Associations of maternal iron intake and hemoglobin in pregnancy with offspring vascular phenotypes and adiposity at Age 10: findings from the Avon Longitudinal Study of Parents and Children

Background: iron deficiency is common during pregnancy. Experimental animal studies suggest that it increases cardiovascular risk in the offspring.Objective: to examine the relationship between maternal pregnancy dietary and supplement iron intake and hemoglobin, with offspring’s arterial stiffness (measured by carotid-radial pulse wave velocity), endothelial function (measured by brachial artery flow mediated dilatation), blood pressure, and adiposity (measured by body mass index), test for mediation by cord ferritin, birth weight, gestational age, and child dietary iron intake, and for effect modification by maternal vitamin C intake and offspring sex.Design: prospective data from 2958 mothers and children pairs at 10 years of age enrolled in an English birth cohort, the Avon Longitudinal Study for Parents and Children (ALSPAC), was analysed.Results: 2639 (89.2%) mothers reported dietary iron intake in pregnancy below the UK reference nutrient intake of 14.8 mg/day. 1328 (44.9%) reported taking iron supplements, and 129 (4.4%) were anemic by 18 weeks gestation. No associations were observed apart from maternal iron intake from supplements with offspring systolic blood pressure (?0.8 mmHg, 99% CI ?1.7 to 0, P = 0.01 in the sample with all relevant data observed, and ?0.7 mmHg, 99% CI ?1.3 to 0, P = 0.008 in the sample with missing data imputed).Conclusion: there was no evidence of association between maternal pregnancy dietary iron intake, or maternal hemoglobin concentration (which is less likely to be biased by subjective reporting) with offspring outcomes. There was a modest inverse association between maternal iron supplement intake during pregnancy with offspring systolic blood pressure at 10 year

Maternal iron status in early pregnancy and birth outcomes : insights from the Baby's Vascular health and Iron in Pregnancy study

Date of Acceptance: 16/03/2015 Acknowledgements N. A. A. was funded by a Wellcome Trust Research Training Fellowship (WT87789). H. J. M. and H. E. H. are supported by the Scottish Government’s Rural and Environment Science and Analytical Services. N. A. B. S. is supported by Cerebra. The authors’ contributions are as follows: N. A. A. was responsible for organising the study conduct, data collection and database management, performed the statistical analysis, interpreted the results and drafted the paper. N. A. A., N. A. B. S., J. E. C., H. J. M. and D. C. G. contributed to the study concept and design, and interpretation of results. H. J. M. and H. E. H. analysed the laboratory samples. J. E. C. and D. C. G. provided advice on statistical strategy and analysis. All authors have fully participated in the reporting stage and have critically reviewed and approved the final draft of the paper. The authors declare no conflict of interestPeer reviewedPublisher PD

Formative evaluation of the usability and acceptability of myfood24 among adolescents: a UK online dietary assessments tool

BackgroundMyfood24 is a new online 24 h dietary assessment tool developed for use among the UK population. Limited information is available on the usability and acceptability of such tools. Hence this study aims to determine the usability and acceptability of myfood24 among British adolescents (11-18y) before and after making the improvements.MethodsA total of 84 adolescents were involved in two stages. In stage-I (beta-version of myfood24), 14 adolescents were recruited, 7 of whom (group-1) were asked to enter standardized tasks in a testing room with screen capture software. The remaining 7-adolescents (group-2) were asked to report their previous food intake using myfood24 at home. All participants then completed a usability and acceptability questionnaire. Stage-II was carried out after making amendments to the live-version of myfood24 in which 70 adolescents were asked to enter their food intake for two days and then complete the same questionnaire. Thematic analysis was conducted of observer comments and open-ended questions.ResultsNavigation, presentation errors and failure to find functions were the main usability issues identified in the beta-version. Significant improvements were found in the usability and acceptability of most functions after implementing certain features like a spell checker, auto-fill option, and adding ‘mouse hover’ to help with the use of some functions. Adolescents’ perceptions of searching food items, selecting food portion sizes and making a list function were significantly improved in the live-version. The mean completion time of myfood24 reduced from 31 (SD?=?6) minutes in the beta-version to 16 (SD?=?5) minutes in the live-version. The mean system usability score (SUS) of myfood24 improved from 66/100 (95 % CI 60, 73) in the beta-version to 74/100 (95 % CI 71, 77) in the live-version, which is considered as ‘good’. Of the adolescents in stage-II, 41 % preferred using myfood24 to the interviewer-administered 24 h recall because myfood24 was quicker, easier to use and provided the adolescents with privacy when reporting dietary intake.ConclusionConsidering adolescents’ feedback has helped in improving the usability and acceptability of the final-version of myfood24. myfood24 appears to support adolescents’ need in reporting their dietary intake, which may potentially improve the overall quality of adolescents’ self-reported dietary information

The effect of maternal iron status and intake during pregnancy on cardiovascular disease risk in the offspring

Iron is an important micronutrient essential in carrying oxygen and maintaining the function of many body enzymes. It is of particular importance during gestation as body demands increase leading to iron deficiency in women with inadequate iron stores at the start of pregnancy. Animal studies have shown that iron deficiency in pregnancy leads to offspring with adverse cardiovascular risk profiles compared to offspring of iron replete mothers. This thesis aimed to examine the association of maternal iron intake and status in pregnancy with short and long term birth outcomes that are considered cardiovascular risk indicators later in life. Analysis of data from three cohorts and one Mendelian randomisation study was included in this thesis. Total maternal iron intake in early, but not late, pregnancy was positively associated with birth size. There was no evidence of association between taking iron-containing supplements in pregnancy and size at birth. However, taking multivitamin-mineral supplements, which contain iron, in late pregnancy was associated with an increased risk of preterm birth. Also taking iron supplements up to 32 weeks gestation was associated with lower offspring systolic blood pressure at 10 years. Maternal iron deficiency and anaemia in early pregnancy were associated with an increased risk of giving birth to a SGA baby. Infant brachio-femoral PWV measured at 2-6 weeks of age was found to be higher in women who were anaemic in early pregnancy, but not in those who were only iron deficient. Finally, using a Mendelian randomisation design, maternal iron status measured by serum ferritin with C282Y mutation as an instrumental variable, was not found to be associated with adult offspring BP and adiposity. In conclusion, maternal iron intake and status in early pregnancy seem to be associated with short term birth outcomes like size at birth, while associations with long term offspring cardiovascular indicators were not detected in this thesis

Quantifying the effect of interpregnancy maternal weight and smoking status changes on childhood overweight and obesity in a UK population-based cohort

Background: Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children. Methods: Records for 5612 women were drawn from a population-based cohort of routinely collected antenatal healthcare records (2003–2014) linked to measured child body mass index (BMI) age 4–5 years. We applied the parametric G-formula to estimate the effect of hypothetical changes between pregnancy-1 and pregnancy-2 compared to the natural course scenario (without change) on child-2 BMI. Results: Observed overweight/obesity and obesity in child-2 at age 4–5 years were 22.2% and 8·5%, respectively. We estimated that if all mothers started pregnancy-2 with BMI 18·5–24·9 kg/m² and all smokers stopped smoking, then child-2 overweight/obesity and obesity natural course estimates of 22.3% (95% CI 21.2–23.5) and 8·3% (7·6–9·1), would be reduced to 18.5% (17.4–19.9) and 6.2% (5.5–7.0), respectively. For mothers who started pregnancy-1 with BMI 18·5–24·9 kg/m², if all smokers stopped smoking, child-2 overweight/obesity and obesity natural course estimates of 17.3% (16.0–18.6) and 5·9% (5·0–6·7) would be reduced to 16.0% (14.6–17.3) and 4·9% (4·1–5·7), respectively. For mothers who started pregnancy-1 with BMI ≥30 kg/m², if BMI was 18·5–24·9 kg/m² prior to pregnancy-2, child-2 overweight/obesity and obesity natural course estimates of 38.6% (34.7–42.3) and 17·7% (15·1–20·9) would be reduced to 31.3% (23.8–40.0) and 12.5 (8.3–17.4), respectively. If BMI was 25.0–29.9 kg/m² prior to pregnancy-2, these estimates would be 34.5% (29.4–40.4) and 14.6% (11.2–17.8), respectively. Conclusion: Interventions supporting women to lose/maintain weight and quit smoking between pregnancies could help reduce rates of overweight/obesity and obesity in second children. The most effective interventions may vary by maternal BMI prior to the first pregnancy

Why the Patient-Made Term 'Long Covid' is needed

The patient-made term ‘Long Covid’ is, we argue, a helpful and capacious term that is needed to address key medical, epidemiological and socio-political challenges posed by diverse symptoms persisting beyond four weeks after symptom onset suggestive of coronavirus disease 2019 (COVID-19). An international movement of patients (which includes all six authors) brought the persistence and heterogeneity of long-term symptoms to widespread visibility. The same grassroots movement introduced the term ‘Long Covid’ (and the cognate term ‘long-haulers’) to intervene in relation to widespread assumptions about disease severity and duration. Persistent symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are now one of the most pressing clinical and public health phenomena to address: their cause(s) is/are unknown, their effects can be debilitating, and the percentage of patients affected is unclear, though likely significant. The term ‘Long Covid’ is now used in scientific literature, the media, and in interactions with the WHO. Uncertainty regarding its value and meaning, however, remains. In this Open Letter, we explain the advantages of the term ‘Long Covid’ and bring clarity to some pressing issues of use and definition. We also point to the importance of centring patient experience and expertise in relation to ‘Long Covid’ research, as well as the provision of care and rehabilitation.</ns4:p

Misaligned or misheard?:Physical activity and healthy eating messaging to ethnic minority communities during the COVID-19 pandemic: A qualitative study and scoping review

This mixed-methods study identified physical activity (PA) and healthy eating messages produced during the COVID-19 pandemic and explored how they were received by UK ethnic minority communities. A scoping review of research and grey literature identified categories of PA and healthy eating messaging targeted at ethnic minorities. Individual and group interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. There was active community engagement in all study phases to ensure relevance and co-production of findings. Interviews were held with 41 study participants aged 18-86 years (20 men) residing in England and Wales using digital conferencing and in person. The scoping review identified 24 records containing messages grouped into three categories: 1) PA messages; 2) healthy eating messages; 3) risk messages. Five themes described participants' views of these messages: 1) lack of awareness of messaging; 2) responses to PA messaging; 3) responses to healthy eating messaging; 4) perceptions of risk messaging and 5) perceptions of conflict in messages. The review revealed that physical activity and healthy eating messaging specifically targeting ethnic minority communities is limited. This limited messaging was almost entirely missed by these communities. When received, the messaging was not interpreted as intended, perceived to be conflicting and risk messaging was perceived as blaming. More work with ethnic minority communities needs to be done to co-produce meaningful and appropriate PA and healthy eating messaging in a timely manner.</p

Risk of new-onset Long Covid following reinfection with SARS-CoV-2: community-based cohort study

Background: Little is known about the risk of Long Covid following reinfection with SARS-CoV-2. We estimated the likelihood of new-onset, self-reported Long Covid after a second SARS-CoV-2 infection, and compared to a first infection. // Methods: We included UK COVID-19 Infection Survey participants who tested positive for SARS-CoV-2 between 1 November 2021 and 8 October 2022. The primary outcome was self-reported Long Covid 12 to 20 weeks after each infection. Separate analyses were performed for those <16 years and ≥16 years. We estimated adjusted odds ratios (aORs) for new-onset Long Covid using logistic regression, comparing second to first infections, controlling for socio-demographic characteristics and calendar date of infection, plus vaccination status in those ≥16 years. // Results: Overall, Long Covid was reported by those ≥16 years after 4.0% and 2.4% of first and second infections, respectively; the corresponding estimates among those <16 years were 1.0% and 0.6%. The aOR for Long Covid after second compared to first infections was 0.72 (95% confidence interval: 0.63–0.81) for those ≥16 years and 0.93 (0.57–1.53) for those <16 years. // Conclusions: The risk of new-onset Long Covid after a second SARS-CoV-2 infection is lower than that after a first infection for those ≥16 years, though there is no evidence of a difference in risk for those <16 years. However, there remains some risk of new-onset Long Covid after a second infection, with around 1 in 40 of those ≥16 years and 1 in 165 of those <16 years reporting Long Covid after a second infection