Iron status in early life and associations with developmental outcomes

Infants and young children are at particular risk of iron deficiency and its associated consequences for growth and development. The main objectives of this thesis were to quantify iron intakes, status and determinants of status in two year olds; explore determinants of neonatal iron stores; investigate associations between iron status at birth and two years with neurodevelopmental outcomes at two years and explore the influence of growth on iron status in early childhood, using data from the Cork BASELINE (Babies after SCOPE: Evaluating Longitudinal Impact using Neurological and Nutritional Endpoints) Birth Cohort Study (n=2137). Participants were followed prospectively with interviewer-led questionnaires and clinical assessments at day 2 and at 2, 6, 12 and 24 months. At two years, there was a low prevalence of iron deficiency and iron deficiency anaemia in this cohort, representing the largest study of iron status in toddlers in Europe, to date. The increased consumption of iron-fortified products and compliance with recommendations to limit unmodified cows’ milk intakes in toddlers has contributed to the observed improvements in status. Low serum ferritin concentrations at birth, which reflect neonatal iron stores, were shown to track through to two years of age; delivery by Caesarean section, being born small-for-gestational age and maternal obesity and smoking in pregnancy were all associated with significantly lower neonatal iron stores. Despite a low prevalence of iron deficiency in this cohort, both a mean corpuscular volume <74fl and ferritin concentrations <20μg/l were associated with lower neurodevelopmental outcomes at two years. An inverse association between growth in the second year of life and iron status at two years was also observed. This thesis has presented data from one of the largest, extensively-characterised cohorts of young children, to date, to explore iron and its associations with growth and development

Premature labour? A reflexive appraisal of one young teacher’s journey into first time motherhood and her return to teaching.

This Ethnographic/Autoethnographic study reflects in rich detail a young teacher’s life as she navigates the changing landscape of her first pregnancy, the birth of her child and her subsequent return to work as a full-time teacher. Using data which has been collected from a personal journal which she kept throughout the eighteen month period of the study, it examines the practical and emotional challenges which she faced, and the commitment, self-sacrifice and dedication required of her for the continuation and advancement of her career. By combining her data with observed field notes, semi-constructed interviews and reflexive narrative, I have been able to offer a holistic and balanced account of her experience and expose the complexities of motherhood today and the impact they have on a woman’s life choices and professional decision making. My study revealed how this new mother faced a myriad of decisions and dilemmas, decisions, which ultimately impacted on her emotional well-being, and her power and identity as a woman, a wife, a daughter and a professional teacher. Its findings suggest that notwithstanding the historical political and legislative policies which have been implemented, in reality, little has changed since my own experience of being a working mother some thirty years ago. It recommends that if the increase in working mothers is to continue to rise, more must be done, both culturally and institutionally to alleviate the physical and emotional pressures which currently only serve to exacerbate the guilt and stress which appear to be an innate characteristic of the maternal condition. It concludes by recommending that working mothers need to harness “their strengths, their ability to learn, their confidence and joy in their work –[because this is] all part of being a woman now, [it is] part of [their] female identity” (Friedan, 1963, p.331), and rather than accepting motherhood as being a moderating factor, they should allow it to become an influence for further personal and professional growth and liberation, so that they can reassert their power and fight back to assume their equal place in society (Kristeva, 2015)

The neonatal period: a missed opportunity for the prevention of iron deficiency and its associated neurological consequences?

Iron deficiency is the most common micronutrient deficiency worldwide. Iron is essential for the development of multiple organ systems, most especially the developing brain. Iron deficiency, particularly during sensitive periods of brain development, such as in early childhood, is associated with long‐lasting adverse consequences for cognition, motor function and behaviour. Little consideration has been given to iron deficiency in newborn infants and its potential health consequences. Fetal iron accretion is compromised by pregnancy complications such as pre‐term birth and gestational diabetes mellitus, and our work has identified an increased risk of low iron stores at birth from maternal lifestyle factors such as smoking and obesity. Early‐life events, including Caesarean section delivery, further add to the cumulative risk of neonatal iron deficiency, which can persist throughout infancy into early childhood. While investigations into the long‐term neurological consequences of neonatal iron deficiency are limited, there is evidence of poorer memory, motor function and language ability in children born iron deficient. Recently, we also identified significant behavioural consequences of neonatal deficiency persisting from 2 to 5 years of age, with effects particularly apparent in ‘high‐risk’ children born to obese or smoking mothers or delivered by Caesarean section. Interventions targeting the fetal/neonatal period could therefore represent a key opportunity for the prevention of iron deficiency and its associated long‐term health consequences. A dual approach is required, comprising public health strategies targeting prevention, to improve health in women of reproductive age, and the development of screening strategies for the early detection of iron deficiency in newborn infants

Vitamin D and muscle strength throughout the life course: a review of epidemiological and intervention studies.

The putative role of vitamin D in muscle function and strength throughout the life course is of interest because muscle strength is required for engagement in physical activity at all ages. As vitamin D deficiency is widely reported in the population, especially in countries at high latitude, the potential importance of vitamin D in muscle function throughout life, and the potential impacts on growth and development, participation in physical activity, and effects on skeletal and cardio‐metabolic health, comprise an important topic for discussion. This review provides an overview of muscle function and summarises the role of the vitamin D receptor and the proposed molecular mechanisms of action of vitamin D in muscle cells. In addition, the review provides a comprehensive assessment of the clinical evidence surrounding the association between vitamin D and muscle strength. Among adults, particularly older adults, cross‐sectional and cohort studies reported a positive association between vitamin D status and muscle strength. These associations have been largely confirmed by intervention studies. Limited research has been carried out in adolescents and children; two cross‐sectional studies in adolescents have suggested an association between serum 25‐hydroxyvitamin D concentrations and muscle strength. However, the two intervention studies in adolescents have yielded conflicting results. Other than a single observational study, data in young children are very limited and further investigation in under 12‐year‐olds is warranted