Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    Dietary Interventions for Healthy Pregnant Women: A Systematic Review of Tools to Promote a Healthy Antenatal Dietary Intake
    Beulen, Yvette H. ; Super, Sabina ; Vries, Jeanne H.M. de; Koelen, Maria A. ; Feskens, Edith J.M. ; Wagemakers, Annemarie - \ 2020
    Nutrients 12 (2020)7. - ISSN 2072-6643
    health promotion tools - nutrition - pregnancy

    Maternal nutrition is essential for the development and lifelong health of the offspring. Antenatal care provides unique opportunities for nutrition communication, and health promotion tools (e.g., guidelines, instruments, packages, or resources) might help to overcome several concurrent barriers. We conducted a systematic literature review to map tools that are available for the promotion of a healthy dietary intake in healthy pregnant women in Western countries, and to identify what makes these tools feasible and effective for these women and their healthcare providers. Seventeen studies were included, evaluating tools with various delivery modes, content, and providers. Nine studies employed multiple, complementary delivery methods and almost all studies (n = 14) tailored the content to varying degrees, based on the individual characteristics and lifestyle behaviors of the participants. We found that the feasibility of a tool was dependent on practical issues, time investment, and providers' motivation, skills, and knowledge, while the effectiveness was related more to the type of provider and the content. Most effective interventions were provided by dietitians and nutritionists, and were highly tailored. Based on the results of this review, we believe that custom tools that are sensitive to inequalities are needed to support all women in obtaining or maintaining a healthy diet during pregnancy.

    Genome-wide association study for genotype by lactation stage interaction of milk production traits in dairy cattle
    Lu, Haibo ; Wang, Yachun ; Bovenhuis, Henk - \ 2020
    Journal of Dairy Science (2020). - ISSN 0022-0302
    genetic background - genome-wide association study (GWAS) - lactose - negative energy balance - pregnancy

    Substantial evidence demonstrates that the genetic background of milk production traits changes during lactation. However, most GWAS for milk production traits assume that genetic effects are constant during lactation and therefore might miss those quantitative trait loci (QTL) whose effects change during lactation. The GWAS for genotype by lactation stage interaction are aimed at explicitly detecting the QTL whose effects change during lactation. The purpose of this study was to perform GWAS for genotype by lactation stage interaction for milk yield, lactose yield, lactose content, fat yield, fat content, protein yield, and somatic cell score to detect QTL with changing effects during lactation. For this study, 19,286 test-day records of 1,800 first-parity Dutch Holstein cows were available and cows were genotyped using a 50K SNP panel. A total of 7 genomic regions with effects that change during lactation were detected in the GWAS for genotype by lactation stage interaction. Two regions on Bos taurus autosome (BTA)14 and BTA19 were also significant based on a GWAS that assumed constant genetic effects during lactation. Five regions on BTA4, BTA10, BTA11, BTA16, and BTA23 were only significant in the GWAS for genotype by lactation stage interaction. The biological mechanisms that cause these changes in genetic effects are still unknown, but negative energy balance and effects of pregnancy may play a role. These findings increase our understanding of the genetic background of lactation and may contribute to the development of better management indicators based on milk composition.

    Genome-wide association study for genotype by lactation stage interaction of milk production traits in dairy cattle
    Lu, Haibo ; Wang, Yachun ; Bovenhuis, Henk - \ 2020
    Journal of Dairy Science 103 (2020)6. - ISSN 0022-0302 - p. 5234 - 5245.
    genetic background - genome-wide association study (GWAS) - lactose - negative energy balance - pregnancy

    Substantial evidence demonstrates that the genetic background of milk production traits changes during lactation. However, most GWAS for milk production traits assume that genetic effects are constant during lactation and therefore might miss those quantitative trait loci (QTL) whose effects change during lactation. The GWAS for genotype by lactation stage interaction are aimed at explicitly detecting the QTL whose effects change during lactation. The purpose of this study was to perform GWAS for genotype by lactation stage interaction for milk yield, lactose yield, lactose content, fat yield, fat content, protein yield, and somatic cell score to detect QTL with changing effects during lactation. For this study, 19,286 test-day records of 1,800 first-parity Dutch Holstein cows were available and cows were genotyped using a 50K SNP panel. A total of 7 genomic regions with effects that change during lactation were detected in the GWAS for genotype by lactation stage interaction. Two regions on Bos taurus autosome (BTA)14 and BTA19 were also significant based on a GWAS that assumed constant genetic effects during lactation. Five regions on BTA4, BTA10, BTA11, BTA16, and BTA23 were only significant in the GWAS for genotype by lactation stage interaction. The biological mechanisms that cause these changes in genetic effects are still unknown, but negative energy balance and effects of pregnancy may play a role. These findings increase our understanding of the genetic background of lactation and may contribute to the development of better management indicators based on milk composition.

    Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries
    Bourassa, Megan W. ; Osendarp, Saskia J.M. ; Adu-Afarwuah, Seth ; Ahmed, Saima ; Ajello, Clayton ; Bergeron, Gilles ; Black, Robert ; Christian, Parul ; Cousens, Simon ; Pee, Saskia de; Dewey, Kathryn G. ; Arifeen, Shams El ; Engle-Stone, Reina ; Fleet, Alison ; Gernand, Alison D. ; Hoddinott, John ; Klemm, Rolf ; Kraemer, Klaus ; Kupka, Roland ; McLean, Erin ; Moore, Sophie E. ; Neufeld, Lynnette M. ; Persson, Lars Åke ; Rasmussen, Kathleen M. ; Shankar, Anuraj H. ; Smith, Emily ; Sudfeld, Christopher R. ; Udomkesmalee, Emorn ; Vosti, Stephen A. - \ 2019
    Annals of the New York Academy Of Sciences 1444 (2019)1. - ISSN 0077-8923 - p. 6 - 21.
    LMICs - micronutrient - pregnancy - supplements

    Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.

    Theory of developmental origins of health and disease
    Kupers, Leanne - \ 2019
    child nutrition - pregnancy - epigenetics - disease prevention - disease incidence
    The first 1000 days of your (unborn) life play a crucial role in the risk of chronic diseases. But what if food is scarce?
    This lesson is part of the WageningenX MOOC called 'Nutrition, Heart Disease and Diabetes'.
    Assessing the effect of pregnancy stage on milk composition of dairy cows using mid-infrared spectra
    Lainé, A. ; Bastin, C. ; Grelet, C. ; Hammami, H. ; Colinet, F.G. ; Dale, L.M. ; Gillon, A. ; Vandenplas, J. ; Dehareng, F. ; Gengler, N. - \ 2017
    Journal of Dairy Science 100 (2017)4. - ISSN 0022-0302 - p. 2863 - 2876.
    dairy cow - milk mid-infrared spectrum - pregnancy

    Changes in milk production traits (i.e., milk yield, fat, and protein contents) with the pregnancy stage are well documented. To our knowledge, the effect of pregnancy on the detailed milk composition has not been studied so far. The mid-infrared (MIR) spectrum reflects the detailed composition of a milk sample and is obtained by a nonexhaustive and widely used method for milk analysis. Therefore, this study aimed to investigate the effect of pregnancy on milk MIR spectrum in addition to milk production traits (milk yield, fat, and protein contents). A model including regression on the number of days pregnant was applied on milk production traits (milk yield, fat, and protein contents) and on 212 spectral points from the MIR spectra of 9,757 primiparous Holstein cows from Walloon herds. Effects of pregnancy stage were expressed on a relative scale (effect divided by the squared root of the phenotypic variance); this allowed comparisons between effects on milk traits and on 212 spectral points. Effect of pregnancy stage on production traits were in line with previous studies indicating that the model accounted well for the pregnancy effect. Trends of the relative effect of the pregnancy stage on the 212 spectral points were consistent with known and observed effect on milk traits. The highest effect of the pregnancy was observed in the MIR spectral region from 968 to 1,577 cm−1. For some specific wavenumbers, the effect was higher than for fat and protein contents in the beginning of the pregnancy (from 30 to 90 or 120 d pregnant). In conclusion, the effect of early pregnancy can be observed in the detailed milk composition through the analysis of the MIR spectrum of bovine milk. Further analyses are warranted to explore deeply the use of MIR spectra of bovine milk for breeding and management of dairy cow pregnancy.

    Validation of transrectal ultrasonography for assessment of corpora lutea characteristics in pregnant sows and its relationship with litter characteristics at birth
    Lima Alvares da Silva, Carolina ; Laurenssen, B.F.A. ; Knol, E.F. ; Kemp, B. ; Soede, N.M. - \ 2017
    Translational Animal Science 1 (2017)4. - ISSN 2573-2102 - p. 507 - 517.
    corpora lutea - piglet birth weight - pregnancy - sows - transrectal ultrasonography
    In experiment 1 we investigated the accuracy of transrectal ultrasonography (TUS) to assess the number (OR) and diameter of corpora lutea (CL) in 45 and 25 sows, respectively, at 23.4 ± 2.9 d of pregnancy. The diameter was calculated as the average diameter of 10 biggest CL. Sows were subsequently slaughtered and OR was assessed by dissection of CL from both ovaries (n = 45) and average diameter of the 10 biggest CL was also calculated after measurement of CL with the caliper rule (n = 25). There was a weak relationship between OR counted after dissection of the ovaries and OR counted with TUS (β = 0.28 ± 0.01 CL/CL, P = 0.01), but there was a strong relationship between the average CL diameter measured with the caliper rule after dissection and the average CL diameter based on TUS (β = 1.0 ± 0.1 mm/mm, P < 0.0001). This shows that TUS is not a valid method to assess OR in pregnant sows but it is a valid method to assess average CL diameter. In experiment 2, we investigated the relationship between the average CL diameter assessed by TUS (n = 100) at 23.8 ± 2.4 d of pregnancy and average piglet birth weight (BW) and observed an increase of 37.6 ± 17.8 g in piglet BW per mm increase in average CL diameter measured by TUS (P = 0.04). This relationship is probably because larger CL develop from bigger follicles at ovulation, which might have ovulated oocytes of higher quality that developed into embryos with higher growth potential and thus higher birth weight.
    Temporary undernutrition during early gestation, corpora lutea morphometrics, ovarian progesterone secretion and embryo survival in gilts
    Langendijk, P. ; Bouwman, E.G. ; Chen, T. ; Koopmanschap, R.E. ; Soede, N.M. - \ 2017
    Reproduction Fertility and Development 29 (2017)7. - ISSN 1031-3613 - p. 1349 - 1355.
    fasting - LH - pigs - pregnancy
    The present study reports effects of severe undernutrition on luteal function and pregnancy in pigs. Gilts were inseminated and either fasted on Day 10 and 11 after conception (n = 11) or fully fed throughout (n = 10). Fasting did not affect LH or progesterone pulsatile secretion pattern on Day 11 in samples taken from blood vessels draining an ovary. Ultrasonographic measurements of the size of the corpora lutea did not show any effect of fasting either. However, fasted gilts had 10 to 30 % lower systemic progesterone from Day 12 through Day 15 after conception (P < 0.05). All gilts farrowed, but fasted gilts had fewer born piglets than fully fed gilts (8.8 ± 0.8 vs 10.9 ± 0.5 respectively; P < 0.05). In conclusion, fasting during embryo elongation can compromise embryonic survival by affecting ovarian function in the days after fasting, without having an immediate effect on LH secretion and progesterone output by the ovaries.
    The tree under which you sit : district-level management and leadership in maternal and newborn health policy implementation in the Greater Accra Region, Ghana
    Kwamie, A. - \ 2016
    Wageningen University. Promotor(en): Han van Dijk; I.A. Agyepong. - Wageningen : Wageningen University - ISBN 9789462576742 - 158
    health policy - birth - pregnancy - policy - management - administration - ghana - west africa - gezondheidsbeleid - geboorte - zwangerschap - beleid - bedrijfsvoering - bestuur - ghana - west-afrika

    Health system governance has to do with decision-making – who makes decisions, when, where, how and why. At the district level – the level of care which operationalises health policies – governance is critical, yet remains little understood. Governance has the ability to influence health system performance, and this is essential in maternal and newborn health, where timely decisions are required to support policy implementation. In this regard, district managers are particularly important. They are the link in the middle of the health system, connecting top-end policy formulation to bottom-end implementation. Their abilities to interpret, translate, support and challenge policy will have an effect on what gets operationalised. However, capacity weaknesses in district management and leadership are often cited as a factor in poor health system performance.

    This thesis seeks to deepen understandings of district-level management, leadership and decision-making for policy and programme management and implementation for maternal and newborn health. Within this, the thesis also seeks to understand the scope for change that an intervention to strengthen management and leadership capacities can bring.

    This thesis contributes to the applied field of health policy and systems research by drawing on policy implementation theory, organisational management theory and complexity theory as its theoretical basis. A realist approach methodology was undertaken to understand the contexts in which district managers are embedded, how this influences their decision-making, and what the effects of a managerial intervention are, given these contexts. The thesis followed an embedded case study flexible design. The first case study was an exploratory qualitative case study to understand how and why district managers make decisions in maternal and newborn health policy implementation. The second case study was an historical case study of district manager decision-space over time. The third case study was an explanatory qualitative case study of the management and leadership intervention. The final validation of our theorising throughout the cases was achieved through the administration of a questionnaire across all district health management teams of the Great Accra Region.

    This thesis demonstrates that district managers find themselves in contexts of strong hierarchical authority and resource uncertainty – in particular, lacking financial transparency. This promotes a management and leadership typology which attunes managers towards serving the health system bureaucracy, resulting in reduced district-level responsiveness to maternal and newborn health challenges. The outcome is that district manager decision-space is narrow surrounding resource allocation decisions, and this in turn affects local planning programming and management.

    The thesis further demonstrates that broader patterns of centralised governmental decision-making have affected the development of the district health system over time. Particularly, the sequencing of decentralisation processes has ensured that national-level decision-making has remained empowered in contrast to district-level decision-making. System fragmentation – through reduced Government of Ghana funds and increasingly verticalised donor funds – has also been a contributor. This accounts for the observed hierarchical authority and resource uncertainty which affects district managers. As a result of these contexts, this thesis also showed that an intervention to strengthen management and leadership capacities was limited in its sustainability.

    This thesis raises the issues of health system organisation as critical to the potential of district management and leadership effectiveness. It provides evidence that weaknesses in district management and leadership arise out of the organisational governance mismatches in autonomy and responsibility. It suggests that in strengthening management and leadership, approaches which seek to address organisational capacities, not only individual capacities, are needed to convey sustainable change. Advancements in this regard have the scope to improve district manager decision-making for maternal and newborn health policy and programme implementation in the future.

    Alternative testing strategies for predicting developmental toxicity of antifungal compound
    Li, H. - \ 2016
    Wageningen University. Promotor(en): Ivonne Rietjens; Bennard van Ravenzwaay, co-promotor(en): Jochem Louisse. - Wageningen : Wageningen University - ISBN 9789462576780 - 197
    toxicity - fetal development - transfer - infant development - adolescent development - child development - pregnancy - in vivo experimentation - modeling - placenta - in vitro - risk assessment - tebuconazole - conazole fungicides - antifungal agents - alternative methods - toxiciteit - foetale ontwikkeling - overdracht - zuigelingenontwikkeling - adolescentenontwikkeling - kinderontwikkeling - zwangerschap - in vivo experimenten - modelleren - placenta - in vitro - risicoschatting - tebuconazool - conazoolfungiciden - antimycotica - alternatieve methoden

    Determination of safe human exposure levels of chemicals in toxicological risk assessments largely relies on animal toxicity data. In these toxicity studies, the highest number of animals are used for reproductive and developmental toxicity testing. Because of economic and ethical reasons, there is large interest in the development of in vitro and/or in silico test systems as alternatives for the animal studies. The aim of the present thesis was to evaluate the applicability of combined in vitro approaches taking toxicokinetic and toxicodynamic aspects into account, as well as of an integrated in vitro and in silico approach for prediction of developmental toxicity using a series of antifungal compounds as the model compounds.

    Transplacental transfer of compounds is highly likely to play an important role in developmental toxicity, so we developed and validated an in vitro placental barrier model using BeWo b30 cells to predict placental transfer. Then we investigated the applicability of the ES-D3 cell differentiation assay combined with the in vitro BeWo transport model to predict the relative in vivo developmental toxicity potencies of two sets of selected antifungal compounds. The data obtained show that the combined in vitro approach provided a correct prediction for the relative in vivo developmental toxicity, whereas the ES-D3 cell differentiation assay as stand-alone did not. In order to detect specific structural alterations induced by chemicals, we investigated the applicability of the ex ovo assay of chicken embryos to predict the specific alterations induced by the antifungal compounds. Data revealed that the ex ovo assay of chicken embryos is able to assess the teratogenic potential of antifungal compounds, and, when combined with the in vitro BeWo transport model, is able to better predict relative in vivo prenatal developmental toxicity potencies.

    Subsequently, we translated in vitro concentration–response data of the antifungal compound tebuconazole, obtained in the ES-D3 cell differentiation assay and the ex ovo assay of chicken embryos, into predicted in vivo dose–response data using physiologically based kinetic (PBK) modelling-facilitated reverse dosimetry. The results show that the BMD10 values from predicted dose–response data from both assays are in concordance with BMD10 values derived from in vivo data (within 5-fold difference). This revealed that PBK modeling is a promising tool to predict in vivo dose-response curves based on the results of in vitro toxicity assays, and may therefore be used to set a point of departure for deriving safe exposure limits in risk assessment.

    It is concluded the combined in vitro approaches and the integrated in vitro-in silico approaches appear to be promising for the screening and prioritization of chemicals and to provide reference values, such as BMD10 values, without using animals, therefore contributing to the 3R principle of animal testing.

    Substitution of starch for palm oil during gestation: Impact on offspring survival and hepatic gene expression in the pig
    Almond, K.L. ; Fainberg, H.P. ; Lomax, M.A. ; Bikker, P. ; Symonds, M.E. ; Mostyn, A. - \ 2015
    Reproduction Fertility and Development 27 (2015)7. - ISSN 1031-3613 - p. 1057 - 1064.
    development - liver - nutrition - pregnancy

    Piglet neonatal mortality rates are high (∼20%), so nutritional strategies to reduce this are highly desirable. Maternal fat substitution (FS) may promote the preweaning survival of piglets by improving their energy status. Therefore, the aim of the present study was to investigate the effects of FS throughout pregnancy on offspring viability, together with the gene expression of stress-related markers in the liver. Sixteen pregnant sows were randomly allocated to one of two isocaloric diets, control (C) or FS in the form of palm oil, fed from 0 to 110 days gestation. Glucose tolerance was examined on Day 108. Median and low birthweight offspring were allocated to tissue sampling at either 7 days or 6 months postnatal age. In response to a glucose tolerance test, FS sows exhibited a raised glucose area under the curve with no change in basal glucose. Average piglet mortality (up to Day 28) was increased fourfold in the FS group, with surviving median-sized piglets exhibiting significantly lower fatty acid binding protein 1 (FABP1) expression at 7 days. There were no effects on the abundance of any other stress- or metabolic-related genes examined. Thus, this study demonstrates that maternal FS throughout gestation causes maternal glucose intolerance that may be linked to the observed increase in piglet mortality. However, the surviving offspring do not exhibit any detectable differences in postnatal growth or hepatic gene profile in later life.

    Human nutrition : a crunchy bite
    Kok, F.J. - \ 2015
    Wageningen : Wageningen University - ISBN 9789462573703 - 28
    obesity - malnutrition - infant nutrition - nutrition and health - nutrition research - human nutrition research - vitamins - aging - pregnancy - abdominal fat - body fat - obesitas - slechte voeding - zuigelingenvoeding - voeding en gezondheid - voedingsonderzoek - voedingsonderzoek bij de mens - vitaminen - verouderen - zwangerschap - buikvet - lichaamsvet
    Farewell address upon retiring as Professor of Nutrition and Health
    at Wageningen University on 15 October 2015
    Effect of iodine supplementation in Indian pregnant women on maternal and newborn thyroid function and cognitive development
    Jaikrishna, N. - \ 2015
    Wageningen University. Promotor(en): Michael Zimmermann, co-promotor(en): Alida Melse-Boonstra; K Srinivasan. - Wageningen : Wageningen University - ISBN 9789462573338 - 244
    jodium - maternale voeding - zwangerschap - voeding - hypothyreoïdie - schildklierziekten - schildklierwerking - jodiumhoudend zout - minerale supplementen - kenvermogen - cognitieve ontwikkeling - mineraaltekorten - voedingsstoffentekorten - iodine - maternal nutrition - pregnancy - nutrition - hypothyroidism - thyroid diseases - thyroid function - iodized salt - mineral supplements - cognition - cognitive development - mineral deficiencies - nutrient deficiencies


    Background: Iodine is a key nutrient in neurodevelopment, and the fetus is entirely dependent on the iodine intake of the mother to fulfill this important requirement for proper brain function. While this is clearly known, it is uncertain if maternal iodine nutrition should be monitored separately against what is in current practice in public health programs to control iodine deficiency. Also, it is unclear whether it is beneficial to supplement pregnant women with iodine in mild-to moderately iodine deficient and also iodine sufficient areas. Finally, the role of thyroid dysfunction in depression during pregnancy is uncertain.

    Objectives: 1) to determine whether iodine supplementation to pregnant women improves maternal and newborn thyroid function, pregnancy outcome, birth weight, infant growth and cognitive performance; 2) to assess iodine intake and potential determinants of intake, in pregnant women and their children who were sharing all meals; 3) to measure thyroid status during pregnancy and assess potential determinants of maternal thyroid function including iodine status, thyroid autoimmunity, body weight and anemia; 4) to assess the association of maternal depression, and thyroid function during pregnancy.

    Methods: 1) In a randomized placebo controlled trial (RCT), the MITCH (Maternal Iodine Supplementation and its Effects on Thyroid function and CHild Development) study, pregnant women, gestational age ≤14 weeks, in Bangalore, India, were randomized to receive either a daily supplement of 200 µg oral iodine or placebo from enrolment until delivery. Women were followed through delivery, and then with postnatal follow-up of their infants at 6 weeks, 1 and 2 year. Early neonatal development was assessed using the Neonatal Behavioral Assessment Scale (NBAS) at 6 weeks of age; neurocognitive assessment was done using the Bayley Scales of Infant Development (BSID III) at 1 and 2 years, and BRIEF-P (Behavior Rating Inventory of Executive Function) at 2 years; 2) A cross-sectional study comparing iodine status of pregnant women and their children, who were sharing all meals in Bangalore, India; 3) A cross-sectional study among 334 pregnant women ≤14 weeks of gestation, in Bangalore, India, who were screened for the RCT; 4) Secondary analysis of the longitudinal data on 318 pregnant women in the RCT.

    Results: 1) In the RCT, there were no significant differences between groups in maternal thyroid function tests or thyroid volume during gestation. The prevalence of thyroid dysfunction or anti-TPO antibodies did not differ significantly during gestation and postpartum. Postpartum, there were no significant differences between the maternal and infant groups in thyroid function, birth outcomes or UIC. Neonates whose mothers received iodine supplementation during pregnancy had better orientation scores at 6 weeks of age and lower scores of inhibition suggesting better executive function at 2 years of age although neurocognitive development on the BSID III were not significantly different between groups; 2) In the pilot study, a) median UIC in pregnant women was 172 µg/L, b) the median UIC was >150 µg/L in all trimesters and c) thyroid size was not significantly different across trimesters; the median UIC in children was 220µg/L, indicating ‘more than adequate’ iodine intake at this age. Median UIC was significantly higher in children than in their mothers (p=0.008). 3) In the cross-sectional study, 21% women were vegetarian, 19% were anemic and 23% were overweight or obese. Iodized salt was used by 98% of women and they were iodine sufficient, median UIC was 184.2 µg/L and all had normal thyroid volume. However, 18% of women had thyroid insufficiency: 3.7% had overt hypothyroidism (83% with positive TPO-Ab), 9.2% had subclinical hypothyroidism and 5.2% had hypothyroxinemia. Women consuming vegetarian diets did not have significantly lower iodine intakes or higher risk of hypothyroidism than those consuming mixed diets, but overweight/obesity and anemia predicted thyroid insufficiency; 4) In the longitudinal study, there was no significant difference in depressive symptoms between the iodine intervention and placebo groups. Women with depressive symptoms had significantly lower serum TSH compared to women without depressive symptoms in the first trimester. Pregnant women with prenatal depressive symptoms had a significantly higher number of medical symptoms.

    Conclusion: 1) Iodine supplementation in mildly iodine deficient and in iodine sufficient pregnant women was well-accepted and safe and did not increase the risk of excess iodine intake, hyper- or hypothyroidism, or thyroid autoimmunity. Though there were no significant effects of iodine supplementation on neonatal and maternal thyroid function and birth outcomes, there were modest effects on neurocognitive development of children as assessed by executive function of children at 2 years. Thus, additional follow-up of these children for neurocognitive testing at a later age when development and cognitive testing is more reliable would provide valuable add on information; 2) The iodized salt program in Bangalore, India was providing adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children, suggesting that the current WHO/UNICEF/ICCIDD cut-off for median UIC in children indicating more-than-adequate intake may need to be reconsidered; 3) Despite iodine sufficiency, many pregnant women had thyroid insufficiency predicted by low hemoglobin and higher BMI. The prevalence of overt hypothyroidism was >5-fold higher than reported in other iodine-sufficient populations of pregnant women, thus, screening of maternal thyroid function should be considered in antenatal care at hospitals in Bangalore, India; 4) Although iodine supplementation did not affect maternal depression, we highlighted the need for systemic screening for prenatal depression during antenatal visits as it is an independent risk factor for later development of clinical depression

    Gestational diabetes mellitus in Tanzania : public health perspectives
    Mwanri, A.W. - \ 2015
    Wageningen University. Promotor(en): Edith Feskens, co-promotor(en): J.L. Kinabo; K. Ramaiya. - Wageningen : Wageningen University - ISBN 9789462572645 - 202
    diabetes mellitus - voedselintolerantie - zwangerschap - zwangerschapscomplicaties - obesitas - koolhydraten - diabetes mellitus - food intolerance - pregnancy - pregnancy complications - obesity - carbohydrates

    Gestational diabetes mellitus in Tanzania – public health perspectives


    Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy. Women with GDM are at increased risk for preeclampsia during pregnancy and for delivery complications. In most cases GDM ends after pregnancy, but it increases the risk for future type 2 diabetes, and cardiovascular diseases, to both the mother and the child. With the current increase in prevalence of overweight/obesity and type 2 diabetes in Tanzania and other Sub Saharan African countries, it is possible that GDM may exist and may be on the rise.

    Methods: A cross-sectional survey was done in 2011 through 2013 where 910 women in Tanzania (609 from urban, 301 from rural areas) were studied during their usual antenatal clinic visits. Weight, height, mid upper arm circumference (MUAC), blood pressure and haemoglobin levels were measured by a trained technician. Blood glucose was measured at fasting and at two hours after 75 g oral glucose tolerance test. Women were classified as having GDM using WHO 1999 criteria. Sociodemographic information was collected through face-to-face interviews using structured questionnaire or retrieved from the antenatal clinic card. Dietary intake data was collected using 24-hour recall interview and foods were categorised into groups based on dietary diversity. The international physical activity questionnaire (IPAQ) was used to assess activities in the past one week. Information on birth outcome was obtained from 466 urban mothers (response rate 77%) through telephone interviews. To estimate the burden of GDM in the region, we additionally conducted a systematic search of published literature on the prevalence and risk factors of GDM in Sub Saharan Africa. Out of the 22 reviewed studies, 15 studies graded as having low or moderate risk of bias were included in a meta-regression analysis. Finally, a review of literature regarding the health system and antenatal care was done and supported by a survey to assess antenatal care services in 24 health facilities that provide maternal and childcare services in Dar es Salaam region.

    Results: The prevalence of GDM was much higher among women residing in the urban (8.4%) compared to those in the rural areas (1.0%), which was much higher compared to 0% reported in the 1990s. Prevalence of GDM was higher for women who had a previous stillbirth, family history of type 2 diabetes and MUAC ≥28 cm, and lower for women with normal haemoglobin concentrations compared to those with anaemia. Likewise, the prevalence of hypertension disorders of pregnancy (HDP) was higher in urban (8.9%) compared to rural areas (5.3%). Risk factors for HDP in urban women were advanced maternal age, high MUAC, gestional age and being HIV positive, and in rural women age and gestational age.

    We reviewed 22 studies conducted in six out of the 47 Sub saharan African countries. Heterogeneity between the studies was high and it could not be significantly explained by study setting, population, diagnostic criteria, or the year the study was done. Nevertheless, a relatively higher prevalence was observed in studies done after the year 2000, when women at risk were selected and when more current diagnostic criteria were used. The prevalence was up to about 14.0% when women with at least one risk factor were studied. In Dar es Salaam women, despite a high prevalence of anemia and HIV, the prevalence of macrosomia was higher (5.9%) compared to the prevalence of low birth weight (3.6%). Presence of GDM (OR 3.46, 95% CI 1.01-11.85) and birth weight of the previous child (OR 2.42, 95% CI 1.17-4.99) were the main predictors of macrosomia and HDP (OR 3.75, 95% CI 1.11-12.68) was the main predictor of low birth weight. Although glucose testing in urine appeared to be universally done in the urban setting, the sensitivity of this test for detection of GDM is low. Therefore selective blood glucose testing should be implemented and HIV testing and counselling may be used as an entry point.

    Conclusions: The prevalence of GDM and HDP was higher in the urban compared to the rural areas in Tanzania, indicating an increasing in women who are at risk for delivery complications, poor pregnancy outcomes, type 2 diabetes and cardiovascular diseases in later life. The risk factors observed can be used to identify risk groups for screening and as target for prevention interventions. To inform policy makers and for better health care planning, further studies on the costs for blood glucose testing during the usual antenatal clinic visits and on the management of women with GDM are warranted.

    Een nieuwe rol voor de verloskundige : onderzoek naar kansen en belemmeringen voor de Wageningse verloskundigen
    Wagemakers, A. ; Vaandrager, L. - \ 2015
    Wageningen : Wetenschapswinkel (Rapport / Wetenschapswinkel Wageningen UR 309) - 63
    verloskundigen - seksuele voorlichting - seksuele gezondheid - lagere klassen - arbeidersklassen - voorbehoedsmiddelen - orale voorbehoedsmiddelen - onderwijs - zwangerschap - midwives - sex education - sexual health - lower classes - working classes - contraceptives - oral contraceptives - education - pregnancy
    Determinants of maternal fetal attachment in women from a community-based sample
    Maas, A.J.B.M. ; Vreeswijk, C.M.J.M. ; Braeken, J. ; Vingerhoets, A.J.J.M. ; Bakel, H.J.A. van - \ 2014
    Journal of Reproductive and Infant Psychology 32 (2014)1. - ISSN 0264-6838 - p. 5 - 24.
    prenatal attachment - antenatal attachment - child characteristics - personality - pregnancy - representations - temperament - variables - validity - behavior
    BackgroundMaternal fetal attachment (MFA) has been found to be an important predictor for the developing relationship between mother and child. During the last decades, research on determinants of MFA has yielded inconclusive and even contradictory results. Until now, a process model in which multiple determinants of MFA are studied concurrently has been lacking. The present study evaluates a process model (based on Belsky's model of parenting) in which the specific contributions of parental, contextual, and expected child characteristics to MFA were examined.MethodsParticipants, 351 pregnant women from a community-based sample, completed questionnaires concerning their personality, attachment security, partner support, perceived stress, expected child temperament, and MFA at 26 weeks gestational age. Based on Belsky's model, a set of competing structural equation models were formulated and evaluated with path analysis.ResultsMFA was found to be multiply determined by parental, contextual, and expected child characteristics. These factors explained 19% of the variance in MFA. Pregnant women who were more extrovert, conscientious and agreeable reported having higher levels of MFA. In contrast, those women who perceived more stress and expected having an infant with a dull temperament reported lower levels of MFA.ConclusionThis study demonstrated that the theoretical framework of Belsky's model is applicable for explaining variations in the quality of the mother-fetus relationship in the pregnancy period. More knowledge of the determinants of MFA could help to identify mothers at risk for developing suboptimal feelings of attachment.
    Association between placentome size, measured using transrectal ultrasonography, and gestational age in cattle
    Adeyinka, F.D. ; Laven, R.A. ; Lawrence, K.E. ; Bosch, M. van den; Blankenvoorde, G. ; Parkinson, T.J. - \ 2014
    New Zealand Veterinary Journal 62 (2014)2. - ISSN 0048-0169 - p. 51 - 56.
    dairy-cows - bovine - pregnancy - agreement - fetometry
    AIM: The aim of this study was to estimate whether fetal age could be accurately estimated using placentome size. METHODS: Fifty-eight cows with confirmed conception dates in two herds were used for the study. The length of the long axis and cross-sectional area of placentomes close to the cervix were measured once every 10 days between approximately 60-130 days of gestation and once every 15 days between 130-160 days of gestation. Four to six placentomes were measured using transrectal ultrasonography in each uterine horn. A linear mixed model was used to establish the factors that were significantly associated with log mean placentome length and to create an equation to predict gestational age from mean placentome length. Limits of agreement analysis was then used to evaluate whether the predictions were sufficiently accurate for mean placentome length to be used, in practice, as a method of determining gestational age. RESULTS: Only age of gestation (p
    Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda
    Leerlooijer, J.N. ; Kok, G. ; Weyusya, J. ; Bos, A.E.R. ; Ruiter, R.A.C. ; Rijsdijk, E. ; Nshakira, N. ; Bartholomew, L.K. - \ 2014
    Health Education Research 29 (2014)4. - ISSN 0268-1153 - p. 598 - 610.
    hiv-1 infection - parenting teens - rural uganda - pregnancy - stigma - metaanalysis - adolescents - prevention - behavior - program
    Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried teenage mothers in rural Uganda. We used Intervention Mapping (IM) for systematically developing a theory and evidence-based comprehensive health promotion programme. A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM: needs assessment, programme objectives, methods and applications, intervention design, planning for adoption and implementation and planning for evaluation. The programme includes five intervention components: community awareness raising, teenage mother support groups, formal education and income generation, counselling, and advocacy. The intervention components are based on a variety of theoretical methods, including entertainment education, persuasive communication, mobilization of social networks and social action. In conclusion, IM facilitated the planning group to structure the iterative, bottom-up, participatory design of the project in a real-life setting and to use evidence and theory. The article provides suggestions for the planning of support interventions for unmarried teenage mothers.
    Genetic correlations between bodyweight change and reproduction traits in Merino ewes depend on age
    Rose, I.J. ; Mulder, H.A. ; Werf, J.H.J. van der; Thompson, A.N. ; Arendonk, J.A.M. van - \ 2014
    Journal of Animal Science 92 (2014)8. - ISSN 0021-8812 - p. 3249 - 3257.
    wool production - liveweight - nutrition - sheep - parameters - pregnancy - survival - components - lactation - variance
    Merino sheep in Australia experience periods of variable feed supply. Merino sheep can be bred to be more resilient to this variation by losing less bodyweight when grazing poor quality pasture and gaining more bodyweight when grazing good quality pasture. Therefore, selection on bodyweight change might be economically attractive but correlations with other traits in the breeding objective need to be known. The genetic correlations (rg) between bodyweight, bodyweight change, and reproduction were estimated using records from ~7350 fully pedigreed Merino ewes managed at Katanning in Western Australia. Number of lambs and total weight of lambs born and weaned were measured on ~5300 2-year-old ewes, ~4900 3-year-old ewes and ~3600 4-year-old ewes. On a proportion of these ewes bodyweight change was measured: ~1950 two-year-old ewes, ~1500 three old ewes and ~1100 four-year-old ewes. The bodyweight measurements were for three periods. The first period was during mating period over 42 days on poor pasture. The second period was during pregnancy over 90 days for ewes that got pregnant on poor and medium quality pasture. The third period was during lactation over 130 days for ewes that weaned a lamb on good quality pasture. Genetic correlations between weight change and reproduction were estimated within age classes. Genetic correlations were tested to be significantly greater magnitude than zero using likelihood ratio tests. Nearly all bodyweights had significant positive genetic correlations with all reproduction traits. In two-year old ewes, bodyweight change during the mating period had a positive genetic correlation with number of lambs weaned (rg = 0.58); bodyweight change during pregnancy had a positive genetic correlation with total weight of lambs born (rg = 0.33) and a negative genetic correlation with number of lambs weaned (rg = - 0.49). All other genetic correlations were not significantly greater magnitude than zero but estimates of genetic correlations for three-year-old ewes were generally consistent with these findings. The direction of the genetic correlations mostly coincided with the energy requirements of the ewes, and the stage of maturity of the ewes. In conclusion, optimized selection strategies on bodyweight changes to increase resilience will depend on the genetic correlations with reproduction, and are dependent on age.
    Effects of iodine supplementation in mild-to-moderately iodine-deficient pregnant women on thyroid function, pregnancy outcomes and newborn development in Thailand
    Gowachirapant, S. - \ 2014
    Wageningen University. Promotor(en): Michael Zimmermann, co-promotor(en): Alida Melse-Boonstra; P. Winichagoon. - Wageningen : Wageningen University - ISBN 9789462570290 - 162
    jodium - voedingstoestand - sporenelementtekorten - minerale supplementen - zwangerschap - schildklierwerking - zuigelingenontwikkeling - thailand - iodine - nutritional state - trace element deficiencies - mineral supplements - pregnancy - thyroid function - infant development - thailand

    Background: Iodine deficiency (ID) during pregnancy has been recognized as a major cause of hypothyroidism and adverse health consequences in both mothers and children. Although urinary iodine concentration (UIC) in school-aged children is recommended as an indicator to assess ID in the general population, it may not be a good surrogate for directly assessing iodine status in pregnant women. Iodine supplementation of mildly iodine-deficient pregnant women has been recommended worldwide; however, long-term benefit and safety of iodine supplementation in this group is uncertain. Finally, pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) may negatively affect thyroid function and pregnancy outcomes.

    Objectives: 1) to measure UIC in pairs of pregnant women and their school-aged children living in the same household; 2) to investigate the effects of iodine supplementation on maternal thyroid function, pregnancy and birth outcomes, and newborn development; 3) to evaluate the association between pre-pregnancy BMI and GWG with thyroid function and pregnancy outcomes.

    Methods: 1) In a cross-sectional pilot study, UIC was measured in spot urine samples from pairs (n=302) of healthy pregnant mothers and their school-aged children in Bangkok; 2) Arandomized controlled trial was conducted with 200 µg iodine per day or placebo given to mildly ID pregnant Thai women from <14 weeks to term. Anthropometrics, maternal thyroid function, UIC and thyroid volume were measured at baseline, 2ndand 3rdtrimester, at delivery and 6-week postpartum. Birth outcomes were collected from hospital records. Neonatal thyroid function, UIC and thyroid volume were measured at delivery and 6 weeks after birth. The Neonatal Behavioral Assessment Scales (NBAS) was used to assess newborn development.

    Results: 1) In the pilot study, median UIC in the pregnant women was 108 (11–558) µg/L and was lower than UIC in their school-aged children [200 (25–835) µg/L] (P<0.001); 2) In the RCT, medianUIC increased significantly from baseline in both groups, and the increase was higher in the iodine group (p<0.001). At 30 weeks of gestation, only 2% of the women in the placebo group and 7% in the iodine group reported a median UIC >500 µg/L. Maternal thyroid function, thyroid volume and the prevalence of all thyroid dysfunction subtypes did not differ significantly between treatment groups during the study (p>0.05). At 6-week postpartum, the prevalence of postpartum thyroiditis (hyperthyroidism) was significantly lower in the iodine group (3%) as compared to the placebo group (9%) (OR: 95%CI, 0.17: 0.04-0.70). There were no significant differences between newborn groups in thyroid function, thyroid volume, birth characteristics, UIC and NBAS score (p>0.05); 3) Pre-pregnancy BMI was a negative predictor of free thyroxine (fT4) (β=-0.20, P<0.001) in early gestation (<14 weeks). Compared to normal weight women, the prevalence ratio (95% CI) of a low fT4 in overweight women was 3.64 (2.08–6.37) (P<0.01). In addition, secondary data analysis showed that overweight women had an 11-fold higher risk of delivering a large for gestational age infant compared to normal weight women, while women who had excessive GWG were 5.6 times more likely to deliver a macrosomic infant compared to women with normal GWG.

    Conclusion: 1) UIC in school-aged children should not be used as a surrogate for monitoring iodine status in pregnancy; 2) iodine supplementation (200 µg/d) in mildly iodine-deficient pregnant Thai women was effective in increasing iodine intakes into the adequate range but had no benefit on antenatal maternal thyroid function or newborn outcomes out to 6 weeks; however, it significantly reduced the risk of maternal postpartum thyroid dysfunction; 3) excess maternal body weight both before and during pregnancy may have adverse impacts on maternal thyroid function as well as birth weight. Therefore, maintaining normal body weight before and throughout pregnancy should be recommended.

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