Understanding the Predictors of Low Take-Up of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): A Nationwide Longitudinal Study.

INTRODUCTION: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among eligible individuals) has steadily declined in the past decade. This study addresses gaps in our knowledge regarding predictors of WIC take-up during this time. METHODS: Data were drawn from the 1998-2017 waves of the National Health Interview Study (NHIS), a serial cross-sectional study of the U.S. POPULATION: The analytic sample included 23,645 children and 10,297 women eligible for WIC based on self-reported demographic characteristics. To investigate predictors of WIC take-up, we regressed self-reported WIC receipt on a range of individual-level predictors (e.g., age, nativity, income) and state- level predictors (e.g., unemployment rate, governor's political affiliation) using multivariable logistic regression. In secondary analyses, results were additionally stratified by race/ethnicity, time period, and age (for children). RESULTS: For both women and children, older maternal age and higher educational attainment were associated with decreased take-up of WIC. Associations differed by race/ethnicity, time period, and state characteristics including caseload of other social programs (e.g., Medicaid). DISCUSSION: Our study identifies groups that are less likely to take up WIC benefits for which they are eligible, thereby contributing important evidence to inform programs and policies to increase WIC participation among groups with lower take-up. As WIC evolves past the COVID-19 pandemic, special attention will be needed to ensure that resources to encourage and support the participation of racially and economically marginalized individuals are equitably distributed.

SARS-CoV-2 infection alters the breast milk glycomic profile

Breast milk is generally accepted as the perfect source of nutrition for the health and development of infants. It also assists in infant innate and adaptive immunity through many proteins that are decorated with glycans. Examples of these glycoproteins include IgA, IgG, and innate immune lectins. Maternal diet and environmental exposure such as pathogens and pollutants affect human milk composition including its glycoprofile. Despite altered glycosylation can have a consequence on the nursing infant's health and immunity, the current knowledge is still emerging in this area of study. COVID-19 has gained attention in recent years by causing severe morbidity and mortality. Similar to other infectious diseases such as influenza, our lab recently revealed alterations in glycome of plasma and different tissue samples of COVID-19 infected patients. Inspired by these findings, we are interested in disclosing the effect of SARS-CoV-2 on glycosylation of breast milk proteins. Toward this, we performed a large-scale systematic study using our high-throughput lectin microarray analysis technology. We analyzed 132 control samples (breast milk collected pre- COVID) and breast milk from 78 COVID-19 infected mothers. Our data showed there is a 4-fold increase in -2,3 sialic acid on glycoproteins that is associated with SARS-CoV-2 infection in lactating mothers. Lectin pulldown experiments further testified to these findings. Given the significance of -2,3 sialic acid glycan signature in infectious diseases, our finding could provide valuable insight into therapeutic development.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

How COVID-19 affected food systems, health service delivery and maternal and infant nutrition practices: Implications for moving forward in Kenya.

This implementation research study sought to examine the impact of the COVID-19 pandemic on maternal and infant nutrition practices, and related aspects of health and food systems in Nairobi and Uasin Gishu Counties, Kenya. The study triangulated in-depth interviews with 16 pregnant women, 31 lactating women (including COVID-19 positive), 10 facility health workers, 10 community health volunteers, 6 focus group discussions (FGDs) with food vendors, 4 FGDs and 15 stakeholder interviews with government and implementing partners. Trends from Kenyan Health Information System indicators (i.e., exclusive breastfeeding and initiation of breastfeeding, antenatal care) were also examined. During the COVID-19 pandemic, a decline in attendance of antenatal care, and maternity facilities was observed, and corroborated by Kenyan Health Information System data. Lack of clarity among health workers on COVID-19 breastfeeding guidance and fear of COVID-19 infection early in the pandemic were key drivers of early infant formula use, mother-child separation following delivery and delayed initiation of breastfeeding. Most women exclusively breastfed due to Government of Kenya restrictions in movement. Unemployment and job loss was linked to food insecurity and worsened by increased food prices and limited social protection measures. In response, pregnant and lactating women resorted to skipping meals and reducing quantity and variety of foods consumed. Efforts to build forward from COVID-19 in Kenya should include facility and community health education to prevent disruptions in breastfeeding and to support maternal dietary intake, and in the provision of targeted social protection measures alongside other multisectoral interventions (i.e., psychosocial support) for Kenyan pregnant and lactating women.

Effects of the revised WIC food package on women's and children's health: a quasi-experimental study.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was revised in 2009 to be more congruent with national dietary guidelines. There is limited research examining effects of the revision on women's and children's health. The objective of this study was to evaluate whether the revised WIC food package was associated with various indicators of physical and mental health for women and children. METHODS: We used 1998-2017 waves of the National Health Interview Survey (N = 81,771 women and 27,780 children) to estimate effects of the revised WIC food package on indicators of health for both women (self-reported health and body mass index) and children (anemia, mental health, and parent-reported health). We used difference-in-differences analysis, a quasi-experimental technique that assessed pre-post differences in outcomes among WIC-recipients while "differencing out" the secular underlying trends among a control group of non-recipients. RESULTS: For all outcomes evaluated for women and children, we were unable to rule out the null hypothesis that there was no effect of receiving the revised WIC food package. These findings were confirmed across several secondary analyses conducted to assess heterogeneity of effects and robustness of results. CONCLUSION: While we did not find effects of the revised WIC food package on downstream health indicators, studies using similarly robust methods in other datasets have found shorter-term effects on more proximal outcomes related to diet and nutrition. Effects of the modest WIC revisions may be less impactful on longer-term indicators of health, and future studies should examine the larger COVID-19-era expansion.

Review of dietary intervention studies that utilized online tools for pregnant or postpartum women

Objective: Due to the prolonged social restrictions implemented during the novel COVID-19 pandemic, there is a need to develop effective dietary intervention methods for pregnant/postpartum women without meeting in-person. We conducted a literature review on online dietary intervention studies on pregnant/postpartum women.

Dietary intake and lifestyle practices of eastern mediterranean postpartum women before and during COVID-19 pandemic: An internet-based cross-sectional survey.

Background: During the lockdown period, a substantial group of these women reported lifestyle changes. Aim: The aim of the study is to characterize the dietary patterns, intake and the adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Eastern Mediterranean postartum women. Methods: An internet-based cross-sectional survey was used to collect the data. The survey was carried out among 1,939 postpartum women from five countries from the Eastern Mediterranean region. Change in dietary intake from the five food groups and the adherence to USDA's daily recommendations were assessed. Findings: There was a significant increase in the mean (SD) consumption of all the food groups, including bread, rice, and other cereals, fruits, vegetables, milk and milk products, white and red meat, and nuts during the pandemic. Around 84% of participants reported no/low adherence (0-2) to USDA guidelines, whereas only 15% reported moderate or high adherence (3-5) to the guidelines before the pandemic. However, there was an increase in the proportion of subjects reporting moderate/high adherence (22%) during the pandemic. Discussion and conclusions: A substantial proportion of our study participants reported a lower dietary intake than the recommended amounts, and low adherence to the five food groups. Reasonable and applicable actions should be taken to protect postpartum women and their children from the effects of low dietary intake, particularly during pandemics and lockdowns. More researches are needed to identify the modifiable factors which could improve the nutritional status of the postpartum women during the pandemic.

PRENATAL MATERNAL STRESS NOT ASSOCIATED WITH BIRTH OUTCOMES IN BABIES BORN DURING COVID-19 RESTRICTIONS: THE AUSTRALIAN BITTOC STUDY

Background: Certain forms of prenatal maternal stress (PNMS) are risk factors for preterm birth and low birthweight. In the context of the COVID-19 pandemic, two components of PNMS, objective hardship and subjective distress, may be differentially associated with birth outcomes. We aimed to determine the association of pandemic-related objective hardship and subjective distress with birth outcomes, and we explored moderating factors of objective hardship. Methods: Australian women who delivered during the pandemic completed online questionnaires at baseline and at two months postpartum, including self-reports of pandemic-related objective hardship, subjective distress and birth outcomes. We conducted linear regressions with objective hardship and subjective distress controlled for objective hardship as predictor variables and gestational length and birthweight as outcome variables. Moderation of objective distress by subjective distress, infant sex, and change in diet was evaluated by adding two-way interaction terms. Results: The sample included 2285 women (51.6% male infants, 48.0% female and 0.4% unreported sex). Age 30-34 years was the most frequent maternal age category. No associations between maternal objective hardship or subjective distress with gestational age at birth or birthweight were identified. After controlling for objective hardship, female infant sex and self-reported improvement in maternal diet were significantly associated with lower birthweight (β = -0.090 and -0.069, respectively), but there were no significant interactions with objective hardship. Conclusions: Objective hardship and subjective distress were not associated with birth outcomes. Other factors such as change in diet and infant sex may be more important for risk stratification in this context.

Association of Maternal Nutritional Status with COVID-19 Infection and its Effects on Pregnancy Outcomes- A Retrospective Study

Introduction: Need is felt to perform research for assessing the impact of maternal nutrition status on severity of Coronavirus Disease 2019 (COVID-19) in pregnancy and effect of COVID-19 on maternal outcomes as it has not been established. Aim: To evaluate association of maternal nutritional status and pregnancy outcomes with COVID-19 infection in pregnancy. Materials And Methods: A retrospective study was conducted among 260 antenatal patients admitted in COVID-19 level 3 hospital (Teerthanker Mahaveer Medical College and Research Centre), Moradabad, Uttar Pradesh, India, from April 2020 to May 2021 with COVID-19 infection. Records were studied for the effect of maternal nutrition status along with COVID-19 and outcome of pregnancy in terms of anthropometric markers (body mass index), nutritional markers (haemoglobin, total serum proteins) and biochemical markers (oral glucose tolerance test, vitamin D). Pregnancy outcomes were assessed in terms of severity of symptoms, Intensive Care Unit (ICU) admission, labor outcome and obstetric complications. Data were tabulated and examined using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: Mean age of the patients enrolled was 21.4±5.6 years. A statistically significant association was seen with high body mass index (88.24%), hyperglycaemia (82.35%), hypoproteinaemia (6.01±0.47) and hypoalbuminaemia (0.93±0.24). Statistically significant association between adverse pregnancy outcomes in terms of bleeding per vaginum (11.76%), preterm labour (54.92%), gestational diabetes mellitus (82.35%), hypertension (29.41%), Intrauterine Device (IUD) baby (35.29%) with increasing severity of COVID-19 infections. C onclusion: COVID-19 adversely affects the maternal obstetric outcome. Maternal nutrition status factors associated with severity of COVID-19 were body mass index, deranged blood sugar levels and protein levels.

Adherence to the United States Department of Agriculture Dietary Recommendations Pre- and During the Coronavirus Disease-19 Pandemic Among Pregnant Women in Arab Countries.

During pregnancy, woman's diet is one of the most preeminent factors affecting mother and child's health. Prior to the coronavirus disease-19 (COVID-19) pandemic, inadequate maternal diet and low adherence to dietary guidelines was reported among pregnant women in the Arab countries. Nowadays, COVID-19 infection during pregnancy is widely discussed among literature. However, there is limited data on the health impacts of the COVID-19 pandemic on non-infected pregnant women. This substantially larger group also suffered significant lifestyle changes during the lockdown period. The aim of the study is to characterize dietary patterns, intake and adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Arab pregnant women. Using a specially designed questionnaire and using the snowball sampling method, the survey was carried out among a convenient sample of 1,939 pregnant women from five Arab countries. Our study found an increment in the consumption of cereals, fruits, vegetables, dairy products, meats, and nuts that occurred during the pandemic compared to the preceding period. Despite this noticeable increase during the pandemic, the Arab pregnant women in this study had significantly lower adherence to the USDA pregnancy guidelines. The daily consumption of almost all food groups was lower than the USDA's daily recommendations, except for fruits intake, which was higher than the daily standard. Demonstrated poor adherence to prenatal USDA dietary guidelines by Arab pregnant women can lead to numerous deficiencies and health risks among their offspring. In conclusion, our study showed that before and during the COVID-19 pandemic, poor adherence to dietary recommendations occurred in a considerable number of Arab pregnant women. The findings emphasize the need for nutritional education and intervention during prenatal visits.

A Very precocious inflammatory colitis: A case of A20 haploinsufficiency (HA20)

Introduction: We describe a case of non-specific colitis as the first manifestation of an autoinflammatory disease. Objectives: A., 12 months old, comes to our attention for severe normocytic anemia, without signs of hemodynamic failure. From 3 months of age, A. had a history of bloody diarrhea during exclusive maternal breast-feeding. This condition was diagnosed as allergic proctitis and maternal diet free of milk and derivatives was started. The weaning was conducted in a diet free from milk too. Despite a reduction in bloody diarrhea complete resolution of the symptom never occurred. At admission to our Center, the patient performed a colonoscopy, which revealed the presence of small, eroded translucent nodules and bleeding mucosa suggestive of nodular lymphoid hyperplasia throughout the colon. Histological examination showed active colitis without signs of colitis IBD or allergic colitis. After discharge, we began oral steroid therapy and gastroenterological follow-up. Two weeks later, during steroid withdrawal, A. came to Emergency Room for acute panniculitis of the limbs for which we prescribed an anti-inflammatory therapy. After 48 h the skin condition worsened and she was febrile and suffering. Therefore, A. was hospitalized for further investigations. Blood tests showed a rise in inflammation indexes. Given the inflammatory status, intravenous steroid therapy was started with rapid response. At each attempt to stop steroid treatment, the same symptoms recurred. We also noted the presence of adverse effects related to therapy (Cushing-like aspect and irritability). Methods: In differential diagnosis, the following hypotheses were evaluated and relative tests were performed. 1) Haematological disease: bone marrow aspirate negative for neoplastic conditions. 2) Infectious disease: swabs for viruses and bacteria, as well as serological tests all negative. No history of COVID19 or contact with COVID19 patients. 3)Immunological/inflammatory disease: family history of autoimmune conditions (father with recurrent oral aphthosis, vitiligo and thyroiditis) and unkown diseases with earlyonset (paternal grandfather with liver disease started when he was young, brother of paternal grandfather died at 16 years old due to unexplained causes). Therefore, first level autoimmune tests were done, resulted all normal. Then the possibility of early-onset chronic inflammatory bowel disease (VEO-IBD) were evaluated but genetics was negative. Finally, since autoinflammatory genesis was suspected, interferon signature and molecular investigations of the main known genes responsible for auto-inflammatory diseases were performed. These tests revealed mutation in TNFAIP3, leading to the diagnosis of haploinsufficiency A20 (HA20). In view of this diagnosis, therapy with a biological drug, IL1 receptor antagonist (Anakinra), was started. Results: HA20 is an autoinflammatory disease due to a loss of function of A20 protein, whose role is to down-regulate the proinflammatory pathway of NF-kb. It is autosomal dominant, with earlyonset and with very heterogeneous manifestations even within the same family. This condition is often called Behcet-like, with which it shares some features (oral ulcers, gastrointestinal and skin involvement). Regarded A., the disease appeared at 3 months of age with ulcerative colitis and later skin manifestations started. Probably father and paternal grandfather have the same condition but with milder manifestations. Conclusion: This case taught us that HA20 should be considered in patients with very early-onset inflammatory disease, characterized by colitis as the first manifestation and cutaneous involvement, often with positive family history.

Influence of Vitamin D3 Levels and T Cell-Related Cytokines in Human Milk on Coronavirus Disease 2019 Infection in Lactating Women.

Background: Vitamin D deficiency was associated with an increased risk of coronavirus disease 2019 (COVID-19) infection. Vitamin D deficient mothers are more likely to have infants with vitamin D deficiency, affecting their immunity and protection against infection. This study aimed at comparing the concentrations of vitamin D3 and T cell-related cytokines in milk between mothers with confirmed COVID-19 polymerase chain reaction (PCR) test, mothers with viral infections suggestive of COVID-19, and mothers without infection. Materials and Methods: Concentrations of vitamin D3 and T cell-related cytokines in milk samples were determined by ELISA from 10 mothers who had a positive COVID-19 PCR test, 10 mothers with viral symptoms suggestive of COVID-19, and 20 mothers without infection. Results: Vitamin D3 concentration in human milk was higher in women without infection than in women with viral symptoms or COVID-19 PCR. Interleukin-2 level in milk was higher in the no-infection group than the COVID-19 PCR group but it did not differ with the viral symptoms group. Vitamin D3 did not correlate with any cytokines in human milk. Prenatal vitamin intake did not affect the vitamin D3 in human milk. The percentage of milk from mothers with <20 ng/mL of vitamin D3 was 50% in the COVID-19 PCR group, 60% in the viral symptoms group, and 5% in the no-infection group. Conclusions: Vitamin D3 level in breast milk may influence maternal immunity against COVID-19 infection. A larger study is needed to evaluate the relationship between vitamin D3 concentration in breast milk, maternal immune response, and the incidence of COVID-19 infection in lactating mothers.

Pregnant and hungry: addressing food insecurity in pregnant women during the COVID-19 pandemic in the United States.

Food insecurity is a major social determinant of health affecting more than 10% of Americans. Social determinants of health are increasingly recognized as a driving force of health inequities. It is well established that food insecurity leads to adverse health outcomes outside of pregnancy, such as obesity, hypertension, diabetes mellitus, and mental health problems. However, limited data exist about the impact of food insecurity during pregnancy on maternal and neonatal outcomes. Food insecurity and other social determinants of health are rarely addressed as part of routine obstetrical care. The COVID-19 pandemic has only exacerbated the crisis of food insecurity across the country, disproportionally affecting women and racial and ethnic minorities. Women's health providers should implement universal screening for maternal food insecurity and offer resources to women struggling to feed themselves and their families. Reducing maternal health inequities in the United States involves recognizing and addressing food insecurity, along with other social determinants of health, and advocating for public policies that support and protect all women's right to healthy food during pregnancy.

Learning in times of lockdown: how Covid-19 is affecting education and food security in India.

A vast majority of the relief and rehabilitation packages announced in the months following the nationwide lockdown in India have focused on economic rehabilitation. However, the education sector has remained absent from this effort, including in India's central government's 250 billion dollar stimulus package. In this paper, we discuss the implications of lockdown-induced school and rural child-care center closures on education and health outcomes for the urban and rural poor. We especially focus on food and nutritional security of children who depend on school feeding and supplementary nutrition programs. We argue that the impacts are likely to be much more severe for girls as well as for children from already disadvantaged ethnic and caste groups. We also discuss ways in which existing social security programs can be leveraged and strengthened to ameliorate these impacts.