Pleasant Stone Farm Clinical Reports

Combining probiotics with perinatal dietary counselling could help reduce the risk of diabetes in mothers and provide a “safe and cost-effective” tool in addressing obesity in children, according to a new study from Finland.

Published in the British Journal of Nutrition, the study found that probiotic-supplemented dietary counselling could help reduce the risk of diabetes during pregnancy, improve blood glucose control and improve child health.

“Taken together, long-term health benefits for mothers and children may be conferred by balanced maternal nutrition during pregnancy and lactation and by promoting the healthy gut microbiota in the mother and the child. The results of the present study add weight to the argument that the continuing burden of Western lifestyle diseases is modifiable,” write the researchers.

Methods

Initiated in 2002, the study included 256 women, who were randomized during their first trimester of pregnancy into a control and a dietary intervention group.

The women, none of whom had any chronic diseases, all received dietary counselling provided by welfare clinics according to a national program.

The intervention group received additionally intensive dietary counselling at every study visit provided by a nutritionist, the aim being a dietary intake complying with current recommendations, combined with conventional food products with favourable fat and fibre contents for use at home, said the researchers.

The intervention group was further randomised at baseline in a double-blind manner to receive either placebo capsules or probiotics (Lactobacillus rhamnosus GG supplied by Valio, and Bifidobacterium lactis Bb12 supplied by Chr. Hansen) at a dose of 1010 colony-forming units/d each.

The capsules were taken once per day, and the intervention period extended from the first trimester of pregnancy to the end of exclusive breast-feeding.

Results

The researchers evaluated pregnancy outcome and fetal and infant growth during the 24 months’ follow-up.

All pregnancies were of normal duration, and there were no adverse events noted in mothers or in children, which confirms the safety of this approach, said the researchers.

They noted that those women who had taken probiotics had a reduced frequency of gestational diabetes mellitus (GDM): 13 percent for the diet/probiotics group, compared to 36 percent for the diet/placebo group and 34 percent for the control group.

In addition, the dietary counselling during pregnancy reduced the risk of fetal overgrowth, which is thought to predispose to later obesity.

“Probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases,” wrote the researchers. “The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic. In view of the fact that birth size is a risk marker for later obesity, the present results are of significance for public health in demonstrating that this risk is modifiable.”

Source: Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study
British Journal of Nutrition (2010)
doi:10.1017/S0007114509993898
Authors: Raakel Luoto, Kirsi Laitinen, Merja Nermes and Erika Isolauri

British researchers have concluded pregnant women should be advised to take vitamin D after determining there is a “strong case” to back the vitamin’s benefits.

The researchers from the University College London Institute of Child Health wrote in the British Journal of Nutrition that supplementation of vitamin D will benefit pregnant women and reduce the risk of diseases such as infantile hypocalcaemia and rickets.

They said the UK was the only country in 31 that did not officially recommend vitamin D use women of reproductive age, even though the Department of Health advises pregnant women to take 10 micrograms per day.

But that advice is contradicted by the National Institute of Health and Clinical Excellence (NICE) which advises against supplements use – even though 10 micrograms is not usually attainable via a regular diet and sunshine.

The paper said the UK was the only one of 31 countries examined which did not recommend that women of reproductive age took a vitamin D supplement.

“The incidence of vitamin D deficiency in pregnant women in Britain is unacceptably high, especially during winter and spring,” said Dr Elina Hypponen, one of the report authors.

“This is compounded by a lack of exposure to sunlight and the limitations of an average diet to meet the optimal need. In the most severe cases, maternal vitamin D deficiency can be life threatening to a newborn.”

“We believe that the routine provision of a daily supplement throughout pregnancy would significantly decrease the number of mothers who are clearly vitamin D deficient, reducing related serious risks to their babies.”

The research also highlighted the problem of women with dark skin who do not absorb as much sunlight and therefore manufacture less vitamin D in vivo.

Source: British Journal of Nutrition

Published online ahead of print doi:10.1017/S0007114510002436

“Avoidance of vitamin D deficiency in pregnancy in the United Kingdom: the case for a unified approach in National policy”

Authors: Elina Hyppönen and Barbara J. Boucher

The development of a child’s brain in early pregnancy may be impaired by low folate levels in the mother, and lead to behavioural problems such as hyperactivity and inattention, says a new study.

Low folate levels in early pregnancy were associated with increased rates of childhood hyperactivity and peer problems, according to a study with 100 mothers and their children followed for almost nine years.

Scientists from the University of Southampton and University College London’s Institute of Child Health propose that the low folate levels impair the development of the brain in the foetus, and early pregnancy is a critical time for brain development.

“To our knowledge, this is the first study in humans to provide evidence for associations of maternal folate with behavioural outcomes in the offspring, and it is the first study to demonstrate a putative pathway via foetal head growth,” wrote the researchers in the Journal of Child Psychology and Psychiatry.

B for baby benefits

An overwhelming body of evidence links folate deficiency in early pregnancy to increased risk of neural tube defects (NTDs) – most commonly spina bifida and anencephaly – in infants. Most NTDs occur within the first 22 to 28 days of pregnancy, when the mother-to-be is not aware she is even pregnant.

Folic acid supplements after this time are too late to prevent neural tube defects and therefore fail to benefit women with unplanned pregnancies – more than half of all pregnancies in the US.

This connection led to the 1998 introduction of public health measures in the US and Canada, where all grain products are fortified with folic acid – the synthetic, bioavailable form of folate.

Preliminary evidence indicates that the measure is having an effect with a reported 15 to 50 per cent reduction in NTD incidence. A total of 51 countries now have some degree of mandatory fortification of flour with folic acid.

However, similar measures in other countries, including the UK where the new study was based, have been opposed by concerns that the folate/folic acid may mask vitamin B12 deficiency, which leads to a form of neurological problems.

Study details

Led by Southampton’s Dr Wolff Schlotz, the researchers recruited 100 mothers in early pregnancy and took blood samples to measure folate levels, and the followed them for an average of 8.75 years. The mothers reported on their children’s behaviour using the Strengths and Difficulties Questionnaire.

The results showed that low maternal levels of folate were associated with both higher childhood hyperactivity and peer problems scores.

“Although the associations are small and residual confounding is possible, our data provide preliminary support for the hypothesis that lower folate status in early pregnancy might impair foetal brain development and affect hyperactivity/inattention and peer problems in childhood,” wrote Dr Schlotz and his co-workers.

Dutch researchers reported in the British Journal of Nutrition in September 2009 that the children of mothers who took folic acid supplements during pregnancy were better at internalising and externalising problems, compared to the children of mothers who did not take supplements.

Source: Journal of Child Psychology and Psychiatry
May 2010, Volume 51, Issue 5, Pages: 594-602
“Lower maternal folate status in early pregnancy is associated with childhood hyperactivity and peer problems in offspring”
Authors: W. Schlotz, A. Jones, D.I.W. Phillips, C.R. Gale, S.M. Robinson, K.M. Godfrey