Vitamin D status in healthy populations worldwide: a systematic review protocol.

OBJECTIVE: The objective of this systematic review is to report on circulating concentrations of 25-hydroxyvitamin D (25[OH]D) and the prevalence of 25(OH)D concentrations below commonly used cut points for vitamin D deficiency, insufficiency, and sufficiency in healthy populations worldwide. INTRODUCTION: Vitamin D sufficiency is important for optimal bone health and has been identified as being protective against a range of adverse health outcomes. Poor vitamin D status is considered a global public health concern. This review will provide up-to-date data on 25(OH)D concentrations in healthy populations worldwide. INCLUSION CRITERIA: This review will consider data from publications that include measurements of circulating 25(OH)D concentrations in healthy people of all ages across all global geographical regions. METHODS: MEDLINE, Embase, Scopus, Web of Science, and Global Index Medicus will be searched for relevant studies published from March 1, 2011. Two reviewers will independently screen titles and abstracts using Research Screener, review relevant full-text articles for quality and eligibility, and extract data. Studies will, where possible, be pooled with statistical meta-analysis, while heterogeneity will be statistically tested. If relevant data are available, subgroup and sensitivity analyses will be conducted to investigate latitude, sex, age, season of blood collection, supplement use, 25(OH)D assay used (and whether it's certified to Reference Measurement Procedures developed under the Vitamin D Standardization Program), as well as study quality. REVIEW REGISTRATION: PROSPERO CRD42021242466.

Designing and developing a mobile app (BeBo) in a randomized controlled trial study to promote breastfeeding among Vietnamese mothers.

BACKGROUND: Breastfeeding should begin as soon as possible after birth and continue exclusively to 6 months of age. In Vietnam, as in many other countries, breastfeeding is decreasing because of modern lifestyles and the promotion of infant formula. It is important to provide mothers, family members, and the community with the knowledge and strategies to improve breastfeeding rates. Smartphones are almost ubiquitous in Vietnam and of the potential to provide information about breastfeeding. This study aimed to document the process of designing and developing a mobile app to increase breastfeeding rates in Vietnamese women. METHODS: We used a four-step mixed methods approach with a literature review, formative research (22 in-depth interviews and 49 self-administered online questionnaires), and testing of prototype apps (3 focus groups discussion and external experts). Formative research and focus group discussion involved 99 participants. Finally, the revisions of the app were tested. All of the formative research was undertaken in Hanoi in 2019-2020. Target behaviors followed by key determinants, to improve breastfeeding self-efficacy were studied and this information was then applied in developing the messages and library content. Barriers and facilitators to breastfeeding were identified from literature reviews and qualitative research. The messages were targeted at not only mothers but also included fathers, mothers-in-law, or families. RESULTS: Mothers were mostly concerned about the initiation of breastfeeding, preventing and reducing difficulties encountered during breastfeeding, and nutrition for breastfeeding mothers. Mental health and well-being in the postnatal period are also concerns. Three key features to be included in the app were identified from the formative research: (1) notifications; (2) an information library; and (3) a searching function. The research found that the app should be installed during pregnancy rather than after delivery (81% vs 17%, respectively). Notifications that convey breastfeeding messages should be sent 2-3 times per week. CONCLUSION: The development of the app followed a best practice approach, including the involvement of stakeholders and grounding in behavior change theory. The next step is to evaluate the effectiveness of the BeBo mobile app in a well-conducted randomized controlled trial. TRIAL REGISTRATION: ACTRN12619000531112.

Determination of bioactive compounds, antioxidant and anticancer activities of Tuckeroo (Cupaniopsis anacardioides) fruits.

This study aimed to determine the phytochemical, antioxidant, and anticancer activities of the crude extract and its fractions of Cupaniopsis anacardioides. The results showed that total phenolic content (TPC), their secondary metabolites (flavonoids-TFC; proanthocyanidins-TPro), and antioxidant activity were significantly different between the crude extract and its fractions. The butanol fraction (F3) had the highest levels of TPC, TFC, and TPro, followed by the crude extract, aqueous fraction (F4), dichloromethyl fraction (F2), and hexane fraction (F1). High-Pressure Liquid Chromatography (HPLC) analysis revealed 14 major bioactive compounds were identified in the C. anacardioides extract. Further analysis showed F3 fraction contained the highest levels of the major bioactive compounds, while F1 fraction had the lowest. A similar pattern was observed for antioxidant activities. The crude extract, F3 and F4 fractions were further tested for cytotoxicity against 10 cancer cell lines, including HT29 (colon); U87, SJG2 (glioblastoma); MCF-7 (Breast); A2780 (ovarian); H460 (lung); A431 (skin); Du145 (prostate); BE2-C (neuroblastoma); MIA PaCa-2 (pancreas); and one non-tumour-derived normal breast cell line (MCF10A). Except for Du145 (prostate), the crude extract, F3 and F4 fractions inhibited the cancer cell lines at 100 µg/mL, with F3 possessing greater activity against these cancer cell lines. Future studies are recommended to isolate and identify the major bioactive compounds of the F3 fraction, and further tested their impact against cancer cell lines. This could identify the potential of anticancer agents from C. anacardioides.

Effect of a Mobile Application on Breastfeeding Rates Among Mothers Who Have Cesarean Deliveries: A Randomized Controlled Trial.

Aim: Cesarean section often translates to negative impacts on breastfeeding rates. This study aims to evaluate the effect of a mobile application on breastfeeding outcomes among mothers who had cesarean sections using a randomized controlled trial in Vietnam in 2020-2022. Methods: A triple-blinded randomized trial of a mobile application was conducted. The mobile application was tailored to a Vietnamese cultural context with two separate versions, one for the intervention and one for the control. The intervention group version auto-generated three messages per week and linked with the information in the application's library content to improve breastfeeding practices. In contrast, the control group's version of the application sent messages on related general maternal and child health care. Pregnant mothers were recruited during their antenatal visits and randomly assigned to one of the two groups. Outcomes of interest included early initiation of breastfeeding and exclusive breastfeeding rates. Results: A total of 293 in the intervention group and 275 mothers in the control who had undergone cesarean sections were included in the analyses. Significant increases were observed in the intervention group for early initiated breastfeeding within 2 hours (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.01-2.24) and exclusive breastfeeding during hospital stay (aOR = 1.60, 95% CI: 1.03-2.48). Conclusion: Our results support the use of a theory-based and designed mobile phone application as a part of a promising intervention to improve breastfeeding outcomes among mothers who have cesarean sections.

Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam.

BACKGROUND: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. METHODS: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020-2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. RESULTS: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31-0.96, p = 0.034). CONCLUSIONS: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.

Vitamin D Food Fortification and Biofortification Increases Serum 25-Hydroxyvitamin D Concentrations in Adults and Children: An Updated and Extended Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Low vitamin D status is a global public health issue that vitamin D food fortification and biofortification may help to alleviate. OBJECTIVES: We investigated the effect of vitamin D food fortification and biofortification on circulating 25-hydroxyvitamin D (25(OH)D) concentrations. We expanded the scope of earlier reviews to include adults and children, to evaluate effects by vitamin D vitamer, and investigate linear and nonlinear dose-response relations. METHODS: We conducted a systematic review and meta-analysis. We searched CINAHL, MEDLINE, PubMed, Embase, the Cochrane Library, and gray and unpublished literature sites for randomized controlled trials, including people of all ages, with the criteria: absence of illness affecting vitamin D absorption, duration ≥4 wk, equivalent placebo food control, dose quantification, dose ≥5 µg/d, baseline and endpoint or absolute change in 25(OH)D concentrations reported, random allocation, and participant blinding. Quality was assessed using the Jadad Scale. RESULTS: Data from 34 publications (2398 adults: 1345 intervention, 1053 controls; 1532 children: 970 intervention, 562 controls) were included. Random-effects meta-analysis of all studies combined (mean dose 16.2 µg/d) indicated a pooled treatment effect of 21.2 nmol/L (95% CI: 16.2, 26.2), with a greater effect for studies using cholecalciferol than ergocalciferol. Heterogeneity was high (I2  > 75%). Metaregression analyses for all studies combined suggested positive effect differences for baseline circulating 25(OH)D concentrations <50 nmol/L, dose ≥10 µg/d and a negative effect difference when the intervention arm included a calcium dose ≥500 mg/d greater than the control arm. Dose-response rates were found to be nonlinear (Wald test for nonlinearity P < 0.001). For all studies combined, a threshold occurred at ∼26 nmol/L for a dose of ∼21 µg/d. CONCLUSIONS: These results support use of vitamin D food fortification to improve circulating 25(OH)D circulations in populations. This work was registered with PROSPERO as CRD42020145497.

Differentiation Between Surgical and Nonsurgical Intussusception: A Diagnostic Model Using Multi-Detector Computed Tomography.

BACKGROUND: The differentiation of surgical from nonsurgical adult intussusception may enable the appropriate selection of management strategies. OBJECTIVE: This study aimed to investigate the diagnostic potential of multidetector computed tomography (MCDT) features to differentiate surgical from nonsurgical adult intussusception and develop a diagnostic model. METHODS: A retrospective study was performed on 96 patients with intussusceptions at the University Medical Center Hospital between January 2014 and January 2020. Two radiologists reviewed all images, and intussusception characteristics were documented. The location of intussusception, length, diameter, interposed fat thickness, lead point, and complications were evaluated. Based on the results, a diagnostic tree model was developed to differentiate between surgical and nonsurgical adult intussusception. RESULTS: A total of 99 intussusceptions in 96 patients (mean age: 53.0 ± 16.5 years), including 35 (35.3%) enteroenteric, 27 (27.3%) enterocolic, and 37 (37.4%) colocolic lesions, were evaluated. Of the enteroenteric intussusceptions, 22 (62.9%) were surgical, including 19 (79.2%) with lead points. Among colon intussusceptions, 63 (98.4%) were surgical, and 100% had lead points. The characteristics used to predict surgical intussusceptions included lead point presence, length ≥ 5.0 cm, diameter ≥ 3.2 cm, interposed fat thickness ≥ 0.5 cm, and complications (p < 0.001). Based on these features, we established a diagnostic tree model that correctly classified 96 (97%) of 99 lesions. CONCLUSION: Our study reinforces the importance of MDCT for the diagnosis and guided management of adult intussusceptions. The characteristics that predicted surgical intussusceptions included lead points, length, diameter, interposed fat thickness, and complications. A systematic approach using this diagnostic tree model could be used to distinguish surgical and nonsurgical adult intussusception.

Dietary Inflammatory Index and Epithelial Ovarian Cancer in Southern Chinese Women: A Case-Control Study.

The association between inflammatory properties of diet and ovarian cancer risk has been investigated in some Western populations. However, little evidence is available from Asian women whose ovarian cancer incidence rates are low and dietary and lifestyle patterns are very different from their Western counterparts. We aimed to examine whether more pro-inflammatory diets, as indicated by higher dietary inflammatory index (DII®) scores, are associated with increased odds of epithelial ovarian cancer in southern China. A case-control study was conducted during 2006-2008 in Guangzhou, Guangdong Province. Energy-adjusted DII (E-DII) scores were calculated based on dietary intake assessed by a validated food frequency questionnaire administered to 500 incident epithelial ovarian cancer patients and 500 hospital-based controls. Logistic regression models were used to assess the relationship between E-DII scores and odds of ovarian cancer. Positive associations were observed between higher E-DII scores and ovarian cancer odds, using both continuous DII scores (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.65, 2.13) and by DII tertiles (ORtertile3vs1 7.04, 95% CI: 4.70, 10.54, p for trend < 0.001). Likewise, a more pro-inflammatory diet was associated with a higher chance of serous and mucinous ovarian tumors. Our results suggest that a pro-inflammatory diet was associated with increased odds of developing epithelial ovarian cancer in southern Chinese women. The findings add to epidemiological evidence for the role of dietary inflammatory potential in ovarian cancer development.

Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App.

Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.

Validity of the International Physical Activity Questionnaire-Short Form for Application in Asian Countries: A Study in Vietnam.

This is the first study in the Asia-Pacific region to examine the criterion validity of the self-reported International Physical Activity Questionnaire-Short form (IPAQ-SF) using accelerometers, in terms of achieving the World Health Organization's (WHO) recommended physical activity guidelines for health benefits. Vietnamese adults aged 40-65 years (n = 240) wore an ActiGraph GT3X+ accelerometer for at least 5 days and completed the Vietnamese version of the IPAQ-SF. Correlations between IPAQ-SF and accelerometer-measured physical activity intensities varied from .087 to .232. Mean difference in moderate-vigorous physical activity was 0.699 min/day (95% limits: [-107, 109]). Agreement on the classification of achieving the WHO's physical activity guidelines was 69.16%. The IPAQ-SF identified 71.86% of adults who met the guidelines, whereas 56.09% of those not meeting the guidelines were classified correctly. The IPAQ-SF was found to have acceptable criterion validity and is a useful instrument to classify Vietnamese adults as achieving or not achieving the WHO's physical activity guidelines for health benefits.

Physical activity and sedentary behaviour during pregnancy are associated with gestational weight gain in Vietnamese women.

BACKGROUND AND OBJECTIVES: Gestational weight gain is known to impact maternal and child health outcomes. Energy intake and energy expenditure are major components of clinical nutrition in relation to weight gain during pregnancy. The study was to determine the association of physical activity and sitting time during pregnancy with gestational weight gain in Vietnamese women. METHODS AND STUDY DESIGN: A multicentre prospective cohort study was conducted in Vietnam from 2015 to 2017. A total of 1873 women with a singleton pregnancy were included. Physical activity and sitting exposures during pregnancy were determined using an interviewer-administered validated questionnaire. Multiple regression analysis was performed to assess physical activity and sitting time in relation to gestational weight gain, adjusting for the confounding effects of maternal characteristics and total energy intake during pregnancy. RESULTS: The mean weight gain was 12.9 (Standard deviation 4.1) kg throughout pregnancy. Pregnant women with prolonged sitting time gained an average of 0.6 kg more weight (p=0.016 for highest versus lowest tertiles). Conversely, women who were physically active, in terms of having higher tertiles of total physical activity, moderate-to-vigorous-intensity, household/ caregiving activities, and occupational physical activity, experienced significantly less gestational weight gain (p<0.05 for highest versus lowest tertiles). CONCLUSIONS: Inverse associations were found between gestational weight gain and physical activity (i.e. intensities and several domains), whereas gestational weight gain tended to increase with longer sitting time. Therefore, being physically active and less sedentary is important to regulate weight gain during pregnancy.

Global Mapping of Interventions to Improve Quality of Life of People with Diabetes in 1990-2018.

Improving the quality of life (QOL) of people living with diabetes is the ultimate goal of diabetes care. This study provides a quantitative overview of global research on interventions aiming to improve QOL among people with diabetes. A total of 700 English peer-reviewed papers published during 1990-2018 were collected and extracted from the Web of Science databases. Latent Dirichlet Allocation (LDA) analysis was undertaken to categorize papers by topic or theme. Results showed an increase in interventions to improve the QOL of patients with diabetes across the time period, with major contributions from high-income countries. Community- and family-based interventions, including those focused on lifestyle and utilizing digital technologies, were common approaches. Interventions that addressed comorbidities in people with diabetes also increased. Our findings emphasize the necessity of translating the evidence from clinical interventions to community interventions. In addition, they underline the importance of developing collaborative research between developed and developing countries.

Postpartum Physical Activity and Weight Retention within One Year: A Prospective Cohort Study in Vietnam.

After delivery, mothers are encouraged to increase physical activity (PA) gradually to regulate body weight; however, data on PA in relation to postpartum weight retention remains scarce, particularly among Asian women. In a cohort of 1617 Vietnamese mothers, we investigated the prospective association between habitual PA exposures at 3-month postpartum and weight retention at 6-month and 12-month postpartum. Detailed information on PA intensity and domains was collected from participants using a validated instrument specifically for Vietnamese women. Linear regression analyses and a general linear model for the repeated weight retention measures were used to ascertain the apparent relationships. On average, the participants reported 3.6 (SD 3.9) and 2.6 (SD 3.8) kg weight loss at 6- and 12-month postpartum, respectively. Total and light-intensity PA were inversely associated with the postpartum weight retention (p for trend <0.05). Our findings highlight the importance of resuming PA in the early postpartum period as an appropriate weight management strategy.

Seroprevalence of Tissue and Luminal Helminths among Patients in Hanoi Medical University Hospital, Vietnam, 2018

A serological survey was performed using ELISA to estimate the prevalence of tissue and luminal helminthic infections among hospital patients in Hanoi region, Vietnam. An overall seroprevalence of tissue and luminal helminthiases was 64.0% (95% CI 61.2-66.8) among 1,120 patients who visited Hanoi Medical University Hospital, Vietnam in 2018. The highest seroprevalence was observed against Toxocara spp. (59.0%), followed by Strongyloides stercoralis (46.3%), Gnathostoma spp. (25.5%), cysticercus (12.8%), Angiostrongylus cantonensis (10.5%), Fasciola spp. (11.1%), and Clonorchis sinensis (8.7%). Mono-infection by one species (11.1%) was lower than multiple infections (53.0%) (P0.05). Children (<15 years) revealed lower seroprevalence (34.0%) than adults (68.4%), and the age group 51-70 years revealed the highest seroprevalence (76.0%). Among the seropositive patients, eosinophilia (≥8.0%) was noted in 80.2%. The present results suggested active transmission of various tissue and luminal helminths among people in Hanoi, Vietnam.

Two Human Cases of Echinococcus ortleppi Infection in the Lung and Heart in Vietnam

This is a report of 2 cases of human hydatidosis caused by Echinococcus ortleppi in Vietnam. The patients were a 12-year-old male (case 1) having a cyst of 10.0×9.0 cm size in the lung and a 50-year-old female with a 3.0×3.3 cm-sized cyst in the heart. Eosinophilia was 33.7% in the male and 45.8% in the female patient. C-reactive protein was increased to 16.5 mg/L in the male and 18.2 mg/L in the female. Both patients were positive for ELISA at OD=2.5 and 3.1, respectively. Echinococcus protoscolices were collected from the cysts by amniocentesis and surgery. The protoscolices were identified as E. ortleppi by morphology and analysis of mitochondrial NADH dehydrogenase 1 (nad1) gene sequence. Both patients were cured by surgical resection of the hydatid cyst combined with albendazole medication. The E. ortleppi infection in lung is the second report, and the other in the heart is the first in Vietnam.

Low Prevalence of Folic Acid Supplementation during Pregnancy: A Multicenter Study in Vietnam.

Periconceptional folic acid (FA) supplementation is recommended to prevent neural tube defects (NTDs), but little information is known about its use in Vietnam. It is important that FA supplements start to be taken when planning a pregnancy and continued through the first trimester to prevent NTDs, as the neural tube closes in the first month of pregnancy. However, FA supplementation in Vietnam is usually recommended to commence from the first antenatal visit, which is usually at 16 weeks, and very few women take FA before their first visit. This multicenter study aimed to determine the prevalence of FA supplement use and associated maternal characteristics in Vietnam. FA supplementation was assessed in 2030 singleton pregnant women between 2015 and 2016. In total, 654 (32.2%) women reported taking either supplements containing FA alone or multivitamins containing FA, and 505 (24.9%) reported correctly taking supplements containing FA alone. Women who were aged 30 years or over, had low education levels, had formal employment, and whose current pregnancy was first or unplanned were less likely to supplement with FA. Education programs are needed to encourage FA supplementation when contemplating pregnancy.

Objectively Measured Physical Activity of Vietnamese Adults With Type 2 Diabetes: Opportunities to Intervene.

OBJECTIVES: To objectively determine and compare the physical activity (PA) levels of adults newly diagnosed with type 2 diabetes (T2D) and adults without T2D in Vietnam using an accelerometer. METHODS: A total of 120 participants with newly diagnosed T2D and 120 adults without T2D were recruited from a large hospital in Hanoi, the capital city of Vietnam. All participants wore an ActiGraph GT3X accelerometer for at least 5 days, including 1 weekend day. Freedson cut-off points were used to estimate different intensities of PA. In addition, comparisons between groups were made with respect to achieving the World Health Organization (WHO) and International Diabetes Federation (IDF) recommended PA guidelines. RESULTS: Men with T2D had significantly lower levels of PA than men without T2D. The respective multivariable-adjusted mean values of daily step count, daily light-intensity, moderate-intensity, and moderate-to-vigorous-intensity PA were approximately 14%, 19%, and 22% lower in the men with T2D than in their non-T2D counterparts. However, women with T2D accumulated a greater number of steps per day than women without T2D. Only 59.2% of the adults with T2D met the minimum recommended level of PA (WHO and IDF), compared to 74.2% of adults without T2D (p<0.05). After adjusting for potential confounders, participants with T2D experienced 50.0% significantly lower odds of achieving PA recommendations. CONCLUSIONS: Vietnamese men with T2D were less physically active than those without T2D, and adults with T2D were less likely to meet PA guidelines. The results suggest a need for integrating PA into the self-management of this chronic condition.

Postpartum weight retention in relation to gestational weight gain and pre-pregnancy body mass index: A prospective cohort study in Vietnam.

BACKGROUND: The prevalence of maternal overweight and obesity is increasing in Asia. This study prospectively investigated the association between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and 12-month postpartum weight retention (PPWR) in a large cohort of Vietnamese mothers. METHODS: Of the 2030 pregnant women recruited from three cities in Vietnam at 24-28 weeks of gestation, a total of 1666 mothers were followed up for 12 months after delivery and available for analysis. The outcome variable PPWR was determined by subtracting the pre-pregnancy weight from the 12-month postpartum measured weight, while GWG and pre-pregnancy BMI were classified according to the Institute of Medicine and WHO criteria for adults, respectively. Linear regression models were used to ascertain the association between pre-pregnancy BMI, GWG and PPWR accounting for the effects of plausible confounding factors. RESULTS: Both pre-pregnancy BMI and GWG were significantly associated with PPWR (P<0.001). The adjusted mean weight retention in underweight women before pregnancy (3.71kg, 95% confidence interval (CI) 3.37-4.05) was significantly higher than that in those with normal pre-pregnancy weight (2.34kg, 95% CI 2.13-2.54). Women with excessive GWG retained significantly more weight (5.07kg, 95% CI 4.63-5.50) on average at 12 months, when compared to mothers with adequate GWG (2.92kg, 95% CI 2.67-3.17). CONCLUSIONS: Being underweight before pregnancy and excessive GWG contribute to greater weight retention twelve months after giving birth. Interventions to prevent postpartum maternal obesity should target at risk women at the first antenatal visit and control their weight gain during the course of pregnancy.

Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review.

Studies of gestational diabetes mellitus in relation to breastfeeding are limited, while their findings are inconsistent. This systematic review was conducted to assess the associations between gestational diabetes and breastfeeding outcomes. An initial search of PubMed, Web of Science, and ProQuest identified 518 studies, and after applying the inclusion criteria, 16 studies were finally included in the review. Four studies reported that "exclusive/predominant/full breastfeeding" rates at discharge were lower in mothers with gestational diabetes than in those without gestational diabetes, and 2 studies showed a shorter duration of "exclusive/predominant breastfeeding" in the former than in the latter. However, most studies found no apparent difference in the rate of "breastfeeding initiation", "any breastfeeding" duration, or "any breastfeeding" in hospital and at discharge between mothers with and without gestational diabetes. In summary, mothers with gestational diabetes were less likely to exclusively breastfeed their infants and may have a shorter breastfeeding duration than other mothers.