Biomedical subjects
Publications and source records attributed to B Worthington-Roberts.
"Natural" phenomena allow conclusions that maternal dietary deficiencies or excesses can affect development of the human embryo and fetus adversely. The most important finding in recent years has been the relationship between maternal folic acid status and neural tube defects.
This study was conducted to test the hypothesis that breast-fed infants of smokers are smaller in size at 1 year of age than breast-fed infants of nonsmokers. Three groups of infants were selected from all singletons born to women who were seen for prenatal care in their 6th month of pregnancy at a health maintenance organization in Seattle, Washington, between January 1982 and April 1983. Breast-fed infants of smokers (n = 74) were compared with breast-fed infants of nonsmokers (n = 195) and with bottle-fed infants of smokers (n = 64). Mothers were interviewed at 1 and 3 months after delivery; both the mother and the infant were seen at 1 year. Among breast feeders, smokers' infants were twice as likely as nonsmokers' infants to have body mass more than 1 standard deviation above the mean (relative risk = 2.04, 95% confidence interval 1.15-3.61). This relation persisted after control for gestational age and weight at birth, length of lactation, mother's size and diet, exposure to other drugs in breast milk, and all other variables measured in this study. Every 10 cigarettes smoked while breast feeding predicted an additional 3% infant body mass at 1 year. In summary, breast-fed infants of smokers in this study gained more weight after birth than the other two groups; at 1 year of age, they were heavier and had significantly higher body mass. Reasons for this paradoxical finding are explored.
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The possibility that antigenically active protein macromolecules affect the risk of developing acute graft-versus-host disease (aGVHD) was investigated in a cohort of patients who underwent allogeneic marrow transplantation for hematologic malignancy (n = 575). Daily records of food intake from transplant through discharge or death were evaluated for grams of total protein and summed over consecutive 4-day intervals. The day of onset of aGVHD was partitioned into 4-day time intervals such that assessments of food intake preceded onset of aGVHD by 3-6 days. Acute GVHD developed in 308 (54%) patients. The cumulative incidence of aGVHD among patients eating any amount of protein was lower (4-13%) than that of patients not eating protein (8-19%) for each of the time intervals through day 21 post-transplant; the relative risk associated with protein intake, adjusted for patient and transplant characteristics that are correlated with the occurrence of aGVHD, ranged from 0.23 (95% confidence interval (CI) 0.09, 0.63) to 0.83 (CI 0.46, 1.51). A proportional hazards regression analysis, using protein intake as a time-dependent covariate, confirmed these results. The findings of this study provide no support for the hypothesis that intake of protein-containing foods during the first 3 weeks after marrow transplantation increases the risk of aGVHD.
A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied). Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.
The detrimental effects of maternal drinking during pregnancy on fetal health have been documented. The consequences for infants of maternal drinking during breast-feeding are unknown, but research in animals suggests that the infant could be affected by exposure to alcohol through the mother's milk. In a study of 400 infants born to members of a health maintenance organization, we investigated the relation of the mother's use of alcohol during breast-feeding to the infant's development at one year of age. Mental development, as measured by the Bayley Mental Development Index (MDI), was unrelated to maternal drinking during breast-feeding. However, motor development, as measured by the Psychomotor Development Index (PDI), was significantly lower in infants exposed regularly to alcohol in breast milk (after alcohol exposure during gestation was controlled for), with a dose-response relation (P for linear trend, 0.006). The infants of breast-feeding mothers who had at least one drink daily had a mean PDI score of 98, whereas the infants exposed to less alcohol in breast milk had a mean PDI score of 103 (95 percent confidence interval for the difference of the two means, 1.2 to 9.8). The effect was more pronounced when mothers who supplemented breast-feeding with formula were excluded from the analysis. The association persisted even after we controlled for more than 100 potentially confounding variables, including smoking and other drug use during pregnancy and in the postpartum period. We conclude that ethanol ingested through breast milk has a slight but significant detrimental effect on motor development, but not mental development, in breast-fed infants.
Few data are available about desirable weight gain during twin gestation. The present study addresses this issue through retrospective evaluation of 217 women pregnant with twins who delivered at Swedish Hospital Medical Center, Seattle, between 1982 and 1986. The purpose of the study was to identify an optimum total weight gain and an optimum weight gain pattern for normal twin gestation. A mean prenatal weight gain of 20 kg (44 lb) was associated with "optimum" outcome; optimum outcome was defined as a pregnancy lasting at least 37 weeks with the delivery of two living infants weighing greater than or equal to 2,500 gm each with 5-minute Apgar scores greater than or equal to 7. A weight gain curve for twin gestation was generated and compared with the standard curve for singleton pregnancy. While the weight gain curve during twin gestation was similar to the standard curve during the first half of pregnancy, increased weight gain began in the second trimester and continued to term. The weight gain pattern of twin gestations with less-than-optimum outcome paralleled that of the optimum outcome group until about 30 weeks' gestation, at which time weight gain slowed in women in the former group, whose mean total weight gain was 16.8 kg (37 lb).
Although food cravings and aversions are commonly experienced by pregnant women, the degree to which they persist in the postpartum period is unknown. This study examines this issue in both lactating and nonlactating women. A random sample of 463 subjects was selected from all prenatal patients receiving care at a large health maintenance organization (HMO). Even though almost all of the subjects reported craving some food or beverage during the last trimester of pregnancy and half reported some aversion, those phenomena dropped markedly in the postpartum period. Evaluation of dietary quality as related to food cravings revealed no clear association; that is, the data provided no evidence to support the hypothesis that cravings are caused by dietary deficiencies or that they result in significantly augmented intake of key nutrients found in those foods. Overall, food cravings and aversions do not continue into the postpartum period at a higher rate than one would expect in the adult female population; manifestation of food cravings/aversions is not related to dietary quality.
Much has been learned during the past several decades about the role of nutrition in the course and outcome of pregnancy. While the bulk of the data is derived from animal models, human observations are gradually accumulating. It is generally appreciated at the present time that the fetus is not a "perfect parasite"; maternal stores can be drawn upon for support but a limit exists as to the ability of the fetus to drain maternal supplies. The consequences of poor maternal nutrition range from prevention of pregnancy (through the development of amenorrhea) to the stimulation of spontaneous abortion, stillbirth and congenital malformations. Limited maternal weight gain and subsequent low birth weight is the most common result of suboptimal maternal nutrition. The impact of excessive nutrient intake during pregnancy is poorly understood at the present time. Additional work is also required to clarify the impact of toxic agents consumed by women through water, foods, or nutritional supplements.
Intakes and related biochemical indexes of ascorbic acid, thiamin, riboflavin, pyridoxine, vitamin B-12, and folic acid were examined for adequacy in 30 normal children aged 40 to 108 months. Comparisons were made between intake and biochemical index values of children who reported regular use of vitamin supplements and those who reported none. Three-day food records provided nutrient intake data; blood samples, drawn following an overnight fast, were analyzed for biochemical indexes. Student's t-test and the Pearson r were used for comparisons. Mean intakes of most nutrients differed significantly between the supplemented and nonsupplemented groups only when supplements were considered. Mean biochemical indexes differed significantly for riboflavin (p less than .005). Correlations between intakes and respective biochemical indexes were significant for riboflavin (p less than .01) and vitamin B-12 (p less than .01) in the supplemented group and for folate with RBC folate (p less than .005) in the nonsupplemented group. No deficiencies in either group were evident from biochemical indexes; improvement in indexes with supplement use was interpreted as being only relative and not suggestive that such use is beneficial.
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More than 900 dietitians in the state of Washington were surveyed to determine their personal patterns of dietary supplementation. Seventy-five percent of the population responded; of the respondents, nearly 60% reported the use of some nutritional supplement. The most commonly used supplements were multivitamins plus minerals and vitamin C only, with 21% and 19% of the population choosing these supplementation patterns, respectively. Multivitamins (no minerals) and iron only or with vitamin C were each chosen by 6.9% of the population. Other supplement categories were used less often: calcium with or without vitamin D (2.7%), protein only (3%), and extra calories (0%). The most commonly used "miscellaneous" supplement was potassium. Among subgroups of the population, supplement use was most common among pregnant and lactating women and underweight individuals. The few individuals using iron supplements were women, and most of them were under 30 years of age. The majority of users of calcium supplements were women over 50. Although the bases for the observed supplementation patterns were not determined in the present study, speculations can be put forth. In the meantime, it is clear that many dietitians have chosen to utilize some nutritional supplement for personal health.
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Caffeine is a drug which easily crosses the placental barrier and enters the fetal circulation. To date, most studies that demonstrate caffeine's teratogenic potential have been conducted in animal models. Although no definite relationship in humans has been confirmed, it is suggested that a pregnant woman should limit or discontinue her intake of caffeine.