Simonette R. Mallard

Invited commentary in response to: usual nutrient intake adequacy among young, rural Zambian children - Volume 119 Issue 1 - Simonette R. Mallard

Background: Obesity is associated with lower concentrations of serum 25-hydroxyvitamin D; however, uncertainty exists as to the direction of causation

Background: In the monitoring of infant and young child feeding, dietary diversity is used as an indicator of micronutrient adequacy; however, their r

Background: Although numerous cross-sectional studies have shown an association between WHO infant and young child feeding (IYCF) indicators and chil

To evaluate the impact of a mandatory bread fortification programme on estimated iodine intakes of childbearing women and to describe the extent to which uptake of a maternal iodine supplement recommendation is associated with sociodemographic characteristics. A postpartum survey was conducted using a self-administered questionnaire. Details on pre- and post-conceptional supplement use, bread intake, iodized salt use and maternal sociodemographic and obstetric characteristics were obtained. Eleven maternity wards and hospitals located across New Zealand. Seven hundred and twenty-three postpartum New Zealand women. Mean iodine intake from fortified bread was 37 μg/d prior to conception. Younger women, women with higher parity, single women and those with unplanned pregnancies were less likely to meet the pregnancy Estimated Average Requirement (EAR) for iodine (all P ≤ 0·022). Although not statistically significant for all months of pregnancy, women with less education and income were less likely to meet the EAR (P ≤ 0·11 and P ≤ 0·2 for all months, respectively) and indigenous Māori women and Pacific women were less likely than New Zealand Europeans to meet the EAR (P ≤ 0·17 and P ≤ 0·051 for all months, respectively). During pregnancy, iodine-containing supplement uptake at the recommended level (150 μg/d) was non-uniform across sociodemographic subgroups, with the most disadvantaged women benefiting the least from this public health policy. The disparities in supplement uptake noted here highlight the need for prioritizing further efforts towards universal salt iodization, such as the mandatory fortification of additional processed foods with iodized salt.

New Zealand's Chief Science Advisor has recommended weight loss interventions be made available to women planning a pregnancy. In a postpartum survey of 723 New Zealand women, 44% of all pregnancies were unplanned, and in multivariate analysis, younger women, women with less income, women with higher parity, and single women were more likely to have an unplanned pregnancy (all P0.002). In addition, three-quarters of pregnancies to indigenous Maori and Pacific women were unplanned. In conclusion, New Zealand women known to have the highest rates of overweight and obesity were also most likely to have unplanned pregnancies, thereby preventing their access to any forthcoming preconception weight loss programs.

Introduction and Aims: Alcohol consumption during pregnancy places the foetus at risk of Foetal Alcohol Spectrum Disorders. Little is known about the current prevalence and patterns of alcohol consumption before and following pregnancy recognition in New Zealand.Design and Methods: A retrospective survey of 723 post‐partum women resident in maternity wards located across New Zealand was conducted using a self‐administered questionnaire. Maternal sociodemographic and obstetric characteristics and alcohol intake before and after pregnancy recognition were assessed.Results: Of the 968 women invited to participate, 78% agreed. Eighty‐two percent of women reported consuming alcohol prior to pregnancy and 20% reported typically consuming >4 New Zealand standard drinks per occasion. Overall, 34% of women reported drinking at some time during pregnancy. Twelve percent of pregnancies were at high risk of heavy alcohol exposure in early gestation. In fully adjusted analysis, pregnancies most at risk were those of indigenous Māori women, Pacific women, smokers and drug users. Almost one‐quarter (24%) of drinkers continued to drink following pregnancy recognition, and in fully adjusted analysis, continuing to drink was positively associated with frequency of alcohol consumption before pregnancy (P < 0.001 for linear trend).Discussion and Conclusions: To reduce the burden of alcohol‐related harm to the foetus, these findings suggest that New Zealand alcohol policy should be focused not only on promoting total abstinence when planning a pregnancy and when pregnant, but also on reducing ‘binge drinking’ culture and the frequent consumption of lower levels of alcohol.[Mallard SR, Connor JL, Houghton LA. Maternal factors associated with heavy periconceptional alcohol intake and drinking following pregnancy recognition:A post‐partum survey of New Zealand women.Drug Alcohol Rev2013;32:389–397]

Background: In September 2009, a folic acid fortification mandate (135 μg/100 g bread) was to be implemented in New Zealand. However, due to political and manufacturer objection, fortification was deferred until May 2012. Based on estimates of bread consumption derived from a 1997 nationally representative survey, this program was intended to deliver a mean additional intake of 140 μg folic acid/d to women of childbearing age. Little is known about current bread consumption patterns in this target group. The aim of this study was to assess bread consumption among women prior to and during pregnancy with the intent to estimate periconceptional folic acid intakes that would be derived from bread if mandatory fortification were implemented as currently proposed. Methods: A retrospective survey of 723 postpartum women in hospitals and birthing centres across New Zealand was conducted using a self-administered questionnaire on bread intake prior to and during pregnancy and maternal socio-demographic and obstetric characteristics. Results: Median bread intake before conception (2 slices/d) was below that of previous data upon which the current fortification proposal was modeled (3-4 slices/d). If mandatory fortification is implemented as proposed, only 31% (95% CI = 24%-37%) of childbearing-age women would attain an additional folic acid intake of ≥ 140 μg/d, with a mean of 119 μg/d (95% CI = 107 μg/d-130 μg/d). Based on these data, a fortification level of 160 μg/100 g bread is required to achieve the targeted mean of 140 μg folic acid/d. Nonetheless, under the current proposal additional folic acid intakes would be greatest among the least advantaged segments of the target population: Pacific and indigenous Māori ethnic groups; those with increased parity, lower income and education; younger and single mothers; and women with unplanned pregnancies. Subgroups predicted to derive less than adequate folic acid intakes from the proposed policy were women of Asian descent and those with a postgraduate education. Conclusions: This study provides insight on the ability of a fortification policy to benefit the groups at highest risk of poor folate intakes in a population. However, bread consumption among the target group of childbearing women appears to have declined since the data used in previous dietary modeling were collected. Thus, it seems prudent to re-model dietary folic acid intakes based on more recent national survey data prior to the implementation of a mandatory folic acid fortification policy.

To reduce the risk of neural tube defects, the New Zealand Ministry of Health recommends women take supplemental folic acid from at least one month preconception until the end of the twelfth week of pregnancy, as well as consume folate-rich foods. A postpartum survey was conducted to describe folate knowledge and consumer behaviour among pregnant New Zealand women prior to the potential implementation of mandatory folic acid fortification of bread in May 2012. Increasing knowledge of folic acid recommendations was associated with higher supplement uptake among women who planned their pregnancies (p=0.001 for linear trend). Folic acid information failed to adequately reach some socio-demographic subgroups before conception, even when pregnancy was planned, including: indigenous Maori, Pacific and Asian women, younger women, women with large families, and women with lower educational attainment and income. Only half of all women surveyed knew some bread contained added folic acid, and among these women, less than 2% consistently chose voluntarily fortified bread during the periconceptional period by inspecting labels. Sixty-one percent of women indicated they were either in favour of mandatory fortification, or held no opinion on the matter, while 4% were opposed to the addition of folic acid to bread. Approximately one-third (35%) of women agreed with voluntary fortification. Future health promotion initiatives should be tailored toward women who are younger, less educated, with lower income, multiparous or of minority ethnicity status. Nonetheless, mandatory folic acid fortification may be required to attain the desired degree of equity.