega-3 fatty acids and almost all exceeded recommendation for sodium. Most young children met daily dairy and fruit recommendations although intake of discretionary foods was high. CONCLUSIONS: This study found that diets of Indigenous infants and young children met most key nutrient reference targets. Potential target areas that require dietary optimisation have been identified and will be the focus of community-led strategies in adequate infant nutrition promotion.
Asunto(s)
Dieta , Ingestión de Energía , Animales , Australia , Bovinos , Niño , Preescolar , Ingestión de Alimentos , Femenino , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del LactanteRESUMEN
Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.
Asunto(s)
Dieta , Desarrollo Fetal/fisiología , Pueblos Indígenas , Riñón/embriología , Fenómenos Fisiologicos Nutricionales Maternos , Adulto , Australia , Estudios de Cohortes , Dieta Saludable , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Estudios Longitudinales , Fenómenos Fisiologicos Nutricionales Maternos/fisiología , Necesidades Nutricionales , Embarazo , Resultado del Embarazo , Tercer Trimestre del Embarazo , Efectos Tardíos de la Exposición Prenatal , Estudios ProspectivosRESUMEN
OBJECTIVE: to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN: analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING: women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS: 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS: measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on pre-pregnancy body mass index, the rate of adequate gestational weight gain in this cohort was low (26%). 33% of women had inadequate weight gain and 41% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (65%), with rates of 39% and 31% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.2, p < 0.01) and hypertension (coefficient 4.3, p = 0.049) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS: few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE: a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.
RESUMEN
Maternal obesity during pregnancy has a detrimental impact on offspring renal development and function. This is pertinent to Indigenous Australians as they are twice as likely as non-Indigenous Australians to develop chronic kidney disease (CKD). The aim of this study was to examine whether there was an association between maternal adiposity and fetal kidney growth in late gestation (>28 weeks) and kidney function in infants, <2.5 years of age, from the Gomeroi gaaynggal cohort. Pre-pregnancy body mass index (BMI) was recorded at the first prenatal visit and maternal adiposity indicators (percent body fat and visceral fat area) measured at >28 weeks gestation by bioelectrical impedance analysis. Fetal kidney structure was assessed by ultrasound. Renal function indicators (urinary albumin:creatinine and protein:creatinine) were measured in infants from a spot urine collection from nappies. Multiple linear regression and multi-level mixed effects linear regression models with clustering were used to account for repeated measures of urine. 147 mother-child pairs were examined. Estimated fetal weight (EFW), but not fetal kidney size, was positively associated with maternal adiposity and pre-pregnancy BMI. When adjusted for smoking, combined kidney volume relative to EFW was negatively associated with maternal percentage body fat. Infant kidney function was not influenced by maternal adiposity and pre-pregnancy BMI (n = 84 observations). Current findings show that Indigenous babies born to obese mothers have reduced kidney size relative to EFW. We suggest that these babies are experiencing a degree of glomerular hyperfiltration in utero, and therefore are at risk of developing CKD in later life, especially if their propensity for obesity is maintained. Although no impact on renal function was observed at <2.5 years of age, long-term follow-up of offspring is required to evaluate potential later life impacts.
Asunto(s)
Adiposidad , Riñón/embriología , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Insuficiencia Renal Crónica/epidemiología , Adulto , Australia , Niño , Femenino , Humanos , Pueblos Indígenas/estadística & datos numéricos , Riñón/diagnóstico por imagen , Riñón/fisiología , Masculino , Embarazo , Ultrasonografía PrenatalRESUMEN
OBJECTIVE: to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN: analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING: women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS: 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS: measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS: few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE: a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.
Asunto(s)
Aumento de Peso/fisiología , Adulto , Índice de Masa Corporal , Estudios de Cohortes , Diabetes Gestacional/psicología , Ejercicio Físico/psicología , Conducta Alimentaria/psicología , Femenino , Humanos , Modelos Lineales , Estudios Longitudinales , Nueva Gales del Sur , Obesidad/complicaciones , Sobrepeso/complicaciones , Sobrepeso/prevención & control , Grupos de Población , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/prevención & control , Fumar/psicologíaRESUMEN
The intrauterine environment is critical for fetal growth and organ development. Evidence from animal models indicates that the developing kidney is vulnerable to suboptimal maternal nutrition and changes in health status. However, evidence from human studies are yet to be synthesised. Therefore, the aim of the current study was to systematically review current research on the relationship between maternal nutrition during pregnancy and offspring kidney structure and function in humans. A search of five databases identified 9501 articles, of which three experimental and seven observational studies met the inclusion criteria. Nutrients reviewed to date included vitamin A (n = 3), folate and vitamin B12 (n = 2), iron (n = 1), vitamin D (n = 1), total energy (n = 2) and protein (n = 1). Seven studies were assessed as being of "positive" and three of "neutral" quality. A variety of populations were studied, with limited studies investigating maternal nutrition during pregnancy, while measurements of offspring kidney outcomes were diverse across studies. There was a lack of consistency in the timing of follow-up for offspring kidney structure and/or function assessments, thus limiting comparability between studies. Deficiencies in maternal folate, vitamin A, and total energy during pregnancy were associated with detrimental impacts on kidney structure and function, measured by kidney volume, proteinuria, eGFRcystC and mean creatinine clearance in the offspring. Additional experimental and longitudinal prospective studies are warranted to confirm this relationship, especially in Indigenous populations where the risk of renal disease is greater.