Abstract
BackgroundPatients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea. The aim of this study was to estimate the proportion of protein from dairy sources (PPDS) in mothers with and without IBD, and to explore the impact of PPDS on inadequate gestational weight gain (GWG) or small for gestational age (SGA) in IBD compared to non-IBD in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa).MethodsMoBa includes about 95,000 pregnant women recruited throughout Norway from 1999 to 2008. IBD phenotype and complications during pregnancy and delivery were ascertained. This study included 148 mothers with Crohn disease (CD) and 194 with ulcerative colitis and 68,858 non-IBD mothers. In mid-pregnancy participants answered a comprehensive semi-quantitative food frequency questionnaire assessing diet since the start of pregnancy. PPDS was ranked in quartiles. The two lowest quartiles were merged and considered to represent the lowest of three PPDS groups. We used logistic regression analyses to model multivariate associations, adjusting for potential confounders.ResultsThe risk of belonging to the lowest PPDS group was twice as high in IBD mothers compared to non-IBD mothers (aOR = 2.02, 95% CI: 1.53, 2.67). Low compared to high PPDS strongly predicted inadequate GWG in CD (aOR = 4.22, 95% CI: 1.28, 13.92). Surprisingly, and in opposition to the non-IBD mothers, PPDS was positively associated with the risk of SGA in IBD mothers. IBD mother with low PPDS was associated with significantly lower risk of SGA than non-IBD mothers and IBD mothers with high PPDS (aOR = 0.19, 95% CI: 0.07, 0.50). The interaction term IBD/PPDS was the factor that linked SGA to IBD compared to non-IBD, and increased the association between IBD and SGA with a factor of three.ConclusionThis study shows that intake of dairy products is lower in IBD mothers than in non-IBD mothers, and further, that low intake of dairy products in IBD mothers is associated with reduced risk of SGA compared to non-IBD and IBD mothers with high PPDS.
Highlights
Patients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea
The proportion of protein from dairy sources (PPDS) in IBD and non-IBD mothers Of the IBD mothers who answered the food frequency questionnaire (FFQ), 56.4% reported that their current intake of dairy products was as before and 32.5% higher than before pregnancy
The odds of belonging to the lowest compared to the highest PPDS group were doubled in IBD mothers adjusted for maternal age and education level [aOR = 2.02]
Summary
Patients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea. The most consistent adverse pregnancy outcomes described are small for gestational age (SGA) [6], preterm birth (< 37 weeks of gestation) and low birth weight (< 2500 g) [7,8,9]. Weight loss and malnutrition are common features in IBD patients [10,11,12] and are wellknown risk factors of SGA and low birth weight in the general population [13, 14]. Maternal gestational weight gain (GWG) has a significant effect on fetal development and growth in the general population and in IBD [13,14,15]. In particular consumption of protein from milk or dairy products, has a positive impact on mothers’ GWG as well as the infants’ birth weight [16]
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