Maria Makrides

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

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Publications (163)696.08 Total impact

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    ABSTRACT: Health authorities recommend 6 months of fully breastfeeding and continuation of breastfeeding for at least a year. Many women initiate breastfeeding in hospital but discontinue before the six-month period, and therefore do not optimise the public health benefits. The aim of this study was to determine whether these women could be identified at hospital discharge, to enable targeted interventions. A secondary analysis of women who intended to breastfeed and were enrolled in a large randomised trial was undertaken. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analyses were undertaken to determine the variables associated with early cessation of breastfeeding within six months, compared to women who continued to breastfeed. Of 2148 women who initiated breastfeeding in hospital, 877 continued to breastfed either partially (N = 262) or fully (N = 615) until six months postpartum and 1271 ceased breastfeeding early. Median breastfeeding duration in women who ceased early was 3(+6) weeks (IQR 1(+1) to 11(+2) weeks). In multivariate analysis, factors that were significantly associated with early cessation of breastfeeding were maternal factors of lower education (less than 12 years of schooling, no completion of further education), smoking (pre-pregnancy or during pregnancy), and newborn factors of preterm birth and low birthweight (all p < 0.01). These variables correctly identify 83% of women. We can identify women who initiate and then prematurely discontinue breastfeeding prior to hospital discharge. Evaluation of additional interventions to support longer duration of breastfeeding in women at risk of ceasing prematurely is needed.
    International Breastfeeding Journal 12/2015; 10(1). DOI:10.1186/s13006-015-0040-y
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    ABSTRACT: Observational studies have implicated low serum vitamin D (25-hydroxyvitamin D (25(OH)D)) levels in the development of mood disorders. Postpartum depression (PPD) is an important public health issue, although little is known about its association with serum 25(OH)D. To determine the association between 25(OH)D at delivery and the subsequent risk of PPD at six weeks and six months postpartum in a large cohort of Australian women. Cord blood samples from 1040 women participating in the docosahexaenoic acid (DHA) to Optimise Maternal Infant Outcome randomised controlled trial were analysed for 25(OH)D by mass spectroscopy. Maternal PPD was assessed using the Edinburgh Postnatal Depression Scale at six weeks and six months postpartum. The association between standardised 25(OH)D and PPD was assessed, taking into account DHA treatment, social and demographic variables. There was no association between cord blood 25(OH)D concentration at delivery and PPD at either six weeks or six months postpartum. Cord blood 25(OH)D 25-50 and >50 nmol/L at delivery was associated with decreased risk of PPD at six weeks postpartum compared with 25(OH)D <25 nmol/L in the control group, but not the DHA group. There was no association between cord blood 25(OH)D <25 nmol/L at delivery and PPD at six months postpartum. This largest study to date of 25(OH)D levels at delivery and PPD did not reveal a consistent link with PPD. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 06/2015; DOI:10.1111/ajo.12344 · 1.62 Impact Factor
  • Maria Makrides, Ronald E Kleinman
    PEDIATRICS 05/2015; 135(6). DOI:10.1542/peds.2015-0813 · 5.30 Impact Factor
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    ABSTRACT: Six Year Follow Up of Children at High Hereditary Risk of Allergy, Born To Mothers Supplemented With Docosahexaenoic Acid (DHA) in the DOMInO Trial Best K1,2, Sullivan T6,Gold M1, Kennedy D4,5, Martin J4,5, Palmer D1,7, Makrides M1,2,3 1Women’s & Children’s Health Research Institute, University of Adelaide, North Adelaide, Australia 2School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia ³Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia 4Discipline of Paediatrics, University of Adelaide, Adelaide, Australia 5 Department of Respiratory and Sleep Medicine, Women’s & Children’s Hospital, North Adelaide, Australia 6 School of Population Health, University of Adelaide, Adelaide, Australia 7 School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia Email: Background: Dietary omega-3 (n-3) long chain polyunsaturated fatty acids (LCPUFA) modulate neonatal markers of the immune response but there is uncertainty regarding the effect on clinical allergy outcomes. This double blind, randomised controlled trial aimed to determine whether supplementation with DHA rich fish oil during pregnancy to women with a fetus at high risk of allergic disease, will reduce the risk of allergy in the child. Method: Between 2005 and 2008, pregnant women between 18-21 weeks gestation were randomly assigned to consume capsules containing ~1 g/d of DHA or a blended vegetable oil (no DHA) until birth, the DOMInO trial. From 2012-2014, 603 children (90% of eligible) born to mothers in the DOMInO trial, with a family history of allergic disease completed a six year of age follow up assessment . History of asthma, allergic rhinitis and eczema were assessed, along with food and aero-allergen sensitisation by skin prick testing. Results: Preliminary results show no difference in the overall percentage of children with IgE-mediated allergic disease between the DHA and control groups (75/279 (26.8%) vs 79/263 (30.0%); RR 0.95; 95% CI 0.73,1.23; P=0.69), although there were fewer children with parent reported hay fever in the DHA group (68/314 (21.6%) vs 84/289 (29.1%); RR 0.75; 95%CI 0.57, 0.99; P=0.04) and fewer children were sensitised to house dust mite, D.Farinae, in the DHA group 31/246 (12.6%) vs 49/231 (21.2%) control; RR 0.61 (0.41, 0.92); P=0.019. Conclusions: DHA supplementation in pregnancy did not reduce the overall incidence of IgE-mediated allergies at six years of age although parent reported hay fever and D.Farinae sensitisation were lower.
    Perinatal Society of Australia and New Zealand; 04/2015
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    ABSTRACT: Thirty one infants born less than 30 weeks׳ gestational age were randomised to receive either 40 (n=11), 80 (n=9) or 120 (n=11) mg/kg/day of docosahexaenoic acid (DHA) respectively as an emulsion, via the feeding tube, commenced within 4 days of the first enteral feed. Twenty three infants were enroled in non-randomised reference groups; n=11 who had no supplementary DHA and n=12 who had maternal DHA supplementation. All levels of DHA in the emulsion were well tolerated with no effect on number of days of interrupted feeds or days to full enteral feeds. DHA levels in diets were directly related to blood DHA levels but were unrelated to arachidonic acid (AA) levels. All randomised groups and the maternal supplementation reference group prevented the drop in DHA levels at study end that was evident in infants not receiving supplementation. Australian New Zealand Clinical Trials Registry: ACTRN12610000382077. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Prostaglandins Leukotrienes and Essential Fatty Acids 04/2015; 99. DOI:10.1016/j.plefa.2015.04.003 · 1.98 Impact Factor
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    ABSTRACT: Human milk provides a complex mix of animal lipids, whereas the fat supply of most modern infant formula is based on vegetable oils. We studied the effects of breastfeeding and of feeding infant formula either without or with dairy goat lipids on the composition of infant plasma glycerophospholipids. Healthy term infants were randomized double blind to feeding with infant formula based on whole goats' milk (GIF, approximately 60% milk fat and 40% vegetable oils) or a control cows' milk infant formula based on vegetable oils (VIF) from 2 weeks after birth. A reference group of fully breastfed infants was also followed. At the age of 4 months, blood samples were collected and plasma glycerophospholipids were analysed with liquid chromatography coupled to triple quadrupole mass spectrometry. The group of breastfed infants showed significantly higher contents of glycerophospholipid species containing sn-2 palmitic acid {PC(16:0/16:0) and PC(18:0/16:0)} and significantly higher contents of glycerophospholipid species containing LC-PUFA than infants in both formula groups. The GIF group demonstrated significantly higher glycerophospholipid species containing myristic acid {LPC(14:0), PC(14:0/18:1), PC(16:0/14:0)} and palmitoleic acid {LPC(16:1), PC(16:0/16:1), PC(16:1/18:1)} than the VIF group. We conclude that breastfeeding induces marked differences in infant plasma glycerophospholipid profiles as compared to formula feeding, whereas the studied different sources of formula-fat resulted in limited effects on plasma glycerophospholipids.
    Journal of pediatric gastroenterology and nutrition 03/2015; DOI:10.1097/MPG.0000000000000783 · 2.87 Impact Factor
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    ABSTRACT: Adequate iodine is important during pregnancy to ensure optimal growth and development of the offspring. We validated an iodine-specific FFQ (I-FFQ) for use in Australian pregnant women. A forty-four-item I-FFQ was developed to assess iodine intake from food and was administered to 122 pregnant women at 28 weeks gestation. Iodine supplement use was captured separately at 28 weeks gestation. Correlation between iodine intake from food estimated using the I-FFQ and a 4 d weighed food record as well as correlation between total iodine intake and 24 h urinary iodine excretion (UIE), 24 h urinary iodine concentration (UIC), spot UIC and thyroid function were assessed at 28 weeks gestation. A moderate correlation between the two dietary methods was shown (r 0·349, P< 0·001), and it was strengthened with the addition of iodine supplements (r 0·876, P< 0·001). There was a fair agreement (k= 0·28, P< 0·001) between the two dietary measures in the classification of women as receiving adequate ( ≥ 160 μg/d) or inadequate ( < 160 μg/d) iodine intake from food, but the limits of agreement from the Bland-Altman plot were large. Total iodine intake was associated with 24 h UIE (β = 0·488, P< 0·001) but not with spot UIC. Iodine intake from food using the I-FFQ was assessed at study entry ( < 20 weeks gestation) in addition to 28 weeks gestation, and there was a strong correlation in iodine intake at the two time points (r 0·622, P< 0·001), which indicated good reproducibility. In conclusion, the I-FFQ provides a valid tool for estimating iodine intake in pregnant women and can be used to screen women who are at risk of inadequate intake.
    British Journal Of Nutrition 03/2015; 113(06):1-9. DOI:10.1017/S0007114515000197 · 3.34 Impact Factor
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    ABSTRACT: To determine if improvements in cognitive outcome detected at 18 months' corrected age (CA) in infants born <33 weeks' gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood. Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital. Five Australian tertiary hospitals from 2008 to 2013. 626 of the 657 participants randomised between 2001 and 2005 were eligible to participate. High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2-4 days until term CA. Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted. 604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital -0.3, 95% CI -2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet. Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2-4 until term CA showed no evidence of benefit at 7 years' CA. Australian New Zealand Clinical Trials Registry: ACTRN12606000327583. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 03/2015; 5(3):e007314. DOI:10.1136/bmjopen-2014-007314 · 2.06 Impact Factor
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    ABSTRACT: Oral food challenges for diagnosis and management of egg allergy using fresh egg are common; however to limit the risk of food borne infection many allergy units use pasteurized raw egg. Pasteurization and drying processes have the potential to affect the structure of egg proteins in egg powder and thus the allergenicity when compared to fresh egg. Our aim was to compare the binding of serum IgE from egg allergic children to in vitro digested and undigested pasteurized whole raw egg powder with unpasteurized fresh whole raw egg. Egg proteins from in vitro digested or undigested pasteurized whole raw egg powder, fresh whole egg, white and yolk were separated by SDS-PAGE electrophoresis, transferred onto nitrocellulose membrane, and incubated overnight with pooled sera from egg allergic children. In both the raw egg samples and the pasteurized whole egg powder, protein bands corresponding with known molecular weights of the major egg allergens were present. Pasteurized whole raw egg powder was bound by serum IgE in a similar manner to unpasteurized whole raw egg, and was unaffected by in vitro digestion. Serum IgE also bound egg yolk, indicating sensitization to both egg yolk and egg white proteins. The main egg allergens are present in pasteurized whole raw egg powder and serum IgE of egg allergic children binds to them in a similar pattern to fresh whole raw egg. Pasteurized whole raw egg powder is a suitable substitute for raw egg in clinical practice for oral food challenges. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pediatric Allergy and Immunology 02/2015; 26(3). DOI:10.1111/pai.12365 · 3.86 Impact Factor
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    ABSTRACT: The ability of the World Health Organization (WHO) growth standards to represent the growth of South East Asian infants has been questioned. The aim of this study was to provide contemporary data on the growth of Indonesian breast-fed and formula-fed infants, compared with the WHO growth standards. A prospective cohort study of 160 normal healthy infants was undertaken in a suburban area of South Jakarta, Indonesia. Infants from 2-6 weeks of age were recruited, and consumed exclusively either breast milk or infant formula for at least 6 months, with follow-up until 12 months of age. Overall, the infants in this study were lighter (weight-for-age), were shorter (length-for-age) and had smaller head circumferences (head circumference-for-age) than the average WHO Growth Reference Study (WGRS) population but were of similar proportion (weight-for-length). Compared with the WGRS, the z-scores for weight-for-age, length-for-age and head circumference-for-age in the Indonesian children fell from birth to 6 weeks of age and then increased until 3 months of age in both the breast-fed infants and the formula-fed infants. At 6 weeks of age, the weight-for-age z-scores fell below -2 standard deviations (SD) for 16 (20.5%) breast-fed and 40 (51.3%) formula-fed infants, and the length-for-age z-scores fell below -2 SD for 31 (39.7%) breast-fed and 41 (52.6%) formula-fed infants. The WHO growth standards do not reflect the growth of this cohort of Indonesian infants and may overestimate the levels of underweight and stunted children. Identifier: NCT01721512This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivatives 4.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially.
    Journal of Pediatric Gastroenterology and Nutrition 02/2015; DOI:10.1097/MPG.0000000000000770 · 2.87 Impact Factor
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    ABSTRACT: AimTo assess vitamin D status and its predictors in a representative population sample of pre-school children in Adelaide (latitude of 35°S).Methods Cross-sectional survey of children aged between 1 and 5 years from areas of low, medium and high socio-economic status as identified from the 2001 Census data, Australian Bureau of Statistics. Children were recruited between September 2005 and July 2007 using a door knocking protocol based on a stratified sampling method to obtain a representative sample of this age group. Serum 25-hydroxyvitamin D (25(OH)D) was determined using a radio-immunoassay kit. Vitamin D deficiency was defined as serum 25(OH)D) <30 nmol/L and insufficiency defined as serum 25(OH)D ≥30 and <50 nmol/L according to the Institute of Medicine.ResultsFifty-two per cent of eligible children took part in the study. Mean (standard deviation) serum 25(OH)D was 73 (26) nmol/L (n = 221). The prevalence of vitamin D deficiency and insufficiency was 4% and 16%, respectively, with the prevalence being higher in winter (8% and 22%, respectively). Season of the year of blood collection and mother being born in Australia were significant predictors of serum 25(OH)D concentration, but age, sex, socio-economic status, BMI category or dietary supplement use were not related to vitamin D status.Conclusions Vitamin D status of this representative sample of pre-school children in Australia is adequate, and the prevalence of vitamin D deficiency is low based on the Institute of Medicine criteria.
    Journal of Paediatrics and Child Health 11/2014; 51(6). DOI:10.1111/jpc.12770 · 1.19 Impact Factor
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    ABSTRACT: Objectives Multiple births are an important subgroup to consider in trials aimed at reducing preterm birth or its consequences. Including multiples results in a unique mixture of independent and clustered data, which has implications for the design, analysis and reporting of the trial. We aimed to determine how multiple births were taken into account in the design and analysis of recent trials involving preterm infants, and whether key information relevant to multiple births was reported. Design We conducted a systematic review of multicentre randomised trials involving preterm infants published between 2008 and 2013. Information relevant to multiple births was extracted. Results Of the 56 trials included in the review, 6 (11%) excluded multiples and 24 (43%) failed to indicate whether multiples were included. Among the 26 trials that reported multiples were included, only one (4%) accounted for clustering in the sample size calculations and eight (31%) took the clustering into account in the analysis of the primary outcome. Of the 20 trials that randomised infants, 12 (60%) failed to report how infants from the same birth were randomised. Conclusions Information on multiple births is often poorly reported in trials involving preterm infants, and clustering due to multiple births is rarely taken into account. Since ignoring clustering could result in inappropriate recommendations for clinical practice, clustering should be taken into account in the design and analysis of future neonatal and perinatal trials including infants from a multiple birth.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 11/2014; 100(2). DOI:10.1136/archdischild-2014-306239 · 3.86 Impact Factor
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    ABSTRACT: This paper aimed to identify the dietary and non-dietary determinants of docosahexaenoic acid (DHA) levels in umbilical cord blood at delivery. DHA was measured in cord blood plasma phospholipids of 1571 participants from the DOMInO (DHA to Optimize Mother Infant Outcome) randomized controlled trial. Socioeconomic, lifestyle and clinical data relating to the mother and current pregnancy were obtained from all women and their relationships with cord blood DHA assessed. DHA concentrations in the cord plasma phospholipids at delivery covered a 3–4 fold range in both control and DHA groups. The total number of DHA-rich intervention supplement capsules consumed over the course of pregnancy and gestational age at delivery individually explained 21% and 16% respectively of the variation in DHA abundance in the cord blood plasma phospholipids at delivery, but no other clinical or life-style factors explored in this study could account for >2% of the variation. Indeed, more than 65% of the variation remained unaccounted for even when all factors were included in the analysis. These data suggest that factors other than maternal DHA intake have an important role in determining cord blood DHA concentrations at delivery, and may at least partially explain the variation in the response of infants to maternal DHA supplementation reported in published trials.
    Prostaglandins Leukotrienes and Essential Fatty Acids 10/2014; DOI:10.1016/j.plefa.2014.07.013 · 1.98 Impact Factor
  • Karen Best, maria makrides
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    ABSTRACT: Background: The worldwide epidemic of allergic disease may be a consequence of our changing environment. Western diets have changed dramatically over the last 30-40 years, now comprising an overwhelming predominance of omega-6 (n-6) polyunsaturated fatty acid (PUFA) at the expense of omega-3 (n-3) PUFA. This change coincidently parallels the increasing prevalence of allergy, suggesting the imbalance may have a causal relationship. Methods: Included publications were prospective randomised controlled trials (RCT’s) that evaluated an intervention modifying maternal n-3 long chain poly-unsaturated fatty acid (LCPUFA) intake and observational studies that observed the association of maternal n-3 LCPUFA intake and clinical outcomes of allergic disease. Results: A total of 13 publications from 10 observational studies and 7 publications representing five unique randomised controlled trials (RCT) were included in the review. Decreased incidence of allergic disease symptoms was evident in eight of thirteen observational studies. Incidence of eczema was reported in four RCT’s with one study reporting a significant reduction in cumulative incidence of IgE associated eczema and another reporting significant reduction in severity of disease. Symptoms of recurrent wheeze, persistent cough and diagnosed asthma were reduced in one trial but did not reach statistical significance. There was no difference in asthma at 6 months and 0-24 months or 3 years. A registry based follow up reported a significant reduction in ‘any asthma’ and ‘allergic asthma’ at 16 years. Four trials assessing sensitisation by skin prick test all reported a significant protective effect; three of these reported a significant reduction in sensitisation to egg. Discussion: Findings from this review suggest that increased supply of n-3 LCPUFA to the fetus through maternal intake may influence development and progression of allergic disease. Congruence between epidemiological evidence and RCT’s, further supports this nutrient-disease association.
    Australasian Society of Clinical Immunology and Allergy, Perth; 09/2014
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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 06/2014; DOI:10.1016/j.clp.2014.02.012 · 2.13 Impact Factor
  • JAMA The Journal of the American Medical Association 05/2014; 311(17):1802-4. DOI:10.1001/jama.2014.2194 · 30.39 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
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    ABSTRACT: Magnesium is an essential mineral required for regulation of body temperature, nucleic acid and protein synthesis and in maintaining nerve and muscle cell electrical potentials. Many women, especially those from disadvantaged backgrounds, have low intakes of magnesium. Magnesium supplementation during pregnancy may be able to reduce fetal growth restriction and pre-eclampsia, and increase birthweight. To assess the effects of magnesium supplementation during pregnancy on maternal, neonatal/infant and paediatric outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013). Randomised and quasi-randomised trials assessing the effects of dietary magnesium supplementation during pregnancy were included. The primary outcomes were perinatal mortality (including stillbirth and neonatal death prior to hospital discharge), small-for-gestational age, maternal mortality and pre-eclampsia. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Ten trials involving 9090 women and their babies were included; one trial had a cluster design (with randomisation by study centre). All 10 trials randomly allocated women to either an oral magnesium supplement or a control group; in eight trials a placebo was used, and in two trials no treatment was given to the control group. In the 10 included trials, the compositions of the magnesium supplements, gestational ages at commencement, and doses administered varied, including: magnesium oxide, 1000 mg daily from ≤ four months post-conception (one trial); magnesium citrate, 365 mg daily from ≤ 18 weeks until hospitalisation after 38 weeks (one trial), and 340 mg daily from nine to 27 weeks' gestation (one trial); magnesium gluconate, 2 to 3 g from 28 weeks' gestation until birth (one trial), and 4 g daily from 23 weeks' gestation (one trial); magnesium aspartate, 15 mmol daily (three trials, commencing from either six to 21 weeks' gestation until birth, ≤ 16 weeks' gestation until birth, or < 12 weeks until birth), or 365 mg daily from 13 to 24 weeks until birth (one trial); and magnesium stearate, 128 mg elemental magnesium from 10 to 35 weeks until birth (one trial).In the analysis of all trials, oral magnesium supplementation compared to no magnesium was associated with no significant difference in perinatal mortality (stillbirth and neonatal death prior to discharge) (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.72 to 1.67; five trials, 5903 infants), small-for-gestational age (RR 0.76; 95% CI 0.54 to 1.07; three trials, 1291 infants), or pre-eclampsia (RR 0.87; 95% CI 0.58 to 1.32; three trials, 1042 women). None of the included trials reported on maternal mortality.Considering secondary outcomes, while no increased risk of stillbirth was observed, a possible increased risk of neonatal death prior to hospital discharge was shown for infants born to mothers who had received magnesium (RR 2.21; 95% CI 1.02 to 4.75; four trials, 5373 infants). One trial contributed over 70% of the participants to the analysis for this outcome; the trial authors suggested that the large number of severe congenital anomalies in the supplemented group (unlikely attributable to magnesium) and the deaths of two sets of twins (with birthweights < 750 g) in the supplemented group likely accounted for the increased risk of death observed, and thus this result should be interpreted with caution. Furthermore, when the deaths due to severe congenital abnormalities in this trial were excluded from the meta-analysis, no increased risk of neonatal death was seen for the magnesium supplemented group. Magnesium supplementation was associated with significantly fewer babies with an Apgar score less than seven at five minutes (RR 0.34; 95% CI 0.15 to 0.80; four trials, 1083 infants), with meconium-stained liquor (RR 0.79; 95% CI 0.63 to 0.99; one trial, 4082 infants), late fetal heart decelerations (RR 0.68; 95% CI 0.53 to 0.88; one trial, 4082 infants), and mild hypoxic-ischaemic encephalopathy (RR 0.38; 95% CI 0.15 to 0.98; one trial, 4082 infants). Women receiving magnesium were significantly less likely to require hospitalisation during pregnancy (RR 0.65, 95% CI 0.48 to 0.86; three trials, 1158 women).Of the 10 trials included in the review, only two were judged to be of high quality overall. When an analysis was restricted to these two trials none of the review's primary outcomes (perinatal mortality, small-for-gestational age, pre-eclampsia) were significantly different between the magnesium supplemented and control groups. There is not enough high-quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial.
    Cochrane database of systematic reviews (Online) 04/2014; 4(4):CD000937. DOI:10.1002/14651858.CD000937.pub2 · 5.94 Impact Factor
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    ABSTRACT: Background: Whilst the majority of Australian babies are initially breastfed (92%), by six months rates of partial or total breastfeeding have dropped to 50%. The aim of this study was to determine the associations of continued breastfeeding at six months. Methods: Multi-institutional ethics committee approval and informed consent were obtained. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analysis was undertaken to determine the factors associated with feeding type at six months postpartum. Results: Of 2399 women enrolled, outcome data were available for 2148 women, of whom 877 continued to breastfed either partially (N=262) or fully (N=615) until six months post partum and 1271 did not. In multivariate analysis, factors that remained significantly associated with maternal breastfeeding at six months postpartum were completion of secondary education (p<0.0001), completion of further education (p<0.0001), being a non-smoker pre-pregnancy (p<0.0001) or during the pregnancy (p<0.0001), an absence of preterm birth (P=0.01) or lower birthweight (p<0.0004). Conclusion: Higher maternal education, non-smoking status, term birth and higher birthweight were significant associations of breast feeding at six months.
    Perinatal Society of Australia and New Zealand Annual Scientific Meeting, Perth, Australia; 04/2014
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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 04/2014; 99(4):851-859. DOI:10.3945/ajcn.113.069203 · 6.92 Impact Factor

Publication Stats

4k Citations
696.08 Total Impact Points


  • 2014
    • South Australian Health and Medical Research Institute
      Adelaide Hills, South Australia, Australia
    • University of Western Australia
      • School of Paediatrics and Child Health
      Perth City, Western Australia, Australia
  • 2001–2014
    • Women`s and Children`s Hospital
      Tarndarnya, South Australia, Australia
  • 1998–2014
    • University of Adelaide
      • • Discipline of Paediatrics
      • • Women's & Children's Health Research Institute (WCHRI)
      • • Discipline of Obstetrics and Gynaecology
      Tarndarnya, South Australia, Australia
  • 2007–2013
    • Women's and Children's Health Network
      Tarndarnya, South Australia, Australia
  • 2006–2012
    • Flinders Medical Centre
      Tarndarnya, South Australia, Australia
  • 2011
    • Medical University of Warsaw
      • Department of Paediatrics
      Warszawa, Masovian Voivodeship, Poland
  • 2008
    • Queensland University of Technology
      • Institute of Health and Biomedical Innovation
      Brisbane, Queensland, Australia
  • 1998–2003
    • Flinders University
      • Department of Paediatrics and Child Health
      Adelaide, South Australia, Australia
  • 1997–2000
    • University of South Australia
      Tarndarnya, South Australia, Australia