ORCID Profile
0000-0002-7652-990X
Current Organisation
University of Southampton
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Publisher: BMJ
Date: 08-04-2020
DOI: 10.1136/TOBACCOCONTROL-2019-055325
Abstract: Anti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and friends) and internalised injunctive norms (embarrassed about telling others you are a smoker). A serial cross-sectional population survey of Australian adult smokers (n=6649 2012 to 2015). Logistic regression analyses examined associations of social norms with exposure to different types of tobacco control advertisements, tax increases and other tobacco control policies, adjusting for key demographic, smoking and media exposure covariates. Interaction analyses examined differences by age and socioeconomic status (SES). Greater past month exposure to predominantly fear-evoking advertisements was associated with increased odds of perceiving disapproval (per 1000 gross rating points: adjusted OR (AOR) 2.69, 95% CI: 1.34 to 5.39), while exposure to advertisements evoking multiple negative emotions (fear, guilt, sadness) reduced perceived disapproval (AOR 0.61, 95% CI: 0.42 to 0.87). Increased perceived disapproval was also associated with anticipation (AOR 1.38, 95% CI: 1.02 to 1.88), and implementation of a series of annual 12.5% tobacco tax rises (AOR 1.41, 95% CI: 1.03 to 1.94). Associations were consistent across age and SES. There were no associations nor subgroup interactions between advertisement exposure or policy changes and feeling embarrassed about telling others you are a smoker. Smokers’ perceptions of family and friends’ disapproval of their smoking was more common after exposure to fear-evoking tobacco control c aigns and after large tobacco tax increases were announced and implemented.
Publisher: Royal College of General Practitioners
Date: 31-03-2022
Publisher: University of Queensland Library
Date: 2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
DOI: 10.1097/GME.0000000000000712
Abstract: The aim of the study was to describe the trajectories of depressive symptoms in a large population-based cohort of midaged women, and to examine the associations of current and changing reproductive stage with depressive symptoms over time. Prospective, population-based cohort study of 13,715 women aged 45 to 50 years followed up for over 15 years (Australian Longitudinal Study on Women's Health). Nearly 6,000 women provided complete data for this study. Menopause status was determined from questionnaires about hysterectomy, oophorectomy, hormone therapy, and menstrual patterns. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale (CESD-10). Latent class analysis indicated four distinct profiles of CESD-10 scores over 15 years: stable low (80.0%), increasing (9.0%), decreasing (8.5%), and stable high (2.5%). Those with “increasing” depressive symptoms were more likely to have had bilateral salpingo-oophorectomy or be perimenopausal at baseline compared with women in the “stable low” group. Depressive symptoms were higher in perimenopausal women, (higher CESD-10 score of 0.19, 95% CI 0.02, 0.31), after hysterectomy alone (0.53, 95% CI 0.31, 0.74), bilateral salpingo-oophorectomy with/without hysterectomy (0.85, 95% CI 0.58, 1.12), hormone therapy users (0.19, 95% CI 0.01, 0.36), and after starting or stopping hormone therapy compared with postmenopausal women (adjusted for sociodemographic factors, vasomotor symptoms, health behaviors, and history of depression diagnosis or treatment). Depressive symptoms follow distinct trajectories across the menopause transition. Most women have stable symptoms, but around 9% have increasing symptoms and a similar proportion (8.5%) decreasing symptoms. Increasing depressive symptoms were independent of vasomotor symptoms but were associated with oophorectomy and stopping or starting hormone therapy. A large number of women were excluded due to missing data, and thus the results should be interpreted with caution.
Publisher: Georg Thieme Verlag KG
Date: 16-05-2022
Abstract: Preconception care (PCC) involves a wide-ranging set of interventions to optimize health prior to pregnancy. These interventions seek to enhance conception rates, pregnancy outcomes, childhood health, and the health of future generations. To assist health care providers to exercise high-quality clinical care in this domain, clinical practice guidelines from a range of settings have been published. This systematic review sought to identify existing freely accessible international guidelines, assess these in terms of their quality using the AGREE II tool, and assess the summary recommendations and the evidence level on which they are based. We identified 11 guidelines that focused on PCC. Ten of these were classified as moderate quality (scores ranging from 3.5 to 4.5 out of 7) and only one was classified as very high quality, scoring 6.5. The levels of evidence for recommendations ranged from the lowest possible level of evidence (III) to the highest (I-a): the highest quality evidence available is for folic acid supplementation to reduce risk of neural tube defects and the role of antiviral medication to prevent HIV transmission. This systematic review identified that high-quality guidelines on PCC are lacking and that few domains of PCC recommendations are supported by high-quality evidence.
Publisher: Royal College of General Practitioners
Date: 29-04-2021
Publisher: Cambridge University Press (CUP)
Date: 22-05-2018
DOI: 10.1017/S0007114518001277
Abstract: Carbohydrate quantity and quality affect postprandial glucose response, glucose metabolism and risk of type 2 diabetes. The aim of this study was to examine the association of pre-pregnancy dietary carbohydrate quantity and quality with the risk of developing gestational diabetes mellitus (GDM). We used data from the Australian Longitudinal Study on Women’s Health that included 3607 women aged 25–30 years without diabetes who were followed up between 2003 and 2015. We examined carbohydrate quantity (total carbohydrate intake and a low-carbohydrate diet (LCD) score) and carbohydrate subtypes indicating quality (fibre, total sugar intake, glycaemic index, glycaemic load and intake of carbohydrate-rich food groups). Relative risks (RR) for development of GDM were estimated using multivariable regression models with generalised estimating equations. During 12 years of follow-up, 285 cases of GDM were documented in 6263 pregnancies (4·6 %). The LCD score, reflecting relatively high fat and protein intake and low carbohydrate intake, was positively associated with GDM risk (RR 1·54 95 % CI 1·10, 2·15), highest quartile v . lowest quartile). Women in the quartile with highest fibre intake had a 33 % lower risk of GDM (RR 0·67 95 % CI 0·45, 0·96)). Higher intakes of fruit (0·95 per 50 g/d 95 % CI 0·90, 0·99) and fruit juice (0·89 per 100 g/d 95 % CI 0·80, 1·00)) were inversely associated with GDM, whereas cereal intake was associated with a higher risk of GDM (RR 1·05 per 20 g/d 95 % CI 1·01, 1·07)). Thus, a relatively low carbohydrate and high fat and protein intake may increase the risk of GDM, whereas higher fibre intake could decrease the risk of GDM. It is especially important to take the source of carbohydrates into account.
Publisher: Elsevier BV
Date: 09-2016
Abstract: The contribution of body mass index (BMI) to the observed associations between dietary patterns and risk of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) remains unclear. The objective of this study was to formally quantify the mediating effect of prepregnancy BMI in these associations. Women (aged 25-30 y) participating in the Australian Longitudinal Study on Women's Health were not pregnant at baseline in 2003 and reported ≥1 pregnancy up to 2012. GDM and HDP diagnoses were self-reported for each pregnancy and validated in a subset. A Mediterranean diet score was created by use of a baseline-validated food-frequency questionnaire and dichotomized to reflect low adherence (<25th percentile) and higher adherence (≥25th percentile). A causal inference framework for mediation analysis was used to estimate total, natural direct, and natural indirect effects of the prepregnancy Mediterranean diet on incident GDM and HDP and proportions mediated through prepregnancy BMI. In 3378 women without a history of diabetes, 240 (7.1%) developed GDM. HDP was reported in 273 (8.6%) of 3167 women with no history of hypertension. Low adherence to the Mediterranean diet was associated with higher risk of GDM (OR: 1.35 95% CI: 1.02, 1.60) and HDP (OR: 1.41 95% CI: 1.18, 1.56), after adjustment for education, parity, polycystic ovary syndrome, energy intake, and physical activity. Proportions mediated through prepregnancy BMI (per 1-kg/m(2) increase) were 32% and 22% for GDM and HDP, respectively. These findings suggest that prepregnancy BMI as a single mediator contributes substantially to the total effects of the prepregnancy Mediterranean diet on GDM and HDP risk.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.NUMECD.2017.03.005
Abstract: A pro-inflammatory diet is thought to lead to hypertension through oxidative stress and vessel wall inflammation. We therefore investigated the association between the dietary inflammatory index (DII) and developing hypertension in a population-based cohort of middle-aged women. The Australian Longitudinal Study on Women's Health included 7169 Australian women, aged 52 years (SD 1 year) at baseline in 2001, who were followed up through 4 surveys until 2013. The DII, a literature-derived dietary index that has been validated against several inflammatory markers, was calculated based on data collected via a validated food-frequency questionnaire administered at baseline. Hypertension was defined as new onset of doctor-diagnosed hypertension, ascertained through self-report between 2001 and 2013. Generalised Estimating Equation analyses were used to investigate the association between the DII and incident hypertension. The analyses were adjusted for demographic and hypertension risk factors. During 12-years follow-up we identified 1680 incident cases of hypertension. A more pro-inflammatory diet was associated with higher risk of hypertension in dichotomised analyses with an OR A pro-inflammatory diet might lead to a higher risk of developing hypertension. These results need to be replicated in other studies.
Publisher: American Diabetes Association
Date: 14-12-2015
DOI: 10.2337/DC15-0540
Abstract: Diet may influence the risk of gestational diabetes mellitus (GDM), but inconsistent findings have been reported. The purpose of this study was to synthesize evidence from observational studies on the associations between dietary factors and GDM. Medline and Embase were searched for articles published until January 2015. We included observational studies of reproductive-aged women that reported on associations of maternal dietary intake before or during pregnancy, including energy, nutrients, foods, and dietary patterns, with GDM. All relevant results were extracted from each article. The number of comparable studies that adjusted for confounders was insufficient to perform a meta-analysis. The systematic review included 34 articles comprising 21 in idual studies (10 prospective cohort, 6 cross-sectional, and 5 case-control). A limited number of prospective cohort studies adjusting for confounders indicated associations with a higher risk of GDM for replacing 1–5% of energy from carbohydrates with fat and for high consumption of cholesterol (≥300 mg/day), heme iron (≥1.1 mg/day), red and processed meat (increment of 1 serving/day), and eggs (≥7 per week). A dietary pattern rich in fruit, vegetables, whole grains, and fish and low in red and processed meat, refined grains, and high-fat dairy was found to be beneficial. The current evidence is based on a limited number of studies that are heterogeneous in design, exposure, and outcome measures. The findings support current dietary guidelines to limit consumption of foods containing saturated fat and cholesterol, such as processed meat and eggs, as part of an overall balanced diet. Further large prospective studies are warranted.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.AMEPRE.2019.04.028
Abstract: The influence of women's childhood psychosocial environment and subsequent preconception mental health on risk of developing gestational diabetes mellitus is unclear. This study examines this relationship. Data from a population-based cohort study, the Australian Longitudinal Study on Women's Health, were used. A total of 6,317 women with no pre-existing diabetes were followed from 1996 (aged 18-23 years) until 2015. Gestational diabetes mellitus diagnosis was self-reported. Exposures to eight subcategories of adverse childhood experiences were recalled. In idual subcategories and total number of adverse childhood experiences were examined. Log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. Analyses were adjusted for early life, preconception, and antenatal gestational diabetes mellitus risk factors. Effect modification by preconception mental health was tested using cross-product terms. Analyses were conducted in 2018. Among 11,556 pregnancies, 4.7% were complicated by gestational diabetes mellitus. Compared with women not exposed to adverse childhood experiences, exposure to any three adverse childhood experiences (6% of women, adjusted RR=1.73, 95% CI=1.02, 3.01) or four or more adverse childhood experiences (7%, adjusted RR=1.76, 95% CI=1.04, 2.99) was associated with elevated gestational diabetes mellitus risk in women with preconception depressive symptoms. Among the subcategories of adverse childhood experiences, physical abuse, and household substance abuse were associated with higher gestational diabetes mellitus risk. Adverse childhood experiences were not associated with gestational diabetes mellitus in women without depressive symptoms before pregnancy (p=0.01, for interaction). These findings suggest that, in addition to primary prevention of childhood adversity, strategies to curb poor mental health trajectories among women exposed to adverse childhood experiences may contribute to prevention of gestational diabetes mellitus.
Publisher: Elsevier BV
Date: 2022
DOI: 10.2139/SSRN.4163702
Publisher: Oxford University Press (OUP)
Date: 05-03-2019
Abstract: How has the timing of women’s reproductive events (including ages at menarche, first birth, and natural menopause, and the number of children) changed across birth years, racial/ethnic groups and educational levels? Women who were born in recent generations (1970–84 vs before 1930) or those who with higher education levels had menarche a year earlier, experienced a higher prevalence of nulliparity and had their first child at a later age. The timing of key reproductive events, such as menarche and menopause, is not only indicative of current health status but is linked to the risk of adverse hormone-related health outcomes in later life. Variations of reproductive indices across different birth years, race/ethnicity and socioeconomic positions have not been described comprehensively. In idual-level data from 23 observational studies that contributed to the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) consortium were included. Altogether 505 147 women were included. Overall estimates for reproductive indices were obtained using a two-stage process: in idual-level data from each study were analysed separately using generalised linear models. These estimates were then combined using random-effects meta-analyses. Mean ages were 12.9 years at menarche, 25.7 years at first birth, and 50.5 years at natural menopause, with significant between-study heterogeneity (I2 & 99%). A linear trend was observed across birth year for mean age at menarche, with women born from 1970 to 1984 having menarche one year earlier (12.6 years) than women born before 1930 (13.5 years) (P for trend = 0.0014). The prevalence of nulliparity rose progressively from 14% of women born from 1940–49 to 22% of women born 1970–84 (P = 0.003) similarly, the mean age at first birth rose from 24.8 to 27.3 years (P = 0.0016). Women with higher education levels had fewer children, later first birth, and later menopause than women with lower education levels. After adjusting for birth year and education level, substantial variation was present for all reproductive events across racial/ethnic/regional groups (all P values & 0.005). Variations of study design, data collection methods, and s le selection across studies, as well as retrospectively reported age at menarche, age at first birth may cause some bias. This global consortium study found robust evidence on variations in reproductive indices for women born in the 20th century that appear to have both biological and social origins. InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). GDM is supported by the Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844).
Publisher: Wiley
Date: 30-03-2023
Abstract: Modifiable behaviours during the first 1000 days of life influence developmental trajectories of adult chronic diseases. Despite this, sub‐optimal dietary intakes during pregnancy and excessive gestational weight gain are common. Very little is known about partners' dietary patterns and the influence on women's pregnancy dietary patterns. We aimed to examine dietary intake during pregnancy among women and their partners, and gestational weight gain patterns in the Queensland Family Cohort pilot study. The Queensland Family Cohort is a prospective, observational study piloted at a Brisbane (Australia) tertiary maternity hospital from 2018 to 2021. Participant characteristics, weight gain, dietary and nutrient intake were assessed. Data were available for 194 pregnant women and their partners. Poor alignment with Australian Guide to Healthy Eating recommendations was observed. Highest alignment was for fruit (40% women) and meat/alternatives (38% partners) and lowest for breads/cereals ( % women) and milk/alternatives (13% partners). Fewer women (4.4%–60.3%) than their partners (5.4%–92.3%) met guidelines for all micronutrient intakes from food alone, particularly folic acid, iodine, and iron. Women were more likely to meet daily recommendations for fruit, vegetables, dairy, bread/cereals, and meat/alternatives when their partners also met recommendations. Women with a higher pre‐pregnancy body mass index were more likely to gain above recommended weight gain ranges. In this contemporary cohort of pregnant women and their partners, sub‐optimal dietary patterns and deficits in some nutrients were common. There is an urgent need for evidence‐informed public health policy and programs to improve diet quality during pregnancy due to intergenerational effects.
Publisher: Cambridge University Press (CUP)
Date: 14-08-2019
DOI: 10.1017/S0033291719001958
Abstract: Review findings on the role of dietary patterns in preventing depression are inconsistent, possibly due to variation in assessment of dietary exposure and depression. We studied the association between dietary patterns and depressive symptoms in six population-based cohorts and meta-analysed the findings using a standardised approach that defined dietary exposure, depression assessment and covariates. Included were cross-sectional data from 23 026 participants in six cohorts: InCHIANTI (Italy), LASA, NESDA, HELIUS (the Netherlands), ALSWH (Australia) and Whitehall II (UK). Analysis of incidence was based on three cohorts with repeated measures of depressive symptoms at 5–6 years of follow-up in 10 721 participants: Whitehall II, InCHIANTI, ALSWH. Three a priori dietary patterns, Mediterranean diet score (MDS), Alternative Healthy Eating Index (AHEI-2010), and the Dietary Approaches to Stop Hypertension (DASH) diet were investigated in relation to depressive symptoms. Analyses at the cohort-level adjusted for a fixed set of confounders, meta-analysis used a random-effects model. Cross-sectional and prospective analyses showed statistically significant inverse associations of the three dietary patterns with depressive symptoms (continuous and dichotomous). In cross-sectional analysis, the association of diet with depressive symptoms using a cut-off yielded an adjusted OR of 0.87 (95% confidence interval 0.84–0.91) for MDS, 0.93 (0.88–0.98) for AHEI-2010, and 0.94 (0.87–1.01) for DASH. Similar associations were observed prospectively: 0.88 (0.80–0.96) for MDS 0.95 (0.84–1.06) for AHEI-2010 0.90 (0.84–0.97) for DASH. Population-scale observational evidence indicates that adults following a healthy dietary pattern have fewer depressive symptoms and lower risk of developing depressive symptoms.
Publisher: Springer Science and Business Media LLC
Date: 06-2021
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.JAND.2019.07.021
Abstract: Women with prior gestational diabetes (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). There are no up-to-date systematic reviews analyzing the relationship of diet with risk of developing T2DM following GDM. To systematically review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history. Six electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, Cochrane Central, Proquest, and Scopus) for articles published until May 2019. This review includes intervention and observational studies among women of any age with a history of GDM that reported on the effects of dietary interventions or association of dietary intake (energy, nutrients, foods, dietary patterns) with T2DM, impaired glucose tolerance, impaired fasting glucose, or prediabetes. The systematic review identified five articles reporting results from four intervention studies, and seven articles reporting results from four observational studies. Findings from intervention studies indicated trends toward beneficial effects of a low-glycemic index diet, a low-carbohydrate diet, and a diet in line with general population dietary guidelines, but studies had unclear or high risk of bias. Findings from two cross-sectional and one prospective study indicated poorer diabetes outcomes for women with higher intakes of branched-chain amino acids, total and heme iron, and a diet relatively low in carbohydrates and high in animal fat and protein, and better outcomes among those consuming diets rich in fruit, vegetables, nuts, fish, and legumes, and low in red and processed meats and sugar-sweetened beverages, after adjustment for confounders, including body mass index. Findings from observational studies support current dietary guidelines for the prevention of T2DM. Further dietary intervention studies are needed to confirm whether or not dietary modification following a GDM pregnancy reduces women's risk of developing T2DM.
Publisher: Cambridge University Press (CUP)
Date: 04-03-2015
DOI: 10.1017/S1368980014000135
Abstract: To compare women's diets with recommended intakes from the new Australian Dietary Guidelines (ADG 2013). Cross-sectional study using data from the Australian Longitudinal Study on Women's Health. Diet was assessed using a validated FFQ. Two nationally representative age cohorts of Australian women. Women in the young cohort (born 1973–1978, aged 31–36 years) and mid-age cohort (born 1946–1951, aged 50–55 years). Women ( n 18 226) were categorised into three groups: ‘young women’ ( n 5760), young ‘pregnant women’ at the time or who had given birth in the 12 months prior to the survey ( n 1999) and ‘mid-age women’ ( n 10 467). Less than 2 % of women in all three groups attained the ADG 2013 recommendation of five daily servings of vegetables, with the majority needing more than two additional servings. For young women, less than one-third met recommendations for fruit (32%) and meat and alternatives (28 %), while only a small minority did so for dairy (12 %) and cereals (7 %). Fifty per cent of pregnant women met guidelines for fruit, but low percentages reached guidelines for dairy (22 %), meat and alternatives (10 %) and cereals (2·5 %). For mid-age women, adherence was higher for meat and alternatives (41 %) and cereals (45 %), whereas only 1 % had the suggested dairy intake of four daily servings. For most women to follow ADG 2013 recommendations would require substantially increased consumption of cereals, vegetables and dairy. Findings have implications for tailoring the dissemination of dietary guidelines for women in different age groups and for pregnant women.
Publisher: Wiley
Date: 06-02-2019
Publisher: Elsevier BV
Date: 08-2023
Publisher: Wiley
Date: 20-03-2023
DOI: 10.1111/MCN.13502
Abstract: Low‐carbohydrate diets (LCDs) are popular among people attempting weight loss and recommended for pregnant women with gestational diabetes (GDM), but they may increase health risks if nutritionally inadequate. We aimed to describe the dietary intake of post‐partum women according to their relative carbohydrate intake, overall, and among women attempting weight loss or diagnosed with GDM in their recent pregnancy. This cross‐sectional population‐based cohort study included 2093 post‐partum women aged 25–36 years who participated in the Australian Longitudinal Study on Women's Health. Dietary intake was assessed using a validated food frequency questionnaire. Relative carbohydrate intake was determined using a previously developed LCD score. Data were weighted to account for overs ling of women from rural/remote areas. More than half of women ( n [weighted] = 1362, 66.3%) were trying to lose weight, and 4.6% ( n [weighted]=88) had GDM in their recent pregnancy. Women with the lowest relative carbohydrate intake (LCD score quartile 4) consumed 36.8% of total energy intake from carbohydrates, and had a lower intake of refined grains, whole grains, fruit and fruit juice, and a higher intake of red and processed meat, compared with women with the highest relative carbohydrate intake (quartile 1). Different food groups, both healthy and unhealthy, were restricted depending on whether women were attempting weight loss and had recent GDM. These findings may reflect a lack of knowledge among post‐partum women on carbohydrates and dietary guidelines. Health professionals may have an important role in providing advice and support for post‐partum women who wish to restrict their carbohydrate intake, to ensure optimal diet quality.
Publisher: Elsevier BV
Date: 12-2020
DOI: 10.1093/AJCN/NQAA269
Publisher: Elsevier BV
Date: 07-2015
Abstract: Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-ecl sia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk. We investigated associations between prepregnancy dietary patterns and risk of HDPs. We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors. During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar Mediterranean-style fruit and low-fat dairy and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58 95% CI, 0.42, 0.81). In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs.
Publisher: Springer Science and Business Media LLC
Date: 15-07-2016
Abstract: Diet and lifestyle advice for type 1 diabetes (T1DM) patients is based on little evidence and putative effects on glycaemic control. Therefore, we investigated the longitudinal relation between dietary and lifestyle variables and HbA1c levels in patients with type 1 diabetes. A 7-year prospective cohort analysis was performed in 1659 T1DM patients (52% males, mean age 32.5 years) participating in the EURODIAB Prospective Complications Study. Baseline dietary intake was assessed by 3- day records and physical activity, smoking status and alcohol intake by questionnaires. HbA1c during follow-up was centrally assessed by immunoassay. Analysis of variance (ANOVA) and restricted cubic spline regression analyses were performed to assess dose-response associations between diet and lifestyle variables and HbA1c levels, adjusted for age, sex, lifestyle and body composition measures, baseline HbA1c, medication use and severe hypoglycaemic attacks. Mean follow-up of our study population was 6.8 (s.d. 0.6) years. Mean HbA1c level was 8.25% (s.d. 1.85) (or 66.6 mmol/mol) at baseline and 8.27% (s.d. 1.44) at follow-up. Physical activity, smoking status and alcohol intake were not associated with HbA1c at follow-up in multivariable ANOVA models. Baseline intake below the median of vegetable protein (<29 g/day) and dietary fibre (<18 g/day) was associated with higher HbA1c levels. Restricted cubic splines showed nonlinear associations with HbA1c levels for vegetable protein (P (nonlinear)=0.008) and total dietary fibre (P (nonlinear)=0.0009). This study suggests that low intake of vegetable protein and dietary fibre are associated with worse glycaemic control in type 1 diabetes.
Publisher: Elsevier BV
Date: 05-2018
Publisher: Springer Science and Business Media LLC
Date: 12-04-2012
Publisher: Public Library of Science (PLoS)
Date: 25-08-2022
DOI: 10.1371/JOURNAL.PONE.0273339
Abstract: The COVID-19 pandemic has had a negative impact on the mental health of people globally. Significant concerns about health and access to services among women of reproductive age considering pregnancy may cause psychological distress, and in turn increase health risks during and after pregnancy for mothers and offspring. To examine the association between pregnancy intention and psychological distress during the COVID-19 pandemic in Australia, and explore if this association differed based on local viral transmission rates and corresponding levels of pandemic restrictions. A nationwide online survey was completed by 849 non-pregnant women aged 18–50 years between 15 October and 7 November 2020. Women were asked about their intention to become pregnant, and psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Multivariable regression analysis examined associations between pregnancy intention and psychological distress. An interaction term was added to the model to examine differences in associations by level of viral transmission rates and lockdown restrictions which was determined based on postcode. Pregnancy intention was not associated with experiencing (very) high psychological distress in the overall study population (odds ratio (OR) 1.42, 95% CI 0.94, 2.11). The interaction term (p = 0.09) suggested potential differences by level of restrictions and viral transmission rates. In stratified analysis among women living in a location with strict lockdown restrictions and high viral transmission rates leading up to and during the study, those planning to become pregnant were more likely to experience (very) high psychological distress (OR 3.39, 2.04, 5.65) compared with women not planning to become pregnant. Pregnancy intention was not associated with psychological distress among women exposed to lower levels of pandemic restrictions and viral transmission rates (OR 1.17, 0.74, 1.85). Our findings highlight the need to identify and support women planning pregnancy during a public health crisis to mitigate potential short- and long-term intergenerational negative health outcomes associated with psychological distress.
Publisher: Wiley
Date: 28-04-2017
DOI: 10.1002/OBY.21830
Abstract: This study investigated the contribution of psychosocial stress to mediating inequities in weight gain by educational status in a large cohort of young Australian women over a 9-year follow-up. This observational cohort study used survey data drawn from 4,806 women, aged 22 to 27 years at baseline (2000), participating in the Australian Longitudinal Study on Women's Health, who reported their education level (2000), perceived stress (2003), and weight (2003 and 2012). Using a causal inference framework based on counterfactuals for mediation analysis, we fitted linear or logistic regression models to examine the total effect, decomposed into natural direct and indirect effects via perceived stress, of education level (highest qualification completed: up to year 12/trade or diploma vs. university) on weight change. Women with lower education gained more weight over 9 years (6.1 kg, standard deviation [SD] 9.5) than women with higher education (3.8 kg, SD 7.7 P < 0.0001) and were more likely to be very or extremely stressed. The higher weight gain associated with low education was not mediated through perceived stress (per SD increase, percent mediated: 1.0%). Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels.
Publisher: Oxford University Press (OUP)
Date: 09-2020
DOI: 10.1093/EURPUB/CKAA165.853
Abstract: Observational studies have shown strong associations of preconception nutrition and lifestyle behaviours with maternal and child health outcomes however, awareness of these links among lay people, policy makers and health professionals is very limited. Poor nutrition and obesity are common among women of reproductive age, and the preconception period therefore has underutilised potential as a point of intervention. Intervention studies to improve dietary intake and physical activity during pregnancy have not been successful in reducing adverse maternal and newborn health outcomes, but relatively few interventions have examined effects of modifying diet and lifestyle prior to pregnancy. Despite limited evidence from human clinical trials, increasing evidence from observational studies and from animal trials for the benefits of optimal preconception health suggests public health efforts to increase awareness and improve preconception health behaviours are needed as strategies for disease prevention across generations. This presentation will provide an overview of the evidence for the impact of nutrition and lifestyle behaviours on short and long-term maternal and child health outcomes. This will provide workshop participants with an understanding of health behaviours across the life course that should be considered when building preconception care into existing health services.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Georg Thieme Verlag KG
Date: 07-2022
Abstract: Parental health before conception effects maternal and offspring health outcomes. Preconception care provides healthcare to prospective parents addressing modifiable preconception risks and health behaviors. This umbrella review aimed to consolidate evidence on women's and men's modifiable preconception risks or health behaviors associated with maternal and offspring health outcomes. MEDLINE, EMBASE, Maternity and Infant Care, CINAHL, and PsycINFO were searched from March 4, 2010, to March 4, 2020. Eligible studies were systematic reviews or meta-analyses of observational studies examining associations between modifiable preconception risks or health behaviors and maternal and offspring health outcomes. Screening, data extraction, and methodological quality assessment (AMSTAR 2) occurred independently by two reviewers. Degree of overlap was examined. Findings were summarized for evidence synthesis. Twenty-seven systematic reviews were included. Modifiable preconception risks and health behaviors were identified across categories: body composition (e.g., overweight, obesity), lifestyle behaviors (e.g., caffeine, smoking), nutrition (e.g., micronutrients), environmental exposures (e.g., radiation), and birth spacing (e.g., short interpregnancy intervals). Outcomes associated with exposures affected embryo (e.g., embryonic growth), maternal (e.g., gestational diabetes mellitus), fetal/neonate (e.g., preterm birth), and child (e.g., neurocognitive disorders) health. For real-world practice and policy relevance, evidence-based indicators for preconception care should include body composition, lifestyle, nutrition, environmental, and birth spacing.
Publisher: Cold Spring Harbor Laboratory
Date: 28-01-2023
DOI: 10.1101/2023.01.26.23284338
Abstract: To examine inequalities in preconception health between migrant women in potentially vulnerable situations and non-migrant women. National cross-sectional study. Data from the National Health Service (NHS) Maternity Services Data Set (MSDS) version 1.5, using data submitted by NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Data regarding migration status were available for 66.2% of the study population (n=432,022). Prevalence of preconception indicators were compared between probable migrants (those with complex social factors and English not their first language), possible migrants due to English not being a first language (without complex social factors), possible migrants due to complex social factors (who speak English as their first language) and unlikely migrants (those who speak English as their first language without complex social factors). Complex social factors include recent migrants, asylum seekers or refugees, difficulty reading or speaking English alcohol and/or drugs misuse all those aged under 20 and/or experiencing domestic abuse. Odds ratios were calculated comparing preconception indicators among those identified as migrants compared to unlikely migrants. Women identified as probable migrants (n=25,070) had over twice the odds of not taking folic acid before pregnancy and of having their first antenatal booking appointment after the recommended 10 weeks gestation compared to unlikely migrants (n=303,737), after adjusting for area-based deprivation level, mother’s age at booking, number of previous live births and ethnicity (odds ratio 2.15 (95% confidence interval 2.06 to 2.25) and 2.25 (2.18 to 2.32) respectively). Probable migrants had increased odds of previous obstetric complications and being underweight at booking, but lower odds of recorded physical and mental health conditions (apart from diabetes and hepatitis b), smoking and obesity in unadjusted and adjusted analyses. Inequalities between migrant women in potentially vulnerable situations and non-migrants exist across many preconception indicators. Findings highlight the opportunity to improve preconception health in this population in order to reduce health inequalities and improve perinatal and neonatal outcomes. Nearly a third of live births in the UK are to migrant women (women born outside the UK). Compared with UK-born women, migrant women experience worse perinatal outcomes. The health of a woman before conception influences pregnancy outcomes, but little is known about inequalities between migrant and non-migrant women preconception. This study showed that migrant women in potentially vulnerable situations are less likely to take folic acid before pregnancy, are more likely to be underweight, to have pre-existing diabetes or hepatitis b, and are more likely to have their first antenatal booking appointment after the recommended 10 weeks gestation, compared with non-migrants. Findings highlight the opportunity for more comprehensive preconception care for migrant women in potentially vulnerable situations.
Publisher: Oxford University Press (OUP)
Date: 09-2020
DOI: 10.1093/EURPUB/CKAA165.851
Abstract: Maternal health and health behaviours prior to conception have significant short and long term impacts on maternal and child health. The World Health Organization acknowledges the importance of health care before conception-referred to as 'preconception care' (PCC) -to reduce maternal and childhood morbidity and mortality. PCC is an approach to health promotion and preventive medicine that focuses on interventions that identify and modify biomedical, behavioural and social risks to a parental health or pregnancy outcome. By its nature, PCC relates to care before pregnancy, whether it be a first pregnancy or between consecutive pregnancies. PCC has received increased attention due to growing evidence that maternal health prior to conception can directly affect the health of the mother and the fetal environment during pregnancy. PCC research emphasises the impact of the fetal environment on adverse outcomes such as miscarriage, stillbirth, congenital disorders, and macrosomia. Parental preconception health also been found to impact on risk of the development of chronic diseases such as obesity, diabetes and cardiovascular disease, and cancer across the life course through epigenetic and other cellular responses to developmental exposures. Parental health behaviours that are important in the context of PCC include diet, smoking, and alcohol consumption. Similarly, parental exposure to environmental risk factors, such as phthalates, air pollution and pesticides can increase risk of congenital defects, behavioural issues and cancer in the child. Despite the importance of preconception health, and the potential impact of PCC, there are significant translation gaps between the available evidence and public awareness, clinician knowledge and available health services. This workshop aims to facilitate a deep and rich discussion about the challenges and opportunities associated with (1) improving preconception health in the general population and (2) developing PCC services and interventions that align with existing health services and meet population needs and expectations. The workshop will begin with four short presentations (10 minutes) to orient workshop participants to key literature with a focus on the following topics (1) the interface between public health and preconception health and care (2) nutrition and lifestyle behaviours in the preconception period (3) environmental exposures in the preconception period and (4) considerations for person-centred PCC. Following these presentations, the workshop team will facilitate discussions among breakout groups to identify local challenges and opportunities. This workshop will conclude with a shared discussion consolidating the outcomes of the breakout discussions. Preconception care offers an untapped opportunity to leverage decades of research to develop initiatives that target couples before pregnancy and improve population health for multiple generations. Preconception health initiatives that address local challenges and opportunities may successfully modify parental health behaviours to reduce risk of chronic illness.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2023
DOI: 10.1186/S12889-023-15335-1
Abstract: The preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes. Medline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5 th of January 2023, a date limit was set [2012–2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle–Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables. This review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition ( n = 25), alcohol intake ( n = 6), cannabis use ( n = 5), physical activity ( n = 2), smoking ( n = 20), stress ( n = 3) and nutrition ( n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight. The current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.
Publisher: Springer Science and Business Media LLC
Date: 25-07-2022
DOI: 10.1186/S12884-022-04913-7
Abstract: Establishing a healthy lifestyle post-delivery is pivotal to reduce the incidence of chronic diseases. Due to COVID-19 restrictions, access to postpartum health programs has been increasingly difficult. The aim of this study was to inform, develop and evaluate Beyond the Bump (BtB) an online program to improve access to health and wellbeing education and support for physical activity in the postpartum. A three-phase mixed-methods design of a 10-week Australia-wide online pilot program during COVID-19 with women less than 1 year postpartum and their primary care health professionals was utilised. Phase-one: needs assessment focus groups and interviews. Phase-two: BtB program implementation pre-post health measures survey, attendance and engagement with the program. Phase-three: program evaluation with feedback surveys and interviews. Women ( n = 12) and health professionals ( n = 16) expressed strong need for a postpartum program with access to education from experts on exercise, pelvic floor, sleep and baby nutrition. Despite BtB being developed from women’s suggestions (including time-of-day ‘morning’), attendance to all ten sessions was poor (of 162 registrations 23% participated in the first session and 5% in the last session). Barriers to attendance included ‘too busy’,‘ forgot’ and ‘topic not relevant for age of child’. 88% of women reported the education as the most enjoyable component of the program. 100% ( n = 26) of women interviewed would recommend the program to a friend. There is a continuing need for postpartum support. Online programs with access to expert education and exercise were reported to be of significant interest and value. However, more research is needed to improve the uptake and value placed on mothers’ wellbeing and physical activity.
Publisher: Georg Thieme Verlag KG
Date: 11-2021
Abstract: Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and a significant clinical and public health problem with lifelong and intergenerational adverse health consequences for mothers and their offspring. The preconception, early pregnancy, and interconception periods represent opportune windows to engage women in preventive and health promotion interventions. This review provides an overview of findings from observational and intervention studies on the role of diet, physical activity, and weight (change) during these periods in the primary prevention of GDM. Current evidence suggests that supporting women to increase physical activity and achieve appropriate weight gain during early pregnancy and enabling women to optimize their weight and health behaviors prior to and between pregnancies have the potential to reduce rates of GDM. Translation of current evidence into practice requires further development and evaluation of co-designed interventions across community, health service, and policy levels to determine how women can be reached and supported to optimize their health behaviors before, during, and between pregnancies to reduce GDM risk.
Publisher: Oxford University Press (OUP)
Date: 05-03-2017
DOI: 10.1093/AJE/KWW201
Abstract: In this study, we aimed to examine the association between age at menarche and gestational diabetes mellitus (GDM). Data were from 4,749 women participating in the Australian Longitudinal Study on Women's Health between 2000 and 2012. Age at menarche was reported at baseline in 2000 when women were aged 22-27 years. During 12 years of follow-up, information on GDM diagnosis was obtained for each live birth. Log-binomial regression analysis was used to estimate relative risks and 95% confidence intervals. Analyses adjusted for mother's highest completed educational qualification, nulliparity, polycystic ovary syndrome, physical activity, and body mass index. Mean age at menarche was 12.9 years (standard deviation, 1.4). A first diagnosis of GDM was reported by 357 women (7.5%). Compared with women with menarche at age 13 years, women who had their first menstruation at age ≤11 years had a 51% higher risk of developing GDM (95% confidence interval: 1.10, 2.07) after adjustment for GDM risk factors. Our findings indicate that a young age at menarche may identify women at higher risk of GDM. Further prospective studies are needed to confirm our findings and to elucidate the role of early-life exposures in age at menarche and subsequent GDM risk.
Publisher: Wiley
Date: 03-02-2021
DOI: 10.1111/AJO.13316
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.MATURITAS.2012.12.011
Abstract: Evidence from population-based studies of women increasingly points to the inter-related nature of reproductive health, lifestyle, and chronic disease risk. This paper describes the recently established International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease. InterLACE aims to advance the evidence base for women's health policy beyond associations from disparate studies by means of systematic and culturally sensitive synthesis of longitudinal data. Currently InterLACE draws on in idual level data for reproductive health and chronic disease among 200,000 women from over thirteen studies of women's health in seven countries. The rationale for this multi-study research programme is set out in terms of a life course perspective to reproductive health. The research programme will build a comprehensive picture of reproductive health through life in relation to chronic disease risk. Although combining multiple international studies poses methodological challenges, InterLACE represents an invaluable opportunity to strength evidence to guide the development of timely and tailored preventive health strategies.
Publisher: BMJ
Date: 05-2023
DOI: 10.1136/BMJOPEN-2022-067822
Abstract: Preconception care can significantly improve maternal and infant outcomes, and thus optimise intergenerational health. The aims of this scoping review are to (1) provide an up-to-date summary of preconception health and care strategies, policies, guidelines, frameworks and recommendations across the UK and Ireland and (2) explore preconception health and care services and interventions in Northern Ireland as a case study. This scoping review of grey literature will be conducted as per the Scoping Review Methods Manual by the Joanna Briggs Institute and the Arksey-O’Malley framework for scoping studies, and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted on Google Advanced Search, OpenAire, NICE, ProQuest and relevant public health websites in May 2022. Only results published, reviewed or updated between January 2011 and the time of the searches (May 2022) were considered for inclusion. In addition, searches on interventions and services provided in Northern Ireland will be supplemented by consultations and audits with key stakeholders to validate findings, identify other potentially eligible resources and ensure breadth of coverage. Data will be extracted into Excel and coded using NVivo, and ≥10% of the data will be double-coded. A narrative approach with content analysis highlighting key themes and concepts will be used to report findings. Throughout the research cycle, members of the wider public will be involved and engaged with to provide feedback. Ethical approval is not required as analyses will be conducted on data available in the public domain. Findings will be shared with relevant stakeholders with the aim to inform future research, practice and decision-making, and disseminated through a peer-reviewed publication, conference presentations and infographics. Dissemination plans will be informed by the ‘Healthy Reproductive Years’ patient and public involvement and engagement advisory panel.
Publisher: Springer Science and Business Media LLC
Date: 10-09-2015
DOI: 10.1007/S00125-015-3742-1
Abstract: We examined the associations between pre-pregnancy dietary patterns and the incidence of gestational diabetes mellitus (GDM) in a population-based cohort study of women of reproductive age. The Australian Longitudinal Study on Women's Health included 3,853 women without pre-existing diabetes who were followed-up between 2003 and 2012. Pre-pregnancy dietary patterns were derived using factor analysis based on 101 food items from a validated food frequency questionnaire. GDM was self-reported and validated in a subs le. Multivariable regression models with generalised estimating equations were used to estimate RR and 95% CI. During 9 years follow-up, 292 GDM cases (4.4%) were documented in 6,626 pregnancies. No associations were found for the 'Fruit and low-fat dairy' and 'Cooked vegetables' patterns. The 'Meats, snacks and sweets' pattern was associated with higher GDM risk after adjustment for socioeconomic, reproductive and lifestyle factors (RR [95% CI] per SD increase in score: 1.38 [1.02, 1.86]). Further adjustment for BMI attenuated the results (1.35 [0.98, 1.81]). In stratified analysis, the 'Meats, snacks and sweets' pattern was associated with significantly higher GDM risk in parous and obese women, and in women with lower educational qualifications. The 'Mediterranean-style' pattern was associated with lower GDM risk in the fully adjusted model (0.85 [0.76, 0.98]). These findings support general dietary recommendations for women of reproductive age to consume a diet rich in vegetables, whole grains, nuts and fish, and low in red and processed meats and snacks. Further prospective studies are needed to confirm these findings.
Publisher: BMJ
Date: 09-2020
DOI: 10.1136/BMJOPEN-2019-035569
Abstract: Conduct a head-to-head experimental test of responses to alcohol harm reduction advertisements developed by alcohol industry Social Aspects/Public Relations Organisations (SAPROs) versus those developed by public health (PH) agencies. We hypothesised that, on average, SAPRO advertisements would be less effective at generating motivation (H1) and intentions to reduce alcohol consumption (H2) but more effective at generating positive perceptions of people who drink (H3). Online experiment with random assignment to condition. 2923 Australian adult weekly drinkers (49% high-risk drinkers) recruited from an opt-in online panel. Participants viewed 3 of 83 advertisements developed by PH agencies (n=2174) or 3 of 28 advertisements developed by SAPROs (n=749). Participants reported their motivation to reduce the amount of alcohol consumed behave responsibly and/or not get drunk and limit their drinking around/never supply to minors, as well as intentions to avoid drinking alcohol completely reduce the number of drinking occasions and reduce the amount of alcohol consumed per occasion. Participants also reported their perceptions of people who drink alcohol on six success-related items and four fun-related items. Compared with drinkers exposed to PH advertisements, those exposed to SAPRO advertisements reported lower motivation to reduce the amount of alcohol consumed (β=−0.091, 95% CI −0.171 to −0.010), and lower odds of intending to avoid alcohol completely (OR=0.77, 0.63 to 0.94) and to reduce the amount of alcohol consumed per occasion (OR=0.82, 0.69 to 0.97). SAPRO advertisements generated more favourable fun-related perceptions of drinkers (β=0.095, 0.013 to 0.177). The alcohol harm reduction advertisements produced by alcohol industry SAPROs that were tested in this study were not as effective at generating motivation and intentions to reduce alcohol consumption as those developed by PH organisations. These findings raise questions as to whether SAPROs should play a role in alcohol harm reduction efforts.
Publisher: Oxford University Press (OUP)
Date: 07-06-2018
Publisher: Elsevier BV
Date: 03-2013
Abstract: Treelet transform (TT) is a proposed alternative to factor analysis for deriving dietary patterns. Before applying this method to nutrition data, further analyses are required to assess its validity in nutritional epidemiology. We aimed to compare dietary patterns from factor analysis and TT and their associations with diabetes incidence. Complete data were available for 7349 women (50-55 y at baseline) from the Australian Longitudinal Study on Women's Health. Exploratory factor analysis and TT were performed to obtain patterns by using dietary data collected from an FFQ. Generalized estimating equations analyses were used to examine associations between dietary patterns and diabetes incidence. Two patterns were identified by both methods: a prudent and a Western dietary pattern. Factor analysis factors are a linear combination of all food items, whereas TT factors also include items with zero loading. The Western pattern identified by factor analysis showed a significant positive association with diabetes [highest quintile: OR = 1.94 (95% CI: 1.25, 3.00) P-trend = 0.001). Both factor analysis and TT involve different assumptions and subjective decisions. TT produces clearly interpretable factors accounting for almost as much variance as factors from factor analysis. However, TT patterns include food items with zero loading and therefore do not represent overall dietary patterns. The different dietary pattern loading structures identified by both methods result in different conclusions regarding the relationship with diabetes. Results from this study indicate that factor analysis might be a more appropriate method for identifying overall dietary patterns associated with diabetes compared with TT.
Publisher: BMJ Publishing Group Ltd
Date: 09-2021
Publisher: Elsevier BV
Date: 11-2022
Publisher: Elsevier BV
Date: 02-2201
DOI: 10.1016/J.NUTRES.2018.11.006
Abstract: Evidence on pre-pregnancy dietary micronutrient intake in relation to gestational diabetes (GDM) development is limited. Therefore, we examined the prevalence of inadequate micronutrient intake before pregnancy and the association between pre-pregnancy dietary micronutrient adequacy, i.e. meeting micronutrient intake recommendations for a range of micronutrients, and risk of developing GDM in an Australian population. We hypothesized that women with an overall higher micronutrient adequacy would have a lower risk of developing GDM. We used data from the prospective Australian Longitudinal Study on Women's Health cohort, in which 3607 women, aged 25-30 years at baseline in 2003 and without diabetes, were followed-up until 2015. Diet was assessed with a validated 101-item food frequency questionnaire. The Micronutrient Adequacy Ratio (MAR) was calculated as the micronutrient intake ided by its recommended dietary intake averaged over 13 micronutrients. Multivariable regression models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (95% CI). In 6263 pregnancies, 285 cases of GDM were documented (4.6%). High prevalences of inadequate dietary micronutrient intake were observed for calcium (47.9%), folate (80.8%), magnesium (52.5%), potassium (63.8%) and vitamin E (78.6%), indicating suboptimal pre-pregnancy micronutrient intakes. Inadequate intakes of in idual micronutrients were not associated with risk of developing GDM. However, women in the highest quartile of the MAR had a 39% lower risk of developing GDM compared to women in the lowest quartile (RR 0.61, 95% CI 0.43-0.86, p for trend 0.01). These results highlight the importance of adequate pre-pregnancy micronutrient intake.
Publisher: Elsevier BV
Date: 2023
Publisher: BMJ
Date: 05-10-2017
Abstract: Tobacco smoking before, during and after pregnancy remains one of the few preventable factors associated with poor health outcomes for mothers and their children. We investigate predictors across the life course for change in smoking behaviour during pregnancy and whether this change predicts smoking status in midlife. Data were from the National Child Development Study (1958 British birth cohort). We included female cohort members who reported a first pregnancy up to age 33 years. Among 1468 women who smoked before pregnancy, we examined predictors reported in childhood (age 11 years), adolescence (age 16 years) and early adulthood (age 23 years) of change in smoking behaviour from 12 months before to during pregnancy using log-binomial regression. The association between change in smoking behaviour during pregnancy and smoking status in midlife (age 55 years) was examined while adjusting for predictors across the life course. Among prepregnancy smokers (39%), 26% reduced and 35% quit smoking during pregnancy. Parental smoking and lower social class during childhood, and early adulthood lower social class, depression, early smoking initiation, high smoking intensity, living with a smoker, no pregnancy planning and early motherhood were associated with lower probability of smoking reduction or cessation in pregnancy. Compared with women who smoked before and during pregnancy, women who reduced or quit were two times more likely to be non-smoker at age 55 years (95% CI 1.76 to 2.20). Findings from this population-based birth cohort study lend support for smoking cessation strategies that target those at risk at various stages across the life course.
Publisher: Cambridge University Press (CUP)
Date: 08-08-2016
DOI: 10.1017/S0007114516002853
Abstract: Dietary factors and inflammation markers have been shown to play a role in the development of depression. However, there are very few studies that have explored the association between inflammatory potential of diet and risk of depression. In this study, we examined the association between the dietary inflammatory index (DII), which was developed specifically to measure the inflammatory potential of diet, and risk of depression in the middle-aged cohort of the Australian Longitudinal Study on Women’s Health. A total of 6438 women with a mean age of 52·0 ( sd 1·4) years at baseline were followed-up at five surveys over 12 years (2001–2013). Depression was defined as a score of ≥10 on the Center for Epidemiologic Studies Depression-10 scale. The DII score, a literature-derived, population-based dietary index that has been validated against several inflammatory markers, was computed on the basis of dietary intake assessed using a validated FFQ. Generalised estimating equations were used to estimate relative risk (RR) of depression according to DII score. Models were adjusted for energy intake, highest education completed, marital status, menopause status and symptoms, personal illness or injury, smoking status, physical activity, BMI and depression diagnosis or treatment. In total, 1156 women (18 %) had scores≥10 on the CESD scale over the course of 9 years. Women with the most anti-inflammatory diet had an approximately 20 % lower risk of developing depression compared with women with the most pro-inflammatory diet (RR DII quartile 1 v . 4 : 0·81 95 % CI 0·69, 0·96 P trend =0·03). These results suggest that an anti-inflammatory diet is associated with lower risk of depression in middle-aged Australian women.
Publisher: Environmental Health Perspectives
Date: 08-2022
DOI: 10.1289/EHP10544
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 21-03-2023
Abstract: To present the first national‐level report card on the state of women's preconception health in England. Cross‐sectional population‐based study. Maternity services, England. All pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 ( n = 652 880). We analysed the prevalence of 32 preconception indicator measures in the overall population and across socio‐demographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts. The three most prevalent indicators were the proportion of the 22.9% of women who smoked 1 year before pregnancy who did not quit smoking before pregnancy (85.0%), those who had not taken folic acid supplementation before pregnancy (72.7%) and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area‐based deprivation level. The ten indicators prioritised were not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in the most deprived areas, smoking around the time of conception, overweight, pre‐existing mental health condition, pre‐existing physical health condition, previous pregnancy loss and previous obstetric complication. Our findings suggest important opportunities to improve the state of preconception health and reduce socio‐demographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better quality indicators could be explored and linked to build a comprehensive surveillance infrastructure.
Publisher: Public Library of Science (PLoS)
Date: 12-12-2018
Publisher: The Endocrine Society
Date: 03-2014
DOI: 10.1210/JC.2013-2824
Abstract: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. We examined the association between glycated hemoglobin (HbA1c) and all-cause mortality in patients with type 1 diabetes mellitus. A clinic-based prospective cohort study was performed in 2764 European patients with type 1 diabetes aged 15-60 years enrolled in the EURODIAB Prospective Complications Study. Possible nonlinearity of the association between HbA1c and all-cause mortality was examined using multivariable restricted cubic spline regression using three (at HbA1c 5.6%, 8.1%, and 11.8%) and five knots (additionally at HbA1c 7.1% and 9.5%). Mortality data were collected approximately 7 years after baseline examination. HbA1c was related to all-cause mortality in a nonlinear manner after adjustment for age and sex. All-cause mortality risk was increased at both low (5.6%) and high (11.8%) HbA1c compared with the reference (median HbA1c: 8.1%) following a U-shaped association [P overall effect = .008 and .04, P nonlinearity = .03 and .11 (three and five knots, respectively)]. Results from our study in type 1 diabetes patients suggest that target HbA1c below a certain threshold may not be appropriate in this population. We recognize that these low HbA1c levels may be related to anemia, renal insufficiency, infection, or other factors not available in our database. If our data are confirmed, the potential mechanisms underlying this increased mortality risk among those with low HbA1c will need further study.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.ATHEROSCLEROSIS.2016.07.929
Abstract: Recently, a pro-inflammatory diet based on a dietary inflammatory index (DII) has been related to higher CVD risk in general population, but this has not been investigated among women. We investigated the relationship between DII and risk of total CVD and CVD subgroups (myocardial infarction, ischemic heart disease, stroke and cerebrovascular disease) in a prospective cohort of 6972 Australian women aged 50-55 years at baseline in 2001. We used clinical and procedure information from inpatient hospital separation registries, information on use of health care services, and from the causes-of-death registry to ascertain CVD outcomes during 11-year follow up. The association between baseline DII score and cardiovascular endpoints was analysed through cox-regression, with correction for demographic and cardiovascular risk factors. We identified 335 incident cases of CVD and 191 cases of ischaemic heart disease (including 69 myocardial infarctions) and 59 cases of cerebrovascular disease (including 40 cases of stroke). A statistically significant higher risk of myocardial infarction was observed in analyses using DII scores as a continuous variable with a hazard ratio of 1.46 (95% confidence interval 1.12-1.89), but this was attenuated by further adjustment for other known cardiovascular risk factors. No association was found for total CVD, ischaemic heart diseases, or cerebrovascular disease. There was no statistically significant association between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease, myocardial infarction, cerebrovascular disease or stroke in this population of mid-aged Australian women. Associations were not different for postmenopausal women.
Publisher: Springer Science and Business Media LLC
Date: 16-02-2023
DOI: 10.1038/S41430-023-01274-Y
Abstract: Cardio-metabolic risk factors, including hypertension, are increasingly appearing in childhood. The aims of this study were to examine the associations between dietary trajectories across childhood and subsequent blood pressure (BP) at age 10/11, and to further determine whether these associations were explained by BMI or fat mass. Data from 4360 participants from the Longitudinal Study of Australian Children were analysed. Dietary scores were computed based on similarity of intake to the Australian Dietary Guidelines. Group-based trajectory modelling was used to identify distinct dietary trajectories based on participant’s in idual dietary scores at up to four timepoints between age 4 and 11. Linear regression models examined the associations between dietary trajectories and BP measured at age 10/11. Models were adjusted for relevant covariates, and BMI or fat mass. Four dietary trajectories were identified: “never healthy” (4.3%) “moderately healthy” (23.1%) “becoming less healthy” (14.2%) and “always healthy” (58.4%). Children in the “always healthy” trajectory had a lower systolic (−2.19 mmHg 95% CI −3.78, −0.59) and diastolic BP (−1.71 −2.95, −0.47), compared with children in the “never healthy” trajectory after covariate adjustment. These associations were attenuated after additional adjustment for BMI or fat mass, but remained significant for diastolic BP. A dietary trajectory mostly aligned with the Australian Dietary Guidelines across childhood was associated with slightly lower BP at age 10/11, which was not fully explained by BMI or fat mass. These findings support the need to encourage and enable healthy dietary habits early in childhood to attenuate the increasing burden of cardio-metabolic disease.
Publisher: Wiley
Date: 05-06-2020
DOI: 10.1111/BIRT.12493
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.NUMECD.2019.11.001
Abstract: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis. Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15). Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.
Publisher: Cambridge University Press (CUP)
Date: 04-06-2021
DOI: 10.1017/S2040174421000258
Abstract: Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health health care reproductive health and family planning health behaviours environmental exposures cervical screening immunisation and infections mental health, physical health medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness c aign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population’s preconception needs, improve patient care, inform and evaluate new c aigns and interventions and enhance accountability from responsible agencies to improve preconception health.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.DIABRES.2018.09.021
Abstract: To develop a prediction model for preconception identification of women at risk of gestational diabetes mellitus (GDM). Data from a prospective cohort, the Australian Longitudinal Study on Women's Health, were used. Nulliparous women aged 18-23 who reported a pregnancy up to age 37-42 were included. Preconception predictors of GDM during a first pregnancy were selected using logistic regression. Regression coefficients were multiplied by a shrinkage factor estimated with bootstrapping to improve prediction in external populations. Among 6504 women, 314 (4.8%) developed GDM during their first pregnancy. The final prediction model included age at menarche, proposed age at future first pregnancy, ethnicity, body mass index, diet, physical activity, polycystic ovary syndrome, and family histories of type 1 or 2 diabetes and GDM. The model showed good discriminative ability with a C-statistic of 0.79 (95% CI 0.76, 0.83) after internal validation. More than half of the women (58%) were classified to be at risk of GDM (>2% predicted risk), with corresponding sensitivity and specificity values of 91% and 43%. Nulliparous women at risk of GDM in a future first pregnancy can be accurately identified based on preconception lifestyle and health-related characteristics. Further studies are needed to test our model in other populations.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2021
Publisher: Oxford University Press (OUP)
Date: 26-04-2014
DOI: 10.1093/IJE/DYU094
Publisher: Springer Science and Business Media LLC
Date: 22-09-2014
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Danielle Schoenaker.