In a recent study published in JAMA Network Open, researchers investigated whether lifestyle interventions such as Mediterranean diet abidance and mindfulness-based stress reduction (MBSR) during pregnancy could effectively improve pediatric neurodevelopment at two years of age.
Maternal lifestyle and maternal stress are known modifiable risk factors for fetal neurodevelopment. Studies have reported that unhealthy dietary habits, including increased consumption of fats, and obesity among mothers, can negatively impact neurodevelopment in their children. At the same time, elevated maternal stress levels alter fetal brain structural growth and worsen postnatal neurodevelopment.
The pathophysiological mechanisms underlying these relationships are unclear; however, the hypothalamus-pituitary-adrenal axis (HPA) is reportedly involved. Interventions promoting healthy dietary patterns and stress reduction may restore HPA functions and improve fetal neurodevelopment.
About the study
In the present study, researchers evaluated the impacts of stress reduction and dietary interventions among pregnant females on neurodevelopment in their children aged two years.
The study included the Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) parallel-group randomized controlled trial (RCT) participants, who were enrolled between February 2017 and October 2019 and followed up until childbirth (until 1 March 2020).
The trial was carried out at an educational facility in Barcelona. In total, 1,221 singleton pregnancies (between gestational weeks 19 and 23) with an increased risk of small-for-gestational-age (SGA) newborn delivery were randomly divided into three groups in a 1:1:1 ratio: the dietary intervention group, the Mindfulness-Based Stress Reduction (MBSR) program group, and the regular care group.
The dietary intervention group participants were provided group- and individual-level educational classes and walnuts and extra virgin-type olive oil complimentary every month.
The MBSR group participants underwent an eight-week stress-lowering program tailored to pregnant individuals, and the regular care group received pregnancy care as per standard protocols.
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The MBSR program comprised eight weeks of weekly group classes (20 to 25 females per group) of 2.5 hours, one full-day session, and everyday practice at home. The sessions comprised didactic presentations, 45.0-minute mindfulness meditation practices, body awareness, group discussions, and mindful yoga.
The IMPACT study’s primary endpoint was the proportion of SGA newborns, and the secondary endpoint was adverse perinatal outcomes. The third edition of the Bayley Scales of Infant and Toddler Development Scale (Bayley-III) was used for postnatal evaluation.
All individuals visited the university hospital after completing the intervention (between gestational weeks 34 and 36), to fill out perinatal data-related questionnaires and provide urinary samples for analysis.
The present study outcomes were scores for the motor, language, cognitive, motor, adaptive behavior, and social-emotional Bayley-III domains, evaluated by two trained physiologists. The outcome measure was neurodevelopment at 2.0 years, based on Bayley-III scores.
The relationships between Bayley-III scores, biomarkers, and questionnaire information were also assessed. Linear regression models were used for data analysis between July and November 2022.
Mediterranean dietary evaluations were performed using food frequency questionnaires (FFQs). Stress reduction was assessed using the Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI) questionnaires, the World Health Organization’s Five Well-being Index (WHO-5), and the Five Facet Mindfulness Questionnaire.
Maternal mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ). In addition, maternal 24.0-hour urinary cortisol and cortisone levels were monitored among participants who did not consume corticosteroids.
Results
In total, 626 pediatric individuals [333 (53%) males and 293 (47%) females] participated in the study, among whom the mean age was 25 months. Baseline characteristics were identical among the intervention groups. High adherence was observed among 177 individuals (72%) in the dietary intervention group and 137 (66%) in the MBSR group.
In comparison to regular care group children, those from the dietary intervention group showed higher Bayley-III scores for the socioemotional (mean 109 versus 103) and cognitive (mean 124 versus 119) domains, whereas the MBSR group children showed higher socio-emotional domain scores (mean 108 versus 103), than regular care group children. Similar differences were observed after data adjustments for the mothers’ socioeconomic status and the fetuses’ genders.
Adaptive, motor, and language scores were comparable in the study groups. The IMPACT BCN trial showed a significant decrease in SGA rates (14% with SGA in the dietary intervention group and 16% in the MBSR group compared to 22% in the non-intervention group).
However, non-significant differences were observed in Bayley-III scorings between SGA and non-SGA newborns. The dietary intervention scores showed significantly positive relationships with the language and cognitive domains.
Increased docosahexaenoic acid intake significantly improved language scores, whereas higher trans-fat intake was inversely correlated with language and social-emotional domain scores.
Maternal stress and anxiety levels in the pregnancy period showed significantly negative relationships with domains of Bayley-III. Higher WHO-5 scores were related to higher Bayley-III scores for the language, social-emotional, and adaptive behaviour domains. The 24.0-hour urinary cortisol and cortisone levels were significantly and positively related to the language Bayley-III domain.
Based on the study findings, maternal lifestyle interventions such as MBSR and Mediterranean diets during pregnancy can significantly improve child neurodevelopmental outcomes at two years of age.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
