Journal Articles

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    Dietary Patterns and Diet Quality before and/or during Pregnancy and How These Affect Birth Outcomes: A Systematic Review and Meta-analysis
    (Elsevier Inc. on behalf of American Society for Nutrition, 2025-10) Salatas C; Bronnert A; Lawrence R; Alexander T; Wall C; Bloomfield FH; Lin L
    Limited consistent evidence exists on how diet quality before and during pregnancy influences preterm birth and low birthweight risk. This study aims to assess whether diet quality based on dietary patterns before and during pregnancy affects preterm birth and low birthweight risk. We systematically searched 3 electronic databases and 4 registries for randomized controlled trials (RCTs) and quasi-RCTs without restrictions on publication date or language until 22 November, 2024. Included RCTs evaluated dietary patterns to enhance diet quality before/during pregnancy compared with a usual diet or placebo. Results were synthesized using random-effects meta-analyses with risk ratios (RRs) and 95% confidence intervals. Study quality was assessed using the Cochrane Risk of Bias 1 tool, and certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. Twenty-nine RCTs (7367 participants) were included. Improved diet quality through dietary patterns providing the recommended macronutrient intake or high unsaturated fats before and during pregnancy reduced the incidence of low birthweight (<2500 g) (7 RCTs, 2178 participants, RR 0.53 [0.37, 0.77], low certainty of evidence) and have potential benefit for reducing preterm birth (15 RCTs, 4949 participants, RR 0.79 [0.62, 1.02], low certainty of evidence) compared with usual diet. The data available support interventions starting in the first trimester (RR 0.30 [0.11, 0.80]), lasting 4–7 mo (RR 0.52 [0.37, 0.73]), with similar effects in both high-/upper-middle-income [RR 0.44 (0.19, 10.04)] and lower-middle-income (RR 0.44 [0.31, 0.63]) populations, especially in low-risk women (RR 0.52 [0.37, 0.73]). Diets providing the recommended macronutrient intake or high in unsaturated fats significantly reduced risk of low birthweight when initiated in the first trimester and maintained for 4–7 mo, regardless of country-level socioeconomic context. Healthcare providers should consider recommending dietary patterns emphasizing whole foods and high-quality fats as part of early prenatal care.
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    Adherence to Dietary and Lifestyle Guidelines Among Women With a History of Gestational Diabetes Mellitus and the Influence of a Student-Led Dietetic Clinics
    (Wiley Periodicals LLC, Hoboken, USA, 2025-02-23) Illenberger K; Sekula J; Lawrence R
    Women with a history of gestational diabetes mellitus have an increased risk of developing type 2 diabetes. Healthy diet and lifestyle habits may contribute to reducing this risk. This study aimed to describe dietary intake and lifestyle habits of women with a history of gestational diabetes mellitus and determine the impact of nutrition and lifestyle counseling on dietary intake and lifestyle goals. This retrospective cohort study included 32 women with a history of gestational diabetes mellitus 6 months postpartum who attended the student-led nutrition clinic between 01 June 2021 and 31 August 2022. Dietary intake, lifestyle, and physical activity habits were extracted from student dietitians' notes. The mid-p-value McNemar's test was used to determine whether attendance at the student-led dietetic clinic was associated with a change in the proportion of women meeting the guidelines. Fifteen percent (n = 5) of women did not meet any food group recommendations prior to any interventions. Most women (46.8%) engaged in less than the recommended level of physical activity and more than a quarter (28.1%) did not engage in any physical activity at their initial consultation. After attending at least one consultation, a greater proportion of women met recommendations for at least one food group (41.1% vs. 18.7%, p = 0.256) and a greater proportion of women met physical activity guidelines (60% vs. 25%, p = 0.125). In this cohort of postpartum women with a history of gestational diabetes mellitus, adherence to the Ministry of Health Eating and Activity guidelines was poor. Positive changes towards adherence are possible after attendance at a student-led nutrition and dietetic clinic.
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    Nourishing the Infant Gut Microbiome to Support Immune Health: Protocol of SUN (Seeding Through Feeding) Randomized Controlled Trial.
    (JMIR Publications, 2024-09-02) Wall CR; Roy NC; Mullaney JA; McNabb WC; Gasser O; Fraser K; Altermann E; Young W; Cooney J; Lawrence R; Jiang Y; Galland BC; Fu X; Tonkie JN; Mahawar N; Lovell AL; Ma S
    Background: The introduction of complementary foods during the first year of life influences the diversity of the gut microbiome. How this diversity affects immune development and health is unclear. Objective: This study evaluates the effect of consuming kūmara or kūmara with added banana powder (resistant starch) compared to a reference control at 4 months post randomization on the prevalence of respiratory tract infections and the development of the gut microbiome. Methods: This study is a double-blind, randomized controlled trial of mothers and their 6-month-old infants (up to n=300) who have not yet started solids. Infants are randomized into one of 3 groups: control arm (C), standard kūmara intervention (K), and a kūmara intervention with added banana powder product (K+) to be consumed daily for 4 months until the infant is approximately 10 months old. Infants are matched for sex using stratified randomization. Data are collected at baseline (prior to commencing solid food) and at 2 and 4 months after commencing solid food (at around 8 and 10 months of age). Data and samples collected at each timepoint include weight and length, intervention adherence (months 2 and 4), illness and medication history, dietary intake (months 2 and 4), sleep (diary and actigraphy), maternal dietary intake, breast milk, feces (baseline and 4 months), and blood samples (baseline and 4 months). Results: The trial was approved by the Health and Disability Ethics Committee of the Ministry of Health, New Zealand (reference 20/NTA/9). Recruitment and data collection did not commence until January 2022 due to the COVID-19 pandemic. Data collection and analyses are expected to conclude in January 2024 and early 2025, respectively. Results are to be published in 2024 and 2025. Conclusions: The results of this study will help us understand how the introduction of a specific prebiotic complementary food affects the microbiota and relative abundances of the microbial species, the modulation of immune development, and infant health. It will contribute to the expanding body of research that aims to deepen our understanding of the connections between nutrition, gut microbiota, and early-life postnatal health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000026921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378654 International Registered Report Identifier (IRRID): DERR1-10.2196/56772 JMIR Res Protoc 2024;13:e56772