Alyssa Abreu

Background: Vitamin D deficiency (VDD) and high circulating cortisol during pregnancy have each been linked to adverse maternal and child outcomes, such as pre-term birth. However, limited research has explored the association between vitamin D concentration and cortisol concentration during pregnancy. Our objective for this study was to determine the association between vitamin D and cortisol concentrations among pregnant women. Methods: The Prenatal Health and Nutrition (PHAN) study was a pilot cross-sectional study conducted in targeted areas in Rhode Island which included 30 healthy pregnant women. Data collection included sociodemographic characteristics of participants, substance use, perceived stress, food insecurity, and dietary assessments. Additionally, blood samples were collected to estimate vitamin D status (25(OH)D). Participants provided 10 saliva samples over a two-day period, which were used to estimate cortisol concentrations using a competitive Enzyme-Linked Immunosorbent Assay (ELISA). Linear and logistic regression models were used to analyze the association between vitamin D status and cortisol concentrations. Results: Mean ± SD age was 29 ± 6 years, and pre-pregnancy BMI was 28 ± 6 kg/m². The mean ± SD of serum 25(OH)D concentration was 24 ± 9 ng/mL. The prevalence rates of VDD (p = 0.57). Additionally, no significant association was observed in the logistic regression model. Conclusions: There were no significant associations between vitamin D and cortisol concentrations. Our study revealed a high prevalence of vitamin D deficiency and insufficiency. We advocate for screening of vitamin D status among pregnant women and the intake of vitamin D supplements. Future studies should explore prospective cohorts to examine the association between vitamin D and cortisol concentrations among pregnant women.

Background: Oysters are an excellent source of iron and zinc but may be contaminated by heavy metals such as cadmium. The micronutrient and metal content of smoked, dried oysters as well as the impact of oyster consumption on iron, zinc, and cadmium concentrations in Ghana is unknown. Objectives: Our objectives were to 1) determine the micronutrient and metal content and health risk of dried, smoked oysters, 2) determine the associations between dietary iron intake with hemoglobin or ferritin concentrations and anemia, 3) determine the associations between oyster consumption and iron, zinc and cadmium concentrations in Ghanaian women living near the Densu Estuary. Methods: We purchased one package of dried smoked oysters from the Densu estuary in the Bortianor community in the Greater Accra Region of Ghana. Dried oysters selected from the package were analyzed in bulk by inductively coupled plasma-mass spectrometry for 12 micronutrients and 5 heavy metals. We calculated a total hazard quotient and hazard index (>1 may indicate potential health risks). We also enrolled women in the Bortianor/Tsokomey area in Ghana in a 6-month, longitudinal pilot study, with 66 women who consumed oysters during the open season (oyster group) and 70 women did non consume oysters (non-oyster group). We collected data at two time points: 1) March 2020 (end of closed season) and 2) August 2020 (5 months into the open season). We collected the amount and frequency of dietary iron intake and oyster consumption using a 30-day food frequency questionnaire. We analyzed hemoglobin (to determine anemia prevalence), ferritin (to determine iron deficiency), zinc, and cadmium (ug/g creatinine) concentrations and used paired t-tests to analyze the difference between seasons and used independent t-tests between groups. We also used a pathway analysis to understand the relationships between dietary iron intake or oyster consumption and zinc, cadmium, and serum ferritin or hemoglobin concentrations. Results: The heavy metal contents of the dried oysters (mg/kg) were: Hg (8.96 ± 3.59), Cd (0.96 ± 0.26), As (4.46 ± 0.67), V (1.08 ± 0.32), and Pb (0.59 ± 0.11). The hazard index of dried oyster consumption was 44.62. At enrollment, mean±SD age was 34±8 y and BMI was 26±5 kg/m2. For women in the oyster group, Hb did not differ by season. The prevalence of anemia and iron deficiency (ID) in the oyster group was 78% and 54% in the closed season and 70% and 70% in the open season (anemia p=0.64, ID p=0.008).

Low magnesium intake has been shown to be associated with an increased risk of type 2 diabetes mellitus (T2DM) in several studies conducted in high-income countries. However, very few studies have been performed in Africa, where many countries have a growing rate of T2DM. We conducted a pilot cross-sectional study among 63 women in Ghana to investigate the association between magnesium intake and glycemic markers. We assessed dietary magnesium using a food frequency questionnaire and glycemic markers using fasting blood glucose and glycated hemoglobin A1c (HbA1c). Our findings showed that the mean magnesium intake was 200 ± 116 mg/day. The prevalence of T2DM was 5% by measuring fasting blood glucose and 8% by measuring HbA1c. Unadjusted linear regression models revealed that higher magnesium intake significantly predicted higher fasting blood glucose levels (β = 0.31; 95% CI: 0.07, 0.55; p = 0.01) and HbA1c levels (β = 0.26; 95% CI: 0.01, 0.51; p = 0.04). In adjusted analyses, magnesium intake was no longer significantly associated with either fasting blood glucose levels (β = 0.22; 95% CI: −0.03, 0.46; p = 0.08) or HbA1c levels (β = 0.15; 95% CI: −0.08, 0.39; p = 0.20). In conclusion, our study did not show a significant association between magnesium intake and glycemic markers in women of reproductive age in Ghana. The results of this study need to be further substantiated because this was the first study to examine magnesium intake and glycemic markers in this population in Africa.

It is unknown whether prenatal lipid-based nutrient supplements (LNSs) affect blood pressure (BP). Associations between hypertension and birth outcomes using recently updated BP cutoffs are undetermined. We aimed to assess the impact of LNSs on maternal hypertension and associations between hypertension and birth outcomes. Pregnant Ghanaian women at ≤20 weeks of gestation (n = 1320) were randomly assigned to receive daily 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNSs until delivery. BP was measured at enrollment and 36 weeks of gestation. We analyzed the effect of LNSs on BP using ANOVA and associations between hypertension [systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) ≥80 mm Hg] and birth outcomes by linear and logistic regressions. Mean ± SD SBP and DBP were 110 ± 11 and 63 ± 8 mm Hg at 36 weeks of gestation and did not differ by supplementation group (SBP, P > 0.05; DBP, P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter gestation; women with high DBP had greater risk of low birth weight (LBW) [risk ratio (RR): 2.58; 95% CI: 1.09, 6.08] and preterm birth (PTB) (RR: 3.30; 95% CI: 1.47, 7.40). At 36 weeks of gestation, higher SBP was associated with lower birth weight, length, and head circumference and shorter gestation; higher DBP was associated with lower birth weight and length; and women with high DBP had greater risk of LBW (RR: 3.39; 95% CI: 1.32, 8.69). Neither high SBP nor hypertension were associated with birth outcomes at either time point. Daily provision of LNSs does not affect maternal hypertension, compared with IFA and MMN. Higher SBP and DBP are associated with a shorter gestation and smaller birth size; however, only high DBP is associated with LBW and PTB. The new BP cutoffs may help identify pregnancies at risk of adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT00970866.

Background: Hypertensive disorders of pregnancy impact over 10% of pregnancies worldwide, while increasing the risk of low birth weight. Research is conflicting on the effect of nutrient supplementation on hypertension during pregnancy. The cutoffs to define hypertension have also recently changed to include a lower systolic blood pressure, and little research has examined the association between the newly proposed blood pressure cutoffs and low birth weight. Objectives: Our objectives were to 1) evaluate the impact of prenatal lipid-based nutrient supplement consumption on maternal blood pressure; and 2) assess the association between maternal blood pressure during early and late pregnancy with infant birth weight. Study Design: A total of 1320 pregnant women ≤ 20 weeks gestation in Ghana were randomized to receive daily either: 1) iron and folic acid, 2) multiple micronutrients, or 3) a small-quantity lipid-based nutrient supplement. Gestational age was determined by ultrasound and newborn weight measured at delivery. Blood pressure was measured at enrollment and 36 weeks gestation. The effect of the consumption of a lipid-based nutrient supplement on maternal blood pressure was analyzed using ANOVA and ANCOVA, and associations between maternal hypertension and birth weight were examined by linear and logistic regressions. Results: Mean (±SD) systolic and diastolic blood pressure at 36 weeks gestation were 110±11 and 63±8 mmHg, respectively. The means for systolic and diastolic blood pressure did not differ by supplementation group, (p-value > 0.05). The prevalence of high systolic blood pressure (≥ 130 mmHg) and high diastolic blood pressure (≥ 80 mmHg) at enrollment was 6.6% and 3.6% and there was a significant association between higher diastolic blood pressure and lower birth weight at enrollment (β = - 0.086, SE = 0.001 ; p = 0.011) in adjusted models. High diastolic blood pressure significantly increased the risk for low birth weight (odds ratio = 2.99, 95% confidence interval 1.04-8.62; p=0.042) in adjusted models. At 36 weeks, the prevalence of high systolic and high diastolic blood pressure was 4.3% and 2.4% and lower birth weight was significantly associated with higher systolic (β = -0.074, SE = 0.00 ; p = 0.029) and diastolic (β = -0.094, 0.00; p = 0.006) blood pressure. Diastolic blood pressure was significantly associated with an increased risk of low birth weight (OR=4.14, 95% CI=0.020). Conclusions: Daily consumption of a lipid-based nutrient supplement during pregnancy did not have a significant effect on maternal hypertension compared with iron and folic acid or