Maria Makrides

South Australian Health and Medical Research Institute, Adelaide Hills, South Australia, Australia

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Publications (135)568.13 Total impact

  • JAMA The Journal of the American Medical Association 05/2014; 311(17):1802-4. · 29.98 Impact Factor
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    ABSTRACT: Background: There is limited large-scale longitudinal data evaluating the role of antenatal support on postnatal depressive symptomatology. This aim of the present study was to evaluate if antenatal support is an independent association of postnatal depression. Methods: 2200 pregnant women completed the Maternal Social Support Index at their booking visit. An Edinburgh Postnatal Depression Screen was completed at six weeks and six months postpartum. Univariate and multivariate analysis were undertaken to determine the influence of poor support on depressive symptomatology. Results: 600 women met the criteria for poor support and were compared to 1200 women with normal support levels. Women with poor support were significantly older, more likely to have a past history of depression, a history of having ever smoked, smoked immediately prior to index pregnancy, continuing to smoke during pregnancy and of drinking alcohol prior to index pregnancy (all p<0.001). Women with poor support had higher gravidity (p<0.0001) but not parity. There were no significant differences in gestational age, birthweight or gender. The incidence of maternal depressed mood was significantly higher in women with low support at six weeks (low 21%, normal 9%, p<0.0001) and six months (low 21%, normal1%, p<0.0001). In multivariate analysis, poor social support, past history of depression and continuing to smoke in pregnancy remained significant associations of depressive symptomatology at six weeks and six months (all p<0.0001). Conclusion: Improving antenatal support may modify postnatal depressive symptomatology.
    Perinatal Society of Australia and New Zealand Annual Scientific Conference; 04/2014
  • Q U Lee, D J Palmer, T Sullivan, M Makrides
    Allergy 03/2014; 69(3):411-2. · 5.88 Impact Factor
  • Article: Reply.
    D J Palmer, T Sullivan, M Makrides
    Allergy 03/2014; 69(3):411-2. · 5.88 Impact Factor
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    ABSTRACT: Docosahexaenoic acid (DHA) accumulates in the hippocampus and frontal lobes of the fetal brain during the last trimester of pregnancy. These areas of the brain contribute to attention and working memory and inhibitory control (WMIC). We evaluated the effect of maternal omega-3 (n-3) long-chain polyunsaturated fatty acid supplementation in pregnancy on child attention and WMIC. A total of 185 term-born children of mothers who were randomly allocated to consume 800 mg DHA/d (treatment) or a placebo (control) from ∼20 wk of gestation until birth were assessed with multiple measures of attention and WMIC at a mean (±SD) of 27 ± 2 mo. Primary outcomes were the average time it took to be distracted when playing with a toy (distractibility) and the accuracy of remembering a new hiding location while inhibiting a learned response to search in the previous location (WMIC). Assessments were completed by 81 children in the treatment group (mean ± SD age: 835± 50.4 d) and 77 children in the control group (mean ± SD age: 839 ± 65.6 d). There was no effect of supplementation on primary outcomes [distractibility mean difference: -0.2 s (95% CI: -0.7, 0.4 s); WMIC mean difference: 8.9 mm (95% CI: -10.6, 28.3 mm)]. There was no difference between DHA-supplemented and control groups except that treatment-group children looked away from the toys fewer times than controls when presented with multiple toys competing for attention but less accurately remembered a repeated hiding location. These secondary effects were not consistent with any other outcomes and may have been a result of chance. Cord plasma DHA was not consistently associated with attention and WMIC. Maternal DHA supplementation during pregnancy does not enhance attention or WMIC in term-born preschoolers. The DHA for Maternal and Infant Outcomes trial was registered at as ACTRN1260500056906.
    American Journal of Clinical Nutrition 02/2014; · 6.50 Impact Factor
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    ABSTRACT: The safety and nutritional adequacy of goat milk infant formulas have been questioned. The primary aim of the present study was to compare the growth and nutritional status of infants fed a goat milk infant formula with those of infants fed a typical whey-based cow milk infant formula. The secondary aim was to examine a range of health- and allergy-related outcomes. A double-blind, randomised controlled trial with 200 formula-fed term infants randomly assigned to receive either goat or cow milk formula from 2 weeks to at least 4 months of age was conducted. A cohort of 101 breast-fed infants was included for comparison. Weight, length and head circumference were measured at 2 weeks and 1, 2, 3, 4, 6 and 12 months of age. Nutritional status was assessed from serum albumin, urea, creatinine, Hb, ferritin, and folate and plasma amino acid concentrations at 4 months. Z-scores for weight, length, head circumference and weight for length were not different between the two formula-fed groups. There were differences in the values of some amino acids and blood biomarkers between the formula-fed groups, but the mean values for biomarkers were within the normal reference range. There were no differences in the occurrence of serious adverse events, general health, and incidence of dermatitis or medically diagnosed food allergy. The incidence of parentally reported blood-stained stools was higher in the goat milk formula-fed group, although this was a secondary outcome and its importance is unclear. Goat milk formula provided growth and nutritional outcomes in infants that did not differ from those provided by a standard whey-based cow milk formula.
    The British journal of nutrition 02/2014; · 3.45 Impact Factor
  • Article: Reply.
    The Journal of allergy and clinical immunology 02/2014; 133(2):601-2. · 12.05 Impact Factor
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    Maria Makrides, Ricardo Uauy
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    ABSTRACT: Preterm infants are denied the rapid accumulation of docosahexaenoic acid (DHA) occurring during the third trimester in utero. The potential benefit of long-chain polyunsaturated fatty acids (LCPUFAs) has generated interest over the last 3 decades. Early intervention trials assessed the effects of supplementing infant formulas lacking DHA with concentrations equivalent to LCPUFA in milk of women from Westernized societies, leading to the inclusion of LCPUFA by the year 2000. Recently attention has been on determining the optimal dose of DHA and on whether there is in advantage in matching the higher doses of late pregnancy.
    Clinics in Perinatology. 01/2014;
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    ABSTRACT: Diets high in n-3 long chain polyunsaturated fatty acids (LCPUFA) may modulate the development of IgE-mediated allergic disease and have been proposed as a possible allergy prevention strategy. The aim of this study was to determine whether n-3 LCPUFA supplementation of pregnant women reduces IgE-mediated allergic disease in their children. Follow-up of children (n = 706) at hereditary risk of allergic disease in the Docosahexaenoic Acid to Optimise Mother Infant Outcome randomized controlled trial. The intervention group (n = 368) was randomly allocated to receive fish oil capsules (providing 900 mg of n-3 LCPUFA daily) from 21 weeks' gestation until birth; the control group (n = 338) received matched vegetable oil capsules without n-3 LCPUFA. The diagnosis of allergic disease was made during medical assessments at 1 and 3 years of age. No differences were seen in the overall percentage of children with IgE-mediated allergic disease in the first 3 years of life between the n-3 LCPUFA and control groups (64/368 (17.3%) vs 76/338 (22.6%); adjusted relative risk 0.78; 95% CI 0.58-1.06; P = 0.11). Eczema was the most common allergic disease; 13.8% of children in the n-3 LCPUFA group had eczema with sensitization compared with 19.0% in the control group (adjusted relative risk 0.75; 95% CI 0.53-1.05; P = 0.10). Overall, n-3 LCPUFA supplementation during pregnancy did not significantly reduce IgE-associated allergic disease in the first 3 years of life. Further studies should examine whether the nonsignificant reductions in IgE-associated allergies are of clinical and public health significance.
    Allergy 09/2013; · 5.88 Impact Factor
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    ABSTRACT: Routine iodine supplementation during pregnancy is recommended by leading health authorities worldwide, even in countries where the iodine status of the population is sufficient. We evaluated the efficacy and safety of iodine supplementation during pregnancy or the periconceptional period on the development and growth of children. Secondary outcomes included pregnancy outcome and thyroid function. A systematic review of randomized controlled trials (RCTs) was conducted. PUBMED, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched to identify relevant RCTs. Fourteen publications that involved 8 trials met the inclusion criteria. Only 2 included trials reported the growth and development of children and clinical outcomes. Iodine supplementation during pregnancy or the periconceptional period in regions of severe iodine deficiency reduced risk of cretinism, but there were no improvements in childhood intelligence, gross development, growth, or pregnancy outcomes, although there was an improvement in some motor functions. None of the remaining 6 RCTs conducted in regions of mild to moderate iodine deficiency reported childhood development or growth or pregnancy outcomes. Effects of iodine supplementation on the thyroid function of mothers and their children were inconsistent. In this review, we highlight a lack of quality evidence of the effect of prenatal or periconceptional iodine supplementation on growth and cognitive function of children. Although contemporary RCTs of iodine supplementation with outcomes addressing childhood development are indicated, conduct of such RCTs may not be feasible in populations where iodine supplementation in pregnancy is widely practiced.
    American Journal of Clinical Nutrition 09/2013; · 6.50 Impact Factor
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    M Netting, P Middleton, M Makrides
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    ABSTRACT: Objectives To investigate the relationship between maternal diet during pregnancy and lactation and development of atopic disorders in childhood. Methods We included studies published up to August 2011 which either assessed food-based maternal dietary interventions or examined associations between maternal dietary intake during pregnancy and/or lactation and allergic outcomes (eczema, asthma, hay fever and sensitization) in their children. Results We included 43 studies (over 40 000 children): 11 intervention studies (including seven RCTs), 27 prospective cohort studies, four retrospective cohort studies and one case-control study. In the RCTs, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish and foods containing vitamin D and ‘Mediterranean’ dietary patterns were among the few consistent associations with lower risk of allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts and fast food. Conclusion This review did not find widespread or consistent links between mother’s dietary intake and atopic outcomes in their children. However, maternal consumption of ‘Mediterranean’ dietary patterns, diets rich in fruits and vegetables, fish and vitamin D containing foods were suggestive of benefit, requiring further evaluation.
    Clinical and Translational Allergy. 07/2013; 3(3).
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    ABSTRACT: Observational studies suggest that early regular ingestion of allergenic foods might reduce the risk of food allergy. We sought to determine whether early regular oral egg exposure will reduce subsequent IgE-mediated egg allergy in infants with moderate-to-severe eczema. In a double-blind, randomized controlled trial infants were allocated to 1 teaspoon of pasteurized raw whole egg powder (n = 49) or rice powder (n = 37) daily from 4 to 8 months of age. Cooked egg was introduced to both groups after an observed feed at 8 months. The primary outcome was IgE-mediated egg allergy at 12 months, as defined based on the results of an observed pasteurized raw egg challenge and skin prick tests. A high proportion (31% [15/49]) of infants randomized to receive egg had an allergic reaction to the egg powder and did not continue powder ingestion. At 4 months of age, before any known egg ingestion, 36% (24/67) of infants already had egg-specific IgE levels of greater than 0.35 kilounits of antibody (kUA)/L. At 12 months, a lower (but not significant) proportion of infants in the egg group (33%) were given a diagnosis of IgE-mediated egg allergy compared with the control group (51%; relative risk, 0.65; 95% CI, 0.38-1.11; P = .11). Egg-specific IgG4 levels were significantly (P < .001) greater in the egg group at both 8 and 12 months. Induction of immune tolerance pathways and reduction in egg allergy incidence can be achieved by early regular oral egg exposure in infants with eczema. Caution needs to be taken when these high-risk infants are first exposed to egg because many have sensitization already by 4 months of age.
    The Journal of allergy and clinical immunology 06/2013; · 12.05 Impact Factor
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    ABSTRACT: AIM: The composition of faecal microbiota of babies is known to be influenced by diet. Faecal calprotectin and α1-antitrypsin concentrations may be associated with mucosal permeability and inflammation. We aimed to assess whether there was any difference after consumption of a probiotic/prebiotic formula on faecal microbiota composition, calprotectin and α1-antitrypsin levels, and diarrhoea in comparison with breast milk-fed Indonesian infants. METHODS: One hundred sixty infants, 2 to 6 weeks old, were recruited to the study. They were either breastfed or formula fed (80 per group). Faecal samples were collected at recruitment and 3 months later. Bacterial groups characteristic of the human faecal microbiota were quantified in faeces by quantitative polymerase chain reaction. Calprotectin and α1-antitrypsin concentrations were measured using commercial kits. Details of diarrhoeal morbidity were documented and rated for severity. RESULTS: The compositions of the faecal microbiota of formula-fed compared with breast milk-fed children were similar except that the probiotic strain Bifidobacterium animalis subsp. lactis DR10 was more abundant after 3 months consumption of the formula. Alpha1-antitrypsin levels were higher in breastfed compared with formula-fed infants. The occurrence of diarrhoea did not differ between the groups of babies. CONCLUSION: Feeding Indonesian babies with a probiotic/prebiotic formula did not produce marked differences in the composition of the faecal microbiota in comparison with breast milk. Detrimental effects of formula feeding on biomarkers of mucosal health were not observed.
    Journal of Paediatrics and Child Health 06/2013; · 1.25 Impact Factor
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    ABSTRACT: The aim of the study was to compare the composition of the fecal microbiotas of infants fed goat milk formula to those fed cow milk formula, or breast milk as the 'gold standard'. Pyrosequencing of 16S rRNA gene sequences was used in the analysis of the microbiotas in stool samples collected from 90 Australian babies (30 in each group) at two months of age. Beta-diversity analysis of total microbiota sequences and Lachnospiraceae sequences revealed that they were more similar in breast milk/goat milk comparisons compared to breast milk/cow milk. The Lachnospiraceae were mostly restricted to a single species (Ruminococcus gnavus) in breast milk-fed and goat milk-fed babies compared to a more diverse collection in cow milk-fed babies. Bifidobacteriaceae were abundant in the microbiotas of infants in all three groups. Bifidobacterium longum, Bifidobacterium breve, and Bifidobacterium bifidum were the most commonly detected bifidobacterial species. A semi-quantitative PCR method was devised to differentiate between B. longum subsp. longum and B. longum subsp. infantis and was used to test stool samples. Subspecies infantis was seldom present in stools, even of breast milk-fed babies. The presence of B. bifidum in the stools of breast milk-fed infants at abundances greater than 10% of the total microbiota was associated with the highest total abundances of Bifidobacteriaceae. When Bifidobacteriaceae abundance was low, Lachnospiraceae abundances were greater. New information about the composition of the fecal microbiota when goat milk formula is used in infant nutrition was thus obtained.
    Applied and environmental microbiology 03/2013; · 3.69 Impact Factor
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    ABSTRACT: BACKGROUND: Maternal fish consumption during pregnancy has been positively associated with cognitive and visual abilities in the offspring, leading to the hypothesis that maternal omega-3 (n-3) long-chain PUFA (LCPUFA) supplementation improves children's neurologic and visual development. OBJECTIVE: The objective was to evaluate the effect of maternal omega-3 LCPUFA supplementation in pregnancy on neurologic and visual development in the offspring. DESIGN: Five electronic databases were searched. Human randomized controlled trials that supplemented the maternal diet with omega-3 LCPUFAs during pregnancy, or pregnancy and lactation, and that assessed either neurologic or visual development of the offspring were included. Trial quality was assessed, and the results of eligible trials were compared in meta-analyses. RESULTS: Eleven RCTs involving 5272 participants were included in the review. Most trials had methodologic limitations. No differences in standardized psychometric test scores for cognitive, language, or motor development were observed between the LCPUFA-supplemented and control groups, except for cognitive scores in 2-5-y-old children, in whom supplementation resulted in higher Developmental Standard Scores (mean difference: 3.92; 95% CI: 0.77, 7.08; n = 156; P = 0.01). However, this effect was from 2 trials with a high risk of bias. Because of the variety of visual assessments and age ranges, it was not possible to combine studies with visual outcomes in a meta-analysis, although 6 of the 8 assessments in 5 trials reported no difference between the supplemented and control groups. CONCLUSION: The evidence does not conclusively support or refute that omega-3 LCPUFA supplementation in pregnancy improves cognitive or visual development.
    American Journal of Clinical Nutrition 01/2013; · 6.50 Impact Factor
  • Maria Makrides, Amanda Anderson, Robert A Gibson
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    ABSTRACT: During pregnancy, the metabolic requirements of the mother are increased; however, the relationship between maternal intake of key nutrients and optimal fetal growth is not always clear. In this chapter, we have reviewed randomized controlled trials of nutritional interventions during pregnancy, with a particular focus on birthweight and infants who are small for gestational age (SGA). Of the trials that have investigated changing macronutrient and energy intakes during pregnancy, supplements in which <25% of the energy is provided by protein yielded the most promising results, producing a 31-32% reduction in the risk of SGA infants and an increase in birthweight (38-60 g) compared with control. Single-nutrient intervention trials using n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplements demonstrated small increases in birthweight (≈50 g) and birth length (≈0.5 cm), which may be explained by small increases in gestation length (approximately 2.5 days). n-3 LCPUFA supplementation in pregnancy did not however decrease the proportion of SGA infants. Multiple-micronutrient supplementation trials in developing countries have resulted in increased mean birthweight (22-44 g) and reduced the risk SGA by 9-15%. Further nutritional intervention studies which are rigorously designed and implemented are needed particularly to delineate differential effects in developed and developing countries. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.
    Nestlé Nutrition Institute workshop series. 01/2013; 71:1-9.
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    ABSTRACT: There has been growing interest in the role of n-3 long-chain polyunsaturated fatty acids (LC-PUFA) in the modulation of the immune response during early childhood and whether this may translate to a reduction in childhood allergic disease. Several randomized controlled trials of n-3 LC-PUFA supplementation have been reported, largely involving children who are at high hereditary risk of developing allergies. These studies relatively consistently indicate that supplementation during pregnancy results in fewer children with atopic eczema in early childhood. On the other hand, supplementation studies confined exclusively to the postnatal period have demonstrated mixed results with one trial showing no effect and the other suggesting a transient effect on symptoms of respiratory disease. In summary, supplementation with n-3 LC-PUFA during the perinatal period and before allergic response is established may be a useful strategy to prevent early childhood allergic disease in children at high hereditary risk. Further work is needed to establish the optimal period of supplementation and whether longer term benefits exist. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.
    Nestle Nutrition Institute workshop series. 01/2013; 77:155-162.
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    ABSTRACT: To evaluate nutritional interventions in preterm infants, a simple, accurate assessment of the type of growth, that is, change in body composition through the relative contributions of lean body tissue and fat mass to weight gain, is needed. Bioelectrical impedance may provide such a method. The aim of this study was to develop resistivity coefficients appropriate for use in bioelectrical impedance spectroscopy (BIS) analysis of body water volumes in preterm infants.
    European Journal of Clinical Nutrition 01/2013; 67:S47-S53. · 2.76 Impact Factor
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    ABSTRACT: Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow's milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow's milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow's milk and egg allergy.
    Nutrients 01/2013; 5(6):2028-46. · 2.07 Impact Factor
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    ABSTRACT: Infants born with low birthweight (LBW) have poorer neurodevelopmental outcomes compared with their term counterparts with appropriate weight for gestational age. The perinatal period is a time of high energy and high nutrient needs, and any process, such as preterm birth, poor nutrition or placental insufficiency, that interrupts the concentrated flow of nutrients to the fetus may result in babies with LBW. Therefore, it makes logical sense that at least part of the cognitive deficits may be explained by nutritional deprivation. The nutrients commonly deficient in LBW infants include protein and energy and micronutrients such as iron, zinc and long chain polyunsaturated fatty acids. In this review, we aimed to determine the effect of nutrient supplementation on neurodevelopment in LBW infants. While few trials have supported the hypothesis that nutritional supplementation improves neurodevelopment, many studies are limited by sample size and methodological shortcomings. Further large-scale rigorously designed intervention trials, with long-term neurodevelopment follow-up, are required to determine the optimal nutritional supplements and the timing of their administration to LBW infants. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.
    Nestlé Nutrition Institute workshop series. 01/2013; 74:211-21.

Publication Stats

3k Citations
568.13 Total Impact Points


  • 2014
    • South Australian Health and Medical Research Institute
      Adelaide Hills, South Australia, Australia
  • 2007–2013
    • Women's and Children's Health Network
      Tarndarnya, South Australia, Australia
  • 1999–2013
    • University of Adelaide
      • • Discipline of Public Health
      • • School of Paediatrics and Reproductive Health
      • • Women's & Children's Health Research Institute (WCHRI)
      • • Discipline of Paediatrics
      • • Discipline of Obstetrics and Gynaecology
      Adelaide, South Australia, Australia
  • 2012
    • University of Western Australia
      • School of Paediatrics and Child Health
      Perth, Western Australia, Australia
  • 2011
    • Boston Children's Hospital
      • Division of Newborn Medicine
      Boston, MA, United States
    • Medical University of Warsaw
      • Katedra i Klinika Pediatrii, Hematologii i Onkologii
      Warsaw, Masovian Voivodeship, Poland
  • 2008
    • Queensland University of Technology
      • Institute of Health and Biomedical Innovation
      Brisbane, Queensland, Australia
  • 1996–2007
    • Flinders Medical Centre
      Tarndarnya, South Australia, Australia
  • 2001–2005
    • Women`s and Children`s Hospital
      Tarndarnya, South Australia, Australia
  • 1998–2005
    • Flinders University
      • • Department of Paediatrics and Child Health
      • • Flinders Medical Centre
      Adelaide, South Australia, Australia