Cecilia Marie Jevitt

Purpose: Previous studies have suggested that milk consumption can promote growth in children. However, limited studies have been performed on the effects of cow milk varieties, especially β-casein A2 milk. This study aims to investigate the effect of β-casein A2 cow milk supplementation on physical growth, inflammation, and growth-related hormone and nutritional biomarker profiles in growth-stunted children.Methods: This is a quasi-experimental study with only one group and a pre-and posttest design. This research is divided into 3 stages: allele testing in the β-casein gene, processing into ready-to-drink milk, and a clinical trial. The participants were children aged 12–36 months who were given 200-mL β-casein A2 cow milk supplementation once a day for 3 months. The outcome assessments were physical growth (body weight and height), inflammation (tumor necrosis factor-alpha [TNF-α] and cortisol levels), and biological markers related to growth and nutrition (insulin-like growth factor-1 [IGF-1], growth hormone [GH], and transferrin) that were measured during pre-, mid (week 6)-, and post (week 12)-intervention periods.Results: This study included 30 study participants. Significant body weight and height improvements were observed at week 6 and postintervention (week 12) compared to preintervention. There were significant reductions in the inflammation markers TNF-α and cortisol levels postintervention. Additionally, IGF-1 and GH levels increased significantly, and transferrin levels also rose, potentially reflecting improved nutritional status.Conclusion: This study suggests that β-casein A2 milk supplementation was associated with improvements in physical growth and related biomarkers in stunted children. Additionally, β-casein A2 milk may produce fewer BCM-7 metabolites compared to β-casein A1 milk, which has been hypothesized to be associated with certain adverse health outcomes. However, further controlled studies are needed to confirm its efficacy as a dietary intervention.

Research demonstrates associations between oral health and specific mental health conditions in the general population, yet these relationships remain understudied during pregnancy, despite pregnancy’s profound effects on both oral and psychological well-being. Our rapid review examines current evidence on associations between oral health conditions and psychological states (anxiety, depression, and stress) during pregnancy, aiming to inform and strengthen integrated prenatal care strategies. Following PRISMA-RR guidelines, we conducted a systematic search on OVID Medline, CINAHL, and PsycINFO (January 2000–November 2024) for studies examining relationships between oral health conditions (periodontal disease, dental caries) and psychological status during pregnancy and up to one year postpartum. Systematic screening of 1201 records yielded 22 eligible studies (13 cross-sectional studies, 3 longitudinal cohort studies, 3 comparative studies, 2 prospective studies, and 1 case–control study). Analysis confirmed significant associations between oral health and psychological well-being during pregnancy through three pathways: psychological (dental anxiety directly limits oral healthcare utilization), behavioral (maternal depression reduces oral health self-efficacy), and physiological (elevated stress biomarkers correlate with periodontal disease, and periodontal therapy is associated with reduced salivary cortisol). These interactions extend intergenerationally, with maternal psychological distress showing significant associations with children’s caries risk. Evidence suggests interactions between oral health conditions and psychological states during pregnancy, warranting integrated care approaches. We recommend: (1) implementing combined oral–mental health screening in prenatal care, (2) developing interventions targeting both domains, and (3) establishing care pathways that address these interconnections. This integrated approach could improve both maternal and child health outcomes.

Background: Qualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI. Methods: The multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care. Results: Of 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25–25.9, 30–34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased. Conclusions: While socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.

Objective: Because eating, nutrition, and weight management patterns adopted during pregnancy may persist beyond the postpartum period, pregnancy provides an opportunity for health education that affects the future health of the pregnant person, the fetus, and the family. This systematic review aimed to find nutrition and weight management behaviors that could be used safely during pregnancy to optimize gestational weight gain. Methods: PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews published in English from 2018 to 2023 using terms including gestational weight gain maintenance, weight, management, pregnancy, behavior, strategy, and strategies. Excluded research used pediatric or adolescent populations, restrictive diets such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry, or profit-earning programs using food brands or specific diet programs. Results: The abstracts reviewed in these areas: excessive gestational weight gain (1019), low-glycemic index diet (640), Mediterranean diet (220), MyPlate diet (2), the Dietary Approaches to Stop Hypertension (DASH) diet (50), portion control (6), home meal preparation (6), mindful eating (13), intuitive eating (10), self-weighing (10), and motivational interviewing during pregnancy (107), were reduced to 102 studies. Studies in those 10 areas were reviewed for nutrition and eating behaviors that are safe to use during pregnancy and could be used along with motivational interviewing. Conclusion: Clinicians can discuss these behaviors using motivational interviewing techniques to assist clients in optimizing gestational weight gain. Dialogue examples pairing these strategies with motivational interviewing principles are included.

Background: International prenatal care guidelines set a standard for clinicians to discuss gestational weight gain with their patients along with the complications associated with prepregnancy obesity and excessive gestational weight gain. Clinicians often lack evidence-based eating, nutrition, and activity strategies to share with patients. Methods: This systematic review aimed to find eating patterns and behaviors that could be used safely during pregnancy to limit excessive gestational weight gain. PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews performed in the United States or Canada and published in English from 2013 to 2023. Keyword search terms included weight, manage, behavior, strategy, strategies, gestational weight gain, and nutrition. Excluded research used pediatric or adolescent populations, restrictive diets, such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry or profit-earning programs using food brands, or specific diet programs. Results: A total of 844 abstracts were retrieved, with 103 full-text studies reviewed. Behaviors had to be useful for maintaining a healthy gestational weight gain and had to be safe for use during pregnancy. Behaviors useful during pregnancy included meal planning, home meal preparation, portion control, using diets such as the Mediterranean diet, the low-glycemic index diet, and the Dietary Approaches to Stop Hypertension diet (DASH), regular physical activity, sleeping 6–7 h a night, mindful eating, intuitive eating, and regular seif-weighing. Conclusion: The evidence-based strategies outlined in this review are safe for use during pregnancy and can assist patients in avoiding excessive gestational weight gain while maintaining the nutrition needed for healthy fetal growth.

Background: Pre-pregnancy obesity has long been associated with a higher risk of antepartum, intrapartum, and postpartum complications, leading to classifying all patients within the WHO obese body mass index range (BMI ≥30 kg/m2) as high-risk. Excessive risk classification can lead to over-treatment and iatrogenic harm. Research supporting these increased risks comes from a variety of countries with different baseline population health and perinatal health care systems. Recent research documents that parturients with high pre-pregnancy BMI can have uncomplicated pregnancies and births. Here, the relationship between obesity and perinatal outcomes in a Canadian population is investigated using Canada as a model of a country with stable nutrition sufficiency and universal access to health care. Methods: We searched electronic databases PubMed, Ovid MEDLINE, and CINAHL for peer-reviewed articles in English that examined perinatal outcomes of singleton pregnancies in Canada between 1980 and 2020 based on pre-pregnancy obesity as the exposure of interest. Results: The search yielded 1946 results. After full-text screening, 21 articles met criteria for analysis. The impact of obesity on preterm labour, preterm birth, post-term delivery, labour induction, post-partum hemorrhage, and parturient morbidity and mortality in Canada remains inconclusive. The risk of hypertensive disorders, gestational diabetes, shoulder dystocia, and cesarean section delivery was significantly elevated as BMI increased. Operative vaginal delivery was less common in those with pre-pregnancy obesity. Conclusions: Though certain adverse perinatal outcomes are associated with increasing pre-pregnancy BMI, given the wide range of results and range of risk values, further research is required to better delineate comorbid risk factors that contribute to poorer outcomes. Nation-specific outcomes that reflect the accessibility of perinatal care and population health are a necessary baseline for the development of accurate health management guidelines.

The study aim was to appraise the relevance and appropriateness of an interprofessional prenatal oral care model among pregnant women and healthcare providers in British Columbia (BC), Canada. Audio-recorded semi-structured interviews with 39 purposefully selected participants (13 pregnant women and 26 healthcare professionals) were used qualitatively to appraise relevance of an existing model. The existing model emphasizes communication and collaboration among multiple health providers for the delivery of integrated prenatal oral care. All interviews were transcribed verbatim and analyzed using an inductive thematic approach and N-Vivo® software. During the first round of interviews, most participants considered the existing model as simple and well-defined but not fully relevant to the BC context. The participants suggested revisions to Steven’s model to incorporate facilitators of integrated care, including interprofessional education, oral health funding, and advocacy for oral healthcare. Participants suggested a different graphical portrayal for the revised model; an implementation guide was also suggested. A revised model based on participants’ feedback, was shared with 14 of the initial participants during secondary interviews. Further evaluation of the appropriateness of the revised model is warranted.