• Diet Quality Among Pregnant Women Associated with Food Supplementation from the Women, Infants, and Children Program

      Zvenyach, Tracy; Regan, Mary J. (2018)
      Background: Dietary intake is known to influence human metabolism in ways that can affect health. The Special Supplemental Women, Infants, and Children program (WIC) is a population-based program aimed at improving nutrition and reducing health disparities among pregnant women and children. There is a paucity of research about diet quality in WIC that could optimize maternal and child health outcomes. Purpose: The purpose of this study was to describe diet quality of pregnant women receiving WIC food supplementation and estimate how much WIC food components contribute to quality of the diet. Methods: The study population was drawn from a large federally funded study examining the influence of diet on the vaginal microbiota and preterm birth (Birth, Eating and the Microbiota Study-BEAM: NR014826). A sub-group of 63 women enrolled in the WIC program formed the cohort for this study. An image-based dietary intake method called FoodFotoTM was used to capture nutritional intake. Diet quality was estimated using the healthy eating index (HEI-2010) representing conformance to Dietary Guidelines for Americans. Three-digit food codes aligned to the Food and Nutrient Database for Dietary Studies were used to quantify the density of WIC approved foods in participants diets. Results: The HEI scores for the sample ranged from 32.2 -71.3 (x50.8, SD=9.7). Food components scores for total vegetables, greens and beans, dairy, seafood plant protein and fatty acid ratio exceeded the 50th percentile. Inversely, low scores for sodium and refined grain scores demonstrated high consumption. Regression analysis showed that for every 1% increase in the proportion of WIC approved foods in the diet there was a corresponding increase of 0.65 points to the total HEI score (t=.6.86 (1, 61), P=.001). Conclusions: The mean HEI score for this study was consistent with other studies. The study findings support the hypothesis that the WIC food supplement significantly improves diet quality among the pregnant women enrolled in the program.
    • Substance Use Disorders during Pregnancy: Comprehensive Care and Predictors of Delivery Outcomes

      Seger, Celeste Marie; Storr, Carla L. (2019)
      Introduction: Illicit substance use is increasing among pregnant women seeking treatment for substance use disorders. Resources are scarce for this vulnerable population in terms of addressing their complex needs. Comprehensive care programs offering perinatal care services and substance abuse treatment in a single location have been found to favorably treat pregnant clients and positively affect neonatal and maternal delivery outcomes. Purpose: To review comprehensive care program studies, evaluate research quality, and examine outcome criteria. Also, to examine the impact of pregnant women’s comprehensive care attendance and pre-treatment psychiatric severity on neonatal and maternal delivery outcomes. Methods: A systematic literature review was conducted on treatment programs offering a so called “one-stop” comprehensive care approach. A secondary analysis study was employed to examine the effects of treatment attendance on neonatal and maternal delivery outcomes for pregnant women with substance use disorders receiving comprehensive care. A subsequent secondary analysis study was completed to determine the relationship between pre-treatment psychiatric severity and delivery outcomes for pregnant clients with substance use disorders in a comprehensive program. Results: The literature review identified thirteen comprehensive care studies, most of which used an observational design. Overall study quality was assessed as moderate for reporting and strength of evidence. Outcome criteria measures often included neonatal parameters such as weight, estimated gestation age, neonatal abstinence syndrome, and hospital length of stay, and maternal delivery outcomes frequently included urine toxicology screens on delivery and hospital length of stay. The first data analysis indicated comprehensive care attendance was favorably related to most neonatal and maternal delivery outcomes. The second data analysis showed similar neonatal and maternal outcomes regardless of psychiatric severity grouping, suggesting comprehensive care as an effective treatment for those with high levels of psychiatric symptomology. Conclusion: Results across all three manuscripts illustrate comprehensive care models as a favorable treatment approach for pregnant women with substance use disorders.
    • Temporal Dynamics of Gastrointestinal Microbiota during Pregnancy

      Chung, SeonYoon; Regan, Mary J. (2016)
      Background: Research about the gastrointestinal (GI) microbiota has demonstrated that it plays a crucial role in maintaining human physiologic homeostasis. In particular, it regulates inflammatory pathways, glucose and energy metabolism, and vitamin production that have significant relevance during pregnancy. Purpose: To characterize the structure of GI microbiota during pregnancy and changes that occur over time. Methods: This study expanded the scope of a large prospective longitudinal study looking at the influence of diet on vaginal microbiota during pregnancy and preterm birth (Birth, Eating and the Microbiota - BEAM, R01-NR014826). A subset of 20 women from the parent study was included in the sample and stool was collected monthly from 20 weeks gestation to birth. The specimens were analyzed using culture-independent molecular sequencing-based techniques following 16SrRNA gene polymerase chain reaction amplification. Descriptive analytics and advanced statistical modeling techniques were used to characterize the structure and the temporal dynamics of the GI microbiota during pregnancy. Results: Three enterotypes were identified at all taxonomic ranks. Members of Firmicutes were dominant at all levels. Enterotypes changed at each time point within subjects, forming 17 temporal enterotype profiles that classified into three enterotypes categories. Significant associations were identified between race, body mass index, fiber, iron, fat, protein, carbohydrate and sweets in the diet and specific GI microbiota. The associations were more pronounced at lower taxonomic ranks. Discussion: The findings of the study are important because they identify specific relationships between the microbial composition of the GI microbiota and factors such as body mass index and diet quality that are known factors implicated in adverse pregnancy outcomes. More research using a larger sample size is needed to verify these findings.
    • Utility of a Nutrition Education Web Site to Supplement Prenatal Care

      Wierwille, Lauren (2011)
      Objective: Prenatal nutrition education is lacking in the clinic during routine prenatal care due to a myriad of barriers including decline in provider knowledge, time limitations during visits, and insurance constraints for dietician and nutritionist referrals. Online resources are an effective way to reduce such barriers to prenatal education by providing a flexible and available source of information. The purpose of this evidence translation project was to develop, implement, and evaluate the utility and uptake of a prenatal nutrition education Web site in the University of Maryland Medical System (UMMS) outpatient clinics as a supplement to routine prenatal care. Methods: This project used a single group, post-test only, non-experimental descriptive design to evaluate the utility and uptake of a prenatal nutrition education Web site entitled "Pregnancy Nutrition for Healthy Babies" in the UMMS clinics. Twenty prenatal care clinicians were recruited to participate using convenience sampling. The Diffusion of Innovations (001) theory by Everett Rogers was the foundation for implementing the Web site into the clinics. Data were collected from surveys completed by clinicians after they had incorporated the Web site into their prenatal care practices for approximately one month in order to evaluate their experience with utilizing the site as a supplementary nutrition education tool. Results: The snowball effect occurred and resulted in 19 clinician respondents who completed an anonymous and confidential survey to evaluate the utility of the Web site in the clinic based on five domains of the 001 model. An average of 81 patients were seen per week by the providers, and about 95% of the providers referred more than half of these patients to the Web site. Likewise, approximately 95% of the providers said that more than half of their referred patients engaged in further discussion about nutrition-related topics following the referral. The mean overall utility of the Web site in the clinic was determined to be 4.28 on a 5-point Likert scale. Based on the responses provided, the Web site was perceived to have a relative advantage mean of 4.03, a compatibility mean of 3.71, a complexity mean of 4.05, an observability mean of 3.81, and a trialability mean of 3.95. In totality, 89.5% of clinicians said that the "Prenatal Nutrition for Healthy Babies" Web site was a tool that they would regularly refer their prenatal care patients to for nutrition education, Conclusion: Internet Web sites can be effective tools for increasing prenatal nutrition education as supplements to routine prenatal care. The utility and uptake of a prenatal nutrition education Web site was found to be favorable in the UMMS outpatient clinics. The results were consistent with the evidence for increased utility and uptake of Web-based innovations within organizations when implementation is based on the 001 theory.