OBGYN.net Staff

Pregnant and lactating women are not meeting recommendations for daily docosahexaenoic acid (DHA) consumption, a recent Canadian cohort study found. Sufficient amounts of fatty acids in both the mother and child are required for the child's nervous system and immune system to fully develop.

- Pregnant and breastfeeding women are not meeting current guidelines for omega-3 consumption, either through their diets or with dietary supplements.

- Researchers suggest that the recommendations for DHA consumption should be better explained to pregnant and postpartum patients, especially those who are breastfeeding.

After analyzing data from 24-hour recall and supplement intake questionnaires of 600 pregnant women, researchers at the University of Alberta and the University of Calgary determined that most women were not consuming enough omega-3 long-chain polyunsaturated fatty acids. The questionnaire responses, which were conducted in person during pregnancy visits and at 3 months' postpartum, revealed that approximately one third of the women took DHA supplements at 1 or more of the measured points.

Overall, only 27% of women during pregnancy and 25% of women at 3 months' postpartum met the current European Union consensus recommendation for consuming a minimum of 200 mg of DHA per day, the authors reported.

Even then, the biggest factor was eating seafood, not dietary supplements, they said. “Seafood, fish, and seaweed products contributed to 79% of overall n-3 [omega 3] long-chain polyunsaturated fatty acids intake from foods, with the majority from salmon,” they found.

Still, women who reported taking a supplement were 10.6 and 11.1 times more likely to meet the current recommended intake of the fatty acid during pregnancy and postpartum, respectively. The study relied on the European Commission and the International Society for the Study of Fatty Acids and Lipids (ISSFAL) recommendation that pregnant and lactating women consume a minimum of 200 mg of DHA per day in establishing a threshold. They did note, however, that the American Dietetic Association and Dietitians of Canada recommend consuming at least 500 mg/d of omega-3 long-chain polyunsaturated fatty acids.

Finally, the authors suggest that the recommendations for DHA consumption need to be better explained to postpartum women who are breastfeeding. The study showed that only 44% of the women who reported taking a supplement during pregnancy continued to take the supplement when breastfeeding.

Articles

Pregnant and postpartum women aren't getting enough omega-3 fatty acids, putting the development of their babies' nervous and immune systems at risk.

Nursing Moms Not Getting Enough Fatty Acids

New mothers needing to express breast milk should start early, but they can also benefit from a number of low-cost aids. Relaxing, listening to music, breast massage, warming the breasts, hand expression and lower cost breast pumps may all be helpful in trying to pump milk for infants, an 

 of available studies found. Still, the body of scientific evidence on expressing breast milk is varied and doesn't easily identify the best tools to help new mothers maximize their comfort and output.

- Listening to music, relaxing, massaging the breasts, and warming the breasts may all help improve the process of pumping breast milk.

- Different techniques used for expressing breast milk were associated with not only the volume of milk produced but also the properties of the breast milk.

“Small sample sizes, large standard deviations, and the diversity of the interventions argue caution in applying these results beyond the specific method tested in the specific settings,” the authors warned.

The updated meta-analysis looked included 34 randomized controlled studies, with 17 studies involving slightly less than 1,000 women being used in the Cochrane data analysis. The studies also included significant global diversity, with mothers from the United States, the United Kingdom, Australia, Malaysia, Brazil, Egypt, India, Mexico, Turkey, Kenya, and Nigeria.

For mothers who give birth to low birth weight and premature babies, beginning to pump within the hour of giving birth does increase the amount of milk expressed, the analysis showed. The various techniques not only affected the volume of milk expressed but also the milk’s properties. For instance, more milk was expressed when mothers listened to an audio relaxation tape, warmed their breast, and massaged the breast. One study found sodium concentration was higher when women hand expressed milk compared with manual and electric pumps, and fat content was higher with breast massage and with listening to an audiotape while pumping.

Several small studies focused on pump comparisons, but no consistent difference in milk volume was found between the pumps studied. This included a finding that lower cost pumps may be as effective as the large electric pumps, the authors noted. Furthermore, any milk contamination was similar for hand expressed and pumped milk, and the level of maternal breast or nipple pain was no different between the two pump types.

There are several techniques new mothers can use to express breast milk more comfortably while yielding higher output, a meta-analysis finds.

Analysis Offers Guidance on Breast Milk Expression

 from the Physicians Committee for Responsible Medicine (PCRM) discussed the organization's efforts to urge public hospitals to end contracts with the popular food chains McDonald's and Chick-fil-A. These contracts compel the hospitals to promote unhealthful foods, such as fried chicken, to all who enter, because the amount of food purchased is tied to the rent the hospital makes (more food sold means the hospital makes more money), explains the PCRM. This promotion of unhealthful food essentially harms the health of those who consume it, says the PCRM.

Whether hospitals serve fast food from the above-named restaurants or always have daily options of burgers, fries, and pizza, how do you feel about the food?

Yes, every effort should be made to promote healthful habits.

No, people should have options, even unhealthy ones.

Poll

POLL: How healthy should hospital food be? Should junk food not be offered at all, removing any temptation, or should people make better choices?

Should Hospital Cafeteria Food Be Healthier?

Body fat, slowed reaction time, and poor sleep are associated with women who experience urinary problems during and after menopause, a recently published study found.

The study noted that urinary issues, including frequent urination, nocturnal urinary urgency, stress incontinence, and urge incontinence, are very common among women at the time of menopause and in the years following.

- Researchers linked urinary troubles in menopausal women to excess body fat, poor sleep, and slowed reaction time.

- However, no direct cause and effect in the relationship of these common symptoms among women during and after menopause was documented.

While no causal relationships between weight, sleep, or reaction time were identified, the researchers said that their relationship to storage lower urinary tract symptoms is worth a closer look. “Careful evaluation of nonrestorative sleep, body fat and visceral fat accumulation, or delayed reaction time might reveal undisclosed storage LUTS in this population,” the authors concluded.

The research involved approximately 350 Japanese perimenopausal and postmenopausal women ages 40 to 76 years old enrolled in a health and nutrition education program at the menopause clinic of the Tokyo Medical and Dental University Hospital. The data was obtained through completed questionnaires from each of the women.

Nearly half of the women said they experienced urinary frequency more than once a week, including 22% saying it was a nearly daily occurrence. Stress incontinence was reported by 33% of the women, while nocturia and urge incontinence each bothered about 11% of the women.

Furthermore, stress incontinence was statistically linked to increased body fat (odds ratio, 1.06; 95% CI, 1.03-1.09), while urge incontinence was associated with reaction time (odds ratio, 1.10; 95% CI, 1.01-1.19).

The study didn’t determine a cause and effect, so it’s unclear whether the urge to urinate in the middle of the night is caused by poor sleep or if the need to use the toilet is causing the poor sleep. Similarly, the authors said they were unable to determine whether excess weight was leading to urinary problems.

 the journal of The North American Menopause Society (NAMS), and will appear in the print version later this year.

New research identifies 3 factors that may play a role in menopause-related storage lower urinary tract symptoms, or incontinence.

Does Body Fat, Other Factors Cause Incontinence?

An intensive pelvic floor muscle training (PFMT) program did not improve pelvic organ prolapse (POP) in primiparous women following vaginal delivery, a study of 175 women found. 

The 4-month program also did not prompt improvement in bladder neck support or vaginal bulge symptoms in the study population. The researchers had hoped to replicate findings of other studies that have shown that PFMT could help reduce symptoms of POP in middle-aged women.

- An intensive PFMT program did little to help postpartum women ward of POP following vaginal delivery.

- The researchers said clinicians should not discount the importance of pelvic floor exercises for postpartum women and instead urged additional studies that could pinpoint how to best teach the exercises.

The randomized controlled trial included 87 women in the intervention group, who were asked to attend a weekly group training session and perform 3 sets of 8 to 12 daily maximal contractions at home (96% adhered to at least 80% of home and group training sessions) and 88 women in the control group. There were no statistically significant differences between the groups of women. 

While the researchers were unable to show a benefit to providing women with intervention to improve their pelvic floor function, they were not ready to discount the importance of teaching postpartum women to do pelvic floor exercises.

“Given the disparity between our results and those in populations of middle-aged women, we suggest that in future trials PFMT should include supervised individual training rather than, or in addition to, group training,” the authors concluded in calling for additional randomized controlled trials. “Given the high prevalence of POP in the general female population, early prevention and treatment should have high priority.”

The study authors also suggested that PFMT may be more beneficial to women who have more severe POP, since none of the study participants had POP-Q stage III.

 were published in the January issue of the 

American Journal of Obstetrics and Gynecology.

Pelvic floor muscle training, or Kegel exercises, did not improve pelvic organ prolapse in a group of women after a vaginal delivery, research shows.

Study Shows No Benefit of PFMT for Prolapse

Vasomotor symptoms and other symptoms related to decreased estrogen levels from menopause are costly to women as well as the health care system. Women who experience them are burdened with hot flashes, sleep disturbances, and a variety of other issues that can diminish their quality of both home and work life, including dyspareunia, anxiety, depression, irritability, and memory impairment. Also, 

 shows that untreated vasomotor symptoms are associated with significant increases in healthcare utilization, work loss, and cost burden.

The one treatment that most effectively manages many of these symptoms is hormone therapy, but a 

 has shown that use of hormone replacement therapy is associated with an increased risk of the two most common forms of ovarian cancer. Also, 

 has shown that HRT isn't cardioprotective. Yet other 

 shows that some women can experience hot flashes for up to 14 years.

POLL: How do you compare with your colleagues in your comfort level for prescribing hormone replacement therapy for symptoms of menopause.