Isabelle Marc

BACKGROUND AND OBJECTIVE: Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants. METHODS: Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at <29 weeks’ gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. RESULTS: Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82–1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at ≤32 weeks’ gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74–1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23–1.10, 5 studies, n = 900 infants) was observed with LCPUFA. CONCLUSIONS: Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period.

OBJECTIVE: To examine the link between gestational diabetes mellitus (GDM) and sleep-disordered breathing using complete polysomnography and questionnaires in a case–control study of pregnant women. METHODS: Pregnant women (body mass index [BMI] less than 35, no prior diabetes or hypertension) were eligible as cases (n=26) if diagnosed with GDM by routine 75-g oral glucose tolerance test. Women in the control group without GDM (n=26) were matched for gestational age at polysomnography, BMI, and age. Polysomnography were conducted at home at 24–32 weeks of gestation. Sleepiness score (Epworth Sleepiness Scale), subjective sleep quality (Pittsburgh Sleep Quality Index), risk for depression (Edinburgh Postnatal Depression Scale), and restless legs syndrome were assessed by questionnaire. RESULTS: Primary outcome apnea–hypopnea index (4.2±3.9 events per hour in women in the case group compared with 3.8±2.3 events per hour in women in the control group) as well as other objective and subjective sleep measures, including oxygen desaturation index, snoring, and flow limitation, were not significantly different between groups. Sleepiness was greater in women in the case group than in women in the control group (9.8±3.6 compared with 7.2±3.6, P=.05). Additionally, 23% of women in the case group compared with 0% of women in the control group (P<.01) reported an Edinburgh Scale score of at least 10 (suggesting significant depression) and 46% of women with GDM reported restless legs syndrome compared to 19% of women in the control group (P=.07). CONCLUSION: There was no association between GDM and sleep-disordered breathing in pregnant women with prepregnancy BMIs under 35 and no medical comorbidities. LEVEL OF EVIDENCE: II

Summary: What is already known about this subject: A healthy life begins in utero and a healthy pregnancy requires a fit and healthy mother. Physical activity during pregnancy provides a stimulation that is essential for promoting optimal body oxygenation and composition as well as metabolic fitness during pregnancy. Although a higher maternal fitness is expected to provide a beneficial fetal environment, it is still unclear whether physical fitness during pregnancy contributes to perinatal health. What this study adds: Participation in sports and exercise previously and at the beginning of pregnancy can benefit maternal health by improving cardiorespiratory fitness during pregnancy, irrespective of maternal body mass index. Maternal strength, an indicator of muscular fitness, is an independent determinant of infant fetal growth and can positively influence birth weight. Background: It is still unclear whether maternal physical activity and fitness during pregnancy contributes to perinatal health.Objectives: The aims of this study were to characterize maternal physical fitness at 16 weeks of pregnancy and to examine its effects on infant birth weight.Methods: Maternal anthropometry (body mass index [BMI] and skin‐folds), physical activity, cardiorespiratory fitness (VO₂peak) and muscular fitness (handgrip strength) were assessed at 16 weeks of gestation in 65 healthy pregnant women. Offspring birth weight was collected from maternal charts after delivery.Results: A higher VO₂peak was associated with physical activity spent at sports and exercise before and in early pregnancy (P = 0.0005). Maternal BMI was negatively associated with cardiorespiratory fitness (P < 0.0001) but positively related to muscular strength (P = 0.0001). Unlike maternal cardiorespiratory fitness, handgrip strength was positively associated with infant birth weight (r = 0.34, P = 0.0068) even after adjustment for confounders (adjusted r = 0.27, P = 0.0480).Conclusion: A positive relationship between maternal muscular fitness and infant birth weight highlighted maternal strength in pregnancy as a new determinant of infant birth weight.

Given the high risk for inactivity during pregnancy in obese women, validated questionnaires for physical activity (PA) assessment in this specific population is required before evaluating the effect of PA on perinatal outcomes. No questionnaire was validated in pregnant obese women. The Pregnancy Physical Activity Questionnaire (PPAQ) has been designed based on activities reported during pregnancy and validated in pregnant women. We translated the PPAQ to French and assessed reliability and accuracy of this French version among pregnant obese women. In this cross-sectional study, pregnant obese women were evenly recruited at the end of each trimester of pregnancy. They completed the PPAQ twice, with an interval of 7 days in-between, to recall PA of the last three months. Between PPAQ assessments, participants wore an accelerometer (Actigraph GT1M) during 7 consecutive days. Fourty-nine (49) pregnant obese women (29.8±4.2 yrs, 34.7±5.1 kg.m⁻²) participated to the study. The intraclass correlation coefficients (ICCs) between the two PPAQ assessments were 0.90 for total activity, 0.86 for light and for moderate intensity, and 0.81 for vigorous intensity activities. It ranged from 0.59 for “Transportation” to 0.89 for “Household and Caregiving” activities. Spearman correlation coefficients (SCCs) between the PPAQ and the Matthews’ cut point used to classify an activity of moderate and above intensity were 0.50 for total activity, 0.25 for vigorous intensity and 0.40 for moderate intensity. The correlations between the PPAQ and the accelerometer counts were 0.58 for total activity, 0.39 for vigorous intensity and 0.49 for moderate intensity. The highest SCCs were for “Occupation” and “Household and Caregiving” activities. Comparisons with other standard cutpoints were presented in files S1, S2, S3, S4, S5, S6, S7. The PPAQ is reliable and moderately accurate for the measure of PA of various intensities and types among pregnant obese women.

Background Anxiety during pregnancy is a common problem. Anxiety and stress could have consequences on the course of the pregnancy and the later development of the child. Anxiety responds well to treatments such as cognitive behavioral therapy and/or medication. Non‐pharmacological interventions such as mind‐body interventions, known to decrease anxiety in several clinical situations, might be offered for treating and preventing anxiety during pregnancy. Objectives To assess the benefits of mind‐body interventions during pregnancy in preventing or treating women's anxiety and in influencing perinatal outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 November 2010), MEDLINE (1950 to 30 November 2010), EMBASE (1974 to 30 November 2010), the National Center for Complementary and Alternative Medicine (NCCAM) (1 December 2010), ClinicalTrials.gov (December 2010) and Current Controlled Trials (1 December 2010), searched the reference lists of selected studies and contacted professionals and authors in the field. Selection criteria Randomized controlled trials, involving pregnant women of any age at any time from conception to one month after birth, comparing mind‐body interventions with a control group. Mind‐body interventions include: autogenic training, biofeedback, hypnotherapy, imagery, meditation, prayer, auto‐suggestion, tai‐chi and yoga. Control group includes: standard care, other pharmacological or non‐pharmacological interventions, other types of mind‐body interventions or no treatment at all. Data collection and analysis Three review authors independently assessed trials for inclusion all assessed risk of bias for each included study. We extracted data independently using an agreed form and checked it for accuracy. Main results We included eight trials (556 participants), evaluating hypnotherapy (one trial), imagery (five trials), autogenic training (one trial) and yoga (one trial). Due to the small number of studies per intervention and to the diversity of outcome measurements, we performed no meta‐analysis, and have reported results individually for each study. Compared with usual care, in one study (133 women), imagery may have a positive effect on anxiety during labor decreasing anxiety at the early and middle stages of labor (MD ‐1.46; 95% CI ‐2.43 to ‐0.49; one study, 133 women) and (MD ‐1.24; 95% CI ‐2.18 to ‐0.30). Another study showed that imagery had a positive effect on anxiety and depression in the immediate postpartum period. Autogenic training might be effective for decreasing women's anxiety before delivering. Authors' conclusions Mind‐body interventions might benefit women’s anxiety during pregnancy. Based on individual studies, there is some but no strong evidence for the effectiveness of mind‐body interventions for the management of anxiety during pregnancy. The main limitations of the studies were the lack of blinding and insufficient details on the methods used for randomization.

Very preterm infants are vulnerable to deficiency in DHA. In a longitudinal study, 10 mothers who delivered ≤29 wk gestation and planned to breast-fe