THE RELATION BETWEEN MATERNAL VITAMIN D STATUS IN PREGNANCY AND INCIDENCE OF INFECTION IN INFANTS UP TO ONE YEAR OF AGE

Research findings have suggested vitamin D enhances innate immunity in humans. Vitamin D deficiency among pregnant women is common, especially among women of darker skin. Studies have positively correlated newborn cord 25-hydroxyvitamin D (25(OH)D) with maternal serum 25(OH)D concentration during pregnancy. To our knowledge, no studies have addressed the associations between maternal serum 25(OH)D levels during pregnancy and incidence of infection in infants. The aim of this study was to assess the relationship between maternal vitamin D status during pregnancy and incidence of infections in infants during the first six and twelve months of life. The number and type of medically-diagnosed illnesses and infections of 220 infants were collected, and the associations between maternal 25(OH)D concentrations and incidence of illness, total infections, and specific infection types (respiratory; skin; eye, ear, nose and throat (EENT); and others) were examined. Significant negative correlations were found between maternal 25(OH)D concentrations and the incidence of illness (p= 0.022), infection(p=0.033), EENT (p=0.043), and skin infections (p=0.021) during the first six months, but not during the first 12 months. Ethnic differences in this relationship was also examined in infants of African-American (AA) mothers (n=69) and in those who were not African-American (n=151) because we were aware that AA mothers had a higher incidence of vitamin D deficiency (plasma 25(OH)D < 50 nmol/L; 84.1% vs. 37.1%) and lower mean plasma 25(OH)D (35.20 ± 22.74 vs. 63.30 ± 31.96 nmol/L). Infants of AA mothers were more likely than other women to have at least one incidence of any illness (p=0.013) and skin infection (p=0.007) during the first six months of life. In infants of non-AA mothers, significant negative correlations were found between maternal 25(OH)D concentrations and incidences of skin (p=0.025) and EENT (p=0.026) at six months in the first six months of life. The relative risk for being diagnosed with at least one EENT and one skin infection with increasing 25(OH) concentrations trended lower in the first twelve months, but did not reach statistical significance. Results suggest low maternal vitamin D status during pregnancy increases the risk of infection, in particular, the risk of skin and EENT infections in young infants. Few AA women had normal vitamin D status (4.3%), compared to women of other ethnic groups (26.5%), which could be one reason why their infants had more overall illnesses, infections, and skin infections during the first six month of life. Clinical trials to improve maternal vitamin D status during pregnancy could determine if there is a causal relationship between maternal vitamin D status and infant illness from infection, but caution should be taken since high concentrations of maternal 25(OH)D may be a risk factor for infant asthma

A qualitative examination of barriers against effective medical education and practices related to breastfeeding promotion and support in Lebanon.

Background: Insufficient breastfeeding promotion and support by physicians contribute to suboptimal breastfeeding rates globally. Understanding setting-specific barriers against breastfeeding promotion and support from the perspective of medical students and addressing those that can be modified through undergraduate medical education may help improve learning outcomes, medical practice, and ultimately health outcomes associated with breastfeeding.Objectives: We selected the underserved and under-supported public medical school in Lebanon to explore psychosocial, institutional, and societal barriers hindering effective preventative medicine practices using breastfeeding promotion and support as an exemplar case.Methods: One-on-one semi-structured interviews, each lasting around 60 min, were conducted with medical interns (in Med III and Med IV) at their training hospitals. Interviews were voice-recorded, transcribed verbatim, coded, and analyzed thematically based on Theory of Planned Behavior.Results: Interns (n= 49; 96% response rate) completed the study. Five major themes emerged addressing barriers at various levels. At the health care system level at large, interns identified the predominant focus on pathophysiology and treatment rather than on disease prevention and health promotion as a barrier. At the level of trainees and their education experiences, interns reported limited and optional clerkship training in obstetrics/gynecology and in neonatology which contributes to their insufficient knowledge and low self-efficacy. Competing financial interests from infant formula companies and social pressures to promote infant formula were identified as two main barriers at the level of physicians and clinical practice.Conclusions: Our work using breastfeeding as an exemplary case highlights how undergraduate medical education and its learning outcomes and how medical practices and patient behavior are highly intertwined with psychosocial, institutional, and social drivers and constraints. Re-evaluating the success of undergraduate medical curricula in light of overcoming these constraints and not only based on meeting national accreditation and certification guidelines might prove helpful in improving medical education and ultimately clinical practice

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools.

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long-term by targeting children and adolescents' knowledge, attitudes, skills, and intentions. Breastfeeding rates in Lebanon are suboptimal. Psychosocial drivers of breastfeeding intention among the youth are unknown. We administered a survey to 658 high school students (448 females; 210 males) at two large Lebanese schools to understand intentions, intention drivers, and views on SBBE as means to guide SBBE programme design on the basis of the theory of planned behaviour. We collected information on demographics, intention to breastfeed/support wife to breastfeed future. Intention was predicted by attitude related to breastfeeding health outcomes and family normative beliefs-χ2 (25)&nbsp;=&nbsp;115, P&nbsp;&lt;&nbsp;.001 for males, and χ2 (39.3)&nbsp;=&nbsp;186, P&nbsp;&lt;&nbsp;.001 for females. Among females, intention was also positively associated with being breastfed, higher socio-economic status, and being more accepting of public breastfeeding. Seventy-eight per cent of students felt they were not learning enough about breastfeeding in school but were interested in SBBE through didactic teaching methods and interactive experiences. Findings indicate that breastfeeding intention among adolescent students is not merely influenced by the extent of knowledge but by more complicated psychosocial drivers that may differ by gender. Our findings also suggest a misalignment exists between what schools are providing with what students feel they need, thereby opening up a potential space for intervention

Maternal Vitamin D Status and Infant Infection

Maternal vitamin D status during pregnancy may modulate fetal immune system development and infant susceptibility to infections. Vitamin D deficiency is common during pregnancy, particularly among African American (AA) women. Our objective was to compare maternal vitamin D status (plasma 25(OH)D concentration) during pregnancy and first-year infections in the offspring of African American (AA) and non-AA women. We used medical records to record frequency and type of infections during the first year of life of 220 term infants (69 AA, 151 non-AA) whose mothers participated in the Kansas University DHA Outcomes Study. AA and non-AA groups were compared for maternal 25(OH)D by Mann–Whitney U-test. Compared to non-AA women, AA women were more likely to be vitamin D deficient (<50 nmol/L; 84 vs. 37%, p < 0.001), and more of their infants had at least one infection in the first 6 months (78.3% and 59.6% of infants, respectively, p = 0.022). We next explored the relationship between maternal plasma 25(OH)D concentration and infant infections using Spearman correlations. Maternal 25(OH)D concentration was inversely correlated with the number of all infections (p = 0.033), eye, ear, nose, and throat (EENT) infections (p = 0.043), and skin infection (p = 0.021) in the first 6 months. A model that included maternal education, income, and 25(OH)D identified maternal education as the only significant predictor of infection risk in the first 6 months (p = 0.045); however, maternal education, income, and 25(OH)D were all significantly lower in AA women compared to non-AA women . The high degree of correlation between these variables does not allow determination of which factor is driving the risk of infection; however, the one that is most easily remediated is vitamin D status. It would be of value to learn if vitamin D supplementation in this at-risk group could ameliorate at least part of the increased infection riskThis work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (R01 HD047315 [to SC])the Kansas Intellectual and Developmental Disabilities Research Center (P30 HD002528 [to SC and JC]