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What are the long-term benefits of breastmilk for preterm babies? Also, a first-of-its-kind study looks at maternal folate levels and BMI and the role they play in the child's risk of obesity. Plus: What are the adverse neonatal outcomes of untreated depression in the mother?
Breastfeeding of preterm neonates may provide cardiac benefits long after infancy, according to results of a British study published in Pediatrics.
The researcher was a follow up to a randomized controlled trial, in which postnatal milk-feeding regimens were assessed across 5 UK centers between 1982 and 1985. In that study 926 preterm infants studied were randomly assigned to receive either nutrient-rich formula or breastmilk donated by unrelated women who were lactating.
For the new study, the researchers followed 102 people from the original cohort: 16 who had exclusively been fed formula and 30 who had exclusively been fed human milk. They recruited 102 individuals who had been born at term following uncomplicated pregnancy. Magnetic resonance imaging was used to assess cardiac morphology and function.
When compared with preterm-born individuals who were exclusively fed with formula, those who had been exclusively given breastmilk as infants had increased left and right ventricular end-diastolic volume index (+9.73%, P = .04 and +18.2%, P < .001) and stroke volume index (+9.79%, P = .05 and +22.1%, P = .01).
The researchers concluded that there appears to a beneficial association between cardiac morphology and function in adult life and breast milk, the first evidence of such an association.
Maternal folate and BMI impacts childhood obesity
Results of a first-of-its-kind study underscore the need for optimal folate intake in pregnancy because deficiencyâespecially in obese womenâcan lead to childhood obesity. The data, published in JAMA Pediatrics, are from a low-income urban cohort.
For the report, the authors hypothesized that maternal folate concentrations can significantly affect child metabolic health and that sufficient maternal folate concentrations can mitigate prepregnancy obesity-induced child metabolic risk. Several previous studies have shown such a linkage, but according to the researchers, theirs is the first prospective birth cohort in which it has been assessed.
Conducted at Boston Medical Center, the study included 1517 mother-child dyads recruited at birth from 1998 to 2012 who were followed up prospectively for up to 9 years between 2003 and 2014. The researchers calculated child body mass index (BMI) and the metabolic markers leptin, insulin, and adiponectin.
An L-shaped association was found between maternal folate concentrations and child overweight or obesity (OWO). Children whose mothers were obese and had folate concentrations in the second through fourth quintiles had a 43% lower likelihood of OWO than did those whose mothers had the lowest levels of folate (odds ratio [OR] 0.57; 95% CI, 0.34-0.95). The highest risk for OWO (after accounting for multiple variables) was among children of obese mothers with low folate concentrations (OR 1.45; 95% CI, 1.13-1.87) compared with those whose mothers were normal weight but had folate concentrations in quartiles 2 through 4.
The researchers noted that the threshold folate concentration identified in their study exceeded the clinical definition of deficiency and that their results demonstrate the benefit of sufficient intake of the vitamin, particularly in obese mothers.
Does untreated maternal depression lead to adverse neonatal outcomes?
According to a new meta-analysis published in JAMA Psychiatry, women with untreated depression may have an increased risk of delivering infants who are born preterm or at low birth weight.
The researchers included randomized and nonrandomized studies that looked at the neonatal outcomes of infants born to women with depression who were receiving neither pharmacological nor nonpharmacological treatments in comparison to women without depression. Two reviewers looked at titles and abstracts independently of one another. They assessed full-text articles, extracted data, and assessed their quality using a version of the Newcastle-Ottawa Scale. They pooled data using random-effect meta-analyses.
Twenty-three studies from a pool of 6646 initially identified met inclusion criteria. All 23 of the studies were observational and covered 25,663 women. Depression that was untreated was significantly tied to low birth weight (odds ratio [OR], 1.96; 95% CI, 1.24-3.10; 8 studies; I2, 48%) and preterm birth rate (PTB) (OR, 1.56; 95% CI, 1.25-1.94; 14 studies; I2, 39%). Studies that reported a conflict of interest had more than double the odds of PTB (OR, 2.50; 95% CI, 1.70-3.67; 5 studies; I2, 0%). Moderate results were seen in studies that showed no conflicts (OR, 1.34; 95% CI, 1.08-1.66; 9 studies; I2, 30%).
The authors concluded that untreated depression carries significant risks of 2 perinatal outcomes: PTB and low birth weight. This contrasts with another previous systematic review on the impact of untreated depression in pregnancy. They believe that these results should help inform the decision-making process regarding depression treatment.