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Low levels of omega-3 fatty acids might be associated with a higher risk of preterm birth

Low levels of omega-3 fatty acids might be associated with a higher risk of preterm birth

For decades, there were ongoing discussions whether a high intake of fatty acids, either by eating more sea fish or by taking fish oil supplements, can reduce the risk of preterm birth, and different studies produced different results. A new study [1], published in the journal EBioMedicine, now suggests that there might be a connection between low levels of fatty acids in the blood and preterm birth.

In the new study from Olsen SF et al. , researchers looked at data from the Danish National Birth Cohort, a government database that contains information and blood samples for research purposes from more than 100,000 pregnant women in Denmark since it started in 1993. They extracted 376 early preterm cases (<34 gestational weeks) from the database, and for the control group they randomly selected 348 women who delivered term babies. The researchers then compared the concentrations of the long-chain fatty acids EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid) in both groups. EPA and DHA are the two omega−3 fatty acids that can be found in marine oils.

What the researchers found was “a strong and significant non-linear association (p < 0.0001) in which the risk of early preterm birth steeply increased when EPA and DHA concentrations were lower than 2% and flattened out at higher levels.”[1] In comparison, the mean EPA/DHA concentrations in people not taking omega-3 supplements are about 3%-4%.[2]

These results seem to confirm other studies saying that eating more sea fish or taking a fish oil supplement during pregnancy could potentially lower the risk of preterm birth. However, the authors caution that the study included only a small number of participants and was conducted in Denmark, a country where preterm births are rare, so further studies are needed to determine if the results can be reproduced in larger populations and in other countries. Also more research is needed to determine the potential influence of dietary versus genetic factors.

Nutrition experts recommend seafood for kids and pregnant mothers since it is a rich source of vitamins, minerals, proteins and omega-3 fatty acids. The highest levels of omega-3 fatty acids can be found in cold-water sea fish. However, there is also evidence that some species contain increased levels of mercury, which can impair the development of the nervous system of babies in the womb or in their first years of life. Some of the recommended fish species for pregnant mothers and small children are, due to their rich nutrients and low levels of mercury: salmon, catfish, mullet, herring, anchovies, haddock, sardine and hake.

If you are unsure which fish to eat, please refer to official recommendations, e.g. “Advice About Eating Fish for Pregnant Women and Parents“, published by the FDA.

References

[1] Plasma Concentrations of Long Chain N-3 Fatty Acids in Early and Mid-Pregnancy and Risk of Early Preterm Birth.
Olsen SF, Halldorsson TI, Thorne-Lyman AL, et al.
EBioMedicine. 2018 Sep;35:325-333.

[2] Omega-3 Fatty Acids, Fact Sheet for Health Professionals by the US National Institutes of Health (NIH)

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EPICE/SHIPS consortium provides new knowledge on breast milk feeding of very preterm infants in Europe

On the occasion of World Breastfeeding Week 2018, we are happy to share these recent findings regarding practices of breastfeeding preterm infants. As a proud partner within the EPICE/SHIPS research consortium EFCNI is happy to present newest results on breast milk feeding outcomes in European NICUs and after discharge. Two publications using data of a Europe-wide cohort of very preterm infants investigated manifold factors associated with breastfeeding rate and duration after discharge.

Due to the benefits of breast milk for preterm infants in the prevention of various morbidities and in fostering of brain development, exclusive breastfeeding is recommended in the first 6 months of age. Thus, research interest in maternal, neonatal, and organisational factors associated with breastfeeding has raised to develop strategies which can promote breastfeeding and its continuation after discharge. Bonnet et al. and Cuttini et al. used data from the Effective Perinatal Intensive Care in Europe (EPICE) cohort including all births below 32 weeks of gestation in 19 regions from 11 European countries in 2011/2012.

The researchers analysed medical records for maternal and infant variables, a parental questionnaire sent out at 2 years of age, and a survey of neonatal units on visiting policies.

Cuttini et al. found that NICU policies regarding parental presence and involvement in care varied across Europe. More liberal policies supported exclusive breast milk feeding in the NICU and also after discharge. Next to organisational aspects of healthcare Bonnet et al. analysed breastfeeding continuation and investigated maternal sociodemographic variables found to be connected with breastfeeding. Among very preterm infants 34,4% were breastfed until 6 months with wide variation within European countries. Breastfeeding and its continuation is marked by social inequalities. A lower maternal educational level and younger age are connected with lower breastfeeding continuation rates. Maternal and neonatal factors like a multiple birth, suffering from Bronchopulmonary Dysplasia (BPD) and having several transfers negatively influenced continuation. Breastmilk fed infant receiving additional formula at discharge were half likely to be breast fed to 6 months.

These studies not only add new knowledge on the effectiveness of policies foreseeing parent participation and involvement in baby care on breastfeeding and respective improved health outcomes. They also highlight the importance of post-discharge counselling and support especially for socially disadvantaged families or mothers with multiples or whose infants suffer from BPD. In-hospital promotion of exclusive breastfeeding and coordination of efficient transfers could improve breastfeeding continuation in the longer term.

 

View more:
Cuttini M, et al. Arch Dis Child Fetal Neonatal 2018. https://fn.bmj.com/content/early/2018/06/28/archdischild-2017-314723.long 
Bonnet C, et al. Matern Child Nutr 2018. (accepted for publication)
Rodrigues C, et al. Paediatr Perinat Epidemiol 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/ppe.12457
Herich LC, et al. J Pediatr 2017. https://www.jpeds.com/article/S0022-3476(16)31179-9/fulltext

http://www.epiceproject.eu/en/

https://www.efcni.org/activities/projects/ships/

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 633724.

 

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First RECAP preterm-related publication is out – a meta-analysis on the association of preterm birth and adult markers of wealth

Logo_RECAP_pretermRECAP preterm proudly announces that a first research paper is published now in Pediatrics: Bilgin, Mendonca & Wolke performed a metanalysis investigating whether preterm birth and low birth weight are associated with markers of wealth in adulthood. A prospective longitudinal and registry study containing reports on selected wealth-related outcomes in preterm or low-birth-weight-born adults compared with term-born controls was conducted. To compile the database the authors searched Medline, PubMed, PsycINFO, Web of Science, and Embase and could include 23 studies in the analysis, i.e. 5.9 million adults from eight countries. The key results display a decreased likelihood for preterm or low-birth-weight-born adults to obtain a higher education degree. Furthermore, these adults have a lower employment rate than term-born controls and as a results receive more likely social services – in other words preterms were more likely to have financial problems as adults than babies carried to full-term. A dose-response relationship according to gestational age was only found for education qualifications. Preterm born adults did not differ significantly from those born at term in independent living.

Due to the was high heterogeneity between studies the results might be limited. Structured and efficient follow-up from the early beginning could help in identifying educational need timely and providing coordinated care.

Get the abstract here (pediatrics.aappublications.org).

Could Early Birth Hinder Adult Success?  Read the full article about the research paper  (drugs.com/MedNews).

Please Note: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733280.

 

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Regenerative Therapies for sick term and preterm born infants

An interview with Professor Mario Rüdiger, Professor for Neonatology and Pediatric Intensive Care Medicine, Head of Department at the Neonatal Research Group at the University Hospital Dresden, Germany

What was the idea behind the planned project?

In the past decades, improvements in feto-neonatal care have significantly reduced mortality. Long-term morbidity however, still represents a major problem. Most prominent disease entities with a feto-neonatal origin are chronic lung disease of preterm infants, sepsis and brain injury. Though affecting hundred thousands of patients every year, these diseases are of little interest to the industry.

Scientific evidence suggests a beneficial effect of regenerative therapies in these disease entities, with the most promising intervention being based on mesenchymal stromal cells (MSC)[1]. Whereas MSC have become standard therapy in some adult diseases, translation into neonatal routine care was hampered by the lack of firstly, a cell product of clinical grade that can be used in newborns and secondly, well-performed clinical studies testing these cells.

That’s where our project offers solutions to overcome these problems.

What are mesenchymal stem cells?

MSC are considered somatic stem cells which possess the potential to adapt to the microenvironment of injured organs and to regulate the healing process by secreting various factors. Therefore, they have also been termed “medicinal signalling cells” which ameliorate severe complications of diseases. MSC will not stay within the host tissue but will disappear after about two weeks. Therefore the risk of potential long-term complications is very low and the cells are considered to be safe.

What will you be doing in the project?

Our group has developed a way to manufacture MSC from the umbilical cord tissue of healthy term born infants in a high quality and has thereby opened a unique chance of successfully transferring MSC-based therapies into neonatal routine.

Based on that technique, we, the MASC-collaboration will establish the prerequisites for getting the MSC licensed for chronic lung disease of preterm infants. Therefore, we will conduct four clinical trials in Europe, Canada and the USA. The results from these trials will then be analysed together in a meta-analysis based on single patient data.

Furthermore, we will investigate prospectively further applications of MSC in newborns, focusing on brain-injury, sepsis and on the patient/parent perspective.

What is the aim of the “MASC-n-EU” project?

The European MASC-collaboration dedicates its effort with the “MASC-n-EU” project (“MSC to Ameliorate Severe Complications in Newborns in Europe”) to introduce umbilical cord-MSC-based therapy into neonatal care, with a special focus not only on treating but also preventing diseases originating in the feto-neonatal period. By providing a medicinal product specifically developed for the use in newborns we are addressing a great need and will improve the health of children in Europe.

Which professional areas will be involved?

The European MASC-collaboration dedicates the combined expertise and enthusiasm of leading scientists, clinicians, patient organisations, regulatory authorities and industry to make MSC-based regenerative therapies an integral part of clinical routine in newborns. Thereby, the European collaboration is embedded in a strong international network of experts, ensuring the success and sustainability of the project.

Thank you Prof. Rüdiger, for giving us insights into this innovative project.

[1] multipotent stromal cells that can differentiate into a variety of cell types.

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Obesity in children and adolescents: a growing global health challenge

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The number of obese children and adolescents has risen dramatically in the past four decades, reveals a large study that was published in The Lancet in October 2017. Although more children and adolescents worldwide are moderately or severely underweight than obese at this time, the situation will reverse by 2022 if the current trend continues. The rise in obesity is of great concern, as excessive body weight in childhood and adolescence is associated with greater risk and earlier development of several health problems (e.g. type 2 diabetes, cardiovascular diseases and negative psychological consequences).

Researchers from the Imperial College London and the World Health Organization (WHO) collected data from 200 countries to see how global and national numbers on obesity, overweight, and underweight in childhood and adolescence had changed between 1975 and 2016. They looked at measurements of height and weight of 31.5 Mio. children and adolescents aged five to 19 years and calculated their Body Mass Index (BMI). The BMI is a measure that indicates whether a person’s weight is in a healthy range for their height, or too high (=overweight) or too low (=underweight).

Results show that the number of obese children and adolescents worldwide has increased more than tenfold since 1975, from 11 million to 124 million. Whereas less than 1% of all children and adolescents had been obese in 1975, almost 6% in girls and 8% in boys were obese in 2016. On a country level, the highest rates in both sexes were seen in Polynesia and Micronesia (around 25%; one in four) as well as in high-income English-speaking countries (USA, Canada, Australia, New Zealand, UK, Ireland). In Europe, boys in Greece (16.7%; almost one in five) and girls in Malta (11.3%; more than one in ten) had the highest obesity rates.

These numbers and trends are alarming and need to be urgently addressed. According to the authors, it is important that countries do not only provide a general feature of policies that target overweight and obesity in children and adolescents, but also use taxes and industry regulations to change eating and drinking behaviours. It would be a crucial step to make healthy foods such as whole grains, fresh fruit and vegetables more affordable. This would not only encourage people to rather buy them instead of unhealthy food but also tackle social inequalities in overweight and obesity. Population-based prevention of overweight and obesity is as important as the enhancement of access to healthcare interventions for weight management.

Read the original study (The Lancet)

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Breastfeeding during vaccinations reduces pain

Essential, but painful: needles are used for babies’ early childhood vaccinations and medical care during childhood illnesses. They cause distress for the babies and often also for their parents and caregivers, and can result in future anxiety and fear about needles. Researchers around Harrison et al. examined if breastfeeding reduces vaccination pain in babies aged 1 to 12 months. The results were published in the Cochrane Database for Systematic Review

Painful procedure - blood samplingIn an intervention review in February 2016, the Canadian scientists searched the medical literature for studies of randomised controlled trials (RCTs) examining the effectiveness of breastfeeding babies beyond the neonatal period up to one year of life during the use of needles. They compared the effectiveness of breastfeeding in reducing pain (as scored by crying time and pain scores), to parental holding, skin- to-skin contact, babies lying flat, the giving of water or sweet solutions, placebo, other interventions, and to no intervention. For the data collection and analysis, they searched several scientific databases and identified 10 studies with a total of 1066 infants aged 28 days postnatal to 12 months. All studies examined if breastfeeding reduced pain during vaccinations. 

The results showed that breastfeeding reduced crying in young babies having vaccinations compared to no treatment, oral water, and other interventions such as cuddling, oral glucose, topical anaesthetic, massage, and vapocoolant spray (“cold spray”). On average, breastfed babies cried for 38 seconds less than babies who were not breastfed and pain scores were significantly lower. There was no evidence that breastfeeding had an effect on physiological responses, such as heart rate. No studies reported on any harm while breastfeeding healthy babies during vaccinations (based on low-quality evidence).

No studies included in this review involved populations of hospitalised infants undergoing skin-breaking procedures. Because the studies only evaluated the effects of breastfeeding during vaccination, more evidence is needed to learn if breastfeeding helps older babies in hospital during blood work or procedures such as the insertion of drips. 

View more (Original study)

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