Adherence to vitamin and dietary supplement intake in fertility and pregnancy care: insights into knowledge, information satisfaction, and formulation variability.

Pregnant women and their infants are at increased risk for severe influenza-related complications. A decade has passed since influenza vaccination was first recommended for pregnant women in Germany in 2010; however, monitoring of vaccination coverage (VC) has not yet been implemented for this target group. Using nationwide outpatient claims data, we here provide results on influenza VC among pregnant women in Germany for seasons 2014/15 to 2019/20. For any given season, pregnant women were defined as women who had undergone prenatal health care in at least two consecutive quarters within a season. VC increased from 9.0% in season 2014/15 to 16.6% in 2019/20 (+84%), while most of the increase occurred from season 2016/17 (VC: 9.9%) onwards (+68%). Consistently across seasons, women in east Germany were 40 to 60% more likely to be vaccinated compared to women residing in west Germany. According to age, the highest VC was observed among women aged 35 to <40 years (2019/20: 18.2%). Despite noticeable increases in influenza VC during recent years, overall coverage remains low among pregnant women. Starting with this analysis, VC among pregnant women in Germany will be monitored on a yearly basis in order to detect trends and identify immunization gaps.

Dietary supplements refer to the products that contain vitamins, minerals, herbs, amino acids, oil supplements, or other substances intended to supplement the diet. Nutrient deficiencies are frequently addressed with dietary supplements. Supplements can fill in these gaps and ensure that you get enough nutrients. Objectives: The aim of the study was to assess the frequency of dietary supplement intake, to assess the association between knowledge and intake of dietary supplements and to assess the association of quality of life with the intake of dietary supplements among the university students. Methodology: It was an analytical cross-sectional study which was conducted among the students at the University of Lahore. Probability Simple Random Sampling was employed to select students of the departments, and the data was gathered through self-administrated questionnaire. The data was analyzed using SPSS version 25.0. Used SF-36 questionnaire to measure quality of life while a pre validated self-administered questionnaire was used to access the knowledge and intake of dietary supplements. Results: Data from 266 participants was collected. The frequency of dietary supplement use among students was 75.9%. Intake of dietary supplement was higher in females (71%) as compared to males (60.5%). Moreover, it revealed a significant association between the level of knowledge about dietary supplements with the intake of dietary supplements (p-value &lt; 0.05). Intake of dietary supplement was higher among those students who have adequate knowledge regarding dietary supplements (88.1%) as compared to those who have inadequate knowledge regarding dietary supplements (73.7%). However, no significant difference was observed in the domains of quality of life between ds users and non-ds users. (p&gt;0.05) except for physical functioning (p=0.041*). Conclusions: It was observed that the use of dietary supplements increases the physical functioning capacity of its users.

BackgroundThere is little evidence that dietary supplements are beneficial for patients with breast cancer; therefore, they are usually not recommended by treatment guidelines. The aim of the present analysis was to assess the prevalence of dietary supplement (DS) intake among women before and after a breast cancer diagnosis.MethodsParticipants in the SUCCESS C lifestyle intervention study, a randomized controlled trial in women with newly diagnosed intermediate- to high-risk breast cancer, completed two questionnaires on dietary supplement intake 24 months (QS1) and 48 months (QS2) after beginning the lifestyle intervention. The study was registered on 12.17.2008 under the EU Clinical Trials Register https://www.clinicaltrialsregister.eu/, trial registration number: 2008-005453-38. The questionnaires collected data on DS intake during the 5-year period prediagnosis (QS1) and in the period postdiagnosis (QS2). Multivariate logistic regression models were fitted to examine differences in DS intake between the two intervention groups. The groups were then pooled to examine differences in DS use between the prediagnostic and postdiagnostic period.ResultsA total of 320 questionnaires from 58.5% of intervention group completers and 416 questionnaires from 46.6% of low-level intervention group completers were included in the analysis. Overall, 20.2% of all respondents reported taking DS prior to their diagnosis. After a cancer diagnosis, the percentage of women taking DS significantly increased to 56.4% (p for time effect < 0.0001). No differences in DS intake between the intervention groups were observed. Single or combined preparations of vitamins and minerals/trace elements were the most frequently reported supplements. Notably, a 9-fold increase in vitamin D intake was reported postdiagnosis, where the proportion of women increased from 3.8 to 34.5%.ConclusionA 3-fold increase in the reported intake of dietary supplements was seen in women after a breast cancer diagnosis. These observations underscore the need to incorporate patient education surrounding the use of dietary supplements in a treatment care plan, particularly addressing the negligible benefits as well as the potential risks and treatment interactions.

This study investigated the association of neural tube defects (NTDs) with maternal periconceptional intake of folic acid-containing supplements and dietary nutrients, including folate, among deliveries that occurred after folic acid fortification in selected California counties. The population-based case-control study included fetuses and live born infants with spina bifida (189) or anencephaly (141) and 625 nonmalformed, live born controls delivered from 1999 to 2003. Mothers reported supplement use during telephone interviews, which included a 107-item food frequency questionnaire. For dietary nutrients, intakes <25th, 25th to <75th (reference), and > or =75th percentile were compared, based on control distributions. After adjustment for potential confounders, any versus no supplement intake resulted in ORs of 0.8 (95% CI, 0.5-1.3) for anencephaly and 0.8 (95% CI, 0.6-1.2) for spina bifida. After stratification by maternal intake of vitamin supplements, most factors in the glycemic pathway were not associated with either NTD, with the exception of low levels of fructose and glucose that were significantly associated with anencephaly. Some nutrients that contribute to one-carbon metabolism showed lowered risks (folate, riboflavin, vitamins B(6) and B(12)); others did not (choline, methionine, zinc). Antioxidant nutrients tended to be associated with lowered risks (vitamins C, E, A, beta-carotene, lutein). Mothers' intake of vitamin supplements was modestly if at all associated with a lowered risk of NTDs. Dietary intake of several nutrients contributing to one-carbon metabolism and oxidative stress were associated with reduced NTD risk.

The analysis of individual microRNAs (miRNAs) as a diagnostic and prognostic tool for the effective treatment of various diseases has aroused particular interest in the scientific community. The determination of circulating miRNAs makes it possible to assess biological changes associated with nutritional processes, the intake of dietary supplements and drugs, etc. The profile of circulating miRNAs reflects the individual adaptation of the organism to the effect of specific environmental conditions. The objective of this study is to systematize the data and show the importance of circulating miRNAs as new potential biomarkers of the organism's response to the intake of various dietary supplements, drugs, and consider the possibility of their use in doping control. A systematic analysis of scientific publications (ncbi.nlm.nih.gov) on the miRNA expression profile in response to the intake of dietary supplements and drugs most often used by athletes, and supposed their role as potential markers in modern doping control was carried out. The profile of circulating miRNAs is highly dependent on the intake of a particular drug, and, therefore, may be used as a marker of the effects of biologically active supplements and drugs including the substances from the Prohibited List of the World Anti-Doping Agency (WADA). Monitoring of circulating miRNAs can serve as a high-precision marker for detecting doping abuse in elite sports. However, it is necessary to conduct additional studies on the effect of complex drugs on the profile of circulating miRNAs and individual circulating miRNAs on a particular biological process.

Objective: Descriptive study on maternal serum vitamin B12 and folic acid in term pregnancy and in umbilical cord blood that was performed in an inner city hospital with a mixed ethnic population in the region of Flanders in Belgium. Materials and Methods: A prospective cohort study that took place from April 1 until May 31, 2011. Plasma folic acid and vitamin B12 were measured in maternal and umbilical cord blood from all term uncomplicated deliveries in a single regional hospital. Data on age, previous obstetric history, ethnicity, nutritional intake, and use of vitamin supplements were registered. Results: Data were collected from 110 patients, mean maternal serum vitamin B12 was 243.9 pmol/l and mean folic acid level was 43.0 nmol/l. Using a cutoff of respectively 150 pmol/l for vitamin B12 and 7.1 nmol/l for folic acid, 13% of the women were classified as vitamin B12-deficient and 23% were deficient for folic acid. Vitamin B12 deficiency was only seen in autochthonous Belgian women. A correlation between the maternal and umbilical cord levels was noted (R = 0.7 for vitamin B12, R = 0.85 for folic acid), but none of the umbilical cord levels demonstrated deficiency. Number of previous pregnancies and intake of supplements had no influence. Conclusion: Pregnant women in Antwerp, Belgium, frequently show vitamin B12 and folic acid deficiency, although a correlation exists with lower umbilical cord levels, the present limited data did not demonstrate any case of deficiency in umbilical cord blood. The frequency is highest in the autochthonous population and is not influenced by intake of vitamin supplements.

IntroductionPhysical training can improve several health variables in patients with type 2 diabetes mellitus (T2DM). A growing body of studies also finds a positive influence of dietary supplement (DS) intake. The aim of this review is to shed light on the possible effects of training interventions combined with DS intake in T2DM patients.MethodsA systematic search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the PubMed and BISp Surf databases. Inclusion criteria were defined using the Patient-Intervention-Comparison-Outcome (PICO) scheme. The Physiotherapy Evidence Database (PEDro) scale was used for quality assessment and risk of bias analysis.ResultsTen controlled interventional studies with a total number of 643 subjects met the inclusion criteria. These studies investigated the effects of (a) vitamin D (VD), (b) VD + whey protein, (c) polyphenol containing antioxidant capsules, (d) creatine, (e) L-arginine, (f) leucine-rich amino acids, and (g) broccoli sprouts powder. Eight studies investigated effects on one or more of the following health outcomes: body mass index, fat mass, insulin resistance, glycemic control, lipid profile, oxidative stress/antioxidative capacity and/or inflammatory markers/molecules. Five of the studies show clear superior effects of physical training combined with DS intake (supplements a, b, c, e) on some of these variables compared with training only. However, one study indicates that VD intake might attenuate the training effects on triglyceride levels. Another study found that training + VD + whey protein intake increased tumor necrosis factor-α levels in T2DM patients. The effects of training combined with DS intake on renal function (supplement d) or incretin metabolism (supplement a) were investigated in two further studies. These studies do not show any additional effects of DS intake. The quality of the majority of the studies was high.ConclusionDS intake can potentially increase the benefits of physical training for specific health outcomes in T2DM patients. However, negative effects can also be observed. Possible cellular and molecular mechanisms behind potential synergistic or divergent effects of exercise training and DS use in T2DM should be explored in detail in future studies for the development of safe recommendations.

The use of dietary supplements and perceived quality of life in patients with Parkinson’s disease

Effects of menstrual symptoms on dietary intake frequency.

Background: Germany is one of the most densly populated countries in Europe, yet it has low allele frequencies for hemoglobinopathies in its population. According to estimates by Kohne et al. (2010), approx. 0.48%1 of Germany’s population are carriers for at least one hemoglobinopathy. Modell et al. (2007) estimated the proportion of carriers among pregnant women in Germany at 0.54%2. Given the sharp increase in migration between 2014 and 2016, predominantly from high prevalence countries for hemoglobinopathies (Figure 1), we expect a rise in carrier numbers among present German population. Although new-born screening for sickle cell disease has been introduces as standard of care in Germany in 2021, low awareness for hemoglobinopathies among general medical staff in general and the lack of existing routine screening in later life, e.g. during pregnancy, still pose a major challenge to monitor the development of these disorders and to ensure appropriate clinical care and consulting services.Aims: To estimate hemoglobinopathies carriage rates among pregnant women in Germany during the last decade. Methods: We extracted data on number and origin of foreign women at childbearing age (15 - 50 years) between 2010 and 2020 in Germany by federal state and year3 from the GENESIS database of the German federal statistical office. Using the published data by Modell and Darlison on carriage rates in pregnancies by country4, we calculated the proportion of women at childbearing age with risk for carrying a hemoglobinopathy per state and year. With the help of data on life births by mothers’ citizenship status (German or foreign)3, we calculated a fertility adjustment factor (= fertility rate of all foreign women/ total fertility rate in Germany, both per state and year) and estimated the yearly proportion of pregnancies at risk for carrying a hemoglobinopathy per state. Results: The estimated hemoglobinopathies carriage rates among pregnancies showed an increasing trend in all 16 German federal states in the last decade (Figure 2). The states Bremen, Hamburg, Berlin, and Hesse showed the highest carriage rates in 2020 with 3.84%, 2.78%, 2.66% and 2.64% respectively (HbS heterozygosity included). Notably, the states with lowest estimated carriage rates in 2020 (Thuringia, Saxony, Saxony-Anhalt and Brandenburg) showed the strongest increases compared to its initial rates in 2010 (Figures 2-4). On a national average, we calculated an increase of approximately 60% in pregnancies at risk for hemoglobinopathy carriage (Figure 5).Conclusion: Our analysis indicates a clear and strong increase in hemoglobinopathy carriage rates among pregnancies in all federal states in parallel to the increase in migration into Germany between 2014 and 2016. Further studies are required to verify these findings and to evaluate the necessity of new public health measures as prenatal screening and consulting services for hemoglobinopathies in Germany.

Analysis of German nutrition brochures for pregnant women with evidence-based patient information criteria

Opportunities and challenges to the development and deployment of vaccines for pregnant women in Germany

Iron deficiency is prevalent in a sample of pregnant women at delivery in Germany

Objectives: In perinatal medicine, morbid (severe) obesity of the mother occurs in approx. 1 % of cases and is gaining in importance, even more so when considering the rising trend of juvenile adiposity. This retrospective cohort study aims at characterising high-risk pregnancies associated with morbid obesity (BMI ≥ 40). Along with epidemiologic insights, the analysis purveys clinically relevant results useful for developing guidelines regarding preconceptional and pregnancy care in morbid obesity. Methods: Perinatal statistics from eight German federal states of the years 1998 – 2000 (n = 508 926 singleton pregnancies) were analysed. Pregnant women with coexistent morbid obesity were stratified into two groups – group 1: BMI 40.00 – 44.99; n = 3188 (0.6 %) and group 2: BMI ≥ 45.00; n = 787 (0.2 %) – and compared to a reference population with a BMI between 18.50 and 24.99 (n = 320 148) with regards to gestational, perinatal and neonatal risks. Weight percentiles were used to classify the neonates according to size (hypotrophy if < 10th, hypertrophy/fetal macrosomia if > 90th). χ2-Test was used to test for significance of results. Due to the large sample size, all differences between the control group (BMI: 18.50 – 24.99) and the group of morbidly obese pregnant women (BMI ≥ 40) were highly significant (p < 0.001). Results: The obtained risk profile for morbidly obese pregnant women primarily shows pregnancy related diseases, such as hypertension, preeclampsia and gestational diabetes. Hypertension occurred in 1.2 % of controls, whereas it occurred in 17.1 % (BMI = 40.00 – 44.99) and 23.3 % (BMI ≥ 45) with morbid obesity. Signs of fetal hypoxemia were found in 21.1 % of controls vs. 30.9 % (group 1), and 33.9 % (group 2) respectively, of obese women. At a BMI ≥ 45 (25.9 %), 38.4 % underwent caesarean sections. Hypertrophic neonates were born 3.3 times more often to obese mothers than to mothers of the normal population. The percentage of neonates with a 5-minute-Apgar-score < 4 was three times as high (0.9 and 0.8 % respectively vs. 0.3 %). Conclusion: At a BMI ≥ 40 the rate of complications such as preeclampsia, gestational diabetes, impending fetal hypoxemia, fetal macrosomia, as well as neonatal infections and hyperbilirubinaemia is significantly higher. Both, adiposity as well as maternal comorbidities, account for a higher rate of caesarean sections of up to 38.4 % at a BMI ≥ 45. During pregnancy, metabolic and cardiologic monitoring, as well as accurate and careful birth planning, is of utmost importance. Preconceptionally, the therapeutic approach consists of weight reduction.

BackgroundMicronutrient deficiencies among pregnant women remain highly prevalent in low and middle-income countries. Multiple micronutrient supplementation (MMS) has been proven more beneficial than standard iron-folic acid supplementation in reducing adverse pregnancy outcomes. Limited data on adherence to MMS in pregnant women in programmatic settings is available. Therefore, our study aims to assess adherence to the recommended intake of a multiple micronutrient supplement (UNIMMAP-MMS) in relation to demographic characteristics alongside a community-based MMS program.MethodA prospective longitudinal study was performed in the Parepare district, South Sulawesi province, Indonesia, including 1216 participants. MMS was provided at the first antenatal care visit and women were followed up until delivery. The number of MMS tablets consumed, the start of MMS intake and information regarding possible intake determinants were recorded. Adherence was defined as ≥ 90 tablets. Binary logistic regression was used to assess associations between characteristics of women and adherence.ResultsAmong the 655 women (53.9%) who started MMS intake in the first trimester, approximately 90% continued using MMS in the following trimesters and 75.3% consumed MMS ≥ 90 tablets. Among the 41.2% of women who started in the second trimester, 90% continued intake in the third trimester and 32.3% consumed ≥ 90 tablets. Only 4.9% started MMS in the third trimester. Overall adherence to MMS was 53.9%. Factors that impacted MMS intake were pregnancy interval ≤ 2y (AOR = 0.65, 95% CI 0.46, 0.92), start of MMS use in the second trimester and third trimester (AOR = 0.15, 95% CI 0.12, 0.20) and (AOR = 0.01, 95% CI 0.00, 0.04) respectively, being overweight (AOR = 1.44, 95% CI 1.04, 2.00) and experiencing no side effects (AOR = 3.46, 95% CI 1.82, 6.58).ConclusionImplementation of MMS via community health centers resulted in high adherence once supplementation started. As many women started MMS late, attention to antenatal visit planning earlier in pregnancy can be further improved.