Food Classification System Research Articles

Biopharmaceutics Permeability Classification of Lorcaserin, a Selective 5-Hydroxytryptamine 2C Agonist: Method Suitability and Permeability Class Membership

The objectives of the study were (1) to demonstrate that a Caco-2 cell-based permeability assay, developed in our laboratory, is suitable to identify the permeability classification according to the US Food and Drug Administration Biopharmaceutics Classification System guidance, and (2) to use the validated Caco-2 method to determine permeability class membership of lorcaserin. Lorcaserin, marketed in United States as Belviq, is a selective human 5-hydroxytryptamine 2C agonist used for weight management. First, the permeability of twenty commercially available drugs was determined in the apical-to-basolateral direction at a final concentration of 10 μM, with the pH of transporter buffer in the apical and basolateral compartments being 6.8 and 7.4, respectively. A rank-order relationship between in vitro permeability results and the extent of human intestinal absorption for the drugs tested was observed. Second, the apparent permeability coefficient values of lorcaserin at 2, 20, and 200 μM and apical pH values of 6.8 and 7.4 in the apical-to-basolateral direction were determined using the validated method and found to be comparable to those of the high-permeability internal standard metoprolol. Lorcaserin permeability across Caco-2 cell monolayers was not dependent on the variation of apical pH. Furthermore, lorcaserin was not a substrate for efflux transporters such as P-glycoprotein. In conclusion, using the validated Caco-2 permeability assay, it was shown that lorcaserin is a highly permeable compound.

Pilot Project on the implementation of FoodEx2 as part of the Standard Sample Description for the electronic transmission of harmonised chemical occurrence data to EFSA

EFSA Supporting PublicationsVolume 10, Issue 5 432E External scientific reportOpen Access Pilot Project on the implementation of FoodEx2 as part of the Standard Sample Description for the electronic transmission of harmonised chemical occurrence data to EFSA Food and Veterinary Service (PVD), Food and Veterinary Service (PVD)Search for more papers by this author Food and Veterinary Service (PVD), Food and Veterinary Service (PVD)Search for more papers by this author First published: 23 May 2013 https://doi.org/10.2903/sp.efsa.2013.EN-432 The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors. Published date: 23 May 2013 Question number: EFSA-Q-2012-00768 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References EFSA (European Food Safety Authority), 2010. Guidance on Data Exchange EFSA Journal 2010; 8(11): 1895, 50 pp. doi: 10.2903/j.efsa.2010.1895. EFSA (European Food Safety Authority), 2011. The food classification and description system FoodEx 2 (draft-revision 1). Supporting Publications 2011:215, 438 pp. EFSA (European Food Safety Authority), 2011. Report on the development of a food classification and description system for exposure assessment and guidance on its implementation and use. EFSA Journal 2011; 9(12):2489, 438 pp. doi: 10.2903/j.efsa.2011.2489. EFSA (European Food Safety Authority), online. Standard Sample Description – SSD. Available online: http://www.efsa.europa.eu/en/datexcallsfordata/datexsubmitdata.htm DFI (Danish Food Informatics), online. LanguaLTM – the International Framework for Food Description. Available online: http://www.langual.org/Default.asp PVD (Food and Veterinary Service of Latvia), 2011. MK noteikumi Nr.97 (01.02.2011.) Regulation on classification, quality and labeling requirements for dairy products and composite dairy products. Original title: Noteikumi par klasifikācijas, kvalitātes un marķējuma prasībām piena produktiem un saliktiem piena produktiem. (LV, 19 (4417), 03.02.2011.), Regulation KoM No97. Available online: http://www.likumi.lv/doc.php?id=225278 Wikipedia, online. Curd snack. Available online: http://en.wikipedia.org/wiki/Curd_snack Kārums, online. Curd snack. Available online: http://www.karums.eu/en/products/curd-snacks Volume10, Issue5May 2013432E ReferencesRelatedInformation

Translating land cover/land use classifications to habitat taxonomies for landscape monitoring: a Mediterranean assessment

Periodic monitoring of biodiversity changes at a landscape scale constitutes a key issue for conservation managers. Earth observation (EO) data offer a potential solution, through direct or indirect mapping of species or habitats. Most national and international programs rely on the use of land cover (LC) and/or land use (LU) classification systems. Yet, these are not as clearly relatable to biodiversity in comparison to habitat classifications, and provide less scope for monitoring. While a conversion from LC/LU classification to habitat classification can be of great utility, differences in definitions and criteria have so far limited the establishment of a unified approach for such translation between these two classification systems. Focusing on five Mediterranean NATURA 2000 sites, this paper considers the scope for three of the most commonly used global LC/LU taxonomies—CORINE Land Cover, the Food and Agricultural Organisation (FAO) land cover classification system (LCCS) and the International Geosphere-Biosphere Programme to be translated to habitat taxonomies. Through both quantitative and expert knowledge based qualitative analysis of selected taxonomies, FAO-LCCS turns out to be the best candidate to cope with the complexity of habitat description and provides a framework for EO and in situ data integration for habitat mapping, reducing uncertainties and class overlaps and bridging the gap between LC/LU and habitats domains for landscape monitoring—a major issue for conservation. This study also highlights the need to modify the FAO-LCCS hierarchical class description process to permit the addition of attributes based on class-specific expert knowledge to select multi-temporal (seasonal) EO data and improve classification. An application of LC/LU to habitat mapping is provided for a coastal Natura 2000 site with high classification accuracy as a result.

Ethnic differences in drug utilization pattern during pregnancy: a cross-sectional study

Objective: To investigate the differences in exposure to medications in a cohort of multi-ethnic pregnant women.Methods: Six hundred and forty-one pregnant women of Western, Arab/Turkish and “other origins” participated in this cross-sectional study using a questionnaire in a university hospital in Brussels, Belgium. Assessment of the drug safety was done using the food and drug administration (FDA) risk classification system. Data analysis was performed using SPSS (Chicago, IL).Results: In overall cohort, 83.8% used at least one preparation (including multivitamins) during pregnancy and 37.0% of women used at least one drug (excluding multivitamins). Significantly more Western women (43.7%) used one or more medications compared to Arab/Turkish women (28.7%; p = 0.000). This difference in exposure was most pronounced for over-the-counter (OTC) drugs for occasional and pregnancy-related complaints, and was observed for potentially unsafe drugs or drugs with unknown safety. None of the women reported use of FDA X category drugs.Conclusions: The use of drugs known to be harmful was not observed, but a higher prevalence of exposure to potentially harmful drugs (FDA C/D) was found among Western women who also consumed more OTC drugs. This highlights the need for cautious prescribing for women in the fertile age in general and for continuous monitoring of medication use during pregnancy.

Predictors of positive outcomes of a school food provision policy in Australia

This study identified predictors of parents' and school principals' perceptions of the impact of a Western Australian school food policy. An initial qualitative phase involving focus groups with parents and interviews with school principals, teachers, canteen managers and Parents & Citizens Committee members provided general feedback on the policy and identified various factors that appeared to be related to its successful implementation. In the following quantitative phase of the study, 1200 parents responded to a telephone questionnaire and 310 principals responded to an internet-based questionnaire. The primary outcome variables were, respectively, the extent to which parents reported that their children's diets were healthier as a result of the policy, and the extent to which principals reported that their schools complied with the policy. Logistic regression models were generated for the parent and principal samples. Those parents reporting that their children's diets were healthier were more likely to agree that the policy reflected their beliefs and their children's dietary needs and preferences, that their child talked about the traffic light food classification system and that this system influenced their food choices in the supermarket. Those principals reporting full compliance with the policy were more likely to agree that implementing the policy was not overly difficult. Specific factors facilitating school compliance were canteen manager training and conducive kitchen setup. Provision of appropriate information and training prior to implementation may assist schools in implementing new food policies, thereby enhancing their impact beyond the school environment.

Finer resolution observation and monitoring of global land cover: first mapping results with Landsat TM and ETM+ data

We have produced the first 30 m resolution global land-cover maps using Landsat Thematic Mapper (TM) and Enhanced Thematic Mapper Plus (ETM+) data. We have classified over 6600 scenes of Landsat TM data after 2006, and over 2300 scenes of Landsat TM and ETM+ data before 2006, all selected from the green season. These images cover most of the world's land surface except Antarctica and Greenland. Most of these images came from the United States Geological Survey in level L1T (orthorectified). Four classifiers that were freely available were employed, including the conventional maximum likelihood classifier (MLC), J4.8 decision tree classifier, Random Forest (RF) classifier and support vector machine (SVM) classifier. A total of 91,433 training samples were collected by traversing each scene and finding the most representative and homogeneous samples. A total of 38,664 test samples were collected at preset, fixed locations based on a globally systematic unaligned sampling strategy. Two software tools, Global Analyst and Global Mapper developed by extending the functionality of Google Earth, were used in developing the training and test sample databases by referencing the Moderate Resolution Imaging Spectroradiometer enhanced vegetation index (MODIS EVI) time series for 2010 and high resolution images from Google Earth. A unique land-cover classification system was developed that can be crosswalked to the existing United Nations Food and Agriculture Organization (FAO) land-cover classification system as well as the International Geosphere-Biosphere Programme (IGBP) system. Using the four classification algorithms, we obtained the initial set of global land-cover maps. The SVM produced the highest overall classification accuracy (OCA) of 64.9% assessed with our test samples, with RF (59.8%), J4.8 (57.9%), and MLC (53.9%) ranked from the second to the fourth. We also estimated the OCAs using a subset of our test samples (8629) each of which represented a homogeneous area greater than 500 m × 500 m. Using this subset, we found the OCA for the SVM to be 71.5%. As a consistent source for estimating the coverage of global land-cover types in the world, estimation from the test samples shows that only 6.90% of the world is planted for agricultural production. The total area of cropland is 11.51% if unplanted croplands are included. The forests, grasslands, and shrublands cover 28.35%, 13.37%, and 11.49% of the world, respectively. The impervious surface covers only 0.66% of the world. Inland waterbodies, barren lands, and snow and ice cover 3.56%, 16.51%, and 12.81% of the world, respectively.

Evaluating food menus from daycare centers in Guatemala City: Descriptive and analytical approaches

ObjectiveThis objective of this study was a methodological analysis of the variety and diversity of dietary items and their different origins offered in institutional menus across four daycare centers serving low-income families in Guatemala City. MethodsFoods, as served in daycare centers, were used to explore and illustrate the different approaches to evaluating food quality. Foods served at daycare centers were analyzed for variety (number of different items) and diversity (using three food-classification systems). The weight and energy contributions for each meal were reported for animal, plant, mixed, or water; modern versus traditional foods; fortified versus non-fortified foods; and processed versus unprocessed foods. ResultsDuring 5 d of observation, three of the four daycare centers served 100% of the food groups of the current Guatemalan and international classification systems. In addition, the results showed the four daycare centers provided mainly traditional and non-fortified plant-based foods. However, although the traditional foods contributed more by weight, the modern foods contributed more energy. These findings showed that the “modern” foods served at daycare centers are energy dense compared with traditional foods. ConclusionsThese daycare centers contributed to variety and diversity while serving mainly traditional, plant-based foods. Our analysis went beyond the simple existence (mention) of a food as consumed to weight in grams or calories to provide potentially new and useful perspectives for understanding how guidelines for healthful eating patterns can be promoted and assessed, not only in children or in institutions but across all age groups, and settings.

Drug use before and during pregnancy in Serbia

Observation of drug use patterns during pregnancy is necessary for the recognition of potential bad practices and improvement of safe drug use in pregnancy. To investigate prescription and over the counter drug use among Serbian women in the 6 months before pregnancy and in the first 6 months of pregnancy, and to evaluate the drugs used according to the risk to a fetus. Setting Six maternity care units and five community pharmacies. A multi-center study was performed in Serbia during the period from March 2009-March 2010. A self-reporting questionnaire was used as a data source. Food and Drug Administration (FDA) risk classification system was used to determine the risk of used drugs for the fetus. Differences between subgroups were assessed using McNemar's test on paired proportions. Main outcome measure Proportion of women exposed to drugs or class of drugs. The overall drug exposure was higher in pregnancy (34.7 %) than before pregnancy (29.9 %), p > 0.05, in the cohort of 311 pregnant women. A significantly greater prescription drug use, 19.0 versus 27.3 % of women, p < 0.05, and less selfmedication with over the counter drugs in pregnancy, 15.1 versus 8.7 %, p < 0.05, were observed. Commonly used drugs were musculoskeletal drugs, analgesics/antipyretics and respiratory system drugs before pregnancy (13.8, 12.5, and 6.4 % of women, respectively), and progestogens, analgesics/antipyretics, and antibiotics for the systemic use in pregnancy (9.0, 7.7, and 7.4 %, respectively). A greater exposure to drugs belonging to the FDA risk category A (3.9 vs. 60.8 %, p < 0.05), B (18.0 vs. 19.6 %, p > 0.05), C (10.0 vs. 10.3 %, p > 0.05) and D (2.9 vs. 10.9 %, p < 0.05), as well as less exposure to drugs belonging to category X (0.3 vs. 0 %, p > 0.05) were observed in pregnancy. Folic acid was used by 60.8 % of women in pregnancy, and by only 3.9 % before pregnancy. Besides higher overall drug use in pregnancy than before pregnancy, particularly the use of progestogens, and, subsequently, D category drugs, less selfmedication with over the counter drugs was observed in pregnancy. Insufficient use of folic acid before pregnancy requires public health service activities.

Influence of environmental factors on the spatial distribution and diversity of forest soil in Latvia

This study was carried out to determine the spatial relationships between environmental factors (Quaternary deposits, topographical situation, land cover, forest site types, tree species, soil texture) and soil groups, and their prefix qualifiers (according to the international Food and Agricultural Organization soil classification system World Reference Base for Soil Resources (FAO WRB)). The results show that it is possible to establish relationships between the distribution of environmental factors and soil groups by applying the generalized linear models in data statistical analysis, using the R 2.11.1 software for processing data from 113 sampling plots throughout the forest territory of Latvia. A very high diversity of soil groups in a relatively similar geological structure was revealed. For various reasons there is not always close relationship between the soil group, their prefix qualifiers and Quaternary deposits, as well as between forest site types, the dominant tree species and specific soil group and its prefix qualifiers. Close correlation was established between Quaternary deposits, forest site types, dominant tree species and soil groups within nutrient-poor sediments and very rich deposits containing free carbonates. No significant relationship was detected between the CORINE Land Cover 2005 classes, topographical situation and soil group.

Report on the development of a Food Classification and Description System for exposure assessment and guidance on its implementation and use

Report on the development of a Food Classification and Description System for exposure assessment and guidance on its implementation and use

The food classification and description system FoodEx 2 (draft‐revision 1)

The food classification and description system FoodEx 2 (draft‐revision 1)

Traffic light food labelling in schools and beyond

Objective: The present study investigated stakeholders’ reactions to the introduction of a traffic light food classification system in primary and secondary school canteens. Design: Interviews and focus groups were conducted with stakeholders approximately 18 months after the introduction of the traffic light system, followed by telephone and web-based surveys. Setting: The context of the study was Western Australia, where a comprehensive healthy food policy was recently introduced in government schools. Method: Stakeholder groups included parents, principals, teachers, canteen managers, and representatives of parents and citizens committees. Results: Participants reported high levels of acceptance of the traffic light system and supported its extension to nutrition education programmes targeting children and parents. Conclusion: The results suggest that there is likely to be considerable support for an extension of the traffic light policy to the health curriculum in schools and into other food provision contexts.

Patterns of medication use during pregnancy in rheumatoid arthritis

To characterize therapies prescribed during pregnancy to women with rheumatoid arthritis (RA). We conducted a cohort study of women with RA with pregnancies using health care utilization data from 2002-2008. We examined the distribution of RA drugs by therapeutic classes, including nonsteroidal antiinflammatory drugs (NSAIDs)/coxibs, glucocorticoids, nonbiologic disease-modifying antirheumatic drugs (DMARDs), and biologic DMARDs, during 90-day pregnancy trimesters and the 180 days prior to pregnancy. Drugs were characterized according to the Food and Drug Administration risk classification system. Differences in exposure by period were determined by chi-square tests. A total of 393 pregnancies were identified among 34,169 women with RA. Seventy-two percent of pregnancies ended in a delivery. Approximately 24% of women with RA received a DMARD during preconception. At any point during pregnancy, 23% of women with deliveries were dispensed ≥1 DMARD and the proportion of use declined from the first to the third trimester (P = 0.03). Similar to DMARD therapy, use of NSAIDs/coxibs and exposure to category D/X medications were significantly lower compared to prepregnancy use (P < 0.05). In contrast, more women were prescribed glucocorticoids during pregnancy than before pregnancy. Use of biologics occurred in 12.5% of pregnancies. Compared to women with deliveries, women who experienced abortions were more frequently exposed to NSAIDs/coxibs (P < 0.05). Dispensing of category D/X medications was also higher in women with spontaneous abortions and primarily involved methotrexate (P < 0.05). Approximately 24% of women with RA received a DMARD in the 180 days before conception, and the proportion dropped during pregnancy. Glucocorticoid use remained high throughout pregnancy. Our results suggest that continued efforts directed at counseling women and their physicians about the potential risks/benefits of RA therapies during pregnancy are warranted.

Evaluation of the FoodEx, the food classification system applied to the development of the EFSA Comprehensive European Food Consumption Database

The existing food description and classification systems present several drawbacks when assessing exposure to hazardous chemicals. To tackle this issue, the Data Collection and Exposure Unit (DATEX) of the European Food Safety Authority (EFSA) developed a new system called FoodEx. It builds on different food description and classification systems and its main objective is to facilitate the assessment of dietary exposure to hazardous chemicals by allowing accurate matching of the datasets on chemical occurrence and food consumption. At the end of 2008, EFSA started a project aimed at establishing the “EFSA Comprehensive European Food Consumption Database”. FoodEx was used, within this project, to codify all foods and beverages present in the food consumption database provided by 20 Member States and collected from 22 different national dietary surveys. The main objective of this document is to present the outcome of using FoodEx for the harmonised classification of the food consumption data included in the Comprehensive Database. Based on this evaluation, suggestions for improvements of FoodEx are proposed. The present Scientific Report is intended as well to provide input to the Working Group on “Development of a Food Classification and Description System for exposure assessment” for the development of a uniformed food classification and description system. The FoodEx system proved to be user friendly and flexible enough in most situations to interface with national food classification systems. Differences in the classification systems used within the national dietary surveys have been identified. However, findings reported in the present document demonstrate that all data providers were able to classify correctly the large majority of their food items at least at the 2nd level of the FoodEx. A clear recommendation to the above mentioned Working Group is the development of a classification and description system including facets as further descriptors.

Categorizing the Safety of Medications During Pregnancy and Lactation

When physicians and nurses see patients, they must be able to understand and discuss how drugs are labeled with regard to pregnancy and lactation. This article describes the current and proposed U.S. Food and Drug Administration (FDA) classification system for pregnancy and lactation labeling. Using data from animal and human studies, the FDA currently classifies drug safety into five categories; however, there is no current standard FDA classification system to categorize risk for lactation. Because the current labeling category system has been criticized, the FDA has proposed a revision of the system. The proposed change to the labeling system would provide more detailed, comprehensible, and practical information about the use and effects of drugs during pregnancy and lactation.

Antiepileptic drugs: Are women aware of interactions with oral contraceptives and potential teratogenicity?

Women with epilepsy (WWE)'s knowledge of the interaction between antiepileptic drugs (AEDs) and oral contraceptives (OCs) and the potential teratogenicity of AEDs has received limited study. We conducted a cross-sectional questionnaire study (English or Spanish) among young WWE (18-44 years) to assess demographic characteristics, current AED use, and knowledge of AED interactions with OCs and teratogenicity. We used the Food and Drug Administration's classification system to categorize each AED's teratogenic potential. Participants (n=148) had a mean age of 32 years (SD 8); 32% spoke Spanish and described themselves as Hispanic. Among women prescribed a cytochrome p450-inducing AED, 65% were unaware of decreased OC efficacy. Forty percent of those prescribed Category D AEDs were unaware of potential teratogenic effects. WWE have limited knowledge of the potential interaction between AEDs and OCs and the teratogenic effects of AEDs. Educational efforts should highlight the reproductive health effects of AEDs in WWE.

Food group categories used in dietary analysis can misrepresent the amount and type of fat present in foods

AbstractObjective: To determine whether analysis of food intake data using different food group classification systems changes the apparent contribution of defined food groups to total daily fat intake.Design: Three food classification systems were used to assess dietary intake of male omnivore subjects from a food frequency questionnaire.Setting: RMIT University, Melbourne, Australia.Subjects: A total of 78 healthy men aged 20–55 years, divided by meat consumption into moderate meat‐eaters (n = 60) and high meat‐eaters (n = 18).Methods: Dietary intake data were collected as semi‐quantitative food frequency questionnaires and analysed using the NUTTAB 95 database. The contribution of food groups to nutrient intakes was determined using three food classification systems.Results: When red meat was grouped with meat, poultry and game products and dishes, ‘meat’ contributed 19.8% of total fat to a diet typical of an adult Australian man. When lean meat cuts were distinguished from meat products or dishes and fast foods, ‘red meat cuts’ provided only 4.3% of the total fat in this diet, whereas ‘fast foods’ provided 18.7%.Conclusions: Food classification systems have a profound impact on the apparent nutrient content of defined food groups, particularly the fat content attributed to meats. Less precise systems may result in provision of misleading dietary advice. Meats such as lean beef and lamb can be a valuable part of a healthy diet by providing important nutrients, especially iron, zinc and vitamin B12, but relatively little fat.

FROM THE EDITOR

This issue of the Journal represents another landmark development, with the supplementary publication of the abstracts for the 24th National Conference of the Dietitians Association of Australia. The theme of the conference is ‘Food and beyond: exploring frontiers in science and practice’.** Members and subscribers can view the supplement online at http://www.blackwell-synergy.com/loi/ndi. The topics covered in the conference reflect much of the material presented through the Journal, including a plenary session provided by Dr Ruth de Busk, whose Editorial on nutrigenomics in a previous issue of the Journal came to life in her presentation on future dietetics. The Editorial in this issue, provided by Professor Sandra Capra, builds on Professor Capra’s presentation at the conference on the revised nutrient reference values for Australia and New Zealand, with implications for nutrition professionals. Here we are reminded of the challenges faced with defining adequate diets, optimal nutrient intakes and the formulation of food groups. The leading article by McNaughton and the referent research piece by Mann and colleagues both pick up on the impact of decisions that lead to food groups. The logic behind these decisions needs to be made transparent to enable adequate critique of analytical outcomes that use the food group categories. The Mann study draws on dietary methodology, a core element of nutrition and dietetics research. In an analysis funded by Meat and Livestock Australia, the report shows that data from a food frequency questionnaire could produce outcomes showing the impact of red meat consumption on total fat intake to vary from 19.8% to 4.3% depending on how the food classification system was applied. This finding has important implications for practitioners working in both the public health and food industry contexts who need to know how to position their advice on food in a fair, accurate and productive way. Providing effective dietary advice for clinical conditions also requires a strong evidence base. This issue is addressed in the review by Volker and Yunianingtias on the nutritional management of non-alcoholic steatohepatitis, a condition with some association to metabolic syndrome. Although most of the evidence was provided in smaller clinical studies, nutritional therapy was found to be targeted at risk factors. As with metabolic syndrome, diet and exercise intervention appeared to provide benefits, whereas some interesting opportunities with vitamin E and omega-3 fatty acids warranted further exploration. Preventing metabolic syndrome in another population group, recent migrants, would benefit from an understanding of dietary acculturation, the focus of the research by Renzaho and Burns. In a study of 139 Melbourne households, new foods consumed by sub-Saharan migrants were identified as pizza, breakfast cereal and other fast foods, but included new types of vegetables and fruits, and oils (olive and canola). Although concerns about the negative impact of diet acculturation are prudent, there is also room to consider the positives. Breastfeeding mothers are another group that require particular attention from nutritionists, who in turn need to base their advice on a strong evidence base. It is pleasing then to see another systematic review, this time from Giglia and Binns on alcohol and lactation. With a focus on alcohol effects on lactogenesis as well as effects on the infant, the authors conclude that the use of alcohol in this context needs to be prudent, putting limits of only one to two standards drinks after breastfeeding. How parents gain information on diet and nutrition is the focus of the final paper, an insight report from Steinbeck and Owaimrin. Here the focus is on weight management using the Internet. The authors conclude that there appears to be a paucity of accessible information related to childhood weight management. In keeping with the theme of a strong evidence base for practice, the authors also suggest that websites include clinically approved management guidelines and confirm to e-health codes of ethical practice. The June issue of the Journal also includes book reviews on some very interesting new offerings, and an update on articles of interest reported in the nutrition science literature. The continuing education section by Patch, covering consumer behaviour, is something different and relevant to all walks of practice. Combined with the conference supplement, I trust you enjoy the mid-year treat.

Use of prescription medications with a potential for fetal harm among pregnant women

To estimate the prevalence of use of prescription drugs with a potential for fetal harm among pregnant women in the United States. A retrospective study was conducted using the automated databases of eight health maintenance organizations involved in the HMO Research Network Center for Education and Research on Therapeutics (CERT). Women who delivered an infant from January 1996 to December 2000 were identified. The frequency of use of prescription drugs with a potential for fetal harm was based upon the expert review of a clinical teratologist and the U.S. Food and Drug Administration (FDA) risk classification system, assuming a gestational duration of 270 days. Among the 114 165 women with no documentation of a diagnosis suggesting potential pre-term birth or dispensing of ovulation stimulants in the 270 days before delivery, 1305 (1.1%) received a teratogenic drug during the 270 days before delivery, based upon the expert review of a clinical teratologist. A larger proportion of women received U.S. FDA category D or X drugs (5.8%; N = 6600). However, the general patterns of use were similar, with higher use in early pregnancy compared to later trimesters. The proportion of women dispensed a teratogen during pregnancy was substantially higher among women who received a teratogen in the 90 days before pregnancy compared to women who did not (adjusted RR = 38.9, 95%CI, 33.5, 45.3). Our results suggest that further efforts directed at physicians to counsel women or at the women themselves about the potential risks of particular medications appear warranted.

Prescription drug use in pregnancy

ObjectiveThe purpose of this study was to provide information on the prevalence of the use of prescription drugs among pregnant women in the United States. Study designA retrospective study was conducted with the use of the automated databases of 8 health maintenance organizations that are involved in the Health Maintenance Research Network Center for Education and Research on Therapeutics. Women who delivered of an infant in a hospital from January 1, 1996, through December 31, 2000, were identified. Prescription drug use according to therapeutic class and the United States Food and Drug Administration risk classification system was evaluated, with the assumption of a gestational duration of 270 days, with three 90-day trimesters of pregnancy, and with a 90-day period before pregnancy. Nonprescription drug use was not assessed. ResultsDuring the period 1996 through 2000, 152,531 deliveries were identified that met the criteria for study. For 98,182 deliveries (64%), a drug other than a vitamin or mineral supplement was prescribed in the 270 days before delivery: 3595 women (2.4%) received a drug from category A; 76,292 women (50.0%) received a drug from category B; 57,604 women (37.8%) received a drug from category C; 7333 women (4.8%) received a drug from category D, and 6976 women (4.6%) received a drug from category X of the United States Food and Drug Administration risk classification system. Overall, 5157 women (3.4%) received a category D drug, and 1653 women (1.1%) received a category X drug after the initial prenatal care visit. ConclusionOur finding that almost one half of all pregnant women received prescription drugs from categories C, D, or X of the United States Food and Drug Administration risk classification system highlights the importance of the need to understand the effects of these medications on the developing fetus and on the pregnant woman.