Journal Articles

Many women experience prenatal anxiety (PA) during pregnancy, which is a sensation of stress and unease that often causes symptoms like rapid heart rate, sweat, tremors, short breath, etc. Sometimes, anxiety never fully disappears after the baby is born. Prenatal anxiety can disrupt the relationship between a parent and their child, which can lead to the children’s anxiety, depression, hyperactivity and aggression. Boys are more likely to be aggressive and hyperactive, while girls are mor likely to be anxious and depressed. However, not many studies have explored how the relationship, specifically the security of attachment between a parent and child, is associated with prenatal anxiety, as well as child behavioral problems. This research focused on two main goals: 1) Examining how the mother’s PA impacts children’s behavioural problems; and 2) Finding out if mother-child attachment quality and the child’s gender, influenced the relationship between PA and the child’s behavioral problems. Findings showed that PA predicted increased behavioural problems in children. It also found that when children were securely attached to their mother, the impact of PA on children’s behaviour diminished. The sex of the children did not affect the association between PA and children’s behaviour. Understanding the factors that contribute to PA can guide supports for pregnant women to prevent children’s behavioural problems. This study also emphasizes the risks of PA, and highlights the importance of developing a secure parent-child attachment, in order to protect the social, emotional and behavioral health of children, especially when mothers are affected by PA.

Bisphenol A (BPA) is a chemical that is commonly used in the production of plastics, such as food packaging and children’s toys. Studies have reported that early exposure to BPA in children is associated with negative health outcomes including anxiety and depression as well as attention problems. However, the effects of BPA on the physical structure of the brain have not been studied. The goal of this APrON study is to investigate the relationship between BPA exposure during pregnancy and early childhood, and children’s brain and behaviour. It is particularly important to understand the health implications of BPA exposure given that children are exposed to this chemical on a daily basis during all stages of development. In this APrON study, parents will complete urine sampling during their second trimester of pregnancy. Once children are between 2-5 years old they will also complete urine sampling as well as non-invasive brain imaging (MRI); a caregiver report of child behaviour, known as the Child Behaviour Checklist (CBCL), will also be completed at the time of child urine sampling.

This study highlights the potential effects of chemical exposure on children’s brain and behaviour; it encourages future studies to build upon this research to provide further information on the impact that these chemicals have on child development. Finally, this project can help educate parents on how to create a safe and healthy environment for their children to thrive and grow.

Citation: Letourneau, N. L., de Koning, A. J., Sekhon, B., Ntanda, H. N., Kobor, M., Deane, A. J., … & APrON Study Team. (2019). Parenting Interacts With Plasticity Genes in Predicting Behavioral Outcomes in Preschoolers. Canadian Journal of Nursing Research, 0844562119863612. doi: https://journals.sagepub.com/doi/abs/10.1177/0844562119863612

Summary: This paper provides a deep understanding of genetics and how nature and nurture work together to influence human development. Specifically, the paper explores the interaction between parent-child interaction quality and children’s genotype in predicting children’s behavioural problems. Existing research supports the notion that interactions between early exposures to stress in parenting and child genotype predicts children’s behavioral problems. Certain genotypes hint at greater differential susceptibility or plasticity to environmental stressors. Therefore, this paper uncovers the interaction between maternal–child relationship qualities (specifically, sensitivity, controlling, and unresponsiveness) and genotype in 6-month- old infants, in predicting behavioral problems when children are 24 months of age. Problems under study include internalizing (e.g. anxiety and depression) and externalizing (e.g. hyperactivity, inattention, aggression) behaviors. The authors tested the assumption that individual genotype “allelic variants” would interact with parent–child relationship quality in a differentially susceptible manner to predict behavioral outcomes. Findings show children’s genotype interacts with parenting qualities of controlling and responsiveness in parent-child interactions in predicting internalizing and externalizing behavioral problems in children. For externalizing behaviors such as aggression and inattention, children who possessed the CNR1-A plasticity allele and experienced higher caregiver controlling behavior displayed significantly more externalizing behavior, while other children who possessed the CNRI-A plasticity allele and experienced lower caregiver controlling behavior displayed significantly fewer externalizing behaviors, in a differentially susceptible manner. To summarize, parents who are emotionally engaged and supportive of their children during infancy and early life may prevent behavioral problems in their children.

Thyroid hormones are essential for proper growth and brain development of unborn children during pregnancy. During the early stages of pregnancy, the mother provides all needed thyroid hormones until the fetus develops the capability to produce hormones independently. Perfluoroalkyl acids (PFAAs) are a class of chemicals used in everyday products such as non-stick cookware, microwave popcorn bags and food take-out containers. PFAAs are often referred to as “forever chemicals” due to their resistance to breaking down in the environment. Their constant presence means we are continually exposed to these chemicals which leads to their accumulation in our blood. Studies have shown that exposure to PFAAs disrupts thyroid hormones, which are vital to normal growth and brain development of the fetus, especially during early pregnancy. This APrON study investigated the impact of exposure to PFAAs on thyroid hormone levels among Canadian mothers throughout pregnancy. Our findings were in agreement with previous studies that found specific PFAAs to influence a mothers thyroid hormones during pregnancy. However, unlike past studies that only took one sample from each mother to represent the entire pregnancy, our work considered these effects at each trimester of by taking samples throughout. By observing each trimester we identified that mothers were most vulnerable to PFAA exposure during the early stages pregnancy. This was a concerning finding given that during the first trimester the fetus is entirely reliant on the mothers thyroid hormone supply. We also found that external stressors, such as the presence of mercury in the blood, may modify or exacerbate effects from PFAAs. Our findings will help influence government regulation of chemical manufacturers to ensure the safest exposure levels of PFAAs for all Canadians. The APrON group may use these findings to educate vulnerable mothers and families about the importance of thyroid hormones for normal brain development and to provide guidance to mothers with pre-existing thyroid conditions on avoiding excessive exposure to PFAAs and other interacting chemicals that may be pose a danger during pregnancy.

The goal of this study is to learn if partner social support during pregnancy relates to the inflammatory markers in 3 month old infants. Partner support was measured through surveys that were given to the mothers during pregnancy and 3 months after birth. To measure the amount of these markers in infants, blood was drawn when they were 3 months old. Partners giving ambivalent support to the mother results in a greater amount of the markers in infants. This type of support is defined as help that causes distress for the mother. It should be noted that helpful support was not related to the markers. On the other hand, support that resulted in distress caused a higher rate of a certain marker. This shows that helpful support have a lesser affect on health and well being than vexing support.

The diet of a woman often changes with pregnancy. A good diet will improve the growth of the fetus. This means eating enough vitamins, minerals, and calories. Health Canada has suggested what foods women need to eat to help them meet demands when pregnant. This study asked women why they changed their diets while pregnant. It also wanted to see which changes these women made that helped them eat more healthy foods. It was found that women usually made around 6 changes to their diets. Women usually increased the amount of vegetables, fruits, grains, and milk/alternatives they ate. Women usually decreased the amount of meaty foods they ate. About 25 % of the women increased the amount of sweet foods and beverages they had. Women pregnant for the first time changed their diet more than those who had been pregnant before. The main reasons women eliminated foods were for the baby’s health, nausea, concern, and aversions. The main reasons women increased or added foods were due to cravings, health, enjoyment, to decrease illness, and nutrition. This showed that women were choosing to not eat foods that could be bad for the baby’s growth. It also shows that some nutrients were not taken enough with the diets chosen. Doctors need to tell families and pregnant women about the importance of having diets with lots of nutrients to help the baby’s growth.

The objectives of this study were to:

Upon enrolment into APrON (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed “in the 12 months prior to pregnancy”. Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis.

This study adds to the growing evidence that preconception diet and lifestyle is crucial for the optimal health of the mother, and possibly her offspring, and needs to be the focus for future health interventions. Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension.

Researchers require informed consent from participants before a study can begin; participants must be told what they will be doing throughout the study, and how the information collected during their participation will be used. Studies like the APrON study often follow participants for years and yield a large amount of data that is useful after the original study is completed. In this study, researchers asked parents of participants of previous longitudinal studies if and how they would like their consent to be obtained to include their child’s unidentifiable, non-biological results in future research projects. The study results show most participants supported an all-in-one consent process. Parents preferred to give consent one time, during the original consent process they would confirm whether their child’s dataset is to be used for possible future studies. Furthermore, parents agree that when the child participant is approximately 12 years old, parents should inform their child that their data is included in a database and may be used again for a different research question. Parents also stated their child should be at least 18 years old before allowing them to decide whether their data would be used in future research.

Magnetic resonance imaging (MRI) is a powerful tool for studying the brain, and for diagnosing disease. However, it requires individuals to stay still for a period of time, something that can be difficult for young children. Sometimes, research centres or hospitals will train children ahead of time on a mock MRI scanner to help improve the likelihood of success.

In this study, we compared scan success (whether a child provided images) and quality (how good the images were) in children aged 2-5 years, based on whether they had mock MRI training prior to scanning. We also examined whether age, sex, and cognitive and behavioural scores predicted success or scan quality. We found no differences in scan success between participants who received mock MRI training and those who didn’t, but some MRI images of participants who underwent training were better in quality. Children with successful scans had better language and cognitive scores than the unsuccessful group. Age, sex, and behavioural scores were not associated with scan success.

Our study suggests that cognitive scores predict MRI success for young children, and that mock MRI training may improve scan quality. More research is needed to determine the extent to which mock scanner training helps, and which children would benefit the most from it.

Infants who do not have enough vitamin D (VIT D) are at risk of poor bone health. Breast milk can be a crucial source of VIT D for infants who are fully or partly breastfed. VIT D content in a mother’s breast milk also depends on the VIT D in her diet. Many mothers and infants around the world do not have enough VIT D in their body, despite reporting intakes that do meet current recommendations. There have been studies on VIT D supplements for either the mother or the infant, but not for both. This study aimed to find out if both the mother and her infant need a VIT D supplement during breastfeeding. This study surveyed a group of mothers in Alberta on their diets, and then measured the VIT D levels in their infants through blood samples. The study found that 90% of the mothers reported providing daily VIT D supplements to their infants, still 25% of the infants did not have enough VIT D in their bodies. The study concluded both the infant and their breastfeeding mothers need a VIT D supplement to ensure adequate vit D for infants.

Previous research has shown that non-pregnant women with inflammatory bowel disease (IBD) were more prone to vitamin D insufficiency than the general population. Furthermore, vitamin D has shown to be associated with pregnancy-related health issues. With the objective of improving the care of pregnant women with IBD, the authors of this research study compared the vitamin D status of pregnant women with and without IBD. Women who were in their second or third trimesters were included in this cross-sectional study (n = 574). Women without IBD were identified from a subset of maternal APrON participants residing in Calgary (2009 – 2010) and women with IBD were identified from the research registry of the IBD Pregnancy Clinic at the University of Calgary (2012 – 2016). Clinical characteristics, presence of vitamin D supplementation, and risk factors for vitamin D insufficiency were obtained from chart reviews and self-reported questionnaires. Pregnant women with IBD were three times the risk of being vitamin D insufficient than pregnant women without IBD, even after taking women’s ethnicity and season of the year into account. While Health Canada recommends a minimum of 400 international units (IU)/day vitamin D supplementation, women with IBD are considered at increased risk of insufficiency and are recommended to take 2000 IU/day. The majority of pregnant women with IBD did not take 2000 IU/day and of those who did, 23% with Crohn’s disease and 45% with ulcerative colitis remained vitamin D insufficient. Overall, this study implies that the existing routine recommended daily vitamin D supplementation for pregnant women may be insufficient for women with IBD. This study led to the development of an algorithm utilizing higher doses of vitamin D supplementation in pregnant women with IBD.

An overwhelming number of pregnant and lactating women in Alberta are not meeting the recommended intake of specific omega-3 fatty acids vital to their babies’ development and to their own health, according to new AFNS research.

In a study of 600 pregnant women in Edmonton and Calgary, only 27 per cent were meeting the International Society for the Study of Fatty Acids and Lipids’ recommended minimum of 200 mg per day of DHA (docosahexaenoic acid) during pregnancy. By three months postpartum, that had dropped to 25 per cent.

DHA is the major omega-3 fatty acid required during pregnancy for fetal and placental development, and is critical for infant brain development and other growth in every cell of the body. After a baby’s birth, DHA, along with two other fatty acids (known collectively as omega-3 LCPUFA) also helps babies’ health, particularly their neuro-cognitive development.

“DHA is also important to a mother’s health,” said Catherine Field, lead researcher on the study and a professor of nutrition in the Department of Agricultural, Food and Nutritional Science. “Low levels in the body have been associated with depression.”

The recommended intake of DHA during pregnancy could be met by consuming one to two portions per week of fish that are high in omega-3 fatty acids. Health Canada cites the best sources as salmon, tuna, herring and trout, and provides information on safe sources on its website.

Taking supplements also significantly improved the likelihood pregnant women would meet the recommended amounts, according to the study, which uses the large Alberta based maternal-infant birth cohort called Alberta Pregnancy Outcomes and Nutrition (APrON).

“Women who took a supplement containing DHA were 10.6 and 11.1 times more likely to meet the current EU consensus for pregnancy and postpartum respectively,” said the study. However, 44 per cent of women in the study who reported taking a supplement during pregnancy were no longer doing so at three months postpartum, which led researchers to suggest that nutritional counselling about the benefits of a supplement should extend beyond pregnancy.

Probiotics are products that can modify the tiny organisms in our digestive system, and they may be beneficial for some people. Many scientists are studying probiotics, so we wondered how much our APrON mothers knew about probiotics and their uses for themselves and their babies. Dr. Anita Kozyrskyj and her team of scientists at the University of Alberta in Edmonton asked if they could study this question with APrON.

Findings: APrON mothers with a child aged two years or younger were invited to complete a 29 item questionnaire, and 413 mothers did so. The majority (99.3%) of them had heard of probiotics and were aware that they contained live bacteria (87.0%); 89.3% had used a product containing probiotics themselves but only 50.3% had given one to their infant. Most mothers said they believed that probiotics were beneficial (73.1%) and none thought they were harmful. Over a third of mothers did not feel informed enough to make a decision on whether probiotics were safe to use in infants (36.6%).

Comment: The study demonstrated that awareness and understanding of probiotics is high among mothers in Alberta. However, there is still uncertainty regarding the benefit and safety of probiotics in infants. Further studies that demonstrate beneficial effects and safety of probiotics in healthy infants should help to answer their questions.

Folate, vitamin B12, and vitamin B6 are essential for a healthy pregnancy. Yet, recent studies found a deficiency of vitamin B12 and B6 in pregnant women with high folate levels. These deficiencies may negatively affect fetal health. The goal of our study was to examine how folate levels affect vitamin B12 and B6. We also examined the relationship between folate levels and folate supplementation. 599 pregnant women participated in the study. They were assessed once during each trimester (every 3 months) of their pregnancy. Medical history was gathered during the first visit. Information about folate intake and supplementation was assessed using questionnaires. Blood samples were taken at each visit to measure levels of folate, vitamin B12 and B6. 36% of participants reported taking a folate supplement in the year before pregnancy. However, folate deficiency was only noted in 3% of participants. In the first trimester, 24% of women had folate levels which were lower than recommended. This number fell to 9% and 7% in the following trimesters. About half of the women had higher than normal folate levels in each trimester. The upper limit for folate supplementation is defined as 1000 micrograms per day. Folate levels were much higher in women who took more than, compared to less than this limit. We also found that less than 1% of the participants were deficient in vitamin B12 and B6. Overall, we found no evidence of folate causing vitamin B12 and B6 deficiencies. Participants were generally healthy with a low risk for nutritional deficiencies. Because of this, supplementation with folic acid above what is recommended by Health Canada during pregnancy may not be appropriate. Further studies are needed to explore the risks of high and low folate levels in pregnancy.

Giesbrecht and Dewey’s (2014) study explored the effects of “does not apply” responses on the Infant Behaviour Questionnaire (IBQ). The IBQ was made to study differences in infant behaviour that can be watched and described by parents. In this study, parents completed a short version of the IBQ (91 questions) when their children were at 3 and 6 months of age.

They found that there were more “does not apply” responses with 3-month olds (22%) compared to 6-month olds (7%). This hints that parents found there were questions that did not apply and were not fitting to ask very young infants. These questions were usually related to the baby’s ability to be aware of things around them. “Does not apply” responses cannot be completely avoided, but researchers should be careful when explaining results received from infants at 3 months of age.

The purpose of this article was to describe the reasons for establishing the APrON cohort and the methods that we used. The rationale is based on lots of previous scientific studies on three topics: that nutrition affects mood, that some nutrients might affect the events that happen around birth, and that prenatal nutrition might also have a significant influence on how a baby’s brain develops. Because of those earlier studies, we decided to build the APrON cohort but to do a much better job of evaluating prenatal nutrition than had been done in the past. For instance, most studies asked women about what they ate on only one occasion during pregnancy. We decided to ask women every trimester and once postpartum, and also to ask them for blood samples so that we could evaluate various nutrient levels. To cover the three areas mentioned (maternal mood, birth outcomes, and infant brain development), we had to select measures that other scientists would accept. In summary, this paper reviews the literature on those three areas of maternal mood, birth outcomes and infant neurodevelopment, and presents the measures and other details of methodology.

Many people believe that a pregnant woman’s body becomes less responsive to stress as her pregnancy progresses. This reduction of her biological response to stress is thought to protect mother and fetus from exposure to too much cortisol. There is little scientific evidence, however, to support this idea. The aim of this study was to determine whether stress has different effects on a pregnant woman’s stress response at different points in pregnancy. We examined the everyday experiences of 82 women by assessing their stress and cortisol 5 times daily for 2 days in each trimester of pregnancy and found that the association between stress and cortisol was not, in fact, weakened across the course of pregnancy. The findings do not support the claim that mother and fetus are protected from the effects of stress at the end of pregnancy. This research provides important new evidence suggesting that stressful experiences during any period of pregnancy have the potential to affect fetal development. As our sample consisted mainly of women without complicated pregnancies and who reported on the ‘everyday’ stressors of life, our findings may not apply to all pregnant women. Taken together with evidence from other studies, however, this research demonstrates the need to make assessment and treatment of stress as a healthcare priority for pregnant women.

Salivary alpha-amylase (sAA) is an enzyme that is produced in saliva to help break down starch. Recent research has shown that levels of sAA are sensitive not only to stress but also to positive mood. This has led researchers to believe that sAA may be a useful measure of psychological arousal (how strongly you feel emotion). Very little is known about sAA during pregnancy, and especially whether it is a valid measure of psychological arousal during pregnancy. The aims of this study were to determine:

1. the daily pattern of sAA during pregnancy,
and
2. whether positive or negative mood is associated with daily changes in sAA.

We examined the everyday experiences of 83 women by assessing their positive and negative mood and collecting sAA samples 5 times daily for 3 days in pregnancy. We found that:

1. there was a strong daily pattern in pregnant women that is similar to the pattern in non-pregnant adults. This pattern did not change over the course of pregnancy; and
2. both positive and negative mood were related to increases in sAA suggesting that sAA is a valid measure of psychological arousal during pregnancy.

These findings are important because they validate the use of a new tool that can be used to study the effects of psychological distress in pregnant women.

Many studies have found that women who have highly supportive partners during pregnancy give birth to healthier babies than women whose partners are less supportive. For instance, social support has been associated with larger birth weight infants, fewer labor complications, and longer pregnancies. Almost nothing is known, however, about how social support changes what is happening within a mother’s body to encourage or discourage the healthy development of her baby. During pregnancy, too much cortisol, often called the ‘stress hormone’ because it increases when people are stressed, can be harmful to a baby’s development. We wondered whether levels of cortisol were different in women with lots of social support compared to women with less social support. To answer this question, we examined the everyday experiences of 82 women by assessing their negative mood and collecting cortisol samples 5 times daily for 2 days in each trimester of pregnancy. We also had them fill out a social support questionnaire during each trimester to assess their experiences of social support. We found that pregnant women who received low levels of social support release more cortisol after an episode of negative mood as compared to women who received more social support. In other words, women with highly supportive partners produced less cortisol when they were stressed compared to women with less supportive partners. This is an important finding because it suggests that social support may protect developing babies from the harmful effects of increases in cortisol that are related to negative mood.

This article presents the major point in its subtitle: we wanted to write about how important it is to establish pregnancy and birth cohorts, and to track development of the babies over many years. This approach is very difficult to do for many reasons, one of which is that it can be very challenging to obtain funds for more than 3 years at a time. In this essay, we especially talked about how the new field of epigenetics requires long-term tracking of participants. Epigenetics refers to the fact that our genes are acquired at conception, but the way in which they function (how they are ‘expressed’) is influenced by environmental factors such as nutrition, stress, and exposure to toxins. So to understand epigenetic influences on development, we need to support longitudinal cohort research such as APrON.

The goals of this study were to assess:

1. is prenatal micronutrient supplementation associated with reducing the risk of postpartum depressive symptoms?
2. what other factors may protect against or worsen the risk for symptoms of postpartum depression?

We analysed the data from the first 600 women in the APrON study. Of the 465 women who filled out the questionnaire on mood, 416 (88%) had scores indicating no depressive symptoms while 59 (12%) had scores that indicated “at least probable minor depression”.

The results revealed women with postnatal depressive symptoms were more likely to have not been born in Canada, greater number of chronic conditions, greater number of stressful life events during this pregnancy, and lower prenatal and postnatal support. As well, women with high prenatal depression scores were three to four times more likely to have postpartum depressive symptoms, while prenatal supplemental selenium decrease the risk by 25% (per 10 µg) and postnatal social support by almost 15% (statistically significant).

One of the biggest challenges for population health studies is this one: how do we attract people to participate in the study, and do our recruitment methods influence those who volunteer for studies like ours? Recently, we had the opportunity to compare APrON’s recruitment methods to the methods used by another Calgary-based pregnancy cohort: the All Our Babies (AOB) study. The paper we published with AOB scientists compared sample characteristics of these two unrelated pregnancy cohort studies taking place in the same city, in the same time period, but which employed different recruitment strategies. We also compared both the APrON and AOB participants to provincial and national statistics derived from the Maternity Experiences Survey (MES). The recruitment methods in which the two Calgary cohorts differed:

• The APrON study used only community-based recruitment (e.g., posters, pamphlets, interviews with community media and face-to-face recruitment in maternity clinics). This means that APrON relied on publicity, word-of-mouth, and interviews in maternity clinics.
• AOB used some of those methods, but they also were able to do population-based recruitment, in which Calgary Laboratory Services identified pregnant women undergoing routine laboratory testing and asked their permission to let AOB contact them. This means that AOB could reach women who might be less likely to respond to ads and posters.

As to sample characteristics, we found that the two cohorts:

• differed in education, income, ethnicity, and foreign-born status
• but they were similar for maternal age, body mass index, and marital status
• That is, AOB was able to reach more of the pregnant women who were less educated, lower income, and were new immigrants — women who were less likely to respond to posters and pamphlets.

When we compared APrON and AOB women to the Maternity Experiences Survey (MES), we again found some differences:

• The MES used a method called ‘stratified sampling’ in which they defined potential participants by province or territory, and also by the mother’s age, and they continued sampling until each level was represented in their sample based on census data.
• Neither APrON nor AOB had the resources to do that type of stratified sampling.
• When compared to the MES, the APrON and AOB cohorts were underrepresented in the lowest age, education, and income groups.

These findings suggest that attracting and retaining young, low resource women into urban studies about pregnancy may require alternate and innovative approaches.

Despite growing evidence that feeding babies only breast milk for their first 6 months is best, it is common practice in Canada for parents to introduce solid foods to their infants at an earlier age. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding at 3 and 6 months. There were 402 mothers who provided complete details at 3 months postpartum, 300 of whom stayed on to provide information at 6 months postpartum.

Even though most women (98.6%) breastfed at some point, at 3 months 54% were exclusively breastfeeding, and at 6 months only 15% did so. Mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree. First mothers were less likely to breastfeed exclusively for 6 months compared to mothers with previous children. Mothers who had a more positive attitude toward breastfeeding (determined earlier from scores on the Iowa Infant Feeding Attitude Scale) were 4 to 5 times more likely to breastfeed exclusively for 3 months. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, first time mothers may help health practitioners focus their support and education for this group.

APrON evaluated all the various methods of recruitment that were followed from 2009-2012, in two very similar cities (Calgary and Edmonton). The recruitment methods we used included having research assistants in the waiting rooms of physician offices, distributing posters and pamphlets, and media coverage. What we found was that the most effective way to find potential participants for APrON was through face-to-face contact in clinics that see a large volume of women in early pregnancy. More women were recruited from Calgary, most likely because Calgary has more of the clinics that see a large volume of women in early pregnancy, whereas prenatal visits in Edmonton are distributed over many more sites.

Weight gain during pregnancy is a widely-used indicator of women and baby’s health during pregnancy. Health Canada updated the recommendations for healthy weight gain in pregnancy in 2010; women who enter pregnancy with a lower BMI (body mass index) are recommended to gain more weight, while those starting with a higher BMI are recommended to gain less weight. Gaining less weight than recommended can add risk for pre-term birth, while gaining more than recommended increases a woman’s risk of having complications such as an emergency c-section, having a large baby (macrosomia), hypertension in pregnancy and extra weight retention after delivery. This paper described how many APrON women adhered to Canadian guidelines for weight gain during pregnancy and also described their weight retention at about 3 months after delivery.

Here’s what we found: Most women gained more weight than is recommended. Those who started out with a higher BMI were more likely to gain more than recommended, in part because the recommendations are to gain less than those starting at a lower BMI. Women who gained more than recommended were also more likely to remain retain more weight after delivery (i.e. they lost less weight after the baby was born). Finding out that a large number of APrON women gain more than Health Canada recommends is very important because it tell us that most women (and their family members and care providers) may benefit from information and programs that support them in gaining within the healthy weight gain recommendations.

Stress during pregnancy is a risk factor for poor fetal outcomes, such as preterm birth. The way that maternal stress affects fetal development, however, is unclear. The goal of this study was to examine the role of maternal cortisol- known as the “stress hormone”- as a biological link between maternal stress during pregnancy and fetal development. Cortisol is an indicator of the human stress response, and high levels of cortisol during pregnancy are thought to be harmful to fetal development. We examined the everyday experiences of 83 women by assessing their stress and cortisol 5 times daily for 3 days in pregnancy and found that, on occasions when stress was greater, cortisol levels were also higher within the same individual.

To our knowledge, this is the first study to demonstrate this important link during pregnancy. These findings show that stress and cortisol are linked during pregnancy and they provide evidence suggesting that one of the ways stress during pregnancy affects fetal development is through increases in cortisol. More work needs to be done to determine what kinds of stress and what periods of pregnancy have the worst outcomes.

It has long been thought that toward the end of pregnancy, women find stressful experiences less stressful than they normally would. It is assumed that this decrease in maternal perception of stress protects the fetus from the potentially harmful effects of maternal distress on development. To examine this assumption, we used an electronic diary to record 85 women’s experiences of positive and negative emotion in everyday life, five times each day over 2 days within each trimester of pregnancy. The women also completed a questionnaire assessing depression in each trimester. We found that the second trimester appears to offer more protective advantage than the third trimester, because this is when positive emotion is at its highest and negative emotion is at its lowest. However, women who rate higher on the depression questionnaire do not seem to get the positive mood ‘boost’ in the second trimester that other women do.

These results suggest that, for non-depressed women, the second trimester of pregnancy may provide a stronger protective advantage than previous research suggests. Furthermore, this research highlights the importance of assessing mood repeatedly during pregnancy and the need for pregnant women to be aware of stressors in their lives and work to lessen stress throughout their whole pregnancy.

Researchers have previously questioned whether an inadequate diet contributes to the development of depression in pregnant and postpartum women. There is a known relationship between food and mood in the general population. Leung and Kaplan (2009) found credible links between inadequate diet and mood for folate, vitamin B12, calcium, iron, selenium, zinc and polyunsaturated fats. However, most of these studies have excluded pregnant and postpartum women. The studies indicated both a correlation (depressed patients suffer from poor nutrition) and a causation (improved mood following supplementation). Pregnant and postpartum women are particularly vulnerable to nutrient inadequacies because of increased demands by fetal and infant growth and the mom’s productive needs. These demands change throughout pregnancy and postpartum, and if the mother is unable to provide the energy and nutrients needed through her diet, both herself and her child risk long-lasting effects. The review reported inadequate consumption of folate, B vitamins, iron, calcium and polyunsaturated fats in pregnant women. Kaplan & Leung (2009) believe that nutrient intake is associated with the risk of depression during and after pregnancy. Further research is warranted to improve nutrition intake and mental health in pregnant and postpartum women.