Search

BackgroundMost cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.MethodsWe searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.FindingsThe guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.DiscussionThe evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.

New-born heel prick blood spots are routinely used to screen for inborn errors of metabolism and life-limiting inherited disorders1. The Danish Newborn Screening Biobank (DNSB) has shown that nucleic acid, metabolic and protein assays are feasible on archived new-born dried blood spots2. Denmark is currently the only country in the world where nation-level linkage of such secondary data to health records is approved2. In the new era of health data science and predictive medicine, the potential value of secondary data from new-born blood spot archives merits wider ethical consideration and assessment of feasibility for public benefit. Early life exposures and behaviours set health trajectories in childhood and later life. The new-born blood spot is potentially well placed to create an unbiased and cost-effective population-level retrospective birth cohort study. Scotland has retained new-born blood spots, commonly known as Guthrie cards, for all children born since 1965, around 3 million in total. However, a moratorium on research access is currently in place, pending public consultation. We conducted a Citizens’ Jury, with Jurors delivering an agreed verdict that conditional research access to the Guthrie Cards was in the public interest. The Chief Medical Officer for Scotland authorised restricted lifting of the current research moratorium to allow a feasibility study. In support of a wider public consultation, Guthrie cards from consented Generation Scotland volunteers3,4 were retrieved and their potential for both epidemiological and biological research demonstrated.

Observational ecological and epidemiological studies have suggested increased risks of SARS-CoV-2 infection and severity in groups with high prevalence of vitamin D deficiency (older adults, and those with obesity, pre-existing medical conditions or darker skin). Emerging observational clinical studies have confirmed these associations, reporting higher risk of SARS-CoV-2 infection, severe Covid-19 disease and mortality in those who are vitamin D deplete. Further experimental studies have described the immunological and metabolomic mechanisms by which vitamin D deficiency increases these risks, while recent prospective RCT data have shown reduced Covid-19 disease severity and mortality with vitamin D supplementation, further supporting a causal association. Dietary vitamin D intakes are low (~3-6μg/d (120-240 IU/d)) and sunshine exposure inadequate to achieve optimal vitamin D status in Ireland. Consequently, vitamin D deficiency (serum 25(OH)D50nmol/l on a year round basis. Supplementation with 20-25μg/d (800-1000 IU/d) is therefore required to avoid deficiency and meet the minimum 25(OH)D threshold of 50nmol/l for enhanced immunity to viral respiratory infection. For older adults, and those with obesity, underlying conditions or darker skin, supplementation at higher doses under medical supervision is indicated. Practice and policy development are now required to ensure that Irish adults are supplemented with vitamin D3 at these safe and effective doses to reduce their risks of SARS-CoV-2 infection and severe disease.

Significance Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice. Purpose This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP optical density (MPOD). Methods Two thousand five hundred ninety-four subjects completed a full MP assessment as part of wave 1 of The Irish Longitudinal Study of Aging. Macular pigment optical density was measured using customized heterochromatic flicker photometry. Clinical (blood pressure), plasma (lipoproteins, inflammatory markers), and anthropometric (waist, hip, height, weight) biomarkers were measured for each participant. Results Mean (standard deviation) MPOD for the study group was 0.223 (0.161), with a range of 0 to 1.08. One-way ANOVA revealed that MPOD was significantly lower among participants with low plasma high-density lipoprotein (HDL; P = .04), raised plasma triglyceride-to-HDL ratio (P = .003), and raised total cholesterol-to-HDL ratio (P = .03). Subjects with an elevated waist circumference (WC) had a significantly lower MPOD (mean, 0.216 [0.159]) compared with those with an ideal WC (mean, 0.229 [0.162]; P = .03). Significant correlates of MPOD on mixed linear model analysis included education, smoking status, and WC. Conclusions Higher abdominal fat is associated with lower MPOD in this representative sample of older Irish adults. Although altered lipoprotein profiles (low HDL, raised triglyceride-to-HDL ratio, raised total cholesterol-to-HDL ratio) may affect the transport, uptake, and stabilization of carotenoids in the retina, these plasma biomarkers were not predictive of low MPOD after adjustment for abdominal circumference. Although WC emerged as a viable anthropometric predictor of lower MPOD, its effect size seems to be small.

BACKGROUNDThe aim of this multinational study was to assess the development of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis.METHODSParticipants consisted of 247 249 individuals from seven cohorts across six countries (Denmark, Estonia, Iceland, Norway, Scotland, and Sweden) recruited from April 2020 through August 2021. We used multivariable Poisson regression to contrast symptom-prevalence of depression, anxiety, COVID-19 related distress, and poor sleep quality among individuals with and without a diagnosis of COVID-19 at entry to respective cohorts by time (0-16 months) from diagnosis. We also applied generalised estimating equations (GEE) analysis to test differences in repeated measures of mental health symptoms before and after COVID-19 diagnosis among individuals ever diagnosed with COVID-19 over time.FINDINGSA total of 9979 individuals (4%) were diagnosed with COVID-19 during the study period and presented overall with a higher symptom burden of depression (prevalence ratio [PR] 1·18, 95% confidence interval [95% CI] 1·03-1·36) and poorer sleep quality (1·13, 1·03-1·24) but not with higher levels of symptoms of anxiety or COVID-19 related distress compared with individuals without a COVID-19 diagnosis. While the prevalence of depression and COVID-19 related distress attenuated with time, the trajectories varied significantly by COVID-19 acute infection severity. Individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risks of depression and anxiety (PR 0·83, 95% CI 0·75-0·91 and 0·77, 0·63-0·94, respectively), while patients bedridden for more than 7 days were persistently at higher risks of symptoms of depression and anxiety (PR 1·61, 95% CI 1·27-2·05 and 1·43, 1·26-1·63, respectively) throughout the 16-month study period.CONCLUSIONAcute infection severity is a key determinant of long-term mental morbidity among COVID-19 patients.

Introduction Sexually Transmitted Infections (STIs) disproportionately affect transgender women (TGW). This group faces barriers to accessing health care, especially due to stigma and discrimination. The literature is scarce on data of STIs among TGW in Brazil. We aimed to estimate the prevalence of syphilis and to analyze the completeness of treatment among TGW in two Brazilian cities. Methods A cross-sectional study was conducted in Sao Paulo (SP) and Salvador (SSA) from December 2019 to January 2021, as part of the TransOdara study. Participants aged 18 to 65 years old were recruited using Respondent Driven Sampling (RDS), completed a standard questionnaire and samples were collected for rapid syphilis testing. After laboratory and clinical evaluation by a doctor/nurse, a prescription for antibiotic treatment (oral or injectable) was given, if necessary. Results Of the 562 participants recruited, 71.7% (n=403) were from SP and 28.3% (n=159) from SSA. Most were 20–29 years old (45.1%), with brown skin color (47.5%), were living alone (76.2%), in rented residence (51.1%), had maximum level of high school education (47.9%), and have not legally changed their names (69.5%). The following data related to syphilis is presented for SP and SSA, respectively. Positive rapid test was 57.8% (233/403) (95% CI: 53.0–62.6) and 59.1% (88/159) (95% CI: 47.6–63.0). Of these, 24.9% (58/233) and 47.7% (42/88) received prescription (oral or injectable). Injectable treatment (benzathine penicillin G) was prescribed for 60.3% (35/58) and 97.6% (41/42). The completeness of treatment was assessed only for those who received injectable treatment, occurring for 51.4% (18/35) and 78.0% (32/41). Conclusions Active syphilis is highly prevalent among TGW in both cities. Even in a point-of-care program with active surveillance participants giving up treatment was observed. Our findings reinforce the need for a diversified and creative approach even with a point of care protocol.

Background As a component of an ongoing cohort study measuring the incidence of HIV among transgender women in Sao Paulo, Brazil, this study assessed the acceptability of introducing self-collected sampling for the etiological diagnosis of sexually transmitted infections (STIs). Etiological diagnosis would require sampling potential anatomical infection sites, including oropharyngeal, anorectal, urethral, neovaginal and urine samples. Methods A convenience sample of 23 participants during a scheduled study visit were recruited to this study between October and November 2018. All participants reported being assigned male sex at birth and identified with a feminine gender identity at time of study, with one participant having gender-affirmative surgery to remove their male genitalia. Data collection was through a short investigator-led questionnaire in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams for self-sampling. Three supplemental focus group discussions guided by semi-structured script were conducted in Portuguese between September and October 2019. Results All participants (100%; n=23) indicated willingness to provide samples for STI screening during a future study visit. Participant preference was for self-collection of urine samples (82.6%; n=19), urethral swabs (81.8%; n=18), and anorectal swabs (77.3%; n=17). A lower preference for self-collection of oropharyngeal swabs (47.8%; n=11) was observed. Most respondents (78.3%; n=18) indicated that they would not prefer sampling to be collected by a health professional, mainly due to ‘more privacy’ (72.2%; n=13). All participants (n=20; 3 missing) indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. Conclusion This study suggested acceptability among transgender women of introducing self-collected sampling for etiological diagnosis of STIs from potential infection sites. Novel gender-neutral instructional diagrams received positive responses of understanding to enable self-collected samples, with further development and testing warranted. Uptake and usability will be explored in TransOdara, a cross-sectional STI prevalence study of transgender women in Brazil.

Significance This present study advances our knowledge on the role of lifestyle factors in myopia (short-sightedness), specifically dietary factors. It has been suggested in previous studies that lower zinc status is associated with myopia; however, this article shows no relationship between dietary zinc intake and myopia in U.S. adolescents. Purpose It has been suggested that low zinc levels may contribute to the development of myopia. The aim of the present study is to examine, for the first time in a Western population, the association of total dietary and supplement zinc intake with myopia. Methods A total of 1095 children/adolescents aged 12 to 19 years who participated in the U.S. National Health and Nutrition Examination Survey from 2007 to 2008 were enrolled in this study. Multivariate logistic regression analysis was performed to examine the relationship between total zinc intake and myopia after adjustment for potential confounders. In addition, the association between total zinc intake and spherical equivalent refractive error was examined in the myopia group through multiple linear regression. Results Among study participants, 30% were found to be myopic (≤-1.00 D). Although median total daily zinc intake was lower among myopes (10.8 [10.2] mg/d) than among nonmyopes (11.1 [10.8] mg/d), the difference was not statistically significant (P = .11). In multiple logistic regression analyses, zinc and copper intakes were not significantly associated with myopia after adjustment for age, sex, body mass index, ethnicity, family income, recreational activity, copper intake, and daily energy intake (in kilocalories per day). In multiple linear regression, spherical equivalent refractive error was not associated with total zinc intake in the myopic group after adjustment for confounding factors (P = .13). Conclusions In contrast to previous Asian studies, total zinc intake is not associated with the presence of myopia in U.S. adolescents/children.

ObjectivesMSM Internet Survey Ireland (MISI) 2015 was an anonymous, self-completed, cross-sectional internet survey assessing sexual behaviours and health needs among men who have sex with men (MSM) in Ireland. We explored factors associated with self-reported STI diagnosis among MSM who were sexually active and had an STI test in the previous year.MethodsWe compared the study population (n=1158; 37% of total population), with the sexually active MISI population not testing for STIs (n=1620; 52% of total population). Within the study population, we identified sociodemographics and sexual behaviours associated with self-reporting STI diagnosis. We used multivariable logistic regression to estimate adjusted odds ratios (aORs).ResultsThe sociodemographics, lifestyle and sexual behaviours of the study population differed significantly from the sexually active MISI population who did not test for STIs. Within the study population, 65% met a sexual partner via geosocial networking smartphone application (GSNa) and 21% self-reported an STI diagnosis in the previous year. On univariable analysis, factors associated with STI diagnosis included: older age, identifying as gay, HIV-positive status, increasing number of sexual partners in the previous year, condomless anal intercourse (CAI) with ≥2 non-steady partners and using GSNa to meet a new sexual partner in the previous year or most recent sexual partner. On multivariable analysis, STI diagnosis was associated with: being aged 25–39 years (aOR 1.8, 95% CI 1.04 to 3.15), CAI with ≥2 non-steady partners (aOR 2.8, 95% CI 1.84 to 4.34), total number of sexual partners (aOR 1.02, 95% CI 1.00 to 1.03) and using GSNa to meet a new sexual partner (aOR 1.95, 95% CI 1.12 to 3.39).ConclusionsSTI diagnosis among MSM testing for STIs is associated with GSNa use, as well as sexual behaviours. GSNas are key settings for STI prevention interventions, which should prioritise men with high numbers of sexual partners and those with multiple CAI partners.

BackgroundMaternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes.MethodsWomen ResultsOf the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05).ConclusionsWe found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women’s engagement and modifies dietary behaviour.

Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula, and may therefore protect retinal tissue from the oxidative stress and inflammation associated with ocular disease and ageing. There is a body of evidence implicating oxidative damage and inflammation as underlying pathological processes in diabetic retinopathy. MP has therefore become a focus of research in diabetes, with recent evidence suggesting that individuals with diabetes, particularly type 2 diabetes, have lower MP relative to healthy controls. The present review explores the currently available evidence to illuminate the metabolic perturbations that may possibly be involved in MP’s depletion. Metabolic co-morbidities commonly associated with type 2 diabetes, such as overweight/obesity, dyslipidaemia, hyperglycaemia and insulin resistance, may have related and independent relationships with MP. Increased adiposity and dyslipidaemia may adversely affect MP by compromising the availability, transport and assimilation of these dietary carotenoids in the retina. Furthermore, carotenoid intake may be compromised by the dietary deficiencies characteristic of type 2 diabetes, thereby further compromising redox homeostasis. Candidate causal mechanisms to explain the lower MP levels reported in diabetes include increased oxidative stress, inflammation, hyperglycaemia, insulin resistance, overweight/obesity and dyslipidaemia; factors that may negatively affect redox status, and the availability, transport and stabilisation of carotenoids in the retina. Further study in diabetic populations is warranted to fully elucidate these relationships.

Background Maternal expressed breast milk is the feed of choice for the preterm infant who is unable to latch to feed. Most mothers express and store milk in the fridge or freezer for later use. Irish Breast feeding guidelines recommends storage of fridge freezer for 3 months and deep freezer for 6 months.1 Some reports suggest no change in macronutrient content after freezing up to 3 months while others report a decrease in fat and caloric content of breast milk.2 Aim To compare the difference in macronutrient content between paired fresh and frozen maternal expressed breast milk samples. Methods A total of 20 pooled expressed breast milk samples were collected from 15 mothers, expressing for their preterm infants with mean gestation at birth = 28.3 weeks. Mean infants birth weight was 1143 (±364) grams. As per local hospital policy samples were frozen at -25°C within 24 hours of expression. Breast milk samples were analysed by human milk analyser (MIRIS®) after ultrasonic homogenization after thawing in room-air and warming to 40°C. Results Median time of freezing was 33 (7–70) days. Macro-nutrient composition varied (as shown in table 2), with fat and caloric content most effected. Some loss of protein content was observed. Discussion Our study shows a decrease in fat and energy content of maternal expressed breast when frozen. This should be taken into consideration when using frozen expressed breast milk for preterm infants and fresh breast milk used where feasible. References www.Breastfeeding.ie/factsheet/ Garcia-Lara NR, Escuder-Vieco D, Garcia-Algar O, De la Cruz J, Lora D, Pallas-Alonso C. Effect of freezing time on macronutrients and energy content of breastmilk. Breastfeed Med. 2012;7:295–301. Ahrabi AF, Handa D, Codipilly CN, Shah S, Williams JE, McGuire MA, et al. Effects of Extended Freezer Storage on the Integrity of Human Milk. The Journal of pediatrics. 2016;177:140–3.

Background Little is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions. Methods The MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances. Results In the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p

Purpose: This cross-sectional study compared macular pigment (MP) levels among persons with Type 2 diabetes relative to healthy controls. Additionally, a range of behavioral, anthropometric, clinical and serum measures were explored as possible predictors of low MP optical density (MPOD) in diabetes.

This intervention examined the efficacy of a six-week online weight loss programme. Students and staff of a third level institution (n=183) were recruited to the programme which provided individualised dietary advice for weight loss. Eighty-five participants (mean age 29.7 years, mean BMI 28.9kg/m2, 33% male) met the minimum inclusion criterion of logging on to the study website at least twice. All participants who completed the full six-week programme lost weight (n=31), with significant reductions in mean weight (2.8kg), BMI (0.9kg/m2) and waist circumference (4.1cm) observed between the start and end of the programme (all P5% of their bodyweight, with reductions in biscuit and alcohol consumption being most predictive of weight loss. These findings suggest that individualised online dietary advice is effective in achieving short-term weight loss, especially in males.

Objective this study investigated the relationship between fathers and breast feeding in Ireland. Design and method a cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions was posted to 1398 men with an Irish partner who had given birth 4–7 months previously. Fathers who specified that their partner breast fed their last or only child were questioned about their: influence on the breast feeding decision; ability to assist with breast feeding challenges; preferred type of information on breast feeding; perceived advantages and disadvantages to breast feeding; and views on breastfeeding in public. Data from closed-ended questions on breast feeding were presented using frequencies and associated percentages. Answers to open-ended questions on breast feeding were categorised into themes using content analysis. Each theme was assigned a numerical code and the themes developed were quantitatively counted and presented as frequencies and percentages. Findings of the 583 respondents (42% response rate), 417 (71.5%) had a partner who had breast-fed their last or only child. Most of the 417 fathers were employed (95.7%, n 399), college-educated (76.7%, n 320) and married (87.8%, n 366). Most (75.5%, n 315) fathers were involved in the breast feeding decision. The majority (77.5%, n 323) of fathers were unprepared for at least one aspect of breast feeding, most commonly that their partner encountered difficulties in establishing breast feeding. Of those fathers with a partner who experienced difficulties with breastfeeding (56.8%, n 237), half (49.4%, n 117) were unable to help their partner to overcome her breast feeding difficulties. Two-fifths (41.0%, n 133) of fathers felt deprived of bonding time. Almost one in ten (9.4%, n 39) fathers felt uncomfortable with an unrelated woman breast feeding in public, and this increased to three in ten or one third (34.3%, n 143) if the woman in question was their partner. Key conclusion while fathers in a well-educated and socially advantaged sample are largely supportive of breast feeding, significant challenges remain in terms of their ability to support breast feeding in an informed and practical manner. Implications for practice women who are practically and emotionally supported by their partners are more likely to successfully breast feed, but the male perspective of breast feeding in Ireland has been given little attention. This study supports earlier and more effective engagement of fathers throughout the breast feeding process, and highlights areas of concern with respect to the role of fathers in breast feeding.

The incidence of neural tube defects (NTDs) in Ireland has increased in recent years. This study examines knowledge about folic acid (FA) supplementation for the prevention of NTDs among women presenting for antenatal care. Women were recruited at their convenience in the first trimester after sonographic confirmation of an ongoing singleton pregnancy. A detailed questionnaire was completed under the supervision of a research dietitian. Clinical and socio-demographic details were collected. Of the 587 women studied, 96% took FA during early pregnancy. Of these, 56.4% cited brain/spinal development or the prevention of brain/spinal defects, spina bifida or NTDs as the reason for taking FA. Multivariate analysis showed that women who were experiencing material deprivation or who were living in Ireland

Aim Increased maternal body mass index (BMI) has been consistently associated with elevated blood glucose levels during pregnancy. Studies to date investigating the relationship between maternal blood glucose levels and dietary intake have shown mixed results. We investigated the association between maternal fasting plasma glucose (FPG) levels and food group and macronutrient intakes in the first trimester of pregnancy, after adjustment for maternal bodyweight. Methods Women were recruited after sonographic confirmation of an ongoing singleton pregnancy in the first trimester. Dietary information was collected using the validated Willett Food Frequency Questionnaire. Maternal height and weight were measured and BMI calculated. Body composition was measured using advanced bioelectrical impedance analysis. FPG levels were obtained for women who were selectively screened with a 75 g oral glucose tolerance test. Results No associations were observed between maternal FPG levels and food group or macronutrient intakes but higher energy and starch intakes were found in obese subjects (P = 0.009 and P = 0.03 respectively). On univariate analysis, higher FPG levels were associated positively with higher maternal bodyweight, BMI, body fat, fat free mass and visceral fat (all P 29.9 kg/m2 (OR 7.4, P = 0.01). Conclusions Our findings indicate that maternal BMI is the key determinant of maternal glycaemia. Interventions which focus on overall energy restriction and especially the limitation of dietary starch to optimise prepregnancy maternal bodyweight are likely to be useful in improving glycaemic control in higher risk pregnancies.

Objectives HIV disproportionately affects men who have sex with men (MSM) in Ireland. The aim of this study was to improve understanding of HIV testing among MSM living in Ireland to inform prevention and testing initiatives. Methods We used data from the MSM Internet Survey Ireland 2015 (MISI 2015), a cross-sectional survey of MSM living in Ireland. We identified factors associated with never having tested for HIV using univariable and multivariable logistic regression. We identified preferred sites for future tests and examined the relationships between unmet HIV testing needs and socio-demographic groups. Results More than one-third (n=1006; 36%) of MSM had never tested for HIV. Multivariable logistic regression showed that untested men were more likely to be aged 18–24 years, live outside Dublin,have a lower level of education, be born in Ireland, identify as bisexual, be out to fewer people, and not have had sex with a man in the previous 12 months. The same groups of men also had the least knowledge about HIV and were least confident in accessing an HIV test. Men who had never tested for HIV were more likely to prefer testing by their general practitioner (GP) or using home sampling HIV kits and less likely to prefer testing in a sexual health clinic. Conclusions HIV prevention and testing programmes for MSM should be targeted towards younger men, those living outside Dublin and those with lower levels of education. We recommend increased promotion and availability of free HIV testing services in a range of clinical and nonclinical settings (including self-sampling and home testing).

Background Maternal nutrition intakes may influence neonatal birthweight and adiposity; however, inconsistencies within the literature exist. The relationships between maternal dietary intakes in early pregnancy and both birthweight and neonatal adiposity requires elucidation. This study examined the relationship between early pregnancy dietary intakes and subsequent birthweight and neonatal adiposity. Methods Women were recruited at their convenience after sonographic confirmation of a singleton pregnancy. Women completed a Willet food frequency questionnaire evaluating habitual food and nutrient intakes at their first antenatal visit. Neonatal body composition was measured using air-displacement plethysmography. Results Of the 385 mother-neonate dyads, mean maternal age was 30.8 ± 5.3 years, mean Body Mass Index (BMI) was 24.5 ± 4.8 kg/m2 and 41.8% (n = 161) were nulliparous. There were no relationships between maternal food intakes and birthweight (P > 0.05) (n = 385). On multivariable analysis there was a positive relationship between polyunsaturated fat and neonatal fat mass index (FMI) (beta = 0.015, 95% CI = 0.002-0.028, P = 0.04) (n = 80). Conclusion Dietary intakes of polyunsaturated fat in early pregnancy are positively associated with neonatal FMI at birth on multivariable analysis. Further longitudinal studies need to explore this association and the long-term implications for the neonate.

Strong evidence that folic acid (FA) prevents the majority of cases of neural tube defects (NTDs) has led to national organisations developing guidelines for women concerning periconceptional supplementation. In Europe, there is evidence of national variations in the incidence of NTDs, with a recent Irish study reporting an increase in the rate. This review compares the periconceptional FA supplementation guidelines between the different countries in Europe. An online search of country-specific guidelines produced before 2015 concerning periconceptional FA supplementation was conducted. If an English version was not available directly, the EUROCAT register was searched for the English version of the recommendations. We identified national guidelines from 20 European countries. Over half recommended that FA supplements be taken by women planning a pregnancy, but three recommended that they should be taken by all women of child-bearing age. Four guidelines recommended starting FA at least 4 weeks preconceptionally, but no country recommended starting FA at least 12 weeks preconceptionally as suggested by recently published studies. There is a need for further consideration of the duration of preconceptional FA supplementation specifically. The latest scientific evidence in this area should inform the development of European guidelines on FA, as there is wide variation in current recommendations. Overall, the wide variation in national guidelines concerning periconceptional FA supplementation may in part explain the differences in national rates of NTDs reported by EUROCAT. National guidelines on FA supplementation should be standardised across European countries.

Objective We analyzed trends in folic acid supplementation among women booking for antenatal care between 2009 and 2013. Design Prospective observational study. Setting Large university teaching hospital. Population We included all women who delivered an infant ≥500 g from 1 January 2009 to 31 December 2013. Methods Body mass index was calculated using early pregnancy weight and height measured at first antenatal visits. Sociodemographic and clinical data were gathered prospectively. Multivariate logistic regression analyses were applied to determine the correlates of periconceptional folic acid supplementation. Main outcome measures Rates and correlates of folic acid supplementation. Results Of 42 362 women, 99.2% (n = 42 042) were suitable for analysis. The mean age was 30.7 years and mean body mass index was 25.6 kg/m2, 40.7% (n = 17 054) were primigravidas and 70.6% (n = 29 741) were Irish-born. Overall, 43.9% (n = 18 473) took periconceptional (preconceptional and postconceptional) folic acid, 49.4% (n = 20 782) took postconceptional folic acid only, and 6.6% (n = 2787) took no folic acid. The women most likely to take folic acid were those who planned their pregnancy and were >30 years old, non-obese, Irish-born and employed professionally. The periconceptional folic acid rate decreased from 45.1% in 2009 to 43.1% in 2013 (p = 0.01). Over five years, periconceptional folic acid supplementation decreased among women who were multiparous (43.8–41.6%, p = 0.02), aged 30–39 years (58.9–55.0%, p

Background Neural tube defects (NTDs) are major congenital malformations that are potentially preventable if the woman takes periconceptional folic acid (FA) supplements. A recent report found that NTD incidence had increased in Ireland. This study examined the usage of FA supplementation in women presenting for antenatal care in a maternity hospital. Methods Women were recruited at their convenience in the first trimester. Their clinical and sociodemographic details were computerized. Maternal weight and height were measured before calculating body mass index. Detailed FA questionnaires were completed under supervision of a trained researcher. Results While 96.1% (n = 564) out of 587 reported that they took FA after they became pregnant, only 24.7% (n = 145) took it for >12 weeks preconceptionally as recommended. Only 5.7% (n = 6) of obese women took high-dose FA as recommended. On univariate analysis, the strongest predictors of preconceptional FA usage were higher maternal age, higher education and income, being married, being nulliparous, not smoking, infertility treatment and planned pregnancy. On multivariate analysis, both planned pregnancy and nulliparity were the most important predictors of preconceptional FA use. Conclusions Our study shows that current recommendations to prevent NTDs by FA supplementation pre-pregnancy are not being fully implemented in Ireland. We recommend a review of current public health policies on FA supplementation.

Background We examined the relationship between timing and duration of folic acid (FA) supplementation in achieving red blood cell (RBC) folate levels in early pregnancy which are optimal (>906 nmol/l) for the prevention of neural tube defects (NTDs). Methods Clinical, FA supplementation and dietary folate details were computerized at the first antenatal visit. Maternal blood samples were analysed for RBC and serum folate. Results Of the 502 women, 98.2% (n = 493) reported taking FA. There was a positive correlation between duration of supplementation and both RBC folate (r = 0.43, P < 0.001) and serum folate (rho = 0.29, P < 0.001). The optimal RBC folate level was achieved in 80.4% (n = 46) of women who started FA 400 μg 4–8 weeks before their LMP compared with only 53.6% (n = 153) in women who started 4–8 weeks after their LMP (P < 0.001). Conclusions This study provides, for the first time, information on both the timing and duration of FA that will achieve the optimum RBC folate levels associated with the prevention of NTDs. Women who are taking FA (400 μg) need to start before they conceive.

Aim This observational ecological study aims to compare Ireland’s age-specific cancer incidence rates (ASRs) with equivalent European and global data and to highlight possible dietary, nutritional and lifestyle contributors to cancer in Ireland. Subjects and methods Using the International Agency for Research on Cancer’s (IARC) GLOBOCAN database, Irish ASRs for all-site cancer and for "lifestyle-related" cancers such as those of the colo-rectum, oesophagus, breast, lung and prostate were compared with European and global incidence data. Irish dietary and nutrient intake data were reviewed and evaluated in the context of these cancer incidence data and in relation to the established dietary, nutritional, lifestyle and anthropometric predictors of increased cancer risk previously articulated in the literature. Results Incidence rates of colorectal, oesophageal, breast, lung, prostate and all-site cancer are higher in Ireland than in most other countries. National nutrition surveys in Ireland indicate that dietary, nutritional, lifestyle and anthropometric risk factors for cancer occur with high frequency in the Irish population. For example, low fruit and vegetable consumption, high red and processed meat intake, low fish intake, low dairy consumption, high saturated fat intake, low folate and vitamin D intakes, and excessive alcohol consumption are all common amongst Irish adults. Conclusions Our data suggest that unfavourable diet and nutrient intakes prevail in Ireland and that these may contribute to Ireland’s excess cancer burden. These risk factors should be targeted by interventions seeking to sustainably redress Ireland’s high cancer incidence. Such initiatives may provide a template for intervention in other high-risk countries.

Recent national surveys which measured respondents' blood pressure (BP) levels have shown a high prevalence of hypertension amongst the Irish population, with approximately two-thirds of men and over half of women aged 45 years and over affected. Higher prevalence rates are observed with advancing age. Established diet- and lifestyle-related risk factors for hypertension such as high salt intake, high alcohol consumption and physical inactivity are pervasive in Ireland and are believed to contribute significantly to the high national prevalence of this condition. Additional dietary deficits have been implicated in the development of hypertension, however, including low fruit and vegetable intake, low dairy food consumption and low intake of oily fish. Deficiencies of single micro-nutrients such as folate, riboflavin, vitamin C and vitamin D have also been recently recognised as risk factors for hypertension. For each of these factors, there is evidence that the food and nutrient intakes of many Irish adults fall short of the ideal. These dietary and nutritional deficits, when superimposed on Ireland's existing health-subversive behaviours and escalating rates of obesity, constitute a potent constellation of risk factors for hypertension. However, they also represent viable and potentially effective targets for health promotion initiatives. This review aims to describe the main nutritional, dietary and lifestyle contributors to hypertension in Ireland with a view to informing future interventions aimed at alleviating Ireland's burden of hypertensive disease.

The aim of this article is to review the current evidence on gestational weight gain (GWG). Maternal obesity has emerged as one of the great challenges in modern obstetrics as it is becoming increasingly common and is associated with increased maternal and fetal complications. There has been an upsurge of interest in GWG with an emphasis on the relationship between excessive GWG and increased fetal growth. Recent recommendations from the Institute of Medicine in the USA have revised downwards the weight gain recommendations in pregnancy for obese mothers. We believe that it is time to take stock again about the advice that pregnant women are given about GWG and their lifestyle before, during, and after pregnancy. The epidemiological links between excessive GWG and aberrant fetal growth are weak, particularly in obese women. There is little evidence that intervention studies decrease excessive GWG or improve intrauterine fetal growth. Indeed, there is a potential risk that inappropriate interventions during the course of pregnancy may lead to fetal malnutrition that may have adverse clinical consequences, both in the short- and long-term. It may be more appropriate to shift the focus of attention from monitoring maternal weight to increasing physical activity levels and improving nutritional intakes.

The present study aimed to investigate socio-economic disparities in food and nutrient intakes among young Irish women. A total of 221 disadvantaged and seventy-four non-disadvantaged women aged 18–35 years were recruited. Diet was assessed using a diet history protocol. Of the total population, 153 disadvantaged and sixty-three non-disadvantaged women were classified as plausible dietary reporters. Food group intakes, nutrient intakes and dietary vitamin and mineral concentrations per MJ of energy consumed were compared between the disadvantaged and non-disadvantaged populations, as was compliance with dietary fibre, macronutrient and micronutrient intake guidelines. The disadvantaged women had lower intakes than the non-disadvantaged women of fruit, vegetables, fish, breakfast cereals, low-fat milk and wholemeal bread (allPP= 0·001), low-fat spread (P= 0·002) and fresh meat (P= 0·003). They also had higher intakes of butter, processed red meats, white bread, sugar-sweetened beverages, fried potatoes and potato-based snacks (allPP= 0·014). Nutritionally, the disadvantaged women had higher fat, saturated fat and refined sugar intakes; lower dietary fibre, vitamin and mineral intakes; and lower dietary vitamin and mineral densities per MJ than their more advantaged peers. Non-achievement of carbohydrate (P= 0·017), fat (PPPP= 0·050), vitamin C (PP= 0·047) and Ca (P= 0·019) recommendations was more prevalent among the disadvantaged women. Both groups showed poor compliance with Fe and Na guidelines. We conclude that the nutritional deficits present among these socially disadvantaged women are significant, but may be potentially ameliorated by targeted food-based interventions.

Background The aim of this observational study was to measure food, macronutrient and micronutrient intakes of women presenting for antenatal care and assess compliance with current nutritional recommendations. Methods Women were recruited in the first trimester of pregnancy. Maternal weight and height were measured and body mass index (BMI) calculated. Body composition was measured using bioelectrical impedance analysis. Maternal energy and nutrient intakes were estimated using a validated Willett Food Frequency Questionnaire and misreporting of energy intakes (EI) determined. Results Plausible EIs were reported in 402 women. Mean age, weight and BMI were 30.8 years, 67.1 kg and 24.6 kg/m2 respectively. Median EIs were 2111 kcal, and median protein, carbohydrate and fat intakes were 17.3, 48.1 and 36.2 g/MJ/day, respectively. More than 90% of women exceeded the recommended daily allowance for saturated fat. Nearly all of the women (99%) did not meet estimated average requirements (EAR) for vitamin D. One in three women failed to achieve a dietary folate intake of 400 µg/day. Over one in five women failed to meet the EAR for iron, and 14% failed to achieve the EAR for calcium. Conclusions Our findings highlight concerning deficits in nutrient intakes among women and will help guide professional dietary advice to women attending for future obstetric care in Ireland.

Women seek information about infant feeding from multiple sources, which may conflict. Increasingly women use digital media for pregnancy information. This study examined women's use of digital media for information on infant feeding. In addition to clinical and socio-demographic data, detailed data concerning women's infant feeding practices and their use of digital media for infant feeding information were collected. We surveyed 295 women who attended nine months postpartum as part of a longitudinal study on maternal weight trajectories. Digital media was used by 130 women (44.1%) to access information on infant feeding, which is higher than hitherto reported. Women who did not use digital media were more likely to be multigravidous (p = 0.03), to be socially disadvantaged (p = 0.01), and were less likely to breastfeed (p = 0.01). However, on multivariable analysis, only women economically disadvantaged were less likely to use digital media [OR 0.25, p < 0.02]. The types of digital media used varied, and an overwhelming majority were non-subscription resources. Less than 5% of women used professional evidence-based digital media sources. The use of digital media was not associated with the timing of weaning. Information on infant feeding should be evidence-based and provided digitally to women across all socioeconomic gradients as part of an e-health national policy.

OBJECTIVE: to explore routine weighing in antenatal care and weight management in pregnancy with women who have been weighed during pregnancy.DESIGN: a qualitative study utilising semi-structured telephone interviews, and thematic analysis.SETTING: participants resided in Dublin, Ireland and had been weighed during pregnancy.PARTICIPANTS: individual telephone interviews conducted with ten postpartum women (nine months postpartum).FINDINGS: experiences of routine weighing were positive, and participants believed it should be part of standard antenatal care. Several benefits to routine weighing were cited, including providing reassurance and minimising postpartum weight retention. It was felt that there was a lack of information provided on gestational weight gain and healthy lifestyle in pregnancy, and that healthcare professionals are ideally placed to provide this advice. Increased information provision was seen as a method to improve healthy lifestyle behaviours in pregnancy.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: these findings contribute to the current debate about the re-introduction of routine weighing throughout pregnancy (Allen-Walker et al., 2016). Women stated that they expected to be weighed during pregnancy and, contrary to previous claims, there was no evidence that routine weighing during antenatal care caused anxiety. From discussions it was clear that women desired more information on gestational weight gain and a healthy lifestyle, and felt that health professionals should provide this.

Objectives During pregnancy, women are increasingly turning to web-based resources for information. This study examined the use of web-based nutritional information by women during pregnancy and explored their preferences. Study design Cross-sectional observational study. Methods Women were enrolled at their convenience from a large maternity hospital. Clinical and sociodemographic details were collected and women's use of web-based resources was assessed using a detailed questionnaire. Results Of the 101 women, 41.6% were nulliparous and the mean age was 33.1 years (19–47 years). All women had internet access and only 3% did not own a smartphone. Women derived pregnancy-related nutritional information from a range of online resources, most commonly: What to Expect When You're Expecting (15.1%), Babycenter (12.9%), and Eumom (9.7%). However, 24.7% reported using Google searches. There was minimal use of publically funded or academically supported resources. The features women wanted in a web-based application were recipes (88%), exercise advice (71%), personalized dietary feedback (37%), social features (35%), videos (24%) and cooking demonstrations (23%). Conclusions This survey highlights the risk that pregnant women may get nutritional information from online resources which are not evidence-based. It also identifies features that women want from a web-based nutritional resource.

Background Maternal diet is critical to fetal development and lifelong health outcomes. In this context, dietary quality indices in pregnancy should be explicitly underpinned by data correlating food intake patterns with nutrient intakes known to be important for gestation. Aims Our aim was to assess the correlation between dietary quality scores derived from a novel online dietary assessment tool (DAT) and nutrient intake data derived from the previously validated Willett Food Frequency Questionnaire (WFFQ). Methods 524 women completed the validated semiquantitive WFFQ and online DAT questionnaire in their first trimester. Spearman correlation and Kruskal–Wallis tests were used to test associations between energy-adjusted and energy-unadjusted nutrient intakes derived from the WFFQ, and diet and nutrition scores obtained from the DAT. Results Positive correlations were observed between respondents’ diet and nutrition scores derived from the online DAT, and their folate, vitamin B12, iron, calcium, zinc and iodine intakes/MJ of energy consumed derived from the WFFQ (all P\0.001). Negative correlations were observed between participants’ diet and nutrition scores and their total energy intake (P = 0.02), and their percentage energy from fat, saturated fat, and non-milk extrinsic sugars (NMES) (all P B 0.001). Median dietary fibre, beta carotene, folate, vitamin C and vitamin D intakes derived from the WFFQ, generally increased across quartiles of diet and nutrition score (all P\0.001). Conclusions Scores generated by this web-based DAT correlate with important nutrient intakes in pregnancy, supporting its use in estimating overall dietary quality among obstetric populations.

ObjectiveWe examined whether breast-feeding, and in particular exclusive breast-feeding, was associated with maternal weight and body composition changes at 4 months postpartum independently of other maternal variables.DesignProspective longitudinal study. Women were recruited in the first trimester after an ultrasound examination confirmed an ongoing singleton pregnancy. Weight and body composition were measured using advanced bio-electrical impedance analysis at the first antenatal visit and 4 months postpartum. Detailed questionnaires were completed on breast-feeding, socio-economic status, diet and exercise in addition to routine clinical and sociodemographic details.SettingLarge Irish university maternity hospital.SubjectsWomen who delivered a baby weighing ≥500 g between November 2012 and March 2014.ResultsAt the postpartum visit, the mean weight was 70·9 (sd14·2) kg (n470) and the mean BMI was 25·9 (sd5·0) kg/m2. ‘Any breast-feeding’ was reported by 65·1 % of women (n306). Irish nativity (OR=0·085,PP=0·01), relative income poverty (OR=0·421,P=0·04) and deprivation (OR=0·458,P=0·02) were negatively associated with exclusive breast-feeding. At 4 months postpartum there was no difference in maternal weight change between women who exclusively breast-fed and those who formula-fed (+2·0v. +1·1 kg,P=0·13). Women who exclusively breast-fed had a greater increase in percentage body fat at 4 months postpartum compared with women who formula-fed (+1·0v. −0·03 %,P=0·02), even though their dietary quality was better. Exclusive breast-feeding was not associated with postpartum maternal weight or body fat percentage change after adjusting for other maternal variables.ConclusionsThere are many reasons why breast-feeding should be strongly promoted but we found no evidence to support postpartum weight management as an advantage of breast-feeding.